Beyond Theory of Mind: mentalization as a relational and developmental framework for autism

Autistic individuals and those around them often navigate social and emotional situations in which behaviors, intentions, and affects are difficult to interpret. Supporting mentalizing processes within child–caregiver interactions may help address these challenges; however, a broader conceptual shift is needed, moving beyond a narrow deficit-based perspective toward understanding mentalization as a multidimensional, relational, and developmental process. By shifting the focus from individual deficits to child–caregiver meaning-making processes, this framework may help clarify assessment and intervention targets and inform future research on psychopathological vulnerability in autism. This targeted narrative mini-review therefore aimed to summarize preliminary evidence suggests that other-related mentalizing may show greater difficulties than self-related mentalizing, although this hypothesis requires further replication. Findings also highlight caregiver mentalization, particularly parental reflective functioning, as a key relational process shaping how children’s behavior is interpreted, regulated, and responded to over time. In this light, preliminary intervention studies suggest that mentalization-based and mentalization-informed approaches may improve parental reflective functioning, cognitive reappraisal, self-efficacy, and inferential style, with potential indirect benefits for children’s emotional outcomes. We therefore propose a relational-developmental framework in which mentalization is conceptualized as a shared and dynamic process of meaning-making under conditions of social and emotional ambiguity. Adopting an individual, relational and developmentally informed perspective may contribute to the development of more precise assessment models, more targeted interventions, and a deeper understanding of mental health vulnerability in autism.

Development and Formative Evaluation of a Narrative-Based Serious Game for Pregnancy Education: Mixed Methods Study

Background: Serious games are increasingly used in professional health education and maternal health promotion. However, most pregnancy-related digital interventions target specific behaviors and do not provide a comprehensive, longitudinal simulation of the pregnancy journey that incorporates psychosocial and administrative aspects. Objective: This study aimed to develop and evaluate a narrative-based serious game that simulates the chronological course of pregnancy and to assess its perceived educational usefulness, accessibility, and user acceptance across multiple platforms. Methods: We developed a 9-chapter interactive serious game covering pregnancy recognition, partner communication, public health consultation, mid-pregnancy and late-pregnancy checkups, and home preparation for childbirth. The game was collaboratively created by a pediatrician, 6 medical students, and a student illustrator using a low-cost visual novel engine (TyranoBuilder). It was released in April 2025 on iOS, Android, and Steam. A voluntary, anonymous postgame survey was conducted between April 2025 and January 2026. Descriptive statistics were used to summarize survey responses and platform analytics. This study was approved by the Ethics Committee of Shinshu University Hospital. Results: A total of 65 users completed the postgame questionnaire. Most respondents were aged 10 to 19 years (38/65, 58.5%) and female (55/65, 84.6%). Nearly half of the participants (30/65, 46.2%) completed the game within 1 hour. Gameplay evaluation scores (5-point Likert scale; 3=neutral or appropriate) were balanced: game length (mean 3.37, SD 0.96), difficulty (mean 2.84, SD 0.85), and interactivity (mean 3.31, SD 1.10). Educational outcomes were rated highly (5-point Likert scale; higher=more favorable): reduced anxiety (mean 3.84, SD 0.96), perceived educational usefulness (mean 3.98, SD 1.02), perceived knowledge acquisition (mean 4.06, SD 1.06), story empathy (mean 3.80, SD 1.11), and overall satisfaction (mean 4.05, SD 1.04). Across all platforms, the game achieved 925 cumulative downloads. iOS and Android downloads were predominantly from Japan, whereas Steam downloads were geographically diverse. Of the 21 Steam reviews, 20 (95.2%) were positive. Conclusions: A serious pregnancy education game developed through a low-cost clinician-student collaborative model demonstrated high perceived educational usefulness, balanced gameplay characteristics, and broad user acceptance, including substantial engagement among teenagers and international users. Narrative-based serious games represent an accessible and scalable approach to maternal health education. Further research using more rigorous evaluation designs is warranted to assess long-term educational and behavioral impacts.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/e2f36ab34de77d0bdb26718b9c29b61f" />

<![CDATA[Gerald A. Maguire, MD, shares his experience and insights on the importance of trust and empathy. ]]>

Maintaining Emotional Boundaries as a Parent

Parents often emphasize to children the importance of respecting others’ boundaries — don’t tickle another kid if they say they don’t like it, for example. Don’t kiss someone unless they welcome it. But within the family, we can fail to notice our own difficulty setting and respecting boundaries with our children, especially emotional boundaries.

What are emotional boundaries

Emotional boundaries refer to an individual’s sense of autonomy and ability to control how they think, feel, and engage with others. Those boundaries are crossed either when you try to control someone else’s thoughts or feelings or they try to control yours.   

Difficulty setting your own and respecting others’ emotional boundaries often comes from a place of care and concern. Parents are usually concerned that their child is not going to make safe choices or are trying to protect their child from distressing emotions. But the intrusion can have a negative impact on children’s emotional development as well as parents’ mental health, especially when it’s done repeatedly. Everyone has boundaries, even parents, and it’s important for kids to learn that.  

How parents overstep their child’s emotional boundaries

Parents can inadvertently encroach on their child’s right to their own thoughts and feelings through:

  • Over-involvement in children’s academic and social life: Your child has a whole life outside the home, and it can be anxiety-provoking to trust them to manage their homework, advocate for themselves with teachers, and navigate conflicts with peers. It can alleviate your anxiety to get involved, but that can feel highly intrusive to your child. For example, if your kid feels snubbed by a friend, you might feel the urge to contact that friend’s parent to try to smooth things over. However, over-involvement in these tasks can prevent your kid from developing the skills they need to manage challenging situations successfully and can impact their confidence in their ability to cope independently.
  • Overconcern to protect your child’s safety: Fears that something negative will happen to your child are understandable, but aggressive monitoring can backfire. This can include strict control over the ingredients in your teen’s food, the information they consume online, or what activities they do. This may temporarily alleviate anxiety about the child’s health and safety but it can lead to resentment and rebellion. 
  • Ignoring or rejecting children’s requests for privacy: It is normal for children and adolescents to want more privacy as they mature, from showering alone to keeping a private diary.Unless your child engages in an activity that suggests they are being unsafe, it is important to trust your child and let them decide what to share with you.
  • Sharing private information without the child’s permission: Parents telling anecdotes about their children, much to their kids’ embarrassment, is hardly new. However, that sharing now includes photographs and videos posted on social media that is broadcast far beyond close friends.It is important to include your child in decisions about what information is shared with others (excluding, of course, medical professionals). When in doubt, consider what information you would feel comfortable with them sharing about you.
  • Telling children what is or isn’t acceptable to value, think, or feel: Many parents, in an effort to help their child feel better, say things like, “Don’t worry about that” or “You can’t think that way.” These seemingly innocuous phrases can come across as attempts to control how the child feels. We can forget that kids are real people just like adults. And if they’re mad or upset about something, they want to be able to feel those feelings, not be told that that their feelings are wrong.

How parents fail to set their own emotional boundaries

Letting kids change your own values, thoughts, and feelings can also be unhealthy. Here are some common ways in which parents fail to set their own boundaries:

  • Allowing your child’s thoughts and feelings to influence your own too much:  Your child may act like it will be the end of the world if they don’t get into the right college. If their anxiety becomes your anxiety, then it’s going to be very hard for you to encourage your kid to have fun on the weekend or to go to bed with work left undone. What they need you to do is validate their feelings but challenge those worry thoughts and help them to relax.
  • Implying that your child is responsible for how you feel:  As a parent, your child’s well-being is your priority, and your emotional state is affected by your child’s behavior. But phrases like, “You are making me crazy” or “I cannot cope with one more word from you” unintentionally suggest that the child has control over your feelings. It’s not healthy for children to feel that they are responsible for your well-being.
  • Depending on your child for emotional support: If you’re a parent under stress and you’re not getting support elsewhere, it makes sense that you’re going to vent to a child. It’s not necessarily meant to burden a kid with financial stressors or relationship drama, and the child might be a sympathetic ear. But it blurs the boundaries between the parent role and the kid role, and that often causes difficulties for the kid in accepting parental authority in other domains. If they see themselves as equals in terms of emotional support, then they might think, why can you tell me what to do?
  • Sharing age-inappropriate information: Many children want to be treated as older than they are (at least in certain ways). So they might requestinformation about finances, romantic relationships, or family stressors that are inappropriate for their age. Although it can be tempting to share, it is not helpful long-term. It may alleviate the child’s current anxiety (and stop the nagging), but it will impair their ability to respect boundaries as well as interfere with them just being a kid.
  • Difficulty saying no: If you’re exhausted, the last thing you want is an argument. One way to avoid an argument is to say yes to your kid’s requests to buy a toy, stay up 15 more minutes, or have a different dinner. If you have boundaries around what you will spend, how much sleep you need, or what you will cook, you are still a good parent. Sticking to your limits teaches your child to accept other people’s boundaries without whining or threats. 
  • Allowing your child to treat you unkindly: Many parents allow their children to treat them in ways they would never tolerate from another person. This includes calling the parent mean or profane names, hitting them, or disregarding their needs (for money, sleep, leisure time, etc.).  Allowing this kind of behavior prevents the child from learning how to respect boundaries and tolerate the emotions they experience when they face them.

Factors that contribute to boundary concerns

There are specific circumstances that can make it difficult for a parent to know where the appropriate boundaries are. They include a child’s late development, psychiatric challenges, and history of unsafe choices. For example, a child may have delays in language, executive functioning, or social or emotional skills. These things can make it challenging to determine how involved you need to be in your child’s daily life and how much independence they can handle.

  • Poor risk assessment and impulsivity: Many disorders can impact children’s ability to think clearly, regulate emotionally, and act safely. For example, a teen experiencing a manic episode may overestimate their abilities, underestimate risk, and act impulsively. Or a child with ADHD might hard to control on crowded city streets or in restaurants, so you avoid taking them out or letting them do activities on their own with friends.  
  • Lack of confidence: Anxious children may underestimate their abilities and request continued support past when they are capable of independence. For example, a socially anxious child may ask their parent to order for them at a restaurant or keep track of their homework assignments.  When a parent accommodates these requests, it confirms their belief that they still need help.
  • Executive functioning deficits: Children who struggle with executive functioning may need more scaffolding to complete daily self-care tasks than other kids their age. This can look like parents providing frequent reminders of assignments, events, or even hygiene tasks — as well as cleaning their room for them long past when an child with ADHD should be doing it themselves. Consider how you can scaffold the skills (packing their bookbag!) without doing tasks for them, and gradually remove the supports over time.
  • History of not successfully navigating tasks: A child’s history of poorly handling a responsibility (safe use of technology, completion of homework, brushing their teeth) often reduces parents’ confidence in the child’s abilities and increases their inclination to step in. Although extra supervision and support may be needed initially, it is important to reassess your child’s abilities over time as they can learn and grow if you let them!

How to get better at boundaries

Once you have recognized the challenges in respecting your child’s boundaries and protecting your own, the next step is to figure out what those boundaries are.

  • Identify your boundaries: What things are most important to support your child’s growing independence and sense of autonomy? What boundaries do you need to set to protect your own mental health? Consider what level of involvement you want to have in their academics, friendships, emotion regulation, and appearance and what you want to disclose to them about your own relationship, emotions, or work.  
  • Practice setting these boundaries: It is much easier to set a boundary when you are not forced to make the choice with a child’s puppy dog eyes looking at you. Rehearsing how you will say no, decline to share certain information, or respond to an anxiety-provoking situation can prepare you to respond more effectively and in line with your values in a moment of conflict.
  • Share your reasons for boundaries: Children can be quick to interpret lack of boundaries as “more caring,” but being consistent in language around why boundaries are being set can help prevent this. When setting a boundary, it is helpful to couch it in care. For example, “I care about you enjoying your childhood, so I do not feel comfortable sharing with you about our family’s finances.”

When kids want more independence than you are sure they are ready to handle, identifying steps toward their goal can be effective. Giving them opportunities to show maturity, with success at one step leading to more responsibility, can help you trust your child with greater independence. What can your kids show you that will help you feel confident in their ability to manage their emotions themselves or make well thought-out decisions?

Kids also need to recognize that they sometimes overestimate their own abilities, that there are times they have not assessed risk accurately and still need their parents. It is important to teach your child that you should be alerted if they are experiencing something that is unsafe or concerning (such as a friend talking about suicide or sharing an inappropriate photo). Discussions with your kid can sort out how to work toward new milestones and help everybody feel confident that they have the skills to do it.

Modeling a healthy respect for boundaries will set your child up to establish their own and respect others’ boundaries throughout their life.

Frequently Asked Questions

What are emotional boundaries between parents and children?

Emotional boundaries are the limits that protect each person’s right to their own thoughts, feelings, values, and decisions. In families, healthy boundaries allow children to develop independence while helping parents avoid taking responsibility for emotions or choices that belong to their child.

Why are emotional boundaries important in parenting?

Healthy emotional boundaries support children’s confidence, autonomy, and ability to solve problems on their own. They also protect parents’ well-being by preventing them from becoming overly responsible for their child’s feelings, worries, or decisions.

What are signs a parent is overstepping a child’s emotional boundaries?

Common signs include getting overly involved in a child’s friendships or school life, refusing age-appropriate privacy, sharing personal information without permission, or telling a child what they should think or feel. While these behaviors often come from a place of love and concern, they can undermine a child’s confidence and independence.

How can parents determine appropriate emotional boundaries?

Parents can start by considering where their child is developmentally and what level of support versus independence is appropriate. A good guideline is to provide enough structure to keep children safe while gradually giving them more responsibility and privacy as they demonstrate readiness.

The post Maintaining Emotional Boundaries as a Parent appeared first on Child Mind Institute.

The ECHO study: compassion-focused therapy for young voice hearers and their caregivers. A pilot study

BackgroundVoice hearing can occur in healthy people without a trigger, be caused by a traumatic event, or occur as part of a psychiatric disorder. There are still many gaps in our understanding of voice hearing, and research in this field can be challenging, maybe because it is associated with shame and stigma. Those who experience distress by voice hearing could benefit from a treatment, aimed directly at that. The ECHO manualized treatment is based on the principles of compassion-focused therapy (CFT).MethodsTreatment will take place on several different psychiatric hospitals in the Region of Southern Denmark. Treatment consists of a 10-session, manualized CFT for voice hearing. Caregivers participate in half of the sessions, and a recording of the voice content is made, which the caregivers are encouraged to listen to. The study is designed as a prospective single-arm pre–post intervention study using a mirror-image approach, in which participants serve as their own controls over time. The intervention group consists of (N = 60) voice-hearing adolescents aged 13–18 years. Additionally, a clinical comparison group (who also receive the intervention) of (N = 20) individuals aged 18–20 years with first-episode schizophrenia and voice hearing is included for descriptive and exploratory analyses. Data are collected 3 months prior to CFT treatment, immediately before the start of treatment, immediately after treatment is completed, and at 1 month follow-up. Data will be centered around social cognition, perceived social safeness, social connectedness, general well being, auditory hallucinations and compassion.DiscussionThe ECHO study addresses the wellbeing and thriving of an overlooked group of young people. The results of this study will provide information about who the voice hearers are, what challenges they face, and how they perceive them. The results will also provide information about the feasibility and efficacy of the treatment manual and, thus, its potential further implementability. Caregivers participate in half of the sessions, to facilitate a common language about mental states and voice hearing. To support their understanding, a recording of the voice content is made and the caregivers are encouraged to listen to it. We suggest that when caregivers understand the young voice hearers’ experiences, they can adjust their expectations and approach accordingly. We also suggest that by sharing the voice content, the young voice hearer will feel less isolated.Study protocol registrationhttps://clinicaltrials.gov/study/NCT07314515, identifier NCT07314515.

Clinicians Trust Faulty AI Recommendations Over Experience

Reliance of artificial intelligence (AI) has been increasing across all fields, including in the clinic. How to ensure AI is integrated practically, effectively, and ethically has been the focus of many discussions and debates, however final consensus almost always lands on the idea that however AI is integrated into clinical use, conscientious human oversight is necessary.

To test the veracity of this goal, a team of researchers in Spain put over 200 medical doctors to the test to determine if the clinicians would trust their experience and training over AI recommendations.

“It is important to investigate the errors that humans (including doctors) make when working with algorithms, in order to learn how to minimize the problems that arise from them,” said co-author of the study, Fernando Blanco, PhD, researcher at the Mind, Brain and Behavior Research Center (CIMCYC) in Granada, Spain.

“We wanted to see if professional physicians would act differently so that they would notice and correct these errors,” the authors wrote in their paper published in PLOS Digital Health.

The researchers created treatment plan options for a series of fictitious patients with a rare disease. They asked 223 physician participants whether or not to provide a treatment to a patient based on whether the patient was classified by AI as being highly or lowly sensitive to the treatment plan. The physicians were then presented with patient recovery data and asked to rate their perception on how reliable the AI classification was.

In these experiments, both groups of patients responded to treatment with similar sensitivity, resulting in ineffective AI recommendations that could be identified using the patient recovery data.

“In the first experiment, the treatment worked moderately (and equally) well for both groups. In the second, the treatment did not work at all for either group,” the authors wrote. They expected that “in both experiments, participants would administer the treatment less often to the fictitious patients classified as lowly sensitive to the treatment, consistently with the AI classification.” However, this was not the case.

“In both experiments, physicians mostly trusted the AI’s classifications and had trouble learning from the feedback,” said lead author Aranzazu Vinas, PhD, University of the Basque Country, Spain. “Furthermore, in the second experiment, professionals did not notice that the treatment was completely ineffective.”

These results present a major concern for the medical community in its use of AI in the clinic. While AI can be highly effective and useful for data collection and summary, supervision and critical thinking are still required for effective and safe patient care. This study highlights the need for physicians to take the time to critically consider all available data, regardless of recommendations by AI in their diagnostic and treatment decisions.

“People tend to say that there is always a human controlling the algorithm,” opined Helena Matute, PhD, professor, University of Deusto, Spain on the team’s findings “but our experiments show that doctors (as well as anyone else) have problems in learning from the available evidence when it contradicts the suggestions of an algorithm.”

The post Clinicians Trust Faulty AI Recommendations Over Experience appeared first on Inside Precision Medicine.

The Download: a nuclear landmark, and China eyes Nvidia chips

This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.

Four nuclear reactors hit a big milestone in the US

—Casey Crownhart

I was really looking forward to July 4, and not just because I love a poolside barbecue. This year the American holiday also marked a big symbolic deadline for US nuclear power.

Last year the Trump administration set a goal to see three new microreactors achieve criticality, a technical milestone establishing that a reactor can sustain a chain reaction, by the nation’s 250th birthday. And just in time, not just three, but four reactors did so.

It’s a positive sign for nuclear technologies at a time of increasing need for electricity and emissions-free energy sources. But achieving criticality doesn’t mean a reactor is ready to provide electricity for the grid (or at all, for that matter).

Here’s what the milestone could mean for nuclear power in the US—and where the four companies might go next.

This story is from The Spark, our weekly climate tech newsletter. Sign up to receive it in your inbox every Wednesday.

The must-reads

I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.

1 China plans to let its top AI firms buy Nvidia H200 chips
Alibaba, ByteDance, and DeepSeek are set to get permission. (Information $)
+ China had previously withheld approval despite US authorization. (Reuters $)

2 NATO is building a network to stop Russian attackers in their tracks
It will use sensors, drones, satellites, and AI to detect them. (Business Insider)
+ Troops are donning odd camouflage to elude drones. (Economist $)
+ The US wants cheaper drones as Iran’s wrecking its Reapers. (Ars Technica)

3 Researchers have a new idea to fight future El Niños: dimming the sun
Deflecting solar energy could cool the ocean and mitigate the risks. (Wired $)
+ But there could be unexpected consequences. (New Scientist $)
+ And geoengineering as a field is getting a reality check. (MIT Technology Review)
 
4 Meta is patenting an AI device that records users to analyse emotions
It ostensibly aims to tailor workout plans to the user’s mood. (404 Media)
+ AI memory is privacy’s next frontier. (MIT Technology Review)

5 Chipmakers are going vertical as Moore’s Law slows
They’re stacking transistors to keep chips advancing. (Economist $)
+ IBM is betting on the technique. (MIT Technology Review)
 
6 Ivy League students suspected of AI cheating saw scores fall in person
From 96% all the way down to 48%. (Ars Technica)
+ AI giants want to take over the classroom. (MIT Technology Review)
 
7 A new study says parents’ phone addictions damage bonds with kids
It can exacerbate “insecure attachment” for life. (Bloomberg $)
+ And make children more anxious and avoidant. (Gizmodo)

8 A judge approved Musk’s $1.5 million Twitter settlement with the SEC
Despite what she called “serious misgivings” and “red flags.” (Reuters $)
+ Musk was accused of skirting stock disclosure rules. (Fortune)
 
9 Shoebox-sized “detector satellites” could find nuclear bombs in space
Cubesats carrying the detector could sense a bomb’s radiation. (Space)
+ Russia is suspected of developing space-based nukes. (Reuters $)

10 A World Cup match drove Google Search traffic to a new record
The milestone came after Argentina’s comeback against Egypt. (CNBC)

Quote of the day

“I talk about it on Tic Tac.”

—President Donald Trump tells the public where to find his insights on the dangers of communism, Gizmodo reports.

One More Thing


Robots are bringing new life to extinct species

Paleontologists aren’t easily deterred by evolutionary dead ends or a sparse fossil record. And in the last few years, they’ve developed a new trick for turning back time and studying prehistoric animals: building experimental robotic models of them. 

In the absence of a living specimen, an ambling, flying, swimming, or slithering automaton is the next best thing for studying the behavior of extinct organisms. Learning more about how they moved can in turn shed light on their lives, such as their historic ranges and feeding habits. Scientists can simply sit back and observe their behavior in different environments. 

Read the full story on the rise of paleo-inspired robots—and four examples that are shedding light on creatures of yore.

—Shi En Kim

We can still have nice things

A place for comfort, fun, and distraction to brighten up your day. (Got any ideas? Drop me a line.)

+ Georgia Hill’s monochrome artworks are filled with visual harmony.
+ AI has salvaged text from a papyrus scroll burned to a crisp when Mount Vesuvius erupted 2,000 years ago.
+ Rare images taken by a Japanese space probe show a near-Earth asteroid resembling a cuddly snowman.
+ “Another One Bites the Bee Gees” smoothly merges two classic tracks with a 4/4 time signature into the perfect song for applying CPR.

Autistic- and attention-deficit/hyperactivity disorder-like traits: differential associations with burnout, depression and anxiety, and empathy among Japanese junior residents

IntroductionBurnout, depression, and anxiety are major concerns among physicians because they affect individual well-being, patient care, and healthcare systems. Neurodevelopmental traits, including autistic-like traits (ALTs) and attention-deficit/hyperactivity disorder (ADHD)-like traits (ADHLTs), may increase vulnerability to psychological distress. However, little is known about how these traits relate to burnout, depression and anxiety, and empathy among junior residents.MethodsIn this cross-sectional study, 148 junior residents from two teaching hospitals in Japan completed validated measures of ALTs (21-item Japanese version of the Autism-Spectrum Quotient), ADHLTs (Adult ADHD Self-Report Scale Screener), burnout (Maslach Burnout Inventory), depression and anxiety (Hospital Anxiety and Depression Scale), physician–patient empathy (Jefferson Scale of Physician Empathy), and psychological flexibility and inflexibility processes (Valuing Questionnaire, Cognitive Fusion Questionnaire-7, and Work-related Acceptance and Action Questionnaire). Associations were examined using multivariable logistic and linear regression analyses. Exploratory statistical mediation analyses using structural equation modeling examined indirect associations through psychological flexibility and inflexibility processes.ResultsThe prevalence of ALTs and ADHLTs was 23.6% for each trait. ALTs were associated with lower personal accomplishment, a burnout dimension; higher depression and anxiety; and lower physician–patient empathy. ADHLTs were associated with greater emotional exhaustion, another burnout dimension. In exploratory statistical mediation analyses, progress toward values, a core process of psychological flexibility, showed a significant indirect association between ALTs and personal accomplishment, and the direct association was attenuated and no longer statistically significant after including the process variables. Significant indirect associations through progress toward values were also observed for the associations of ALT with depression and anxiety and empathy. Cognitive fusion, a core process of psychological inflexibility, showed a significant indirect association between ADHLTs and emotional exhaustion. Overall, neurodevelopmental traits were associated with distinct patterns of psychological functioning, suggesting variability in both vulnerability and adaptive processes.DiscussionNeurodevelopmental traits such as ALTs and ADHLTs were significantly associated with burnout dimensions, depression and anxiety, and physician–patient empathy among junior residents. Psychological flexibility and inflexibility processes, particularly progress toward values and cognitive fusion, may be relevant to these associations. Process-based support strategies may warrant further investigation for residents with elevated neurodevelopmental traits.Clinical trial registrationhttps://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R00005, identifier UMIN000046897.