Using the validated Reflective Functioning Questionnaire to investigate mentalizing in individuals presenting with eating disorders with and without self-harm

Psychometric Properties of the Reflective Function Questionnaire in Iranian Prisoners

Reflective functioning is the process of reflecting on the thoughts and feelings of oneself and others and is foundational to healthy human relationships. The 54-item Reflective Function Questionnaire (RFQ) is a self-report measure that assesses reflective functioning, initially developed while studying individuals with borderline personality disorder (BPD) . The purpose of the present study was to translate the RFQ from English to Persian and evaluate its reliability and validity among Iranian prisoners. The sample of this study included 509 (455 men and 54 women) Iranian prisoners. Findings confirm the translated measure had acceptable face and content validity. A confirmatory factor analysis (CFA) confirmed two dimensions of certainty (RFQ-c) and uncertainty (RFQ-u) of reflective functioning. The correlation analysis showed positive relationships between the dimensions of the RFQ and the borderline personality symptoms questionnaire and the emotional dissatisfaction questionnaire. Correlation analysis also showed negative associations between the dimensions of the RFQ and the Toronto Basic Empathy Scale (BES) and the Kentucky Inventory of Mindfulness Skills (KIMS) questionnaire, confirming the concurrent validity of the RFQ. The Cronbach's alphas of the RFQ-c and RFQ-u subscales were .69 and .7 respectively, which demonstrated relatively acceptable internal consistency. The results of the analysis demonstrated that the translated RFQ had desirable psychometric properties for evaluating reflective function among Iranian prisoners.

Construct validity evidence reporting practices for the Reading the Mind in the Eyes Test: A systematic scoping review

The Reading the Mind in the Eyes Test (RMET) is one of the most influential measures of social cognitive ability, and it has been used extensively in clinical populations. However, questions have been raised about the validity of RMET scores. We conducted a systematic scoping review of the validity evidence reported in studies that administered the RMET (n = 1461; of which 804 included at least one clinical sample) with a focus on six key dimensions: internal consistency, test-retest reliability, factor structure, convergent validity, discriminant validity, and known group validity. Strikingly, 63% of these studies failed to provide validity evidence from any of these six categories. Moreover, when evidence was reported, it frequently failed to meet widely accepted validity standards. Overall, our results suggest a troubling conclusion: the validity of RMET scores (and the research findings based on them) are largely unsubstantiated and uninterpretable. More broadly, this project demonstrates how unaddressed measurement issues can undermine a voluminous psychological literature.

A multifaceted approach to assessment of mentalization: the mentalization profile in patients with eating disorders

Purpose: The existing literature, however sparse, suggests an association between eating disorders (ED) and mentalization ability. The aim of this study was to investigate the mentalization profile (MP) in patients with ED. It was hypothesized that patients with ED would have a lower degree of mentalization ability compared to healthy controls (HC).Materials and methods: The study is based on a cross-sectional survey on a sample of patients diagnosed with ED compared to a HC group.Results and conclusion: A total of 88 participants, distributed between patients with ED (N = 30) and HC (N = 58) were included.Results: The study results show statistically significant differences between patients with ED and HC. Thus, patients with an ED scored significantly higher on Reflective Functioning Questionnaire (uncertainty about mental states) (RFQ-U) (mean difference: 0.31, p = 0.048) and Toronto Alexithymia Scale (TAS-20) (mean difference: 0.44, p = 0.019) compared to the HC. Furthermore, the results indicated that patients with Bulimia Nervosa (BN) may have a lower ability to mentalize about oneself as well as a generally lower ability to mentalize across different dimensions of the mentalization profile as the BN group scored significantly higher on RFQ-U (mean difference: 0.71, p = 0.023) and TAS-20 (mean difference: 0.89, p = 0.006) compared to the Anorexia Nervosa (AN) group. Further research should be conducted to gain knowledge on the mentalization ability in patients with an ED.

Attachment and mentalization among survivors of sexual abuse: A questionnaire survey

Knowledge of the long-term consequences of child sexual abuse (CSA) is crucial to further develop preventive strategies and treatment programs. The aim of this study is to investigate attachment and mentalizing ability in people who have experienced CSA. Attachment style, measured with the Experiences in Close Relationships-Relationship Structures Questionnaire (ECR-RS), and mentalization, measured with the Reflective Functioning Questionnaire (RFQ), were examined through a quantitative questionnaire survey in a sample of 49 individuals who had experienced CSA, and a control group of 612 with no history of CSA. The CSA group was, to a greater extent, identified with insecure attachment style. In addition, participants with insecure attachment were more likely to use hypomentalizing compared to individuals identified with a secure attachment. No significant association was found between attachment style and the relationship between the victim and the offender or the length of traumatic episodes.

Reflective functioning and dissociative experiences: A comparison study between adolescents at "high-risk" of psychosis and healthy controls

Background

Despite the established contribution to psychological well-being in young subjects, the investigation of reflective functioning and dissociative experiences in help-seekers adolescents still appears an unmet need.

Objective

The study aimed to assess reflective functioning and dissociative symptoms in help-seekers adolescents, and compare them to gender-matched healthy controls.

Methods

The Reflecting Functioning Questionnaire (RFQ) was used to investigate mentalizing; the Adolescent Dissociative Experience Scale (A-DES) was used to explore dissociative symptoms.

Results

The study involved 102 adolescents (mean age 18.06 ± 1.78 years), split into "help-seekers" (N= 51; mean age 19 ± 1.98 years) and healthy controls (N= 51; mean age 17.12 ± 0.84). "Help-seekers" adolescents showed lower RFQ-certainty scores (mean 3.39 ± 2.47), compared to healthy controls (mean 6.73 ± 5.01). Furthermore, "help-seekers" adolescents reported higher scores on RFQ-uncertainty (mean 7.73 ± 4.38), compared to healthy controls (mean 5.14 ± 4.17), which indicates a greater lack of knowledge about mental states (hypomentalizing). Eventually, "help-seekers" adolescents showed significantly worse dissociative symptoms (A-DES total mean score 3.49 ± 2.04), compared to healthy controls (A-DES total mean score 2.06 ± 1.43).

Conclusion

The importance of an assessment in early adolescence denotes a topic of increasing concern, in order to identify failures in reflective functioning and the onset of dissociative experiences among help-seekers adolescents, toward the implementation of tailored psychological interventions.

Quality of life, mentalization, and perception of challenging patient encounters in dentistry: A cross-sectional study

OBJECTIVE

This study investigated how exposure to challenging patient encounters influenced participants' self-reported quality of life, and how participants' mentalization capabilities affected the perceptions of challenging patients encounters among Norwegian dentists and dental students.

MATERIALS AND METHODS

Data was collected with an online questionnaire, and a total of 165 dentists (n = 126) and dental students (n = 39) responded.

RESULTS

Participants who reported higher total exposure of challenging encounters reported lower quality of life (QoL). Mentalization tendencies affected the perception of challenging encounters with specific types of patients; critical and anxious; as well as the estimation of the total exposure to challenging patient encounters. Participants that were overconfident with regards to the mental states of others found these patient types less challenging and they reported less overall exposure to challenging patients than underconfident participants. Also, overconfident participants reported higher QoL than underconfident participants.

CONCLUSIONS

Mentalization capabilities of dental practitioners interact with the perception of challenging encounters in dental practice, and how practitioners respond to these challenges. Measures should be undertaken to increase the awareness of metacognitive skills in dentistry with the dual goal of improving patient care as well as the quality of life of dental practitioners.

Mentalizing ability, mentalizing impairments, and anorexia nervosa: Validation of the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)

The goal of this study was to validate the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)-an ecological measure for assessing mentalizing ability-among patients with anorexia nervosa (AN) and healthy individuals. We examined the validity of the MASC's general mentalizing ability scale and of its mentalizing impairments subscales using validated measures of mentalizing ability (Reading the Mind in the Eyes test, Cambridge Mindreading Face-Voice Battery, and Reflective Function questionnaire) among female patients with AN (N = 35) and control participants (N = 42). ED symptoms were assessed via self-report questionnaires. The MASCHeb correlated with measures of mentalizing ability and was found to significantly differentiate patients with AN from controls. In addition to differing on general mental ability, the groups differed on hypomentalizing (but not hypermentalizing). Based on our findings, the MASCHeb proved to be an ecologically valid tool for assessing mentalizing ability and impairments among patients with AN. Moreover, our findings demonstrated the role played by general mentalizing ability in EDs and specifically pointed to the importance of hypomentalization in EDs. These findings have therapeutic implications, as outlined in the Discussion section.

The relationship between parental mental health, reflective functioning coparenting and social emotional development in 0-3 year old children

Introduction

The transition to parenthood is a high-risk period for many parents and is an important period for child development. Research has identified that parental mental health, reflective functioning (capacity to consider mental states of oneself and others) and coparenting (capacity to work together well as a parenting team) may be particularly significant predictors of later child outcomes, however these factors have seldom been considered together. The present study therefore aimed to investigate the relationship between these factors and the extent to which they predict child social emotional development.

Methods

Three hundred and fifty parents of infants aged 0 to 3 years 11 months were recruited to complete an online Qualtrics questionnaire.

Results

Results indicate that both positive coparenting and parental reflective functioning (Pre-mentalizing and Certainty subscales) were found to significantly predict child development. General reflective functioning (Uncertainty subscale) predicted parental depression and anxiety, however unexpectedly, parental mental health was not a significant predictor of child development, but did predict coparenting. General reflective functioning (Certainty subscale) was also found to predict coparenting, which in turn was found to predict parental reflective functioning. We found an indirect effect of general reflective functioning (Certainty) on child SE development via parental reflective functioning (Pre-mentalizing). We also found an indirect effect of negative coparenting on child development via parental reflective functioning (Pre-mentalizing).

Discussion

The current results support a growing body of research highlighting the important role reflective functioning plays in child development and wellbeing as well as parental mental health and the interparental relationship.

Mentalizing, Resilience, and Mental Health Status among Healthcare Workers during the COVID-19 Pandemic: A Cross-Sectional Study

The COVID-19 pandemic has caused unprecedented stress on healthcare professionals worldwide. Since resilience and mentalizing capacity play very important preventive roles when it comes to mental health, the main goal of this study was to determine whether the capacity for mentalizing and resilience could explain the levels of depression, anxiety, and stress among healthcare workers during the COVID-19 pandemic. The study was conducted in Serbia on a sample of 406 healthcare workers (141 doctors and 265 nurses) aged 19 to 65 (M = 40.11, SD = 9.41). The participants' mental health status was evaluated using the Depression, Anxiety, and Stress Scale-DASS-42. The Reflective Functioning Questionnaire was used to evaluate the capacity for mentalizing. Resilience was assessed using the Brief Resilience Scale. The results of the correlation analysis showed that there were negative correlations between resilience and all three dimensions of mental health status: depression, anxiety, and stress. Hypermentalizing was negatively correlated with depression, anxiety, and stress, while hypomentalizing was positively correlated. Hierarchical linear regression analysis showed that both resilience and hypermentalizing were significant negative predictors of depression, anxiety, and stress, and that hypomentalizing was a significant positive predictor of depression, anxiety, and stress. Furthermore, socioeconomic status was a significant negative predictor of depression, anxiety, and stress. Marital status, number of children, and work environment were not statistically significant predictors of any of the three dimensions of mental health status among the healthcare workers in this study. There is an urgent need to establish and implement strategies to foster resilience and enhance the capacity for mentalizing among healthcare workers in order to minimize the devastating effects of the COVID-19 pandemic on mental health.

The Spanish version of the reflective functioning questionnaire: Validity data in the general population and individuals with personality disorders

INTRODUCTION

Mentalization or reflective functioning (RF) is the capacity to interpret oneself or the others in terms of internal mental states. Its failures have been linked to several mental disorders and interventions improving RF have a therapeutic effect. Mentalizing capacity of the parents influences the children's attachment. The Reflective Functioning Questionnaire (RFQ-8) is a widely used tool for the assessment of RF. No instrument is available to assess general RF in Spanish-speaking samples. The aim of this study is to develop a Spanish version of the RFQ-8 and to evaluate its reliability and validity in the general population and in individuals with personality disorders.

METHODS

602 non-clinical and 41 personality disordered participants completed a Spanish translation of the RFQ and a battery of self-reported questionnaires assessing several RF related constructs (alexithymia, perspective taking, identity diffusion and mindfulness), psychopathology (general and specific) and interpersonal problems. Temporal stability was tested in a non-clinical sub-sample of 113 participants.

RESULTS

Exploratory and confirmatory factor analyses suggested a one-factor structure in the Spanish version of the RFQ-8. RFQ-8 understood as a single scale was tested, with low scorings reflecting genuine mentalizing, and high scorings uncertainty. The questionnaire showed good internal consistence in both samples and moderate temporal stability in non-clinical sample. RFQ correlated significantly with identity diffusion, alexithymia, and general psychopathology in both samples; and with mindfulness, perspective taking, and interpersonal problems in clinical sample. Mean values of the scale were significantly higher in the clinical group.

DISCUSSION

This study provides evidence that the Spanish version of the RFQ-8, understood as a single scale, has an adequate reliability and validity assessing failures in reflective functioning (i.e., hypomentalization) in general population and personality disorders.

Strengths and Weaknesses of Children Witnessing Relatives with Amyotrophic Lateral Sclerosis

Research on minors who have a close family member with amyotrophic lateral sclerosis (ALS) is scarce. This study aims to analyze the relationships between reflective function and wellbeing among such children, considering their reflective function, representations of death, and behavioral problems with the following instruments: Reflective Functioning Questionnaire, Testoni Death Representation Scale for Children, Positive and Negative Affect Schedule for Children, and Strengths and Difficulties Questionnaire. Participants were 248 minors divided into the target group (38 children-16 females, 22 males-7-18 years old (M = 11.61, SD = 2.97)) and the control group (210 students-120 females, 90 males 9-14 years old (M = 11.17, SD = 1.33)). Results showed that the target group exhibited more negative affect and hyperactivity. However, they also showed less uncertainty in their mental states. The opportunity to support these minors is discussed.

Relationship between mentalizing and teacher burnout: A cross sectional study

BACKGROUND

Teaching is considered a high-risk profession due to the high impact of occupational risk factors which can endanger educators' mental health and lead to burnout syndrome. This study aimed to examine whether the capacity for mentalizing in teachers explains the degree of their burnout syndrome. The expectation was that a low capacity for mentalizing increases the degree of burnout.

METHODS

A cross-sectional study was conducted on a sample of 823 teachers. The Maslach Burnout Inventory-Educators Survey was used to examine the burnout syndrome. The capacity for mentalizing was examined using hypomentalizing and hypermentalizing scales from the Reflective Functioning Questionnaire.

RESULTS

The expectation that a low capacity for mentalizing increases teachers' burnout confirms the finding that hypomentalizing is a positive predictor of their emotional exhaustion as a dimension of burnout (ß = 0.09; p < 0.01). Unexpectedly, hypomentalizing proved to be a positive predictor of personal accomplishment (ß = 0.09; p < 0.05), which indicates that with a lower capacity for mentalizing, teachers experience greater personal accomplishment. Also, hypermantalizing was a negative predictor of emotional exhaustion (ß = -0.17; p < 0.01) and depersonalization (ß = -0.31; p < 0.01), and a positive predictor of personal accomplishment (ß = 0.30; p < 0.01). The findings showed that with higher socioeconomic status, with marriage and having children, the burnout of teachers is lower, as expected.

CONCLUSIONS

Capacity for mentalizing and burnout syndrome in teachers are interrelated phenomena. With a good capacity for mentalizing, emotional exhaustion and burnout in teachers are reduced. Knowledge and skills that enable a good capacity for mentalizing should be included in educational and teacher training programs.

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients’ ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety.

Conceptualisation and Measurement of Reflective Process in Psychotherapy: A Systematic Scoping Review

Psychological therapies use talk as a means to produce change for individuals who are experiencing distress. Despite a significant body of research comparing approaches, there is little evidence for the superiority of one model over another. The process of reflection has been suggested as a common factor across modalities, and research aiming to measure this phenomenon is emerging. This scoping review is focussed on the conceptualisations, measurement and process outcomes of reflective talk as it occurs during therapy. Twenty-two studies were selected from a total of 3712 papers identified following a systematic search of SCOPUS, MEDLINE, PsychINFO and Web of Science databases. A variety of descriptors emerged: intrapersonal constructs such as mentalization and metacognition tended to view reflectivity as an individually acquired skill or trait, where other descriptors adopted an interpersonal understanding of reflection as co-constructed through dialogue. Our findings suggest a shift from individual to intersubjective understandings of reflecting processes in therapy may be a valuable area for future research.

Failures in Reflective Functioning and Reported Symptoms of Anxiety and Depression in Bereaved Individuals: A Study on a Sample of Family Caregivers of Palliative Care Patients

Introduction. This study aims at examining the role of failures in reflective functioning in predicting anxiety and depression among family caregivers of palliative care patients deceased for at least one year. Methods. A sample of 157 bereaved participants (77.1% females, mean age = 43.50 ± 14.04 years) completed the Hospital Anxiety and Depression Scale (HADS) and the Reflective Functioning Questionnaire (RFQ). Results. Results of the correlational analysis showed that anxiety was positively correlated with uncertainty about mental states, indicating one type of impairment in reflective functioning. Anxiety was also negatively correlated with the certainty about mental states. Depression was negatively correlated with certainty but not with uncertainty about mental states. The results of regression analysis indicated that gender and certainty about mental states were statistically significant predictors of anxiety, with the final model explaining 23% of the variance. The results also showed that gender, the condition of being the main caregiver, and the certainty about mental states were significant predictors of depression, with the final model predicting 14% of the variance. Conclusions. Overall, the results of this study point out that the bereaved individuals who scored low on certainty about mental states reported more symptoms of anxiety and depression. Psychological interventions to prevent mental disorders and to promote psychological health in the context of palliative care should carefully consider these findings.

Do attachment-related differences in reflective functioning explain associations between expressed emotion and youth self-harm?

Youth self-harm is associated with poor health outcomes and attempted and completed suicide. Associations exist between self-harm and expressed emotion (EE), attachment insecurity, and reflective functioning (RF), but these associations are poorly understood. This study evaluates a mediation model in which perceived caregiver EE (pEE) exerts an indirect effect on youth self-harm through attachment insecurity and RF uncertainty. 461 participants aged 16-24 years completed an online survey. Statistical analyses revealed significant direct effects of pEE on attachment insecurity, and of RF uncertainty on self-harm; however, some direct effects were specific to pEE from female caregivers, and attachment insecurity in youth relationships with female caregivers. A significant direct effect of pEE on self-harm was found for pEE from male caregivers only. Significant indirect effects of pEE on self-harm through attachment anxiety and RF uncertainty were found only in relation to female caregivers. The findings encourage family-, attachment-, and mentalization-based approaches to preventing and treating youth self-harm, with a recommendation that caregivers are given adequate support, education, and skills-based training following youth disclosures of self-harm.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03614-w.

Resilience, Mentalizing and Burnout Syndrome among Healthcare Workers during the COVID-19 Pandemic in Serbia

The aim of this study was to examine whether the capacity for mentalizing and resilience among healthcare workers (HCWs) explains the degree of burnout syndrome during the COVID-19 pandemic in Serbia. The research was conducted on a sample of 406 healthcare workers (141 doctors and 265 nurses), aged 19 to 65 years (M = 40.11, SD = 9.41)—203 worked on the COVID-19 frontline, and 203 in regular clinical conditions. The Maslach Burnout Inventory was used to measure the burnout syndrome. Capacity for mentalizing was examined using the Reflective Functioning Questionnaire. The Brief Resilience Scale was used to measure resilience. The results indicated that there were negative correlations between resilience and the dimensions of burnout—emotional exhaustion (r = −0.38; p < 0.01) and depersonalization (r = −0.11; p < 0.05), and a positive correlation between resilience and personal accomplishment (r = 0.27; p < 0.01), as was expected. The analyses of hierarchical linear regression showed that hypomentalizing was a significant positive predictor of emotional exhaustion (ß = 0.12; p < 005) and depersonalization (ß = 0.15; p < 0.05), resilience was a significant negative predictor of emotional exhaustion (ß = −0.28, p < 0.01) and positive predictor of personal accomplishment (ß = 0.20; p < 0.01), and that the degree of explained variance of burnout dimensions was higher when resilience and hypomentalizing were included in regression models, in addition to sociodemographic variables. The findings suggest that being a woman and working on the COVID-19 frontline implies a higher burnout, while the level of burnout decreases with better socioeconomic status and more children. Resilience, capacity for mentalizing, and burnout syndrome among HCWs are interrelated phenomena, which have important professional implications.

The mind-in-mind study: A pilot randomised controlled trial that compared modified mentalisation based treatment with supportive clinical management for patients with eating disorders without borderline personality disorder

OBJECTIVE

Mentalisation-based treatment (MBT) aims to improve reflective functioning. There is a growing evidence base outlining positive clinical outcomes for the use of MBT in eating disorder patients with co-morbid borderline personality disorder (BPD). The use of MBT has not been studied for eating disorder patients without BPD. This pilot study is an exploratory randomised controlled trial in which outcomes from MBT are compared with standard clinical management in a cohort of patients diagnosed with an eating disorder but not BPD. The main objectives were two-fold-to explore the use of MBT as a therapeutic modality and to test the acceptability and feasibility of the protocol design.

METHOD

Thirty-two participants were randomised to receive either MBT or standard treatment during an inpatient eating disorders program. All patients enrolled in the study were diagnosed with an eating disorder but did not meet DSM-5 criteria for BPD. On admission patients were categorised as very underweight (BMI 15.0-16.4 kg/m² ), underweight (BMI 16.5-18.4 kg/m² ) or healthy weight range (BMI ≥ 18.5-24.9 kg/m² ). Upon discharge participants were further categorised as weight restored (BMI ≥ 18.5 kg/m² ) or non-weight restored (BMI < 18.5 kg/m² ). The primary outcome was the subscale score on the Reflective Functioning Questionnaire (RFQ-8). Secondary outcomes were subscale scores on the Eating Disorder Examination Questionnaire and the Depression, Anxiety and Stress Scale (DASS)-21. Participants were assessed at baseline and on discharge. Statistical significance was determined using repeated measurements analysis of variance (ANOVA).

RESULTS

Both groups experienced improvements in eating disorder symptoms and measures of psychological well-being. Participants within the MBT group exhibited greater improvements in reflective capacity as defined by the RFQ-8 however these benefits appeared to be limited to patients who achieved weight restoration at discharge. The eligibility criteria-which excluded comorbid BPD-led to challenges in recruitment which limited the power of the study analysis. As participants with a range of different eating disorder diagnoses were included this led to complexities in estimating the treatment effect within a defined cohort.

CONCLUSIONS

Although the small sample size must be noted as a limitation-the finding that weight restoration appears to be associated with improvements in reflective capacity in MBT would be worth exploring in a subsequent larger study. Modification of eligibility criteria and recruitment from a defined cohort may increase the efficiency of a future study.

Investigation of the Factor Structure of the Reflective Functioning Questionnaire (RFQ-8): One or Two Dimensions?

There is a need to have reliable and accessible screening measures of mentalizing ability to investigate the role of this capacity in social functioning and its development, emergence of psychopathological conditions, as well as to understand its role in psychotherapeutic processes. The 8-itemed Reflective Functioning Questionnaire (RFQ-8) has been developed for this purpose, however its factor structure and psychometric properties are unclear. The aim of the current study was to further investigate the factor structure of the RFQ-8 and explore its psychometric properties in a Polish sample. 538 participants aged 17-50 (M = 21.44, SD = 2.92) took part in the study. They were asked to complete the RFQ-8, Difficulties in Emotion Regulation Scale (DERS), General Health Questionnaire (GHQ-28), the Relationship Structures (ECR-RS) questionnaire and the Borderline Personality Inventory (BPI). Results of both exploratory and confirmatory analysis indicated that the RFQ-8 may be regarded as a scale measuring a unidimensional construct. Our results confirmed good construct validity for the unidimensional RFQ-8, suggesting that the one-dimensional RFQ specifically assesses uncertainty concerning mental states. Our findings highlight the need for further studies investigating the factor structure and psychometric properties of the RFQ-8.

The vulnerability of insecure minds: The mediating role of mentalization in the relationship between attachment styles and psychopathology

Insecure attachment is linked to mentalizing difficulties and psychopathology. The current study aimed to examine if failures in mentalization, as observed in the form of uncertainty about mental states, mediated the relationship between attachment styles and global psychopathology in a group of 812 adults (66.5% females) from the community. Participants completed measures on attachment styles, uncertainty about mental states, and clinical symptoms. The authors found that uncertainty about mental states was a partial mediator of the associations between attachment styles and psychopathology. Furthermore, the findings supported the role of secure attachment in protecting from mentalization failures and psychopathology; on the contrary, increased scores on attachment styles involving a negative view of the self (preoccupied and fearful attachment styles) predicted high levels of uncertainty about mental states and psychopathology. Accordingly, clinicians may wish to promote mentalizing abilities in individuals who display a negative view of the self embedded in their attachment styles.

'Rich' and 'poor' in mentalizing: Do expert mentalizers exist?

Mentalization theory is concerned with the capacity to notice, and make sense of, thoughts and feelings in self and others. This development may be healthy or impaired and therefore, by extension, it may be theorized that expertise in mentalizing can exist. Furthermore, a continuum from impairment to expertise should exist within separate dimensions of mentalizing: of self and of others. This study hypothesized that three groups would be distinguishable on the basis of their mentalizing capacities. In a cross-sectional design, Psychological Therapists (‘expert’ mentalizers; n = 51), individuals with a diagnosis of Borderline Personality Disorder (‘poor’ mentalizers; n = 43) and members of the general population (‘non-clinical controls’; n = 35) completed a battery of self-report measures. These assessed the mentalizing of self and of others (using an extended version of the Reflective Function Questionnaire (RFQ18)), alexithymia and cognitive empathy. As hypothesized, Psychological Therapists’ scores were higher than controls on self-mentalizing and control group scores were higher than those with BPD. Cognitive empathy scores in the BPD group indicated markedly lower capacities than the other two groups. Contrary to predictions, no significant differences were found between groups on mentalizing others in RFQ18 scores. The Psychological Therapist and BPD profiles were characterized by differential impairment with regards to mentalizing self and others but in opposing directions. Results suggest that the RFQ18 can identify groups with expertise in mentalizing. Implications of these results for the effectiveness of psychological therapy and of Psychological Therapists are discussed.

The relationship between alexithymia and theory of mind: A systematic review

Theory of Mind (ToM), the ability to represent the mental states of oneself and others, is an essential social skill disrupted across many psychiatric conditions. The transdiagnostic nature of ToM impairment means it is plausible that ToM impairment is related to alexithymia (difficulties identifying and describing one's own emotions), as alexithymia is seen across psychiatric conditions. Whilst many studies have examined links between alexithymia and ToM, results are mixed. Therefore, the purpose of this systematic review is to provide a taxonomy of ToM tests and assess their relationship with alexithymia. Tests are grouped according to whether they assess propensity to engage spontaneously in ToM or accuracy of ToM inferences, with tests further subdivided into those that do, and do not, require emotion recognition. A review of 63 suitable studies suggests that alexithymia is often associated with reduced ToM, and inaccurate ToM when tasks require emotion recognition. This latter finding appears due to impaired emotion recognition, rather than ToM impairment per se. Further directions and considerations for future research are discussed.

Convergent Validity of Three Measures of Reflective Function: Parent Development Interview, Parental Reflective Function Questionnaire, and Reflective Function Questionnaire

Reflective function (RF) is defined as an individual's ability to understand human behavior in terms of underlying mental states including thoughts, feelings, desires, beliefs, and intentions. More specifically, the capacity of parents to keep their child's mental states in mind is referred to as parental RF. RF has been linked to adult mental health and parental RF to children's mental health and development. The gold standard measure of RF is the interview-based Reflective Functioning Scale (RFS) applied to the Parent Development Interview (PDI) or Adult Attachment Interview (AAI), which while well validated, is time-and labor-intensive to administer. Given the increasing need for reliable, valid, and rapid RF assessment in wide-ranging settings, two alternative measures were considered including the Reflective Function Questionnaire (RFQ) and Parental Reflective Function Questionnaire (PRFQ). We determined the convergent validity of these measures in comparison with the PDI-rated RFS. A sample of mothers and fathers (n = 150) was drawn from a sub-study of the ongoing Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort when their children were 42-60 months of age. Pearson correlations and multiple linear regression was conducted, followed by splitting the sample to compute Cohen's kappas measures of agreement. Two subscales of the PRFQ correlated significantly (p < 0.05) with the gold standard PDI-rated RFS, providing evidence for convergent validity. As a brief multidimensional measure of parental RF, the PRFQ offers an alternative for measurement of RF in large-scale studies of parental development and child health.