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Ortuño-Sierra J, Debbané M, Lucas-Molina B, Pérez-Albéniz A, Díez-Gómez A, Fonseca-Pedrero E. Mentalizing in adolescence: Psychometric properties of the reflective functioning questionnaire (RFQ) and links with mental health, psychological well-being, and suicidal behaviours. J Affect Disord 2025; 385:119341. [PMID: 40334860 DOI: 10.1016/j.jad.2025.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 04/08/2025] [Accepted: 05/04/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND Reflective functioning [RF], or mentalizing, refers to the ability to understand others and the self in terms of internal mental states. RF is thought to play a key role in the development of mental health problems, and to attenuate risk and morbidity associated to psychopathology. The main goal of this study was to validate the Reflective Functioning Questionnaire (RFQ) into Spanish in a community-derived sample of adolescents. In addition, the association between RFQ scores and suicidal behaviour, mental health strengths and difficulties, and personal well-being was analyzed. METHOD A total of 1588 students (M = 16.13 years, SD = 1.36; 46.5 % boys), participated in the study. Several measuring instruments of mental health, subjective well-being, and suicidal behaviours were administrated. RESULTS Results revealed that a model with 7 items, excluding item 4 and consistent with RFQ uncertainty scoring, had adequate goodness-of-fit indices. Partial measurement invariance of the RFQ-7 scores across gender was supported. The total score displayed a McDonald's Omega coefficient of 0.98 for the RFQ-7. The RFQ-7 was negatively correlated with psychological well-being and positively associated with suicidal behaviours, and emotional and behavioural problems. CONCLUSIONS The RFQ is a brief, easy, and reliable tool for assessing reflective functioning difficulties in adolescents from the general population.
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Affiliation(s)
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Beatriz Lucas-Molina
- Department of Developmental and Educational Psychology, University of Valencia, Spain
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Schwarzer NH, Behringer N, Dees P, Gingelmaier S, Henter M, Kirsch H, Kreuzer T, Langnickel R, Link PC, Müller S, Turner A, Fonagy P, Nolte T. Epistemic mistrust mediates the association between childhood maltreatment and impairments in mentalizing in a sample of university students. CHILD ABUSE & NEGLECT 2025; 163:107436. [PMID: 40168917 DOI: 10.1016/j.chiabu.2025.107436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 12/12/2024] [Accepted: 03/21/2025] [Indexed: 04/03/2025]
Abstract
BACKGROUND Mentalizing is linked to mental health development and psychosocial functioning. Identifying and understanding the factors that may be associated with ineffective mentalizing is crucial for creating targeted psychosocial or psychotherapeutic interventions. OBJECTIVE This exploratory study assesses whether experiences of childhood maltreatment, along with attachment insecurity and epistemic mistrust, are associated with limitations in mentalizing abilities. PARTICIPANTS AND SETTING A total of 382 primarily young adults from different universities completed questionnaires about their childhood maltreatment experiences (retrospectively assessed), attachment insecurity, epistemic mistrust, and ineffective mentalizing, using a cross-sectional study design. All participants were pursuing a degree in educational fields. METHODS Structural equation modeling was applied to test the hypothesized framework. RESULTS There were significant positive associations between experiences of childhood maltreatment, epistemic mistrust (β = 0.32 [0.17-0.46], p = .001), and attachment insecurity (β = 0.29 [0.18-0.40], p < .001). Epistemic mistrust fully mediated the relationship between childhood maltreatment and ineffective mentalizing (β = 0.17 [0.08-0.28], p = .001). However, attachment insecurity did not mediate this link. CONCLUSION This exploratory study sheds light on the development of mentalizing impairments, though it is limited by its cross-sectional nature, reliance on self-reporting, and the uniformity of the sample with mainly female, primarily young adults from different universities. The preliminary findings suggest the role of attachment insecurity might have been overemphasized previously. Moreover, the link between childhood maltreatment and mentalizing deficits appears more intricate, as it was fully mediated by epistemic mistrust in this study. The findings support the notion of addressing epistemic mistrust in psychosocial interventions designed to improve mentalizing abilities that have been compromised.
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Affiliation(s)
- Nicola-Hans Schwarzer
- Department of Special Education, Heidelberg University of Education, Heidelberg, Germany.
| | - Nöelle Behringer
- Department of Social Work and Health Care, Ludwigshafen University of Buisness and Society, Ludwigshafen, Germany
| | - Paula Dees
- Department of Special Education, Heidelberg University of Education, Heidelberg, Germany
| | - Stephan Gingelmaier
- Department of Emotional and Social Development, Ludwigsburg University of Education, Ludwigsburg, Germany
| | - Melanie Henter
- Department for Special Education, University of Kaiserslautern-Landau, Landau, Germany
| | | | - Tillmann Kreuzer
- Department for Special Eduation, Freiburg University of Education, Freiburg, Germany
| | - Robert Langnickel
- Department for Diversity and Inclusive Education, Luzern University of Education, Luzern, Switzerland
| | - Pierre-Carl Link
- Institute for Educational Support for Behaviour, Social-Emotional, and Psychomotor Development, University of Teacher Education in Special Needs Zürich, Zürich, Switzerland
| | - Sascha Müller
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Agnes Turner
- Department of Instructional and School Development, University of Klagenfurt, Klagefurt, Austria
| | - Peter Fonagy
- Anna Freud, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tobias Nolte
- Anna Freud, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Derome M, Morosan L, Heller P, Debbané M. Atypical functional connectome is associated with low reflective functioning in incarcerated adolescents. Front Psychiatry 2025; 15:1385782. [PMID: 39866687 PMCID: PMC11757290 DOI: 10.3389/fpsyt.2024.1385782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 12/06/2024] [Indexed: 01/28/2025] Open
Abstract
Introduction While functional neuroimaging studies have reported on the neural correlates of severe antisocial behaviors, such as delinquency, little is known about whole brain resting state functional connectivity (FC) of incarcerated adolescents (IA). The aim of the present study is to identify potential differences in resting state connectivity between a group of male IA, compared to community adolescents (CA). The second objective is to investigate the relations among FC and psychological factors associated with delinquent behaviors, namely psychopathic traits (callous unemotional traits, interpersonal problems, and impulsivity), socio-cognitive (empathy and reflective functioning RF) impairments and psychological problems (externalizing, internalizing, attention and thought problems). Methods 31 male IA and 30 male CA participated in 8 minutes resting state functional MRI. Network Based Statistics (NBS) was used to compare FC among 142 brain regions between the two groups. Correlation and regressions analysis were performed to explore the associations between FC and the self-reported psychopathic traits, empathy, RF, and psychological problems. Results Compared to the CA, the IA group presented significantly increased resting state FC in a distributed subnetwork including medial prefrontal, posterior and dorsal cingulate, temporal, and occipital regions. Both within the IA group and across the whole sample, increased mean connectivity of the subnetwork correlated with lower RF (RF uncertainty). Across the whole sample, the mean connectivity was associated with higher scores of externalizing problems and impulsivity dimension of psychopathy. Discussion While extending the characterization of whole brain resting state FC in IA, our results also provide insights into the neurofunctional mechanisms linking low reflective functioning abilities to externalizing behavior during adolescence.
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Affiliation(s)
- Mélodie Derome
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Larisa Morosan
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Division of Clinical Child and Adolescent Psychology, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
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Beneria A, Motger-Albertí A, Quesada-Franco M, Arteaga-Henríquez G, Santesteban-Echarri O, Ibáñez P, Parramon-Puig G, Sanz-Correcher P, Galynker I, Ramos-Quiroga JA, Pintor L, Bruguera P, Braquehais MD. A Suicide Attempt Multicomponent Intervention Treatment (SAMIT Program): study protocol for a multicentric randomised controlled trial. BMC Psychiatry 2024; 24:666. [PMID: 39379877 PMCID: PMC11462794 DOI: 10.1186/s12888-024-06113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 09/24/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Suicide has become a first-order public health concern, especially following the negative impact of COVID-19 on the mental health of the general population. Few studies have analysed the effects of early psychotherapeutic interventions on subjects who have attempted suicide, and even fewer have focused on those hospitalized in non-psychiatric units after a Medically Serious Suicide Attempt (MSSA). The main aim of this study is to describe the protocol designed to evaluate the effectiveness of individual psychological treatment for patients hospitalized after an MSSA. The secondary objectives of the study are: (1) to evaluate the impact on quality of life and other psychosocial variables of patients with a recent MSSA who receive early psychological intervention; (2) to analyse the biological, psychological, and clinical impact of early psychotherapeutic treatment on subjects hospitalized after an MSSA. METHODS A longitudinal randomised controlled trial will be conducted with patients over 16 years of age admitted to two general hospitals. The case intervention group will enrol for 8-sessions of individual psychotherapy, Suicide Attempts Multi-component Intervention Treatment (SAMIT), combining Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Narrative approaches, while the control group will receive a treatment-as-usual intervention (TAU). Longitudinal assessment will be conducted at baseline (before treatment), post-treatment, and 3, 6, and 12 months after. The main outcome variable will be re-attempting suicide during follow-up. DISCUSSION Some psychotherapeutic interventions, usually implemented in outpatient, have proven to be effective in preventing suicidal behaviours. The combination of some of these may be a powerful treatment for preventing future SA in patients hospitalised after an MSSA, which is the most severely suicidal subgroup. Moreover, assessment of the biological, clinical and psychometric impact of this new intervention on patients during the first year after the attempt may help understand some of the multi-level factors associated with the effectiveness of psychotherapeutic interventions in MSSAs. The prevalence of high suicide rates requires the design of effective psychological interventions for their prevention, and also in order to design new pharmacological and psychological treatments. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT06238414. Date of registration: 1st February 2024, final update is protocol version 3.0, 19th March 2024.
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Affiliation(s)
- Anna Beneria
- Department of Mental Health, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain.
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain.
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
| | - Anna Motger-Albertí
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.
- Addictive Behaviors Unit, Psychiatry Department, Institute of Neurosciences, IDIBAPS. RIAPAD (Red de investigación de atención primaria en adicciones), Hospital Clínic, Health and Addictions Research Group, Barcelona, Spain.
| | - Marta Quesada-Franco
- Department of Mental Health, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Gara Arteaga-Henríquez
- Department of Mental Health, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | | | - Pol Ibáñez
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Gemma Parramon-Puig
- Department of Mental Health, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Pedro Sanz-Correcher
- Psychiatry and Mental Health Department, October 12th University Hospital, Madrid, Spain
- Spanish Society of Therapy Based on Mentalization, Barcelona, Spain
| | - Igor Galynker
- Department of Psychiatry, Carl Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josep Antoni Ramos-Quiroga
- Department of Mental Health, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Luis Pintor
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
- Consultation-Liaison Psychiatry Unit, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Pol Bruguera
- Addictive Behaviors Unit, Psychiatry Department, Institute of Neurosciences, IDIBAPS. RIAPAD (Red de investigación de atención primaria en adicciones), Hospital Clínic, Health and Addictions Research Group, Barcelona, Spain
| | - María Dolores Braquehais
- Mental Health and Addictions Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain
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Schwarzer NH, Heim N, Gingelmaier S, Fonagy P, Nolte T. Mentalizing as a Predictor of Well-Being and Emotion Regulation: Longitudinal Evidence from a Community Sample of Young Adults. Psychol Rep 2024:332941241261902. [PMID: 38876977 DOI: 10.1177/00332941241261902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Background: In recent years, mentalizing - the capacity to understand one's own and others' intentional mental states in social contexts - has been considered to be a protective capacity that enables adaptive processing of stress-related emotional arousal, benefits general well-being and underpins adaptive emotion regulation. Objective: Several studies using cross-sectional research designs have demonstrated the potential health-promoting effect of mentalizing in non-clinical samples. However, longitudinal evidence is scarce. The present study aimed to investigate whether mentalizing predicts well-being and emotion regulation strategies in a non-clinical sample of mainly young adults using a prospective longitudinal design. Methods: In a prospective research design, 135 participants completed questionnaires assessing well-being, psychological symptom severity and mentalizing capacity at baseline (T1). Twelve months later (T2), emotion regulation strategies (suppression and cognitive reappraisal), well-being and psychological symptom severity were assessed by self-report. The data were analyzed using multivariate linear regression analysis. Results: Impairments in mentalizing were a significant negative predictor of well-being 12 months later. Furthermore, impairments in mentalizing positively predicted suppression of emotional states at T2. No association was found between deficits in mentalizing and cognitive reappraisal of emotional states over the course of 1 year. Conclusion: The findings indicate that mentalizing is longitudinally associated with mental health indicators in a non-clinical adult sample. Specifically, ineffective mentalizing was associated with impaired psychological well-being and a tendency to suppress intense emotional states over a period of 1 year. Future research should replicate these findings using multiple measurement timepoints to etablish causality.
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Affiliation(s)
- Nicola-Hans Schwarzer
- Institut für Sonderpädagogik, Fakultät für Erziehungs- und Sozialwissenschaften, Pädagogische Hochschule Heidelberg, Heidelberg, Germany
| | - Nikolas Heim
- International Psychoanaytic University Berlin, Berlin, Germany
| | - Stephan Gingelmaier
- Abteilung soziale und emotionale Entwicklung, Fakultät III für Sonderpädagogik, Pädagogische Hochschule Ludwigsburg, Ludwigsberg, Germany
| | - Peter Fonagy
- Anna Freud Centre, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Tobias Nolte
- Anna Freud Centre, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Winquist A, Rönnlund M. A time to reflect: deviations from the balanced time perspective are associated with hypomentalization. Front Psychol 2024; 15:1379585. [PMID: 38860048 PMCID: PMC11163059 DOI: 10.3389/fpsyg.2024.1379585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Poor mentalization, or lack of capacity to reflect on self and others in terms mental states, thoughts, and feelings, and time perspective biases were both related to mental disorders and lower wellbeing in separate studies. Expanding one prior study, we examined the relationship of mentalization and time perspective, including a measure known as deviations from the balanced time perspective (DBTP) that summarizes time perspective biases across the past, present, and future time frames. Method A convenience sample of 258 participants responded to a version of the Reflective Functioning Questionnaire (RFQ-8) and a six-dimensional version of the Zimbardo Time Perspective Inventory (S-ZTPI). Given recent evidence that the original two-factor structure of the RFQ may need to be reconsidered, we used confirmatory factor analyses (CFA) to compare alternative models for RFQ as a first step. Results In line with several recent studies, the CFA favored a unitary model of RFQ-8 reflecting hypomentalization (or uncertainty). The total score showed significant associations with Past Negative, Present Fatalistic, and Future Negative dimensions of S-ZTPI, while hypomentalization was negatively associated with Future Positive. Of major interest, DBTP and hypomentalization showed a strong positive correlation (r = 0.64 for latent constructs; r = 0.62 in an adjusted model). Conclusion Deviations from the balanced time perspective were substantially related to hypomentalization. Further research is required to examine the generalizability of the finding (e.g., to measures of mentalization focused on others) and to provide a better understanding of the theoretical basis of the link. Potentially shared associations in development (e.g., attachment style) and mindfulness, that may influence both time perspective and mentalization is of interest in this regard.
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Andreo-Jover J, Curto Ramos J, Bobes J, Bravo-Ortiz M, Cebria AI, Crespo-Facorro B, De la Torre-Luque A, Díaz-Marsa M, Fernández-Rodrigues V, Garrido-Torres N, Grande I, López Peña MP, Pemau A, Roberto N, Ruiz-Veguilla M, Saiz P, Rodríguez-Vega B, Pérez-Sola V. The mediating role of reflective functioning in the association between childhood trauma and suicide attempt. J Psychiatr Res 2024; 171:30-37. [PMID: 38241967 DOI: 10.1016/j.jpsychires.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far. OBJECTIVE We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts. METHOD We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts. RESULTS Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality. CONCLUSION This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.
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Affiliation(s)
- J Andreo-Jover
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - J Curto Ramos
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - J Bobes
- Department of Psychiatry, Universidad de Oviedo, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - M Bravo-Ortiz
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain.
| | | | - B Crespo-Facorro
- Hospital Virgen del Rocio/IBIS, Sevilla, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Departamento de Psiquiatría, Universidad de Sevilla, Spain
| | - A De la Torre-Luque
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Spain
| | | | - V Fernández-Rodrigues
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Spain
| | - N Garrido-Torres
- Hospital Virgen del Rocio/IBIS, Sevilla, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Departamento de Psiquiatría, Universidad de Sevilla, Spain
| | - I Grande
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain
| | | | - A Pemau
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Spain
| | - N Roberto
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain
| | - M Ruiz-Veguilla
- Hospital Virgen del Rocio/IBIS, Sevilla, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Departamento de Psiquiatría, Universidad de Sevilla, Spain
| | - P Saiz
- Department of Psychiatry, Universidad de Oviedo, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain; Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - B Rodríguez-Vega
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain; Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
| | - V Pérez-Sola
- Institut de Neuropsiquiatria i Addiccions (INAD), Parc de Salut Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain
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Karagiannopoulou E, Milienos FS, Desatnik A, Rentzios C, Athanasopoulos V, Fonagy P. A short version of the reflective functioning questionnaire: Validation in a greek sample. PLoS One 2024; 19:e0298023. [PMID: 38319928 PMCID: PMC10846711 DOI: 10.1371/journal.pone.0298023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
This study aims to validate the Greek version of the 54-item Reflective Functioning Questionnaire (RFQ), a measure designed to assess an individual's capacity for understanding themselves and others based on internal mental states. This capacity, also known as Reflective Functioning (RF) or mentalizing, is believed to play a significant role in both typical and atypical development. The validation process examined the factor structure of the RFQ and its relationship with a variety of psychosocial and clinical constructs that have theoretical and empirical links to RF. Additionally, this research investigated the factor structure's invariance across gender and age groups to determine the robustness of the instrument. A unique contribution of this work lies in examining the application of the RFQ to attachment classifications through the use of cluster analysis. The sample consisted of 875 Greek adults from the general community with a mean age of 28.5 and a median age of 22. Participants completed the Greek RFQ along with a series of self-report questionnaires assessing psychosocial constructs, including attachment, epistemic trust, emotion regulation, and psychological mindedness, as well as clinical variables such as anxiety, depression, and borderline personality traits. Our findings suggest that a shorter, 31-item version of the questionnaire provides a robust three-factor structure across a non-clinical Greek adult population. The three identified subscales are (a) excessive certainty, (b) interest/curiosity, and (c) uncertainty/confusion, all demonstrating satisfactory reliability and construct validity. The uncertainty subscale was found to be associated with insecure attachment styles, epistemic mistrust and credulity, emotional suppression, and low psychological mindedness. In contrast, the certainty and curiosity subscales were linked to secure attachment, epistemic trust, emotion reappraisal, and psychological mindedness. Uncertainty was further shown to differ significantly across probable clinical and non-clinical groups, as distinguished by cut-off scores for anxiety, depression, and borderline personality disorder (BPD). However, the certainty and interest/curiosity subscales only varied between the two BPD groups. Our results provide the first evidence supporting the use of a 31-item version of the RFQ with three validated subscales to reliably assess reflective functioning in the Greek population, demonstrating stronger psychometric properties compared to other RFQ versions reported in previous studies. Findings suggest that impaired mentalizing capacity, as measured by the RFQ, is linked to insecure attachment, epistemic mistrust and credulity, poor emotion regulation, and low psychological mindedness, and potentially plays a role in adult mental health symptoms.
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Affiliation(s)
- Evangelia Karagiannopoulou
- Department of Psychology, University of Ioannina, Ioannina, Greece
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Fotios S. Milienos
- Department of Sociology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Alex Desatnik
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
- Open Door Young People Service, London, United Kingdom
| | | | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
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