Intelligence and Treatment Outcome of Mentalization-Based Treatment in Borderline Personality Disorder.

BACKGROUND: Mentalization-based treatment (MBT) is an evidence based treatment for patients diagnosed with borderline personality disorder (BPD). Although MBT is effective, on average, for individuals with BPD, there are large individual differences in treatment outcomes. Research on predictors of the treatment effect of MBT, such as intelligence, is needed to determine which treatment is most effective for which 'category' of BPD patients, providing more knowledge about optimal indications. OBJECTIVE: The study aimed to investigate whether intelligence is associated with MBT outcomes in patients with BPD and exploratively studying the difference between two variants of MBT. METHODS AND PROCEDURES: A pre-post intervention design was used to examine the effects of MBT on BPD severity. Personal and social recovery were measured as secondary outcome measures. The association between intelligence and the degree of recovery was examined. RESULTS: No significant correlation was found between intelligence level and treatment efficacy. In addition, a negative correlation between IQ and personal and social recovery was found, indicating that, as IQ increased, the level of recovery decreased. Secondary subanalyses showed the treatment effect of MBT was large and significant in reducing BPD symptoms (Cohen's d = 1.5) and that there was no significant difference between the 2-day MBT and 3-day MBT programmes in terms of a decrease in BPD severity. However, a significant medium positive correlational relationship was found between intelligence and a decrease in BPD severity level for the 3-day MBT, which was not found for the 2-day MBT programme. This indicates that in the 3-day MBT programme, the higher the IQ, the higher the decrease in BPD severity level. CONCLUSIONS AND IMPLICATIONS: This study is the first to examine the association between intelligence and the outcome of MBT in BPD patients. It shows that patients with a wide range of intelligence (72-124) can equally benefit from MBT and that effectiveness of MBT was not influenced negatively by lower intelligence. Secondary subanalyses showed that this was particularly evident when the intervention was delivered within the context of a 2-day MBT programme. Nevertheless, further randomized studies are required to ascertain the relationship between IQ and treatment effectiveness, as well as other predictors of MBT outcomes.

A Suicide Attempt Multicomponent Intervention Treatment (SAMIT Program): study protocol for a multicentric randomised controlled trial.

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.

Autistic and schizotypal traits exhibit similarities in their impact on mentalization and adult attachment impairments: a cross-sectional study.

BACKGROUND: Deficits in mentalizing and attachment occur in the autism and schizophrenia spectrum, and their extended traits in the general population. Parental attachment and the broader social environment highly influence the development of mentalizing. Given the similarities in the symptomatology and neurodevelopmental correlates of autism spectrum disorder (ASD) and schizophrenia (SCH), it is crucial to identify their overlaps and differences to support screening, differential diagnosis, and intervention. METHODS: This cross-sectional study utilized questionnaire data from 2203 adults (65.1% female, mean age[SD] = 37.98[9.66]), including participants diagnosed with ASD, SCH, and those exhibiting subclinical traits to investigate the associations between mentalizing, attachment, and perceived social support during adolescence across the autistic and schizotypy spectrum. RESULTS: It was revealed that both autistic and schizotypal traits have comparable effects on insecure adult attachment, primarily through challenges in mentalizing. The impact of mentalizing deficits on adult attachment slightly varies between autistic and schizotypal traits. Conversely, perceived social support during adolescence relates to improved mentalizing and secure adult attachment as a protective factor during development. CONCLUSIONS: These outcomes highlight the significance of supportive therapeutic relationships and community care while suggesting directions for further research and collaborative treatments addressing ASD and SCH, considering the differential impact of mentalizing on adult attachment.

Action expectancy modulates activity in the mirror neuron system and mentalizing system.

Action understanding involves two distinct processing levels that engage separate neural mechanisms: perception of concrete kinematic information and recognition of abstract action intentions. The mirror neuron system and the mentalizing system have both been linked to concrete action and abstract information processing, but their specific roles remain debatable. Here, we conducted a functional magnetic resonance imaging study with 26 participants who passively observed expected and unexpected actions. We performed whole-brain activation, region of interest, and effective connectivity analyses to investigate the neural correlates of these actions. Whole-brain activation analyses revealed that expected actions were associated with increased activation in the left medial superior frontal gyrus, while unexpected actions were linked to heightened activity in the left supramarginal gyrus, left superior parietal lobule, right inferior temporal gyrus, and left middle frontal gyrus. Region of interest analyses demonstrated that the left ventral premotor cortex exhibited greater activation during the observation of expected actions compared to unexpected actions, while the left inferior frontal gyrus, left superior parietal lobule, and left precuneus showed stronger activation during the observation of unexpected actions. Effective connectivity was observed between the left ventral premotor cortex and the left angular gyrus, left intraparietal sulcus, left dorsal premotor cortex, and left ventromedial prefrontal cortex with the middle frontal gyrus when observing unexpected, but not expected, actions. These findings suggest that expected actions are primarily processed by the mirror neuron system, whereas unexpected actions engage both the mirror neuron system and the mentalizing system, with these systems playing complementary roles in the understanding of unexpected actions.

Tracking politically motivated reasoning in the brain: the role of mentalizing, value-encoding, and error detection networks.

Susceptibility to misinformation and belief polarization often reflects people's tendency to incorporate information in a biased way. Despite the presence of competing theoretical models, the underlying neurocognitive mechanisms of motivated reasoning remain elusive as previous empirical work did not properly track the belief formation process. To address this problem, we employed a design that identifies motivated reasoning as directional deviations from a Bayesian benchmark of unbiased belief updating. We asked the members of a proimmigration or an anti-immigration group regarding the extent to which they endorse factual messages on foreign criminality, a polarizing political topic. Both groups exhibited a desirability bias by overendorsing attitude-consistent messages and underendorsing attitude-discrepant messages and an identity bias by overendorsing messages from in-group members and underendorsing messages from out-group members. In both groups, neural responses to the messages predicted subsequent expression of desirability and identity biases, suggesting a common neural basis of motivated reasoning across ideologically opposing groups. Specifically, brain regions implicated in encoding value, error detection, and mentalizing tracked the degree of desirability bias. Less extensive activation in the mentalizing network tracked the degree of identity bias. These findings illustrate the distinct neurocognitive architecture of desirability and identity biases and inform existing cognitive models of politically motivated reasoning.

Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning.

INTRODUCTION: Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents. METHODS: A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors. RESULTS: ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators. CONCLUSION: Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.

Synergy of the mirror neuron system and the mentalizing system in a single brain and between brains during joint actions.

Cooperative action involves the simulation of actions and their co-representation by two or more people. This requires the involvement of two complex brain systems: the mirror neuron system (MNS) and the mentalizing system (MENT), both of critical importance for successful social interaction. However, their internal organization and the potential synergy of both systems during joint actions (JA) are yet to be determined. The aim of this study was to examine the role and interaction of these two fundamental systems-MENT and MNS-during continuous interaction. To this hand, we conducted a multiple-brain connectivity analysis in the source domain during a motor cooperation task using high-density EEG dual-recordings providing relevant insights into the roles of MNS and MENT at the intra- and interbrain levels. In particular, the intra-brain analysis demonstrated the essential function of both systems during JA, as well as the crucial role played by single brain regions of both neural mechanisms during cooperative activities. Specifically, our intra-brain analysis revealed that both neural mechanisms are essential during Joint Action (JA), showing a solid connection between MNS and MENT and a central role of the single brain regions of both mechanisms during cooperative actions. Additionally, our inter-brain study revealed increased inter-subject connections involving the motor system, MENT and MNS. Thus, our findings show a mutual influence between two interacting agents, based on synchronization of MNS and MENT systems. Our results actually encourage more research into the still-largely unknown realm of inter-brain dynamics and contribute to expand the body of knowledge in social neuroscience.

A Randomized Controlled Trial Comparing Mentalization-Based Therapy With the Unified Protocol in the Treatment of Psychopathy and Comorbid Borderline + Antisocial Personality Disorders.

BACKGROUND: Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization-based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self-harm. METHODS: Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6-month intervals to 36 months. RESULTS: Short-term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self-harm, but both treatment groups showed almost complete relapse of symptoms at the 36-month follow-up. UP had more durable effects than MBT. CONCLUSIONS: Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term. CLINICAL IMPLICATIONS: Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment.

Mentalizing self mind but not others: Self-reported mentalization difficulties in multiple sclerosis.

BACKGROUND: Mentalization can be defined as a mental process by which an individual directly or indirectly perceives and interprets one's own and others' behavior, emotions, beliefs, and needs based on designed mental states. Mentalization problems may be linked to remove associative white matter fiber disconnection. Multiple sclerosis (MS) is one of the diseases with white matter lesions. By comparing MS patients with healthy controls, it was aimed to assess whether MS patients' mentalization skills are affected. METHOD: This study involved 243 participants (170 healthy controls and 73 patients with MS). All the participants completed a sociodemographic questionnaire and the Mentalization Scale (MentS). RESULTS: While it was discovered that MentS scores for the dimension of others-based mentalization (MentS-O) were statistically lower in MS group, there was no statistically significant difference between the groups in terms of the dimensions of motivation to mentalize (MentS-M) and self-based mentalization (MentS-S) scores. CONCLUSION: We may conclude that MS patients have trouble comprehending other people's thoughts. This effect can be one of the causes of MS patients' issues with social cognition.

Disruption of dopamine D2/D3 system function impairs the human ability to understand the mental states of other people.

Difficulties in reasoning about others' mental states (i.e., mentalising/Theory of Mind) are highly prevalent among disorders featuring dopamine dysfunctions (e.g., Parkinson's disease) and significantly affect individuals' quality of life. However, due to multiple confounding factors inherent to existing patient studies, currently little is known about whether these sociocognitive symptoms originate from aberrant dopamine signalling or from psychosocial changes unrelated to dopamine. The present study, therefore, investigated the role of dopamine in modulating mentalising in a sample of healthy volunteers. We used a double-blind, placebo-controlled procedure to test the effect of the D2/D3 antagonist haloperidol on mental state attribution, using an adaptation of the Heider and Simmel (1944) animations task. On 2 separate days, once after receiving 2.5 mg haloperidol and once after receiving placebo, 33 healthy adult participants viewed and labelled short videos of 2 triangles depicting mental state (involving mentalistic interaction wherein 1 triangle intends to cause or act upon a particular mental state in the other, e.g., surprising) and non-mental state (involving reciprocal interaction without the intention to cause/act upon the other triangle's mental state, e.g., following) interactions. Using Bayesian mixed effects models, we observed that haloperidol decreased accuracy in labelling both mental and non-mental state animations. Our secondary analyses suggest that dopamine modulates inference from mental and non-mental state animations via independent mechanisms, pointing towards 2 putative pathways underlying the dopaminergic modulation of mental state attribution: action representation and a shared mechanism supporting mentalising and emotion recognition. We conclude that dopaminergic pathways impact Theory of Mind, at least indirectly. Our results have implications for the neurochemical basis of sociocognitive difficulties in patients with dopamine dysfunctions and generate new hypotheses about the specific dopamine-mediated mechanisms underlying social cognition.

Effective connectivity analysis of resting-state mentalizing brain networks in spinocerebellar ataxia type 2: A dynamic causal modeling study.

Neuroimaging studies on healthy subjects described the causal effective connectivity of cerebellar-cerebral social mentalizing networks, revealing the presence of closed-loops. These studies estimated effective connectivity by applying Dynamic Causal Modeling on task-related fMRI data of healthy subjects performing mentalizing tasks. Thus far, few studies have applied Dynamic Causal Modeling to resting-state fMRI (rsfMRI) data to test the effective connectivity within the cerebellar-cerebral mentalizing network in the absence of experimental manipulations, and no study applied Dynamic Causal Modeling on fMRI data of patients with cerebellar disorders typically showing social cognition deficits. Thus, in this research we applied spectral Dynamic Causal Modeling, to rsfMRI data of 13 patients affected by spinocerebellar ataxia type 2 (SCA2) and of 23 matched healthy subjects. Specifically, effective connectivity was tested between acknowledged mentalizing regions of interest: bilateral cerebellar Crus II, dorsal and ventral medial prefrontal cortex, bilateral temporo-parietal junctions and precuneus. SCA2 and healthy subjects shared some similarities in cerebellar-cerebral mentalizing effective connectivity at rest, confirming the presence of closed-loops between cerebellar and cerebral mentalizing regions in both groups. However, relative to healthy subjects, SCA2 patients showed effective connectivity variations mostly in cerebellar-cerebral closed loops, namely weakened inhibitory connectivity from the cerebellum to the cerebral cortex, but stronger inhibitory connectivity from the cerebral cortex to the cerebellum. The present study demonstrated that effective connectivity changes affect a function-specific mentalizing network in SCA2 patients, allowing to deepen the direction and strength of the causal effective connectivity mechanisms driven by the cerebellar damage associated with SCA2.

Validation of the english version of the Multidimensional Mentalizing Questionnaire (MMQ).

BACKGROUND: Mentalizing refers to the ability to understand one's own and others' mental states. Mentalizing is considered a key component of social cognition and healthy personality development. A multinational assessment tools able to appraise the multidimensional and multifaceted aspects of this complex construct are needed. OBJECTIVE: The present study had two aims: (a) validate an English version of the Multidimensional Mentalizing Questionnaire (MMQ, 33 items) which was designed to assess mentalizing based on an integrated and multilevel model of mentalizing; (b) explore the correlational relationships between the six dimensions of the MMQ and a set of sociodemographic, psycho-cognitive, mental health, and socio-functional variables. METHODS: Overall, 1823 individuals (age: 19-76 years old [M = 45; SD = 16]; sex: male = 48.51%, female = 50.57%, non-binary = 0.9%) participated in an online survey. While the participants came from 77 different countries, most of them were residents in UK and USA (95%). Data analytics include confirmatory factorial analysis and Pearson correlations. RESULTS: The CFA results validated the factorial structure of a 28-items MMQ-English version, with acceptable goodness of fit indices. Regarding the psychometric properties, the MMQ-English version showed good internal reliability and significant positive correlation with another scale designed to assess an analogue construct showing a fair convergent validity. The findings indicated that males, individuals with lower levels of education, lower socio-economic status, depressed, and with a higher score of loneliness are significantly more likely to report poor mentalizing compared with females, individuals with higher education level, greater SES, happier, and with lower scores of loneliness. CONCLUSION: The present study validated the English version of the MMQ.

Theory of Mind: A Brief Review of Candidate Genes.

Deficits in theory of mind (ToM), known as the ability to understand the other's mind, have been associated with several psychopathological outcomes. The present systematic review aims to summarize the results of genetic studies that investigated gene polymorphisms associated with mentalization performance tasks in children and adults. The systematic review was carried out following PRISMA guidelines, and the literature search was conducted in PubMed and EBSCOhost using the following keywords: 'theory of mind, mentalizing, mindreading' and 'gene, genetic basis'. Nineteen studies met the eligibility criteria for inclusion. Most of the literature focused on the role of DRD4, DAT1, OXTR, OXT, COMT, ZNF804A, AVP, AVPR, SCL6A4, EFHC2, MAO-A, and the family of GTF2I genes in influencing ToM. However, controversial results emerged in sustaining the link between specific genetic polymorphisms and mentalization abilities in children and adults. Available data show heterogeneous outcomes, with studies reporting an association between the same family genes in subjects of the same age and other studies reporting no correlation. This does not allow us to draw any solid conclusions but paves the way for exploring genes involved in ToM tasks.

Improving mentalizing deficits in older age with region-specific transcranial direct current stimulation.

Older adults have difficulties to detect the intentions, thoughts, and feelings of others, indicating an age-associated decline of socio-cognitive abilities that are known as "mentalizing". These deficits in mental state recognition are driven by neurofunctional alterations in brain regions that are implicated in mentalizing, such as the right temporo-parietal junction (rTPJ) and the dorso-medial prefrontal cortex (dmPFC). We tested whether focal transcranial current stimulation (tDCS) of the rTPJ and dmPFC has the potential to eliminate mentalizing deficits in older adults. Mentalizing deficits were assessed with a novel mindreading task that required the recognition of mental states in child faces. Older adults (n = 60) performed worse than younger adults (n = 30) on the mindreading task, indicating age-dependent deficits in mental state recognition. These mentalizing deficits were ameliorated in older adults who received sham-controlled andodal tDCS over the rTPJ (n = 30) but remained unchanged in older adults who received sham-controlled andodal tDCS over the dmPFC (n = 30). We, thus, showed for the first time that anodal tDCS over the rTPJ has the potential to remediate age-dependent mentalizing deficits in a region-specific way. This provides a rationale for exploring stimulation-based interventions targeting mentalizing deficits in older age.

Online chasing action recruits both mirror neuron and mentalizing systems: A pilot fNIRS study.

Engaging in chasing, where an actor actively pursues a target, is considered a crucial activity for the development of social skills. Previous studies have focused predominantly on understanding the neural correlates of chasing from an observer's perspective, but the neural mechanisms underlying the real-time implementation of chasing action remain poorly understood. To gain deeper insights into this phenomenon, the current study employed functional near-infrared spectroscopy (fNIRS) techniques and a novel interactive game. In this interactive game, participants (N = 29) were tasked to engage in chasing behavior by controlling an on-screen character using a gamepad, with the goal of catching a virtual partner. To specifically examine the brain activations associated with the interactive nature of chasing, we included two additional interactive actions: following action of following the path of a virtual partner and free action of moving without a specific pursuit goal. The results revealed that chasing and following actions elicited activation in a broad and overlapping network of brain regions, including the temporoparietal junction (TPJ), medial prefrontal cortex (mPFC), premotor cortex (PMC), primary somatosensory cortex (SI), and primary motor cortex (M1). Crucially, these regions were found to be modulated by the type of interaction, with greater activation and functional connectivity during the chasing interaction than during the following and free interactions. These findings suggested that both the MNS, encompassing regions such as the PMC, M1 and SI, and the mentalizing system (MS), involving the TPJ and mPFC, contribute to the execution of online chasing actions. Thus, the present study represents an initial step toward future investigations into the roles of MNS and MS in real-time chasing interactions.

Intersubject correlations in reward and mentalizing brain circuits separately predict persuasiveness of two types of ISIS video propaganda.

The Islamist group ISIS has been particularly successful at recruiting Westerners as terrorists. A hypothesized explanation is their simultaneous use of two types of propaganda: Heroic narratives, emphasizing individual glory, alongside Social narratives, which emphasize oppression against Islamic communities. In the current study, functional MRI was used to measure brain responses to short ISIS propaganda videos distributed online. Participants were shown 4 Heroic and 4 Social videos categorized as such by another independent group of subjects. Persuasiveness was measured using post-scan predictions of recruitment effectiveness. Inter-subject correlation (ISC) was used to measure commonality of brain activity time courses across individuals. ISCs in ventral striatum predicted rated persuasiveness for Heroic videos, while ISCs in mentalizing and default networks, especially in dmPFC, predicted rated persuasiveness for Social videos. This work builds on past findings that engagement of the reward circuit and of mentalizing brain regions predicts preferences and persuasion. The observed dissociation as a function of stimulus type is novel, as is the finding that intersubject synchrony in ventral striatum predicts rated persuasiveness. These exploratory results identify possible neural mechanisms by which political extremists successfully recruit prospective members and specifically support the hypothesized distinction between Heroic and Social narratives for ISIS propaganda.

Mentalization based treatment for a broad range of personality disorders: a naturalistic study.

BACKGROUND: Several studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs. METHOD: Personality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable. RESULTS: Overall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p's ≤ .01). Bigger effect sizes were observed for BPD patients (n = 25) than for patients with non-BPD (n = 21), but the difference failed to reach statistical significance (p = 0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p = 0.01), not in non-BPD (p = 0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p = 0.01). Mentalizing capacity of the whole group improved over time (d = .68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System). DISCUSSION: These results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims. CONCLUSION: Mentalization-based treatment may be an effective treatment for patients with a broad range of PDs. TRIAL REGISTRATION: The study design was approved by the Leiden University Ethical Committee.

The reflective function questionnaire for youth: Hungarian adaptation and evaluation of associations with quality of life and psychopathology.

An important correlate of mental health problems is mentalizing capacity, which appears to be particularly influential during adolescence. However, quality of life has not been studied in relation to mentalizing capacity among adolescents. This study aimed to translate the Reflective Function Questionnaire for Youth (RFQY) into Hungarian, present its psychometric properties, and assess its relationship with demographic characteristics, psychopathology and quality of life. A community sample of 384 youths aged 12-18 years completed the RFQY, the Measure of Quality of Life for Children and Adolescents, and the Strengths and Difficulties Questionnaire. First, we conducted an exploratory factor analysis with direct oblimin rotation on the RFQY items. Next, we assessed the associations between the RFQY and demographics, quality of life, and psychopathology. The EFA resulted in four factors: Internal-self, Internal-other, Self-other, and Strong emotions. The Cronbach's alpha coefficients of the scales were .81, .82, .67, and .80, respectively. The subscales were uniquely associated with psychopathology and quality of life. Our study provides the first psychometric support for the Hungarian version of the RFQY and indicates that adolescents suffering from internalizing, externalizing symptoms or lower levels of quality of life could benefit from interventions aimed at enhancing mentalizing capacity.

An important correlate of mental health problems is mentalizing capacity, which appears to be particularly influential during adolescence. However, quality of life has not been studied in relation to mentalizing capacity among adolescents. This study aimed to translate the Reflective Function Questionnaire for Youth (RFQY) into Hungarian, present its psychometric properties, and assess its relationship with demographic characteristics, psychopathology and quality of life. A community sample of 384 youths between the ages of 12 and 18 completed the RFQY, the Measure of Quality of Life for Children and Adolescents, and the Strengths and Difficulties Questionnaire. Our study provides the first psychometric support for the Hungarian version of the RFQY and indicates that adolescents suffering from internalizing, externalizing symptoms or lower levels of quality of life could benefit from interventions aimed at enhancing mentalizing capacity.

Association between pathological narcissism and emotion regulation: The role of self-mentalizing?

Pathological narcissism (PN) is a common psychopathological issue leading to maladaptive strategies to cope with self-esteem threats, including self-enhancement and exploitation (grandiose strategies) or internalized shame, depression, and social withdrawal (vulnerable strategies). Mentalizing is a key process for regulating self and other representations and their associated emotions. Patients with PN further struggle with emotion dysregulation (ED), which during development is intertwined with the growing capacity to mentalize. We seek to contribute to emerging empirical data documenting the associations between PN and ED and between PN and mentalizing, and to provide information on the nature of their mutual relationships. In the present study, we assessed PN, ED, and three mentalizing dimensions (mentalizing self, other, and motivation to mentalize) in 183 patients consulting in our outpatient unit specialized in ED. We found that narcissistic vulnerability was negatively associated with self-mentalizing and positively associated with overall ED, both even after adjustment for borderline and attention deficit hyperactivity disorder (ADHD) symptoms. However, the association with ED was not maintained after further adjustment for self-mentalizing or overall-mentalizing, which suggests that mentalizing may play a mediating role in this relationship. On the other hand, narcissistic grandiosity was positively associated with other-mentalizing and ED and negatively associated with self-mentalizing in bivariate analyses, but these last two associations were not maintained after adjustment for comorbid borderline and/or ADHD symptomatology. This study provides new information on the link between PN and ED and on key mentalizing dimensions meaningfully relating to PN, notably through a potential role of self-mentalizing processes between PN and ED.