https://doi.org/10.4081/ripppo.2023.707
The interplay of mentalization and epistemic trust: a protective mechanism against emotional dysregulation in adolescent internalizing symptoms
Submitted: July 8, 2023
Accepted: November 5, 2023
Published: December 31, 2023
Accepted: November 5, 2023
Abstract Views: 1919
PDF: 511
HTML: 41
HTML: 41
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Mentalization is the ability to interpret actions as caused by intentional mental states. Moreover, mentalization facilitates the development of epistemic trust (ET), namely, the ability to evaluate social information as accurate, reliable, and relevant. Recent theoretical literature identifies mentalization as a protective factor, contrasting psychopathology and emotional dysregulation. However, few investigations have explored the concurrent associations between mentalization, ET and emotion dysregulation in the context of internalizing problems in adolescence. In the present study, 482 adolescents from the general population aged between 12 and 19 were assessed with the epistemic trust mistrust credulity questionnaire, the reflective functioning questionnaire- youth, the difficulties in emotion regulation scale, and the youth self-report. We tested the relationship between the variables through serial mediation models. Results showed that mentalization reduces internalizing problems via emotional dysregulation; ET is positively associated with mentalization but not symptomatology. Finally, both epistemic mistrust and epistemic credulity are significantly associated with internalizing symptomatology; those effects are mediated differently by difficulties in emotional regulation. In conclusion, the present study confirms mentalization’s role as a protective factor in developmental psychopathology. Nevertheless, exploring the role of the different epistemic stances guarantees a better understanding of psychopathological pathways in adolescence.
Achenbach, T. M., & Edelbrock, C. S. (1978). The classification of child psychopathology: a review and analysis of empirical efforts. Psychological Bulletin, 85(6), 1275-1301.
DOI: https://doi.org/10.1037/0033-2909.85.6.1275
Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms & profiles: an integrated system of multi-informant assessment. Aseba.
Allen, J. G., & Fonagy, P.(2008). La mentalizzazione: psicopatologia e trattamento. Il mulino. [Book in Italian].
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Publishing.
DOI: https://doi.org/10.1176/appi.books.9780890425596
Banerjee, R. (2008). Social cognition and anxiety in children. In C. Sharp, P. Fonagy, & I. Goodyer (Eds.), Social Cognition and Developmental Psychopathology (pp. 239-269). Oxford University Press.
DOI: https://doi.org/10.1093/med/9780198569183.003.0009
Barnicot, K. & Crawford, M. (2019). Dialectical behaviour therapy v. mentalization-based therapy for borderline personality disorder. Psychological Medicine, 49, 2060-2068. doi: 10.1017/S0033291718002878.
DOI: https://doi.org/10.1017/S0033291718002878
Bateman, A., & Fonagy, P. (2019). Mentalizzazione e disturbi di personalità. Una guida pratica al trattamento. Raffaello Cortina Editore. [Book in Italian].
Belvederi Murri, M., Ferrigno, G., Penati, S., Muzio, C., Piccinini, G., Innamorati, M., Ricci, F., Pompili, M., & Amore, M. (2017). Mentalization and depressive symptoms in a clinical sample of adolescents and young adults. Child and Adolescent Mental Health, 22(2), 69-76.
DOI: https://doi.org/10.1111/camh.12195
Benzi, I. M. A., & Cipresso, P. (2020). Let’s dive into it! Exploring mentalizing abilities in adolescence in an immersive 360° environment. Annual Review of CyberTherapy and Telemedicine, 18, 271-274.
Benzi, I. M. A., Fontana, A., Barone, L., Preti, E., Parolin, L., & Ensink, K. (2023). Emerging personality in adolescence: developmental trajectories, internalizing and externalizing problems, and the role of mentalizing abilities. Journal of Adolescence, 95(3), 537-552.
DOI: https://doi.org/10.1002/jad.12134
Bradley, S. J. (2000). Affect regulation and the development of psychopathology. Guilford Press.
Brumariu, L. E., & Kerns, K. A. (2010). Parent-child attachment and internalizing symptoms in childhood and adolescence: a review of empirical findings and future directions. Development and Psychopathology, 22(1), 177-204. doi: 10.1017/S0954579409990344.
DOI: https://doi.org/10.1017/S0954579409990344
Campbell, C., Tanzer, M., Saunders, R., Booker, T., Allison, E., Li, E., O’Dowda, C., Luyten, P., & Fonagy, P. (2021). Development and validation of a self-report measure of epistemic trust. PLoS One, 16(4), 0250264. doi: 10.1371/journal.pone.0250264.
DOI: https://doi.org/10.1371/journal.pone.0250264
Caspi, A., Houts, R. M., Harrington, H., Israel, S., Meier, M. H., Shalev, I., Moffitt, T. E., Belsky, D. W., Goldman-Mellor, S. J., Ramrakha, S., & Poulton, R. (2014). The p factor: one general psychopathology factor in the structure of psychiatric disorders? Clinical Psychological Science, 2(2), 119-137. doi: 10.1177/2167702613497473.
DOI: https://doi.org/10.1177/2167702613497473
Chevalier, V., Simard, V., & Achim, J. (2023). Meta-analyses of the associations of mentalization and proxy variables with anxiety and internalizing problems. Journal of Anxiety Disorders, 95, 102694.
DOI: https://doi.org/10.1016/j.janxdis.2023.102694
Chevalier, V., Simard, V., Achim, J., Burmester, P., & Beaulieu-Tremblay, T. (2021). Reflective Functioning in Children and Adolescents With and Without an Anxiety Disorder. Frontiers in Psychology, 12, 698654.
DOI: https://doi.org/10.3389/fpsyg.2021.698654
Costello, E. J., Angold, A., Burns, B. J., Stangl, D. K., Tweed, D. L., Erkanli, A., Worthman, C. M. (1996). The great smoky mountains study of youth: goals, design, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry, 53(12), 1129-1136. doi: 10.1001/archpsyc.1996.01830120067012.
DOI: https://doi.org/10.1001/archpsyc.1996.01830120067012
Di Pietro, M., & Bassi, E. (2013). L’intervento cognitivo comportamentale per l’età̀ evolutiva: strumenti di valutazione e tecniche per il trattamento. Erickson. [Book in Italian].
Debbanè, M. (2019). Mentalizzazione: dalla teoria alla pratica clinica. Edra. [Book in Italian].
Duschinsky, R., & Foster, S. (2021). Mentalizing and epistemic trust: the work of Peter Fonagy and colleagues at the Anna Freud Centre. Oxford University Press.
DOI: https://doi.org/10.1093/med-psych/9780198871187.001.0001
Duval, J., Ensink, K., Normandin, L., Sharp, C., & Fonagy, P. (2018). Measuring reflective functioning in adolescents: relations to personality disorders and psychological difficulties. Adolescent Psychiatry, 8(1), 5-20. doi: 10.2174/2210676608666180208161619.
DOI: https://doi.org/10.2174/2210676608666180208161619
Fischer-Kern, M., & Tmej, A. (2019). Mentalization and depression: theoretical concepts, treatment approaches and empirical studies - an overview. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 65(2), 162-177. doi: 10.13109/zptm.2019.65.2.162.
DOI: https://doi.org/10.13109/zptm.2019.65.2.162
Fonagy, P. (2015). Mutual regulation, mentalization, and therapeutic action: a reflection on the contributions of Ed Tronick to developmental and psychotherapeutic thinking. Psychoanalytic Inquiry, 35(4), 355-369. doi: 10.1080/07351690.2015.1022481.
DOI: https://doi.org/10.1080/07351690.2015.1022481
Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy, 51(3), 372-380. doi: 10.1037/a0036505.
DOI: https://doi.org/10.1037/a0036505
Fonagy, P., Campbell, C., & Bateman, A. (2017). Mentalizing, attachment, and epistemic trust in group therapy. International Journal of Group Psychotherapy, 67(2), 176-201.
DOI: https://doi.org/10.1080/00207284.2016.1263156
Fonagy, P., Luyten, P., Campbell, C., & Allison, L. (2014). Epistemic trust, psychopathology and the great psychotherapy debate. Society for the Advancement of Psychotherapy. Available from: http://www.societyforpsychotherapy.org/epistemic-trust-psychopathology-and-the-great-psychotherapy-debate.
Garnefski, N., Kraaij, V., & van Etten, M. (2005). Specificity of relations between adolescents’ cognitive emotion regulation strategies and internalizing and externalizing psychopathology. Journal of Adolescence, 28(5), 619-631. doi: 10.1016/j.adolescence.2004.12.009.
DOI: https://doi.org/10.1016/j.adolescence.2004.12.009
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54. doi: 10.1023/B:JOBA.0000007455.08539.94.
DOI: https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Hayden, M. C., Mullauer, P. K., Gaugeler, R., Senft, B. & Andreas, S. (2019). Mentalization as mediator between adult attachment and interpersonal distress. Psychopathology, 52(1), 10-17. doi: 10.1159/000496499.
DOI: https://doi.org/10.1159/000496499
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis third edition: a regression-based approach. Guilford Press.
Kamphuis, J. H., & Finn, S. E. (2019). Therapeutic assessment in personality disorders: toward the restoration of epistemic trust. Journal of Personality Assessment, 101(6), 662-674. doi: 10.1080/00223891.2018.1476360.
DOI: https://doi.org/10.1080/00223891.2018.1476360
Lengua, L. J. (2002). The contribution of emotionality and self-regulation to the understanding of children’s responses to multiple risks. Child Development, 73(1), 144-161. doi: 10.1111/1467-8624.00397.
DOI: https://doi.org/10.1111/1467-8624.00397
Li, E. T., Midgley, N., Luyten, P., Sprecher, E. A., & Campbell, C. (2022). Mapping the journey from epistemic mistrust in depressed adolescents receiving psychotherapy. Journal of Counseling Psychology, 69(5), 678-690. doi: 10.1037/cou0000625.
DOI: https://doi.org/10.1037/cou0000625
Liotti, M., Milesi, A., Spitoni, G. F., Tanzilli, A., Speranza, A. M., Parolin, L., Campbell, C., Fonagy, P., Lingiardi, V., & Giovanardi, G. (2023). Unpacking trust: the Italian validation of the epistemic trust, mistrust, and credulity questionnaire (ETMCQ). PLoS One, 18(1), e0280328. doi: 10.1371/journal.pone.0280328.
DOI: https://doi.org/10.1371/journal.pone.0280328
Liotti, M., Spitoni, G. F., Lingiardi, V., Marchetti, A., Speranza, A. M., Valle, A., Jurist, E., & Giovanardi, G. (2021). Mentalized affectivity in a nutshell: validation of the Italian version of the brief-mentalized affectivity scale (B-MAS). PLoS One, 16(12), e0260678. doi: 10.1371/journal.pone.0260678.
DOI: https://doi.org/10.1371/journal.pone.0260678
Locati, F., Benzi, I. M. A., Milesi, A., Campbell, C., Midgley, N., Fonagy, P., & Parolin, L. (2023). Associations of mentalization and epistemic trust with internalizing and externalizing problems in adolescence: a gender‐sensitive structural equation modeling approach. Journal of Adolescence, 95(8), 1564-1577. doi: 10.1002/jad.12226.
DOI: https://doi.org/10.1002/jad.12226
Locati, F., Milesi, A., Conte, F., Campbell, C., Fonagy, P., Ensink, K., & Parolin, L. (2022). Adolescence in lockdown: the protective role of mentalizing and epistemic trust. Journal of Clinical Psychology, 79(4), 969-984. doi: 10.1002/jclp.23453.
DOI: https://doi.org/10.1002/jclp.23453
Lougheed, J. P., & Hollenstein, T. (2012). A limited repertoire of emotion regulation strategies is associated with internalizing problems in adolescence. Social Development, 21(4), 704-721. doi: 10.1111/j.1467-9507.2012.00663.x.
DOI: https://doi.org/10.1111/j.1467-9507.2012.00663.x
Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the national comorbidity study adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980-989. doi: 10.1016/j.jaac.2010.05.017.
DOI: https://doi.org/10.1016/j.jaac.2010.05.017
Midgley, N., Ensink, K., Lindqvist, K., Malberg, N., Muller, N. (2019). Il trattamento basato sulla mentalizzazione per bambini: un approccio time-limited. Raffaello Cortina Editore. [Book in Italian].
Milesi, A., De Carli, P., Locati, F., Benzi, I., Campbell, C., Fonagy, P., & Parolin, L. (2023). How can I trust you? The role of facial trustworthiness in the development of epistemic and interpersonal trust. Human Development, 67(2), 57-68. doi.org/10.1159/000530248
DOI: https://doi.org/10.1159/000530248
Navarro, J., Vara, MD.,Cebolla, A., & Baños, R. (2018). Validación psicométrica del cuestionario de regulación emocional (ERQ-CA) en población adolescente española. Revista de Psicología Clínica con Niños y Adolescentes, 5(1), 9-15. doi: 10.21134/rpcna.2018.05.1.1. [Article in Spanish].
DOI: https://doi.org/10.21134/rpcna.2018.05.1.1
Neumann, A., van Lier, P. A. C., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment, 17(1), 138-149. doi: 10.1177/1073191109349579.
DOI: https://doi.org/10.1177/1073191109349579
Parada-Fernández, P., Herrero-Fernández, D., Oliva-Macías, M., & Rohwer, H. (2021). Analysis of the mediating effect of mentalization on the relationship between attachment styles and emotion dysregulation. Scandinavian Journal of Psychology, 62(3), 312-320. doi: 10.1111/sjop.12717.
DOI: https://doi.org/10.1111/sjop.12717
Parolin, L., Zucchelli, C., & Locati, F. (2023). Lo sviluppo della mentalizzazione in età evolutiva. La relazione tra attaccamento e fiducia epistemica. Psicologia Clinica dello Sviluppo, 1, 31-50. doi: 10.1449/106173. [Article in Italian].
Patterson, M. W., Mann, F. D., Grotzinger, A. D., Tackett, J. L., Tucker-Drob, E. M., & Harden, K. P. (2018). Genetic and environmental influences on internalizing psychopathology across age and pubertal development. Developmental Psychology, 54(10), 1928-1939. doi: 10.1037/dev0000578.
DOI: https://doi.org/10.1037/dev0000578
R Core Team. (2021). R: a language and environment for statistical computing. R Foundation
for Statistical Computing. Available from: https://www.R-project.org/.
Riedl, D., Rothmund, M. S., Grote, V., Fischer, M. J., Kampling, H., Kruse, J., Nolte, T., Labek, K., Lampe, A. (2023). Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study. Frontiers in Psychiatry, 12, 1150422. doi: 10.3389/fpsyt.2023.1150422.
DOI: https://doi.org/10.3389/fpsyt.2023.1150422
Rief, W., & Joormann, J. (2019). Revisiting the cognitive model of depression: the role of expectations. Clinical Psychology in Europe, 1(1), 1-19. doi: 10.32872/cpe.v1i1.32605.
DOI: https://doi.org/10.32872/cpe.v1i1.32605
Rosseel, Y. (2012). Lavaan: an r package for structural equation modeling. Journal of Statistical Software, 48(2), 1-36. doi: 10.18637/jss.v048.i02.
DOI: https://doi.org/10.18637/jss.v048.i02
Shapero, B. G., Abramson, L. Y., & Alloy, L. B. (2016). Emotional reactivity and internalizing symptoms: moderating role of emotion regulation. Cognitive Therapy and Research, 40(3), 328-340. doi: 10.1007/s10608-015-9722-4.
DOI: https://doi.org/10.1007/s10608-015-9722-4
Sharp, C., Williams, L. L., Ha, C., Baumgardner, J., Michonski, J., Seals, R., Patel, A. B., Bleiberg, E., & Fonagy, P. (2009). The development of a mentalization-based outcomes and research protocol for an adolescent inpatient unit. Bulletin of the Menninger Clinic, 73(4), 311-338. doi: 10.1521/bumc.2009.73.4.311.
DOI: https://doi.org/10.1521/bumc.2009.73.4.311
Sighinolfi, C., Pala, A. N., Chiri, L. R., Marchetti, I., & Sica, C. (2010). Difficulties in emotion regulation scale (ders): traduzione e adattamento italiano. Psicoterapia Cognitiva e Comportamentale, 16(2), 141-170.
Talia, A., Duschinsky, R., Mazzarella, D., Hauschild, S., & Taubner, S. (2021). Epistemic trust and the emergence of conduct problems: aggression in the service of communication. Frontiers in Psychiatry, 12, 710011. doi: 10.3389/fpsyt.2021.710011.
DOI: https://doi.org/10.3389/fpsyt.2021.710011
Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616-621.
DOI: https://doi.org/10.1037/a0016669
Wergeland, G. J. H., Riise, E. N., & Öst, L. G. (2021). Cognitive behavior therapy for internalizing disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis. Clinical Psychology Review, 83, 101918. doi: 10.1016/j.cpr.2020.101918.
DOI: https://doi.org/10.1016/j.cpr.2020.101918
Zahn-Waxler, C., Klimes-Dougan, B., & Slattery, M. J. (2000). Internalizing problems of childhood and adolescence: prospects, pitfalls, and progress in understanding the development of anxiety and depression. Development and Psychopathology, 12(3), 443-466.
DOI: https://doi.org/10.1017/S0954579400003102
How to Cite
Parolin, L., Milesi, A., Comelli, G., & Locati, F. (2023). The interplay of mentalization and epistemic trust: a protective mechanism against emotional dysregulation in adolescent internalizing symptoms. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3). https://doi.org/10.4081/ripppo.2023.707
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Gaia Albano, Rubinia Celeste Bonfanti, Salvatore Gullo, Laura Salerno, Gianluca Lo Coco, The psychological impact of COVID-19 on people suffering from dysfunctional eating behaviours: a linguistic analysis of the contents shared in an online community during the lockdown , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 24 No. 3 (2021)
- CV Vijayapriya, Rameshbabu Tamarana, Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 26 No. 3 (2023)
- Kelsey Armusewicz, Miriam Steele, Howard Steele, Anne Murphy, Assessing therapist and clinician competency in parent-infant psychotherapy: The REARING coding system (RCS) for the group attachment based intervention (GABI) , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 1 (2022)
- Danijela Maras, Louise Balfour, Monique Lefebvre, Giorgio A. Tasca, Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 3 (2022): SPECIAL ISSUE: "Group psychotherapy: between settled benchmarks and new horizons"
- Alexandro Fortunato, Annalisa Tanzilli, Vittorio Lingiardi, Anna Maria Speranza, Psychodiagnostic Chart-Child (PDC-C): a valid and clinically sensitive diagnostic tool for patient-tailored intervention planning , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 1 (2022)
- Gianluca Cruciani, Marianna Liotti, Vittorio Lingiardi, Motivations to become psychotherapists: beyond the concept of the wounded healer , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 27 No. 2 (2024)
- Bruno Faustino, António Branco Vasco, Giancarlo Dimaggio, Ana Nunes da Silva, Sophie Seromenho, Self-assessment of patterns of subjective experience: development and psychometric study of the States of Mind Questionnaire , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 23 No. 3 (2020)
- Helena Carvalho, Gil Nata, Paula Mena Matos, How secure is the secure base? Romantic attachment, emotion regulation, and psychotherapists’ role as secure base figures , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 27 No. 1 (2024)
- Paola Manfredi, Claudia Taglietti, A psychodynamic contribution to the understanding of anger - The importance of diagnosis before treatment , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 25 No. 2 (2022)
- Fabienne Gutjahr, Cord Benecke, Crying in psychotherapy: an exploratory mixed-methods study on forms of emotional crying and associated therapeutic interventions , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 27 No. 1 (2024)
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
