Reflective Functioning Questionnaire Research Articles

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.

Parental reflective functioning in mothers and fathers of preschoolers: Associations with adult attachment and parenting behavior.

Parental reflective functioning (PRF) is considered a key parental competence. Since most research on PRF has focused on infancy or the first years of life, there is a gap in our understanding of PRF among parents of older children. Therefore, we investigated PRF in mothers and fathers with preschool-aged children, examining associations between PRF, parent's romantic attachment, and observed parenting behavior. The sample comprised 50 mothers, 40 fathers, and their 5-year-old children. PRF was assessed using the parental reflective functioning questionnaire (PRFQ), parental romantic attachment was assessed using the experiences in close relationships scale-revised (ECR-R), and parenting behavior was assessed during a parent-child free-play interaction with the coding interactive behavior (CIB) coding system. Results showed that mothers scored higher on the interest and curiosity scale than fathers, indicating that mothers show a more active interest and curiosity in their child's mental states. Further, higher levels of attachment anxiety in fathers were associated with higher levels of pre-mentalizing modes. In mothers, higher levels of attachment avoidance were associated with lower levels of interest and curiosity. Finally, and unexpectedly, higher levels of interest and curiosity in mothers were associated with less sensitivity during free play. In summary, the study found meaningful associations between mothers' and fathers' romantic attachment and their PRF indicating a spill-over of their attachment strategies into their relationship with their child. Further, the study results suggest that very high levels of interest and curiosity in mothers reflect hypermentalizing.

A short version of the reflective functioning questionnaire: Validation in a greek sample.

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.

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

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

The interplay of mentalization and epistemic trust: a protective mechanism against emotional dysregulation in adolescent internalizing symptoms.

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.

The role of mentalizing in the relationship between schizotypal personality traits and state signs of psychosis risk captured by cognitive and perceptive basic symptoms.

Schizotypal traits and disturbances in mentalizing (the capacity to understand the mental states driving one's own and others' behaviors) have been implicated in increased vulnerability for psychosis. Therefore, we explored the associations linking schizotypal traits, mentalizing difficulties and their interactions to clinical high-risk for psychosis (CHR-P), as captured by the Basic Symptoms (BS) approach, during adolescence and young adulthood. Eighty-seven adolescents and young adults from the general population (46% male, 44% female; age: 14-23 years) were assessed with the Schizophrenia Proneness Interview (SPI-CY/A) for 11 perceptive and cognitive BS, with the Schizotypal Personality Questionnaire (SPQ) for schizotypal traits, and with the Reflective Functioning Questionnaire (RFQ) for self-reported mentalizing abilities. The RFQ evaluates the level of certainty (RFQc scale) and uncertainty (RFQu scale) with which individuals use mental state information to explain their own and others' behaviors. Logistic regression models showed significant positive effects of the SPQ disorganization scale on perceptive BS and of the SPQ interpersonal scale on cognitive BS. Post-hoc analyses revealed that schizotypal features pertaining to odd speech and social anxiety, respectively, were associated with perceptive and cognitive BS. Furthermore, higher scores on the RFQu scale and lower scores on the RFQc scale independently explained the presence of cognitive BS. Finally, significant interaction effects between RFQc and SPQ odd speech on perceptive BS, and between RFQc and SPQ social anxiety on cognitive BS were found. Our findings suggest that schizotypal traits and mentalizing significantly relate both independently and through their interactions to the presence of cognitive and perceptive BS included in CHR-P criteria. Furthermore, mentalizing dysfunction may contribute in the relation between schizotypal traits and early state signs of CHR-P. Mentalizing may support both detection and early treatment of CHR-P among adolescents and young adults who present with trait risk for psychosis.

Adolescent mentalizing and childhood emotional abuse: implications for depression, anxiety, and borderline personality disorder features.

There is preliminary evidence that childhood emotional abuse (CEA) is a risk factor for adolescent mentalizing difficulties (Uncertainty/Confusion about mental states) and borderline personality features and that Uncertainty/Confusion about mental states mediate the relationship between CEA and adolescent borderline personality features, but these findings need replication. Furthermore, no previous studies have examined the relationship between adolescent mentalizing deficits, anxiety, and depression in the context of CEA. This study examined the associations between CEA, adolescent borderline personality features, depression and anxiety symptoms and tested a pathway model where Uncertainty/Confusion about mental states mediates the relationships between CEA and adolescent borderline personality features, depression and anxiety symptoms. A clinical sample of 94 adolescents completed the Reflective Function Questionnaire for Youth (RFQY) to assess mentalizing, the Childhood Experiences of Care and Abuse Questionnaire (CECA-Q), the Borderline Personality Disorders Features Scale (BPFS-C), and the Beck Youth Inventories for Depression (BDI-Y) and Anxiety (BAI-Y). Uncertainty/Confusion about mental states partially mediated the relationship between CEA and borderline traits as well as anxiety. In addition, there was an indirect effect where CEA predicted Uncertainty/Confusion about mental states, which then predicted depression. The findings are consistent with the mentalizing model of psychopathology and provide new evidence that Uncertainty/Confusion about mental states might be a critical mentalizing deficit that characterizes the associations between CEA and adolescent BPD features and depression and anxiety symptoms. Uncertainty/Confusion may be a transdiagnostic risk factor for adolescent psychological distress and dysfunction. We discuss the clinical implications.

Lessons learned from the adaptation of the Reflective Functioning Questionnaire (RFQ) for Dutch people with mild to borderline intellectual disabilities.

People with mild to borderline intellectual disabilities (MBIDs) face challenges in social functioning, possibly as a result of limited mentalising abilities such as reflecting on the behaviour of themselves and others. Reflective functioning in people with MBIDs has not yet been investigated due to a lack of instruments. The Reflective Functioning Questionnaire (RFQ) is a seemingly easy adaptable, short self-report questionnaire. The aim of the present, explorative study was to adapt the RFQ for people with MBIDs and investigate the psychometric properties and correlations with other mentalising related constructs. The formulation of the items was adapted to the target group and items were added to broaden the scope towards reflection on both the self and other. Participants were 159 adults with MBIDs who completed a Dutch-translated and easy-to-read RFQ with five supplemental items, a questionnaire for autistic traits, a self-report questionnaire assessing perspective taking and two performance-based measures assessing emotion recognition and Theory of Mind. Confirmatory factor analysis confirmed the factor structure of the RFQ and revealed a two-factor structure with a Self and Other subscale. Generally satisfactory internal consistency and test-retest reliability were found. Explorative results showed correlations of the RFQ-8 and RFQ subscales with autistic traits and between the RFQ Other and perspective taking. This explorative study is the first testing psychometric properties of the RFQ as a self-report questionnaire for assessing reflective functioning in adults with MBIDs. This step is relevant in gaining more scientific knowledge on assessing mentalising in people with MBIDs.

Mentalization in young patients undergoing opioid agonist treatment: Implications for clinical management

BackgroundMentalization is the ability to use internal mental states to manage and understand one’s own and others’ behavior. Inefficient mentalization has been associated to poor neuropsychological outcomes, including substance use disorder (SUD) and addiction. However, studies primarily investigating mentalization in SUD are lacking. MethodsUsing the Reflective Functioning Questionnaire (RFQ), the Measurements in the Addictions for Triage and Evaluation, version 2.1 (MATE-IT-2.1), and the Mini International Neuropsychiatric Interview, 7th edition (MINI-7), an outpatient assessment investigated inefficient mentalization (i.e., ‘hypo-mentalization’ or ‘uncertainty’: concrete thinking with poor attribution of mental states; ‘hyper-mentalization’ or ‘certainty’: rigid and biased attribution of mental states) and socio-demographic and clinical characteristics, including SUD-related symptoms and any other psychiatric comorbidity, among opioid addiction (OA) patients in Opioid Agonist Treatment (OAT). ResultsThirty-seven consecutive OA patients in OAT (female, 45.9 %; age, M ± SD, 24.3 ± 3.55) were recruited. Patients’ mentalization differed from normative data, in terms of higher uncertainty and lower certainty scores. Also, higher uncertainty score was found among younger patients and in those with the most severe SUD in terms of craving and need for care. Finally, lower certainty score was found in those with a more severe substance abuse, previous contacts with pediatric mental-health services, and receiving a therapeutic community support. ConclusionsOA patients with inefficient mentalization present with a higher burden in terms of SUD severity, comorbidities, psychosocial disabilities, and service use, with important public health implications. Interventions targeting mentalization may have positive repercussions in preventing SUD, mitigating its severity, and containing its healthcare and social costs.

Coping and Managing ALS Disease in the Family during COVID-19: Caregivers' Perspective

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons, the nerve cells in the brain and the spinal cord that enable voluntary muscle movement. Managing ALS is complex and increasingly requires informal care, most often by the patient's companions/spouses or children. The COVID-19 pandemic posed additional critical issues, particularly the disruption of home care and the increased time caregivers spent on patient care. One aim of this research was to assess caregivers’ health conditions and to understand how the lockdown has affected their lives and the management of their relatives’ illnesses. Another was to observe whether a psychological support intervention for caregivers’ minor children could indirectly impact caregivers. The study involved Italian participants: 26 caregivers (31% males and 69% females) aged between 20 and 69 years (M = 43.85 years, SD = 10.17). The following variables were measured at t0 and t1: reflective functioning with the Reflective Functioning Questionnaire (RFQ), depression with the Beck Depression Inventory-I (BDI-I), hopelessness with the Beck Hopelessness Scale (BHS) and burden of care with Family Strain Questionnaire (FSQ). At t1 only 18 participants also participated in a semi-structured interview to explore the impact of the COVID-19 pandemic, specifically on caregivers of the psychological support participants' children received. The results at t0 showed that caregivers exhibit significant distress symptoms, high stress levels and burden of care. At t1 it was found that the pandemic hurt caregivers' emotions; however, they do not show a worsening but a decrease in hopelessness. The interviews showed that the intervention on their children had a positive effect by allowing containment of the negative effects on well-being. This suggests that it is essential that ALS management also includes a whole-family intervention.

Mentalizing ability, mentalizing impairments and anorexia nervosa: Validation of the Hebrew version of the MASC.

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

Evaluation of the Danish version of the prenatal parental reflective functioning questionnaire in early pregnancy as a screening tool.

Parental reflective functioning (PRF) is the capacity to focus on feelings and experiences in oneself as a parent and in the child. Research has demonstrated that, the better the PRF the better outcomes for the child. This paper evaluated the Danish version of the prenatal parental reflective functioning questionnaire (P-PRFQ). We used data from a cluster-randomized trial of pregnant women recruited from Danish general practice. The sample included 605 mothers. Factor structure and internal consistency were investigated. Linear regression analysis was used to examine the associations between the P-PRFQ score and the five most predictive variables. The confirmatory factor analyses supported the three-factor model. The P-PRFQ had moderate internal consistency. The regression analysis showed a decrease in the P-PRFQ score with increasing age, increasing parity, current employment, better self-reported health, lower anxiety score, and fewer negative life events with persistent impact. The directions of the associations between P-PRFQ score and the predictive variables were opposite of what was hypothesized raising questions about whether the P-PRFQ can be used as an early pregnancy screening tool assessing prenatal PRF. Further validation studies are required to assess the extent to which the P-PRFQ truly measures reflective functioning.

Does mentalizing moderate the relationship between psychopathology and quality of life?

IntroductionMost previous research focused on the association between mentalizing and specific mental disorders, while less is known about the relationship between mentalizing and quality of life among adolescents.ObjectivesThis study aimed to validate The Reflective Function Questionnaire for Youth in the Hungarian language and evaluate the moderating influence of mentalizing on the relationship between psychopathology and quality of life.MethodsA community sample of 384 youths of 12–18 years (72.7% females) completed the following questionnaires: The Reflective Function Questionnaire for Youth (RFQY), The Measure of Quality of Life for Children and Adolescents and The Strengths and Difficulties Questionnaire. First, we tested the different factor structures of the RFQY: the two-factor, the eight-item, and the five-item versions. We conducted a series of moderation analyses with quality of life as the dependent variable, higher-order symptom categories (internalizing or externalizing symptoms separately) as the independent variable, and mentalization as the moderator.ResultsThe confirmatory factor analysis supported the five-item version of the RFQY (Cronbach’s alpha .61) and resulted in a new, 10-item version of The Reflective Function Questionnaire for Youth on the Hungarian sample (Cronbach’s alpha .76). Mentalization had a moderator effect on the relationship between internalizing and externalizing symptoms and quality of life.ConclusionsOur study provides the first psychometric support for the Hungarian version of the RFQY and underlines the importance of assessing the complex relationships between mentalization, quality of life and symptomatology. Targeting mentalization to improve the quality of life among adolescents might be a key factor.Disclosure of InterestNone Declared

Adolescents’ quality of life in the light of mentalization and emotion regulation

Introduction According to research there is a negative association between emotion regulation, mentalization difficulties and quality of life among adolescents, but former research did not examine the relationship between these 3 constructs in a Hungarian adolescent sample.ObjectivesThe aim of our study was to examine the relationship between mentalization and emotion regulation with quality of life among 14- to 18-year-old adolescents.MethodsIn our non-clinical, cross-sectional study 122 adolescents with informed consent answered a list of demographic questions, then completed the Reflective Function Questionnaire (RFQ-H), the Emotion Regulation Difficulties Questionnaire (DERS) and the Quality of Life Scale (ILK). In our mediator model we chose RFQ-H as the independent, DERS as the mediator and ILK as the dependent variable.ResultsThe first model was significant (F(1,120) = 28,79 p < 0,001, R2= 0,19), there was a significant relationship between mentalization disfunction and emotional regulation difficulties (a=0,39, p<0,01, β=0,44). The second model was significant as well (F(2,119= 30,48 p < 0,001, R2= 0,34), though the direct effect between mentalization difficulties and low quality of life was not significant (c’=0,02, p=0,73, β=0,03), the direct effect between emotion regulation difficulties and low quality of life was significant (b=0,58, p<0,01, β=0,57). The indirect effect between mentalization disfunction and low quality of life mediated by emotional regulation difficulties was also significant ab = 0,22 [0,13 – 0,33], β =0,25 [0,14 – 0,36]).Conclusions Our results - taking the limitations into account - imply that emotional regulation mediates the relationship between mentalization and quality of life among the present-day, non-clinical, Hungarian adolescent sample, which could have practical implications.Disclosure of InterestNone Declared

Maternal Impaired Cognition and Infant Neglect: Exploring the Independent and Combined Effects of Maternal Executive Function and Reflective Function.

Infant neglect is a common type of child maltreatment. According to the Social Information Processing theory, maternal executive function (EF) and reflective function (RF) are assumed to be important contributing factors to infant neglect. However, empirical evidence about this assumption is sparse. This was a cross-sectional study. A total of 1010 eligible women participated. The Behavior Rating Inventory of Executive Function-Adult Version, Parental Reflective Function Questionnaire, and Signs of Neglect in Infants Assessment Scale (SIGN) were used to assess maternal EF, RF, and infant neglect, respectively. Random forest was used to assess the relevant importance of maternal EF and RF. K-means clustering was used to identify the profiles of maternal EF and RF. Multivariable linear regression and generalized additive models were used to examine the independent and combined effects of maternal EF and RF on infant neglect. Each dimension of EF was linearly related to infant neglect. The associations between each dimension of RF and infant neglect were nonlinear. The inflection point for each dimension of RF was indicated. Random forest showed EF was more closely related to infant neglect. EF and RF had accumulative effects on infant neglect. Three profiles were identified. Among them, those with globally impaired EF had the highest level of infant neglect compared with those who had normal cognition or only impaired RF. Maternal EF and RF had independent and combined effects on infant neglect. Interventions with maternal EF and RF as targets are promising for reducing infant neglect.

DIFFERENTIATION OF SELF AS A PREDICTOR OF CAPACITY FOR MENTALIZATION

The purpose of this research was to explore if the differentiation of self has a role in predicting capacity for mentalization in female samples. The data was collected using The Reflective Functioning Questionnaire (RFQ) and The Differentiation of Self Inventory (DSI) on a sample of 105 female participants, aged 18-50 years (M = 30.61, SD = 8.09). Both models containing self-differentiation as predictors were significant. The first model that predicted certainty about mental states explains 32.1% of the variance (R² = .32, F(6,98) = 7.732, p = .000), with I position (β = .459, p = .000) and emotional cutoff (β = -.245, p = .024) as significant predictors. The second model that predicted uncertainty about mental states explains 40.4% of the variance (R² = .40, F(6,98) = 11.086, p = .000), with age (β = .233, p = .007), education (β = -.208, p = .024), and emotional reactivity (β = .323, p = .005) as significant predictors. The obtained results indicate that different aspects of the differentiation of self can predict certainty and uncertainty about mental states in the female sample, but also that when it comes to phenomenon such as capacity for mentalization, certain sociodemographic variables (e.g., age, education) might play more important role then it was previously thought. Further research on this matter, with a bigger and more diverse sample, is strongly advised. Keywords: mentalization, self-differentiation, emotional reactivity, emotional cutoff

The parental reflective functioning questionnaire: Infant version in fathers of infants and association with paternal postpartum mental health.

The parents' capacity to reflect upon the psychological processes in their child, termed parental reflective functioning (PRF) can be impaired by parental mental health problems. The present study aimed to investigate the factor structure of an infant version of the Parental Reflective Functioning Questionnaire (PRFQ-I) in a low-risk sample of 259 Danish fathers of 1-11-month-old infants to investigate measurement invariance of the PRFQ-I between fathers and mothers; and to examine the association between PRF and paternal depressive symptoms, psychological distress, and parenting stress. Confirmatory factor analysis supported a three-factor model of the PRFQ-I. Multi-group factor analysis indicated partial measurement invariance. Multiple linear regressions showed that paternal depressive symptoms were not associated with PRF. There was an interaction effect of paternal depressive symptoms and general psychological distress on paternal interest and curiosity in their infant's mental state and certainty of infant mental state. Increased parenting stress was associated with impaired PRF on all three subscales of the PRFQ-I. These results provide further evidence for a multidimensional, brief assessment of paternal reflective skills and insight into how variability in paternal psychological functioning relates to impaired PRF in the postpartum period.

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

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

Psychometric Properties of the Reflective Function Questionnaire in Iranian Prisoners.

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

Association of Attachment and Reflective Function with Baseline Symptoms in Child and Adolescent Psychodynamic Psychotherapy

ABSTRACT The present study aimed to verify the associations between symptoms reported at baseline, attachment style and reflective function (RF) in children and adolescents. For this, we conducted a cross-sectional and naturalistic study, including 90 children and adolescents aged between 9 and 17 years old (M = 13.04, SD = 2.72). Instruments were a demographic form, the Child Behavior Checklist, the Friends and Family Interview and the Reflective Function Questionnaire for Youths. From our findings, internalizing symptoms were reported in 74.4% of the cases, and externalizing symptoms in 55.6%. Concerning the attachment styles, 46.7% of the cases were classified as insecure-dismissing, 38.9% as insecure-preoccupied, 10% as secure and 4.4% as disorganized. Participants’ scores for RF were low. We found associations between attachment styles and anxiety, depression and withdrawal symptoms. We found significant differences between the insecure-dismissing style and the insecure-preoccupied and disorganized styles groups regarding anxiety and depression symptoms. The secure attachment style group showed significant differences in withdrawal symptoms when compared to insecure attachment style groups. Further studies exploring associations between attachment styles, RF and psychopathology in childhood and adolescence, could contribute to the evaluation and planning of psychotherapies processes with this population.