Reflective Functioning Questionnaire Research Articles

Childhood Trauma and Parental Burnout: The Mediating Role of Difficulties in Emotion Regulation and Reflective Functioning.

This study investigated the mediating role of difficulties in emotion regulation and reflective functioning in the association between childhood trauma and parental burnout. The participants included 402 mothers with children ranging in age from 1 to 6years. Mothers completed the Parental Burnout Assessment (PBA) the parental reflective functioning questionnaire (PRFQ), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire (CTQ). Data analysis was performed using SPSS 26, and Hayes Macro in SPSS was also used to analyze the effects of mediating variables. The results show that although childhood trauma and parental burnout do not have a direct and significant relationship, there is a significant indirect relationship through difficulties in emotional regulation and the two factors of parental reflective functioning, i.e., pre-mentalization, interest and curiosity about mental states. These findings contribute to the understanding of the importance of variables such as difficulties in emotion regulation and reflective functioning, which play a mediating role in the relationship between childhood trauma and parental burnout. This suggests that designing interventions and prevention to reduce parental burnout based on emotion regulation and reflective functioning may be beneficial.

Reflective functioning mediates the relationship between insecure adult attachment and the severity of prolonged grief symptoms.

This study aimed to investigate the mediation role of reflective functioning (i.e., certainty and uncertainty about mental states) in the relationship between insecure attachment (i.e., attachment avoidance and attachment anxiety ) and the severity of prolonged grief symptoms. A cross-sectional study was conducted with 329 bereaved participants (51.7% females, mean age= 46.94 ± 14.62 years). Participants completed the Prolonged Grief Scale (PG-13), the Attachment Style Questionnaire (ASQ), and the Reflective Functioning Questionnaire (RFQ). Demographic and bereavement-related information were also collected. Certainty about mental states fully mediated the relationship between both the attachment avoidance and attachement anxiety and severity of prolonged grief symptoms. The findings of this study indicate that reflective functioning impairment, specifically certainty about mental states of self and others, mediate the paths from insecure attachment to prolonged grief symptoms. This suggests that improving reflective functioning may contribute to the treatment bereaved individuals at risk of PGD.

Parenting Attitudes and Self-esteem: The Mediating Role of Reflective Function

<p>反思功能為近年來提出的一個關於個體之心智能力的概念，本研究欲探討教養態度與個體自尊之關聯，以及反思功能在其中所扮演的中介效果。研究方法採取問卷調查法，以臺灣成年初顯期個體為研究對象，總共蒐集495份有效樣本，以教養態度量表、反思功能問卷、Rosenberg自尊量表為研究工具。</p> <p>研究結果如下：（1）關懷的教養態度與自主支持的教養態度，對自尊與反思功能皆具有顯著的正向預測效果；而過度保護的教養態度與心理控制的教養態度，對自尊與反思功能皆具有顯著的負向預測效果。（2）反思功能對自尊具有顯著的正向預測效果。（3）反思功能在關懷的教養態度與自尊之間，具有中介預測效果，越高的關懷教養態度透過高反思功能的中介會具有更高程度的自尊。（4）反思功能在過度保護的教養態度與自尊之間，具有中介預測效果，越高的過度保護教養態度透過低反思功能的中介會具有較低程度的自尊。（5）反思功能在自主支持的教養態度與自尊之間，具有中介預測效果，越高的自主支持教養態度透過高反思功能的中介會具有更高程度的自尊。（6）反思功能在心理控制的教養態度與自尊之間，具有中介預測效果，越高的心理控制教養態度透過低反思功能的中介會具有較低程度的自尊。</p> <p>研究貢獻為提升臨床實務工作者或教育工作者關於個體反思功能的重視，並提供不同的觀點以檢視原生家庭的教養經由透過何種心理運作機制而影響到子女的未來發展。</p> <p> </p><p>Reflective function, a recently introduced concept in the field of individual mental abilities, is defined as the ability to understand the mental states behind one’s own or others’ behaviors, recognizing that these behaviors are expressions of one’s mental states, such as feelings, thoughts, fantasies, beliefs, and desires. Reflective functions allow individuals to understand their mental state and form the basis of self-construction. In academic research, reflective function is often considered an important mediating variable and is used to measure the effectiveness of psychotherapeutic interventions on case outcomes. As an individual’s reflective function is influenced by attachment, early traumatic experiences, parental reflective function, and parental parenting behaviors, primary caregivers play a crucial role in influencing a child’s reflective function. The parenting attitudes of a primary caregiver are apparent patterns of parent-child interaction. An individual’s reflective function impacts self-identity, mental health, and several other aspects. Self-esteem is an individual overall evaluation of self-worth, which can maintain their psychological well-being and may also be influenced by their reflective function. Based on the above, primary caregivers can affect an individual’s reflective function, mental ability development, and individual perception and evaluation of self-esteem. Several studies have confirmed the effect of parenting on self-esteem. However, whether the impact of parenting attitudes on individuals can extend to emerging adulthood, which is the period between 18 and 29 years of age, remains unclear. In addition, no studies have explored the mediating effect of reflective function on parenting attitudes and self-esteem in emerging adulthood. By clarifying the impact of parenting attitudes on individual reflective function and self-esteem, it will be possible to provide counseling or psychotherapy interventions, allowing them to use appropriate therapeutic techniques, such as mentalization-based therapy (MBT). Therefore, this will enable the opportunity to concomitantly improve individual self-esteem and alleviate the negative impact of vulnerable family factors on individuals. Based on the above research motives, the research objectives of this study are as follows:(1) To examine the relationship between parenting attitudes and reflective function in emerging adulthood. (2) To examine the relationship between reflective function and self-esteem in emerging adulthood. (3) To examine the relationship between parenting attitudes and self-esteem in emerging adulthood. (4) To examine the mediating effect of reflective function on parenting attitudes and self-esteem in emerging adulthood. This study employed a questionnaire survey method among emerging adults in Taiwan. A total of 495 valid samples were collected using the Parenting Attitudes Scale, Reflective Function Questionnaire, and Rosenberg Self-Esteem Scale as research tools. The research results are as follows:(1) Caring and autonomy-supportive parenting attitudes have significant positive predictive effects on selfesteem and reflective functions. Overprotective and psychologically controlling parenting attitudes have significant negative predictive effects on self-esteem and reflective function. (2) Reflective function has a significant positive predictive effect on self-esteem. (3) Reflective function has a mediating predictive effect between caring parenting attitudes and self-esteem. The higher the level of caring parenting attitudes, the higher the level of self-esteem that can be achieved through the mediation of a highly reflective function. (4) Reflective function has a mediating predictive effect on overprotective parenting attitudes and self-esteem. The higher the level of overprotective parenting attitudes, the lower the level of self-esteem that can be achieved through the mediation of a low reflective function. (5) Reflective function has a mediating predictive effect on autonomy-supportive parenting attitudes and selfesteem. The higher the level of autonomy-supportive parenting attitudes, the higher the level of selfesteem that can be achieved through the mediation of a high reflective function. (6) Reflective function has a mediating predictive effect between psychologically controlling parenting attitudes and self-esteem. The higher the level of psychologically controlling parenting attitude, the lower the level of self-esteem that can be achieved through the mediation of low reflective functioning. This study contributes to enhancing the attention of clinical practitioners or educators to individual reflective functions. Moreover, it provides different perspectives to examine the effect of parenting of the family of origin on the future development of children and the psychological mechanisms involved.</p> <p> </p>

Psychometric Properties of the Reflective Function Questionnaire for Youth Five-Item Version in Adolescents with Restrictive Eating Disorders

Mentalizing difficulties are an established correlate of eating disorders, but there is a need to establish the validity and reliability of easy-to-administer instruments to measure the construct in adolescents. This study evaluated the psychometric properties of a five-item version of the Reflective Function Questionnaire for Youth (RFQY-5) in a sample of adolescents with restrictive eating disorders recruited for a prospective observational study. Adolescents completed the 46-item version of the RFQ-Y at the start of treatment (T1) (n = 171) and nine months later (n = 51). The factor structure, internal reliability and convergent validity of the RFQY-5 were assessed at T1. Sensitivity to change was assessed in a subsample of n = 51 who completed the RFQ-Y nine months after the start of treatment (T2). At T1, the RFQY-5 demonstrated inadequate internal reliability (McDonald’s Omega = 0.657) and poor model fit for the unidimensional structure (Χ2(5) = 29.98; p < 0.001; CFI = 0.801; TLI = 0.602; RMSEA = 0.171; SRMR = 0.070). Convergent validity was partially supported. The RFQY-5 was not sensitive to change. The RFQY-5 was found to have inadequate psychometric properties in adolescents with restrictive eating disorders. Psychometric studies are needed to further develop valid and reliable measures of mentalizing for this population.

Trauma-related symptoms in adolescents: the differential roles of sexual abuse and mentalizing.

Major gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor. Participants were 273 adolescents aged 12-17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ). 27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor. CSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA.

A preliminary validation of PMQ-A four-factor questionnaire measuring parental mentalizing.

The present study describes the construction and preliminary validation of a new parental mentalizing scale, PMQ. Based on theory, we hypothesized that one higher-order parental mentalizing factor would comprise four dimensions of parental mentalizing: (1) Parental self-mentalizing (SELF), (2) Parental child-mentalizing (CHILD), (3) Effort (E), and (4) Curiosity (C). After modifying the content of one factor (Effort > Lack of Effort, LE), four-factor structure with one higher-order factor was confirmed in data collected from parents of children aged two to 6 years through social media and email lists (N = 321, 10% male). All factors loaded significantly on the higher-order factor, with acceptable internal consistencies. Next, PMQ factors were compared with the factors of a previously validated questionnaire, parental reflective functioning questionnaire (PRFQ). The PMQ and PRFQ factors were consistently and significantly correlated, indicating the validity of the PMQ as a measure of parental mentalization ability. The continuation of PMQ validation is discussed.

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.

The impact of family communication patterns on parent-child attachment and child quality of life

IntroductionPrevious research has demonstrated stable patterns of family communication. The Revised Family Communication Pattern Instrument (RFCP) is a common measure of these patterns. It posits two orientations: conformity orientation, characterized by a tendency to seek agreement within the family and by authoritarian decision-making; and conversation orientation, characterized by shared decision-making with the child and frequent family discussion.ObjectivesThe primary aim of our research was to adapt the RFCP questionnaire to the Hungarian language. Based on previous research, we hypothesized a negative relationship of conversation orientation and a positive relationship of conformity orientation with parents’ mentalizing problems, parental stress and burnout. According to our hypothesis, conformity orientation would predict both attachment anxiety and avoidance, whereas conversation orientation would decrease attachment anxiety.MethodsParents of children aged 6–17 (N=269, female=86,2%, mean age=42,64 [SD=6,10] yrs) completed the following online questionnaires: Child Quality of Life Questionnaire (ILK) parent version, Reflective Function Questionnaire (RFQ-8), Experiences of Close Relationships Questionnaire (ECR-RS), Parent Burnout Questionnaire (PBA-HUN), Perceived Stress Questionnaire (PSS) and the RFCP instrument. We conducted a confirmatory factor analysis. Linear regression analyses predicting attachment anxiety and avoidance included two factors of the RFCP, the RFQ-8, the PBA-HUN, and the PSS total score, as predictors. In addition, two factors of the ECR-R were included in the linear regression analyses predicting quality of life.ResultsThe confirmatory factor analysis confirmed the original two-factor structure of RFCP (χ2=5482.21, df=325 p&lt; .001, χ2/df=16.86, CFI=0.91, TLI=0.90, RMSEA=0.075 (90% CI 0.068–0.082)) and their internal reliability (Cronbach’s alpha = .78 and .74). Attachment avoidance (R2=0.12, F(5)=7.38, p&lt; .001) was only predicted by conversation orientation (β=−0.28, p&lt; .001), while attachment anxiety was predicted (R2=25.2, F(5)=17.7, p&lt; .001) by conformity orientation (β=0.24, p&lt; .001), parental mentalization difficulties (ß=0.20, p&lt; .001) and parenting stress (β=0.15, p= .015). Parental report of the child’s quality of life was predicted most strongly by attachment anxiety (β=−0.28, p&lt; .001), followed by conversation orientation (β=0.21, p&lt; .001) and attachment avoidance (β=−0.18, p&lt; .001, R2=28.8, F(7)=15.17, p&lt; .001).ConclusionsThe Hungarian version of the RFCP questionnaire has proven to be a reliable questionnaire. The importance of family communication patterns is demonstrated by the fact that it explains both the quality of parent-child attachment and the parent’s report on the child’s quality of life.Disclosure of InterestNone Declared

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