Learning to understand: latest contributions about Epistemic Trust and mentalization-related concepts
31 December 2023

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

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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.

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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Fonagy, P., Campbell, C., & Bateman, A. (2017). Mentalizing, attachment, and epistemic trust in group therapy. International Journal of Group Psychotherapy, 67(2), 176-201.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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].
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.
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.
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.
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.
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.
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.
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.
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.
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.
Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616-621.
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.
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.

How to Cite



The interplay of mentalization and epistemic trust: a protective mechanism against emotional dysregulation in adolescent internalizing symptoms. (2023). Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3). https://doi.org/10.4081/ripppo.2023.707