Spontaneous mentalizing refers to the capacity to attribute mental states to oneself and others without explicit prompts or conscious deliberation. This process enables individuals to comprehend and anticipate social behaviors in a more intuitive manner. Individuals diagnosed with schizophrenia frequently demonstrate deficits in this domain, which contribute to impaired social functioning. The present meta-analysis aims to assess the extent of spontaneous mentalizing impairments in schizophrenia.

A comprehensive search was conducted in four prominent databases: MEDLINE, EMBASE, CENTRAL, and Web of Science. Following the review of the retrieved records and subsequent citation searching, a total of 15 studies were selected for inclusion in the quantitative synthesis. The data of 526 patients diagnosed with schizophrenia and 536 controls were subjected to analysis. Effect sizes for intentionality and appropriateness were computed utilizing weighted or standardized mean differences, and heterogeneity was evaluated.

Patients with schizophrenia exhibited substantial impairments in intentionality and appropriateness during mentalizing tasks, with large effect sizes. No significant differences were observed in random movement tasks, although patients also demonstrated deficits in interpreting goal-directed movements. Furthermore, high heterogeneity in some outcomes and variability in study methodologies were also noted.

This analysis corroborates substantial spontaneous mentalizing deficits in schizophrenia, underscoring their potential role in impaired social functioning. In conjunction with previous analyses, the present findings emphasize the pervasive nature of mentalizing deficits in schizophrenia, encompassing explicit, implicit, and spontaneous dimensions. These results hold significant implications for therapeutic strategies designed to augment social cognition in individuals with schizophrenia.

Deficits in Executive Function (EF) and Theory of Mind (ToM) are common and significant in attention deficit hyperactivity disorder (ADHD), impacting self-regulation and social interaction. The nature of ToM deficits is believed to be partially associated with preexisting deficits in other core cognitive domains of ADHD, such as EF, which are essential for making mental inferences, especially complex ones. Evaluating these associations at a meta-analytic level is relevant.

To conduct a systematic literature review followed by a meta-analysis to identify potential associations between EF and ToM among individuals with ADHD and their healthy counterparts, considering different developmental stages.

A systematic review was conducted in seven different databases. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. The meta-analytic measurement was estimated with the correlation coefficient as the outcome. Due to the presence of heterogeneity, a random-effects model was adopted. Independent meta-analyses were conducted for different EF subdomains and ADHD and healthy control groups. Subgroup analyses were performed to examine the influence of age on the outcome of interest.

Fifteen studies were analyzed. Moderate associations were found when comparing EF and ToM between individuals with ADHD (0.20–0.38) and healthy subjects (0.02–0.40). No significant differences were found between child and adult samples (p > 0.20).

The association between EF and ToM was significant, with a moderate effect size, although no significant differences were found according to age, the presence of ADHD, or EF subdomains. Future research is suggested to expand the age groups and overcome the methodological limitations indicated in this review.

The uncertainty of COVID-pandemia, vital danger and disruptions in the habitual social contacts can be paralleled to the experiences of severe emotional stress and violence, usually found in the people with Borderline Personality Disorder. Both can be regarded as hampering the ability to categorize and express thoughts, feelings and experiences. The implementation of distant forms of psychological counseling may accentuate the mentalization deficiency.

To develop a theoretical framework for an empirical typology of impairments of mentalization.

The model of consciousness proposed by L.S. Vygotsky was used for theoretical generalization of the levels of categorical structures of mentalization observed in previous empirical studies.

The following structures were identified: (1) the syncretic type of mentalization with low differentiation and complexity of object representations, their negative affective tone, autistic, chaotically mutable motivation and low emotional investment in relationships were described in patients with schizotypal disorders; (2) the “complex” type, with literal, non-generalized, field-dependent and rigid, or unstable, representation of the self, others and relationships as a result of the “fusion” of cognitive representations with the current emotional states. Similar types of mentalization were previously described in people with BPD and self-harming behavior (Sokolova, Laisheva, 2017).

The ’syncretic’ and ’complex’ types of mentalization produce affective-cognitive distortions of the image of a psychotherapist, hamper the understanding of the conditional and metaphorical character of the therapeutic process, render difficult the de-traumatization of the unbearable experiences, and lessen the effectiveness of consultations of people with BPD.

No significant relationships.

Previous studies indicated, that mentalization mediates the link between adult attachment and stress, however, this relationship was not tested before among non-clinical parents of children aged between 12 and 18 years.

The aim of this study was to explore the relationship between parental reflective functioning, attachment style, perceived parental sense of competence, and stress among parents.

After providing written consent, 186 non-clinical mothers completed a questionnaire packet that included a demographic form, The Parental Reflective Functioning Questionnaire - Adolescent version, the Attachment Style Questionnaire, the Parental Sense of Competence Scale, and the Perceived Stress Scale. A moderated mediation analysis with parental sense of competence as a dependent variable, mother’s attachment style as an independent variable, certainty about mental states hypermentalization subscale as a mediator, and stress as a moderator was conducted.

In the moderated mediation analysis, the direct effect of the attachment style on the parental sense of competence in the case of preoccupied attachment style was significant (p < .001). The interaction term of the hypermentalization subscale by perceived stress was also significant in the case of low level (w = -1.57, p < .001) and high level of perceived stress (w= 1.21, p = .049) among mothers with a preoccupied attachment style.

These findings suggest that the preoccupied attachment style is related to the parental sense of competence through certainty about mental states hypermentalization in case of low level and high level of perceived stress, so mentalization-based interventions are warranted.

No significant relationships.

Trauma, stress, and attachment problems are negatively related to the development of mentalization. Children raised in institutional care are more exposed to these difficulties, therefore the development of population-specific interventions that aim to improve mentalization skills would be highly desirable.

Our goal is to develop mentalization-based intervention programs for specific age groups (9-13 years, 14-18 years, and adult staff members of institutional care centers) - that support children’s and adolescents’ social functioning and conflict resolution skills.

The mentalization-based intervention targeting institutional care staff was launched first. Due to the pandemic, this intervention was executed online with two intervention (N = 17) and two passive control (N = 15) groups. Before and after the intervention, participants completed a demographic questionnaire, the Parenting Sense of Competence Scale, the Reflective Functioning Questionnaire, the Mini Oldenburg Burnout Inventory, The Strengths, and Difficulties Questionnaire, and the Ways of Coping Questionnaire.

The intervention protocol and our results will be shown at the conference. There was no significant difference between the two intervention and two passive control groups in the demographic features. Mentalization uncertainty and burnout was positively related(rs(23) = .42, p = .034), while mentalization uncertainty and parental competence was negatively associated (rs(23) = - .41, p = .041).

The intervention program will be fine-tuned and optimized based on the results of the pilot study. In the next interventions, we plan to focus on the issues that the staff perceived as most difficult and to conduct interventions among the children.

No significant relationships.

Parental reflective function is the ability of a parent to attribute mental states to their child and to themselves. The Parental Reflective Functioning Questionnaire is widely used for the measurement of this construct, the adolescent version of which can be used by parents of children aged 12-18.

The aim of our research was to adapt the adolescent version of The Parental Reflective Functioning Questionnaire to the Hungarian language.

In our study 240 mothers completed the adolescent version of The Parental Reflective Functioning Questionnaire (PRFQ-A), and the Reflective Function Questionnaire (RFQ).

Confirmatory factor analysis did not confirm the original three-factor structure. The principal component analysis resulted in a two-factor structure. Factors corresponded to the original questionnaire’s certainty in mental states (Alpha = .81) and interest and curiosity subscales (Alpha = .70). When analyzing the relationship between parental reflective function and reflective function, the subscales of the parental reflective function questionnaire were examined with two types of median coding in addition to polar coding. During the first median coding, the frequency of scores in the middle of the scales reflected optimal mentalization, while the frequency of extreme values on the scales corresponded to less favorable reflective functioning. With the second median coding, hypermentalization and hypomentalization subscales were also created. The second median transcoding proved to be the most suitable for capturing the relationship between RFQ and PRFQ-A.

The questionnaire proved to be a reliable measure on the Hungarian sample and we recommend using the additional subscales.

No significant relationships.

Suicide-loss survivors (SLSs) are recognized as an at-risk population for several psychiatric complications, including complicated grief (CG) and suicide ideation (SI). However, limited data are available concerning the contribution of CG to SI among suicide survivors. Moreover, knowledge about possible psychological processes which may increase SI levels following CG is rare.

In this study, we aim to examine the role of two important emotion regulation variables––mentalization deficits and entrapment––as possible moderators of the association between CG and SI in the aftermath of suicide loss.

Participants were 152 suicide-loss survivors, aged 18-70, who completed questionnaires tapping CG, SI, mentalization deficits, and entrapment.

The findings revealed SI to have high and positive associations with CG, entrapment, and metallization deficits. Regression analysis showed mentalization deficits and entrapment contributing to SI beyond the contribution of CG. Notably, a significant interaction was found, indicating that CG and SI became more strongly associated at higher levels of mentalization deficits.

The study’s findings highlight the critical link between complicated grief and suicide ideation among SLSs and the role of metallization deficits as a possible facilitator of this link. Practical implications relating to suicide risk among SLSs are discussed, as well as focused clinical recommendations. The importance of mentalization-based interventions for decreasing SI levels in the aftermath of suicide loss is highlighted.

No significant relationships.

Interpersonally coordinated behaviors are crucial for social interactions.The “Theory of Mind,” or mentalization capacity, of an individual is essential for the establishment of behavioral synchronization. The Reading the Mind in the Eyes Test (RMET) is used to assess mentalization, social cognition and empathy. Previous RMET studies, investigated people in isolation, not in social situations. It is unclear how the RMET predicts functioning during real-life social interactions.

To investigate the relationship between the performance measured on the RMET test and the synchronous behavior of two individuals interacting with each other during tasks requiring social collaboration.

Sample included healthy controls (HC,n=48) and patients with ADHD (n=26) or schizophrenia (SCH,n=36) from an ongoing EEG-hyperscanning study, employing a social coordination condition.We applied a Go/NoGo reaction time(RT) task performed by pairs of participants. Synchronous behavior was characterized by the correlation of participants’ RTs.We used the percent (%) correct responses from the RMET to characterize social cognition.

In HC, with better social cognitive performance, the correlation of behavioral responses was significantly (p<0.05) higher. In ADHD, better performance on the RMET was also accompanied by better behavioral synchronization, but the association did not reach significance due to the smaller sample size. In SCH, no relationship was detected.

In HC and ADHD, the mentalization ability as measured by RMET is associated with the behavioral synchronization between individuals in social interaction.The lack of association in the schizophrenia group may be due to psychopathological symptoms, which should be elucidated in future research. Funding: Supported by the Hungarian Brain Research program#2017-1.2.1-NKP-2017-0002

No significant relationships.

In contemporary context the difficulties of making sense of social ambiguity becomes one of the most important appeals for seeking the psychological help. This grounds the importance of studying the mechanism underlying the quality of mentalization and its individual variations.

The objective of the study was to find empirical relations between the quality of mentalization and its cognitive, emotional and expressive mediating factors.

(1) The Adult Attachment Interview, scored using Social Cognition and Object Relations-Global rating method for mentalization ability. (2) Group embedded figures test. (3) New Tolerance-Intolerance to ambiguity and (4) Toronto alexithymia scale questionnaires. Twenty participants, aged 18-38, looking for psychological consultation, took part in the study.

Correlation analysis suggests positive relation between field-independency and tolerance to ambiguity (r = .47; p < .05). The complexity of representations of the mind positively correlates with the understanding of social causality (r = .92; p < .01). The affective quality of relationships’ representations positively correlates with the ability to emotionally invest into relationships (r = .66; p < .01), and with the understanding of social causality (r = .47; p < .05). The ability of emotional investment into relationships also positively correlates with the understanding of social causality (r = .93; p < .01). There is a negative link between the severity of alexithymia and the presence of long-term relationships with a partner (r = -.53; p < .05).

Mentalization should be understood as a system, with underplaying cognitive, expressive and emotional factors.

No significant relationships.

It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients.

The current systematic review aimed to conduct separate meta-analyses of ‘mentalization’ [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls.

A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17–2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24–0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32–0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41–0.79) and faux pas recognition (d = 0.62, CI = 0.35–0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis.

BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.

The COVID-pandemic context is characterized by a global ambiguity, reflecting the unexpected onset of pandemic, unpredictability and amplitude of the related dangers, questionability and the side effects of the policy measures used to protect people.

The development of theoretical framework for understanding variability in the reactions to COVID situation and self-regulatory mechanisms.

Conceptualization and analysis of individual psychotherapy cases in the framework of psychodynamic approach.

Five typical patterns of anxiety, defensive functioning and mentalization structures were identified: Paranoial pattern is marked by flooding with persecutory anxiety, exaggerated subjective uncertainty. reflected in chaotic boundlessness, incoherence, fantasies of hostility, splitting and polarization of self and others. Depressive pattern reflects inability to sustain ambiguity due to deficiency of internal supports, overly dependence on others, conformity, obedience to authority and denial of personal standards and individuality. Noogenic pattern refers to negative affective states, generated by the ambiguity, contradictions and ambivalence of information. The means to regulate it include the lowering of the level of psychical functioning, with cognitive simplification, preference for order, routine and predictability. Transgression pattern suggests maniacal fascination with the dissipation of limits, normative restraints and rules, and the triumph of the narcissistic-perfectionist permissiveness. Constructivity pattern consists of the pleasure from explorations and insights, creation of new meanings, creative reappraisal and reconstruction of ambiguous situations.

The typical patterns of experiencing ambiguity that were singled out may have diagnostic and prognostic significance in evaluating the individual resource potential in situations of COVID related dangers and isolation.

The uncertainty of contemporary social contexts fosters suspiciousness and anaclitic anxieties. In the context of interpersonal relationships this manifests in cognitive distortions and magical thinking, specially in the vulnerable populations.

To study the ability of understanding social causality and its relation to magical thinking and ambiguity intolerance in schizophrenia and controls.

Participants were 40 inpatients with paranoid schizophrenia and 40 controls. Understanding of social causality was measured by corresponding SCORS-S scale for Thematic Apperception Test, Magical thinking was measured by SPQ-74 and intolerance to ambiguity by the New Tolerance-Intolerance to ambiguity questionnaires.

The understanding of social causality was less developed in schizophrenia group (mean values 2.28 and 3.28, p<.001). They manifest omissions of psychological aspects, logical faults and inconsistencies in depicting social relationships. Magical thinking was higher in clinical group (4.32 and 2.33, p<0.001). Two measures were significantly (p<0.05) correlated in both groups. Regression analysis indicates that 37.7% of variance of dependent variable ‘understanding of social causality’ (R2=0,377) was predicted by ‘magical thinking’ (-0,398, p<0,001) and ‘tolerance to ambiguity’ (0,412, p<0,001). The overal level of tolerance of ambiguity was higher in control group (52.2 and 61.0, p<0.002).

Tolerance of ambiguity, being more characteristic for normal population, underlies the understanding of social causality. In contrast, the intolerance to interpersonal ambiguity is related to increment of anxiety, failures in cognitive elaboration of interpersonal relationships and leads to superstition and illogical beliefs. This relationship has a heuristic value for understanding what is happening to vulnerable individuals in the context of current COVID pandemic.

Anorexia Nervosa (AN) and Avoidant/Restrictive Food Intake Disorder (ARFID) are two primary restrictive eating disorders described in DSM-5, characterized both of them by insufficient food intake. This behavior In ARFID is not driven by weight and shape concerns that tipify AN. While there are several studies that highlight the presence of mentalizing difficulties in AN, there are still no data about mentalizing profile in ARFID.

The aim of this study was to better characterize the mentalizing profile of AN and ARFID children and adolescent.

Two groups of AN or ARFID outpatients (15+15), aged 6 to 18 years, were assessed by Alexythimia Questionnaire for Children (AQC) and Toronto Alexythimia Scale-20 (TAS-20) to evaluate alexythimia; by Interpersonal Reactivity Index (IRI) and Basic Empathy Scale (BES) to assess empathy; by NEPSY-II social perception subtests to evaluate Theory of Mind and Emotion recognition. Exclusion criteria were the presence of intellectual disability, pervasive developmental disorders and binge eating behavior (eating disorder other than AN or ARFID).

Preliminary results showed different mentalizing profiles between ARFID and AN patients, with differences in the score for affective empathy, lower in ARFID than in AN patients while the score for alexythimia traits resulted higher in AN population.

By our results, mentalization impairment appeared trans-diagnostic across several eating disorders. This first result should be further improved to better analyze this construct in order to develop effective clinical intervention to improve the subject’s affective regulation.

No significant relationships.

The formation of thinking in ontogenesis follows the line of progressive differentiation and integration of the representations of objects, events, and relationships. The same is true for the development of mentalization ability, conceived as a thought process in the area of social interactions.

The purpose of the study was to compare the particularities of thought processes when dealing with different types of material: physical objects (operational thinking) and social situations (mentalization).

40 inpatients with schizotypal personality disorder, 40 inpatients with paranoid schizophrenia and 40 controls took part in the study. The Objects Sorting Test was used to assess operational thinking. The mentalization ability was assessed using two SCOR-S scales for Thematic Apperception Test: Complexity of representations of people and Understanding of social causality.

The results of correlation analysis support the existence of the reverse links between the impairments of operational thinking and both the complexity of representations of people (r=-.36, р<.001) and the understanding of social causality (r=-.38, р<.001). It is supported by the qualitative analysis, where inpatients with thought distortions, characterized by arbitrary generalizations, are inclined to make similar errors in the reasoning about the mental states, ignoring the conventional explanations and relying on their own emotional impression and etc.

The limitations of the operational thinking as reflected in the inability to form adequate generalizations on the basis of socially predefined attributes of meaning are closely related to the ability of differentiation, integration and causal explanation of meaningful aspects or social situations.