Mentalizing and epistemic trust as critical success factors in psychosomatic rehabilitation: results of a single center longitudinal observational study

Abstract

BackgroundInpatient psychosomatic rehabilitation is a key treatment for patients with mental health issues. However, knowledge about critical success factors for beneficial treatment outcomes is scarce. The aim of this study was to evaluate the association of mentalizing and epistemic trust with the improvement of psychological distress during rehabilitation.MethodsIn this naturalistic longitudinal observational study, patients completed routine assessments of psychological distress (BSI), health-related quality of life (HRQOL; WHODAS), mentalizing (MZQ), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Repeated measures ANOVA (rANOVAs) and structural equation models (SEMs) were calculated to investigate the association of mentalizing and epistemic trust with the improvement in psychological distress.ResultsA total sample of n = 249 patients were included in the study. Improvement in mentalizing was correlated with improvement in depression (r = 0.36), anxiety (r = 0.46), and somatization (r = 0.23), as well as improved cognition (r = 0.36), social functioning (r = 0.33), and social participation (r = 0.48; all p < 0.001). Mentalizing partially mediated changes in psychological distress between T1 and T2: the direct association decreased from β = 0.69 to β = 0.57 and the explained variance increased from 47 to 61%. Decreases in epistemic mistrust (β = 0.42, 0.18–0.28; p < 0.001) and epistemic credulity (β = 0.19, 0.29–0.38; p < 0.001) and increases in epistemic trust (β = 0.42, 0.18–0.28; p < 0.001) significantly predicted improved mentalizing. A good model fit was found (χ2 = 3.248, p = 0.66; CFI = 0.99; TLI = 0.99; RMSEA = 0.000).ConclusionMentalizing was identified as a critical success factor in psychosomatic inpatient rehabilitation. A key component to increase mentalizing in this treatment context is the improvement of epistemic mistrust.

Iranian adaptation of the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ): Validity, reliability, discriminant ability, and sex invariance

“…As these invariances corroborated the suitability of the ETMCQ for meaningful cross-sex contrasts, we compared mean scores, revealing that females scored higher on ET and lower on EM. This finding is partially congruent with Campbell et al (2021), who found similar patterns for ET and EM but also significant differences for EC; partially congruent with and Riedl, Rothmund et al (2023), who found similar patterns but only for ET; and inconsistent with Liotti, Milesi et al (2023), who found no cross-gender differences for the subscales.…”

“…We aimed to evaluate the psychometric properties of the ETMCQ employment status; Campbell et al, 2021;Liotti, Milesi, et al, 2023;Riedl, Rothmund, et al, 2023;Tanzer et al, 2021).…”

“…Nonetheless, the resulting structure showed an acceptable fit in subsequent CFA. Second, despite inconclusive evidence regarding the criterion‐related validity of ET, most studies indicate nonsignificant or negligible associations between ET and relevant constructs (Benzi, Carone, et al., 2023 ; Benzi, Fontana, et al., 2023 ; Campbell et al., 2021 ; Kampling et al., 2022 , 2024 ; Liotti, Milesi, et al., 2023 ; Tanzilli et al., 2022 ), with a minority substantiating its validity (Liotti, Fiorini Bincoletto, et al., 2023 ; Riedl et al., 2024 ; Riedl, Rothmund, et al., 2023 ), and a handful of investigations presenting mixed findings (Brauner et al., 2023 ; De Coninck et al., 2023 ; Hauschild et al., 2023 ; Parolin et al., 2023 ). Third, although good test–retest reliability was found for all three subscales, the majority of the findings demonstrated questionable internal consistency for EM (see Table 1 ).…”

To be a freshman during the COVID‐19 pandemic: A cross‐lagged model of depression, mentalizing, and epistemic trust

“…It involves a tendency for epistemic naivety, which results in a higher liability to misinformation and a risk of exploitation (Campbell et al, 2021). Studies have shown that these three dimensions (trust, mistrust, and credulity) are distinct in both nonclinical and clinical samples (Kampling et al, 2022;Riedl et al, 2023). For example, individuals with borderline personality disorder have been shown to have high levels of both epistemic mistrust and epistemic credulity (Orme et al, 2019).…”

“…University students must continuously evaluate the credibility of information from various sources to make informed decisions and succeed academically. Building epistemic trust enables students to engage critically with academic materials, seek guidance from fellow students and mentors and participate actively in classroom discussions (Campbell et al, 2021;Kampling et al, 2022;Riedl et al, 2023). A welldeveloped sense of epistemic trust is a prerequisite for a supportive learning environment, encouraging knowledge sharing and cooperative learning.…”