Developing a Transdiagnostic Mentalization Skills Module: A Waitlist Control Study

Mentalization, often operationalized as reflective functioning (RF), refers to a person’s capacity to understand the mental states of oneself and others (Bateman & Fonagy, 2012). While it has been widely researched that mentalization deficits exist in neurodevelopmental disorders like autism spectrum disorder (Baron-Cohen, 2000) and schizophrenia (Cotter et al., 2018; Savla et al., 2013), recent findings in the last decade have demonstrated deficits in a wide range of clinical disorders, most notably borderline personality disorder (BPD; Ghiassi et al, 2010; O’Neill et al., 2015) but also social phobia (Washburn et al., 2016), major depressive disorder (MDD; Dalili et al., 2015), posttraumatic stress disorder (PTSD; Nietlisbach & Maercker, 2009) and anorexia nervosa (Russell et al., 2009). While it is clear that mentalization deficits exist across a number of different psychopathologies, only recently has research attempted to study this relationship outside of BPD. Moreover, to date there is no research that directly demonstrates mentalization enhancement or establishes a causal link to psychosocial benefits of such enhancement related to interpersonal functioning. The present study attempted to fill these gaps in literature by creating a transdiagnostic mentalization module that aimed to directly enhance mentalization across a short four-week period using a self-guided, virtual online format. Using a waitlist control repeated measures design, 80 participants were randomized into the intervention (n = 40) or control condition (n =40), with mentalization and interpersonal dysfunction as the the primary outcome variables. Results demonstrated significant efficacy of the intervention (compared to the control condition) for mentalization enhancement with the RFQ uncertainty subscale at end of study (F1,77 = 5.68, p = .017) and maintained at 1 month follow-up (F1,77 = 5.88, p = .018), however, findings were nonsignificant for the other measures of mentalization as well as interpersonal distress. Exploratory analyses revealed significant interactions across conditions related to stress for mentalization enhancement for both the RFQ certainty subscale (F6,73 = 3.56, p = .01) and the RMET (F6,73 = 3.23, p = .01). Additionally, significant interactions were found across conditions for neuroticism and mentalization enhancement with the RFQ certainty subscale (F6,73 = 1.56, p = .03). Efficacy of the intervention was therefore partially demonstrated for mentalization enhancement but not for interpersonal distress. Future research is needed to replicate these findings of mentalization enhancement in a transdiagnostic intervention as well as establish a causal link to interpersonal distress reduction.