Teo, Jane Sze-Hui; (2024) The Development of a Self-reported Measure of Learning for Psychoeducation in Mentalization-based Therapy. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: Impairments in mentalizing are considered a common characteristic across a variety of psychological disorders. The self-reported Reflective Functioning Questionnaire (RFQ) is extensively employed in mentalization research. Yet, no review has previously synthesised findings from studies using the RFQ to compare clinical and non-clinical groups. Aims: This review aims to summarise existing studies that administer the RFQ to assess differences in mentalizing impairments—hypermentalizing (RFQ-C certainty scores) and hypomentalizing (RFQ-U uncertainty scores)—between clinical and nonclinical groups via meta-analyses. The secondary aim is to explore whether these differences vary across clinical disorders. Methods: Studies including adult participants with a validated mental health diagnosis ("clinical" sample) and a non-clinical comparison group, using the RFQ, were selected for inclusion. Five electronic databases—PsycINFO, MEDLINE, Embase, Web of Science, and CINAHL—were systematically searched. Data were synthesised in R studio to pool effect sizes and presented in forest plots. Results: Eleven studies were included, representing disorders such as Borderline Personality Disorder (BPD; n=5), Major Depressive Disorder (MDD; n=1), Eating Disorders (ED; n=2), and early Psychosis (EP; n=2). Clinical groups exhibited significantly higher RFQ-U scores (k=12, Hedge’s g= 1.26 [95% CI: 1.00 to 1.52, p < .001]) and significantly lower RFQ-C scores (k=11, Hedge’s g= -0.65 [95% CI: - 0.88 to -0.42, p < .001]) compared to non-clinical controls. There were differences among clinical subgroups in RFQ-U scores [QM(df=3) = 51.2704, p < .0001], with EP and MDD subgroups showing significantly smaller differences compared to the BPD group. Discussion: The findings confirm the RFQ’s ability to differentiate between clinical and non-clinical groups and support its application in clinical settings. Subgroup analyses reveal potential variations in hypomentalizing impairments among clinical subgroups. However, the limited number of studies, substantial heterogeneity, and the RFQ's constrained psychometric properties restrict the conclusiveness of differences in mentalizing impairments across clinical groups.

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