Is a self-rated instrument appropriate to assess mentalization in patients with mental disorders? Development and first validation of the Mentalization Questionnaire (MZQ)

Abstract The purpose of this study was to develop and validate a self-rating scale for a differentiated assessment of mentalization. A pool of 40 items was developed and evaluated on n=434 inpatients with mental disorders at three time points. Symptom severity, self-injuring behavior, suicidal tendency and attachment style were also assessed. A varimax-rotated factor analysis supported the extraction of four factors. The model fit was checked by confirmatory factor analysis. Internal consistency of the Mentalization Questionnaire (MZQ) was .81. The relation between symptom severity and MZQ scores was found to be significant, and significant group differences were found between patients displaying self-injuring behavior and those who did not as well as between patients with and without suicide attempts. The MZQ can be considered as a practicable self-rated instrument with acceptable reliability and sufficient validity to assess at least aspects of mentalization in patients with mental disorders.

[1]  P Fonagy,et al.  The relation of attachment status, psychiatric classification, and response to psychotherapy. , 1996, Journal of consulting and clinical psychology.

[2]  P. Fonagy,et al.  Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. , 2003, The American journal of psychiatry.

[3]  P. Fonagy,et al.  The widening scope of mentalizing: a discussion , 2011 .

[4]  T. Björgvinsson,et al.  Cognitive Behavioral Therapy Promotes Mentalizing , 2008 .

[5]  R. Karlsson,et al.  Reflective-functioning during the process in brief psychotherapies. , 2006, Psychotherapy.

[6]  H. Kessler,et al.  The Role of Mentalization in the Psychoanalytic Treatment of Chronic Depression , 2011, Psychiatry.

[7]  P Fonagy,et al.  Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. , 1991, Child development.

[8]  F. Skårderud.  Eating one's words, part II: The embodied mind and reflective function in anorexia nervosa--theory. , 2007, European eating disorders review : the journal of the Eating Disorders Association.

[9]  Kenneth N. Levy.  Psychotherapies and lasting change. , 2008, The American journal of psychiatry.

[10]  H. Freyberger,et al.  Erfassung der Therapie- ergebnisse im Rahmen der Qualitätssicherung in einer psychiatrischen Klinik Ein Erfahrungsbericht , 1997, Der Nervenarzt.

[11]  N. Jacobson,et al.  Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. , 1991, Journal of consulting and clinical psychology.

[12]  J. Gunderson,et al.  Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. , 2008, The American journal of psychiatry.

[13]  Gisela Bergmann-Mausfeld.  Pathologische Passung, Mentalisierung und negative therapeutische Reaktion , 2006 .

[14]  P. Fonagy,et al.  Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. , 2009, The American journal of psychiatry.

[15]  P. Fonagy.  The Mentalization‐Focused Approach to Social Development , 2008 .

[16]  Brian Everitt,et al.  Making Sense of Statistics in Psychology: A Second-Level Course , 1996 .

[17]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[18]  H. Löffler-Stastka,et al.  Mentalisierungsfähigkeit bei depressiven Patientinnen: Eine Pilotstudie , 2008 .

[19]  M. Schwannauer,et al.  Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample. , 2011, Psychology and psychotherapy.

[20]  P. Fonagy,et al.  Mentalizing and borderline personality disorder , 2007 .

[21]  G. Dimaggio,et al.  Progressively promoting metacognition in a case of obsessive-compulsive personality disorder treated with metacognitive interpersonal therapy. , 2011, Psychology and psychotherapy.

[22]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[23]  P. Fonagy,et al.  Mentalization-Based Treatment for BPD , 2004, Journal of personality disorders.

[24]  M. Slade.  Routine outcome assessment in mental health services , 2002, Psychological Medicine.

[25]  Jon G. Allen,et al.  The Developmental Roots of Borderline Personality Disorder in Early Attachment Relationships: A Theory and Some Evidence , 2003 .

[26]  H. Stein.  Mentalization with reservations. , 2003, Bulletin of the Menninger Clinic.

[27]  Kenneth N. Levy,et al.  Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. , 2006, Journal of consulting and clinical psychology.

[28]  F. Skårderud.  Eating one's words: Part III. Mentalisation-based psychotherapy for anorexia nervosa--an outline for a treatment and training manual. , 2007, European eating disorders review : the journal of the Eating Disorders Association.

[29]  U. Koch,et al.  Psychometrische Überprüfung einer verkürzten Version der »Hamburger Module zur Erfassung allgemeiner Aspekte psychosozialer Gesundheit für die therapeutische Praxis« (HEALTH-49) , 2009 .

[30]  D. McLean.  Psychotherapy for Borderline Personality Disorder, Mentalization-based Treatment , 2005, British Journal of Psychiatry.

[31]  R. Grabhorn,et al.  The importance of reflective functioning to the diagnosis of psychic structure. , 2006, Psychology and psychotherapy.

[32]  L. Kriston,et al.  Confirmatory factor analysis of the German version of the international index of erectile function (IIEF): a comparison of four models. , 2008, The journal of sexual medicine.

[33]  Stephan Buschkämper,et al.  Der Bielefelder Fragebogen zu Partnerschaftserwartungen , 2002 .

[34]  S. Vanheule,et al.  In search of a framework for the treatment of alexithymia. , 2011, Psychology and psychotherapy.

[35]  J. Vanderlinden,et al.  The dissociation questionnaire (DIS‐Q): Development and characteristics of a new self‐report questionnaire , 1993 .

[36]  P. Fonagy,et al.  8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. , 2008, The American journal of psychiatry.

[37]  M. Target,et al.  Reflective Functioning in Panic Disorder Patients: a Pilot Study , 2006, Journal of the American Psychoanalytic Association.

[38]  F. Skårderud.  Eating one's words, part I: 'Concretised metaphors' and reflective function in anorexia nervosa--an interview study. , 2007, European eating disorders review : the journal of the Eating Disorders Association.

[39]  Neil H. Altman,et al.  Affect Regulation, Mentalization, and the Development of the Self. , 2003 .

[40]  B. Brent.  Mentalization-based psychodynamic psychotherapy for psychosis. , 2009, Journal of clinical psychology.

[41]  P. Fonagy,et al.  Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. , 1999, The American journal of psychiatry.

[42]  L. Cronbach.  Coefficient alpha and the internal structure of tests , 1951 .