Mentalization in the Psychosis Continuum: Current Knowledge and New Directions for Research and Clinical Practice

Impairments in mentalizing - the capacity to utilize mental state information to understand oneself and others -  have consistently been identified across the developmental continuum of psychosis expression, from the premorbid and prodromal stages to its clinical forms. Mentalizing difficulties in psychosis have been investigated using an array of different methodologies, including novel experimental tasks, narrative assessments, self-report measures, as well as neuroscientific and computational methods. These studies have primarily examined how mentalizing disturbances relate to symptom dimensions and functional outcomes in clinical samples, as well as the transition to clinical psychosis among those who are at increased risk. More recently, clinical adaptations of mentalization-based treatments (MBT) and other psychotherapeutic approaches with a focus on supporting people suffering with psychosis reflect on their own and others’ mental states, such as Metacognitive Reflection and Insight Therapy (MERIT), have been reported in the literature.

Given the increasing interest in mentalizing dysfunction as a treatment target for people suffering with psychosis and those at increased risk, the goal of this Research Topic is to explore any aspect of mentalizing as it relates to different stages of the psychosis continuum (including non-clinical samples presenting with schizotypal personality traits, people who meet clinical high risk criteria for psychosis and individuals suffering with schizophrenia-spectrum disorders), highlighting promising directions for basic research in the area, or the translation of mentalization research into clinical settings. In this way we aim to achieve a synthesis of current knowledge and new perspectives on mentalizing and related constructs, such as metacognition that will further elucidate their relevance across the continuum of psychosis expression, as well as provide insights that will inform the development of psychotherapeutic interventions for people suffering with psychosis and those at increased risk.

In this research topic we welcome a broad range of article types, including original research and review articles with a conceptual focus that address:
- The links between specific aspects of mentalizing impairment and symptom dimensions in samples of individuals suffering with psychosis-spectrum disorders.
- The impact of mentalizing, or related constructs such as metacognition on functional outcomes among people suffering with psychosis.
- The role of mentalizing as a risk factor augmenting psychosis vulnerability, or as a resilience factor protecting against clinical psychosis among those who are at increased risk.
- The effects of biological, psychological or social factors on mentalizing abilities among people suffering with psychosis and those at increased risk.
- Innovative psychotherapeutic interventions with a mentalizing or metacognitive focus for people suffering with psychosis-spectrum disorders and those at increased risk.
- The neural underpinnings of mentalizing impairment in psychosis.
- Novel methods for assessing mentalizing or metacognitive abilities in people suffering with psychosis-spectrum disorders and those who are at increased risk.