Kumpasoglu, Guler Beril; (2025) The role of epistemic trust in common mental health disorders and their treatment. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The inherently social nature of human cognition, intertwined with our reliance on complex social collaborations, underscores the fundamental role of cultural knowledge transmission. Recent advancements in mentalizing theory suggest that disruptions in epistemic trust may serve as a vulnerability factor across a wide range of psychopathologies. However, despite its associations with personality disorders, the broader implications of epistemic trust disruptions across various clinical conditions and their treatments remain underexplored. The primary aim of this thesis was to investigate the role of epistemic trust in psychopathology and psychotherapy outcomes among adults with common mental health disorders (CMHDs). Chapter 1 offers a conceptual review of epistemic trust within the developmental psychopathology framework, critically evaluating the current empirical evidence and identifying significant gaps that shaped the research questions for the subsequent chapters. Chapter 2 presents a systematic review and meta-analysis exploring the relationship between perceived treatment credibility, therapist credibility, and psychotherapy outcomes, with an emphasis on the timing of credibility assessments as a potential moderating factor. Chapter 3 focuses on the clinical validation of the Epistemic Trust, Mistrust, and Credulity Questionnaire and investigates differences in epistemic stances (epistemic trust, mistrust, and credulity) between a clinical cohort with CMHDs and a community-based control group. Chapter 4 examines the associations between epistemic trust and key psychological constructs relevant to CMHDs, such as mentalizing capacity, interpersonal problems, and emotion regulation difficulties. Chapter 5 investigates the predictive roles of mentalizing and epistemic trust regarding treatment outcomes, their connections with the therapeutic relationship, and treatment disengagement. Finally, Chapter 6 discusses the findings in relation to their clinical and research implications, providing insights into how epistemic trust influences psychopathology, therapeutic processes, and outcomes in the context of CMHDs.

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