(PS11-68) Changes in Theory of Mind During Partial Hospitalization

Title: Changes in theory of mind during partial hospitalization

Authors: Juliet L. Bockhorst BA, Kailyn Fan BA, Courtney Beard PhD, Chloe C. Hudson PhD

Background: Over the past two decades, researchers identified theory of mind—the ability to consider our own and other’s internal mental states (e.g., emotions, thoughts)—as an important contributor to mental illness. Despite strong theoretical support that existing therapeutic treatments promote theory of mind, there is a dearth of research supporting this claim. Such knowledge is crucial to determine whether modifications to treatments are necessary to target this important mechanism driving mental illness. In the current study we examined changes in theory of mind from admission to discharge in a cognitive-behavioral therapy-based partial hospitalization program. We hypothesized that theory of mind is targeted in this treatment, and therefore predicted that theory of mind would improve from admission to discharge.

Methods: We analyzed preliminary data from 66 patients (M_age = 35.13, 62% female, 87% non-Hispanic White) recruited from a partial hospitalization program in Northeastern United States. Data collection is ongoing, and data will be reanalyzed with a larger sample prior to our presentation. The PHP is a two-week cognitive behavioral therapy (CBT)-based program that involves five CBT groups per day and three individual therapy appointments per week. Patients also meet regularly with a case manager and psychiatrist. Theory of mind was assessed at admission and discharge using three experimental tasks (Reading the Mind in the Eyes Test [RMET], Penn Emotion Recognition Test [ER-40], and Hinting Task) and two self-report questionnaires (Interpersonal Reactivity Index [IRI] and Toronto Alexithymia Scale [TAS]).

Results: Participants reported significant improvements in their ability to identify their own mental states (TAS: t[65] = 3.97, p < .001, d = .49) and others’ mental states (IRI: t[65] = 5.23, p < .001, d = .65) from admission to discharge. However, there were no significant changes in performance on ER-40 (t[57] = 1.67, p = .10, d = .22), Hinting Task (t[65] = 1.10, p = .28, d = .14), or RMET (t[64] = 0.90, p = .37, d = .11).


Discussion: Although individuals’ self-report indicate moderate to large increases in the ability to consider mental states over the course of treatment, the improvements in theory of mind performance on behavioral tasks were much smaller and did not reach statistical significance. It is possible that these results reflect an increase in theory of mind propensity or confidence, without necessarily improving accuracy of these judgements. Alternatively, results may reflect improvements in real-world capacity for theory of mind that are not captured in task performance, which is thought to reflect optimal level of functioning. Finally, analyses are underpowered to detect small effects and may reach statistical significance in our final sample. Nevertheless, given that self-reported theory of mind functioning is associated with important functional outcomes, the results of the current study suggest that CBT-based treatments promote this important social cognitive process, highlighting theory of mind as a potential mechanism of change in psychotherapy.