Epistemic Trust Is a Critical Success Factor in Psychosomatic Rehabilitation—Results from a Naturalistic Multi-Center Observational Study

Abstract

Knowledge about critical success factors underpinning beneficial treatment outcomes in psychosomatic inpatient rehabilitation is scarce. The aim of this study was to evaluate the influence of patients’ epistemic stance in relation to the improvement of psychological distress during rehabilitation. In this naturalistic longitudinal observational study, n = 771 patients completed routine assessments for psychological distress (BSI-18), health-related quality of life (HRQOL; WHODAS), and epistemic trust (ETMCQ) before (T1) and after (T2) psychosomatic rehabilitation. Patients were grouped as best, average, and worst responders based on their mean BSI-18 changes during treatment, and their mean change in epistemic trust, mistrust, and credulity was compared using repeated measures analyses of variance (rANOVAs). No associations of performance with sex (p = 0.09), age (p = 0.11), or relationship status (p = 0.58) were found. Best responders reported significantly improved epistemic trust (p = 0.001) and reduced epistemic mistrust (p < 0.001), whereas worst responders reported a significant increase in epistemic mistrust (p < 0.001) and credulity (p < 0.001). Average responders did not change for either epistemic trust (p = 0.11), mistrust (p > 0.99), or credulity (p = 0.96). Our results underscore the role of the epistemic stance in psychosomatic and psychotherapeutic treatments. These results help to better understand what might determine psychosomatic rehabilitation outcomes and indicate the role of epistemic trust as a critical success factor.

Iranian adaptation of the Epistemic Trust, Mistrust, and Credulity Questionnaire (ETMCQ): Validity, reliability, discriminant ability, and sex invariance

“…In other words, the relationship between ET and other constructs may be nonlinear. Furthermore, in the two abovementioned studies in which clinical samples were recruited, ET scores significantly improved over the course of psychosomatic rehabilitation, albeit with small effect sizes (Riedl et al., 2024 ; Riedl, Rothmund, et al., 2023 ). Thus, future studies may investigate the nonlinearity of the ET associations in nonclinical samples, administer the ETMCQ to individuals with a wider range of diagnoses, and, in the case of replicating our findings, examine the potential redundancy of ET in nonclinical samples.…”

“…Nonetheless, the resulting structure showed an acceptable fit in subsequent CFA. Second, despite inconclusive evidence regarding the criterion‐related validity of ET, most studies indicate nonsignificant or negligible associations between ET and relevant constructs (Benzi, Carone, et al., 2023 ; Benzi, Fontana, et al., 2023 ; Campbell et al., 2021 ; Kampling et al., 2022 , 2024 ; Liotti, Milesi, et al., 2023 ; Tanzilli et al., 2022 ), with a minority substantiating its validity (Liotti, Fiorini Bincoletto, et al., 2023 ; Riedl et al., 2024 ; Riedl, Rothmund, et al., 2023 ), and a handful of investigations presenting mixed findings (Brauner et al., 2023 ; De Coninck et al., 2023 ; Hauschild et al., 2023 ; Parolin et al., 2023 ). Third, although good test–retest reliability was found for all three subscales, the majority of the findings demonstrated questionable internal consistency for EM (see Table 1 ).…”

Utilization of Mental Health Provision, Epistemic Stance and Comorbid Psychopathology of Individuals with Complex Post-Traumatic Stress Disorders (CPTSD)—Results from a Representative German Observational Study

“…In contrast, restoring epistemic trust and reducing epistemic mistrust have been shown to improve trauma-related symptoms in patients with CPTSD [17]. Recent studies have demonstrated a direct correlation between epistemic disruption and treatment outcomes in psychosomatic rehabilitation [43,44]. Psychotherapy has been suggested as a method to disrupt the cycle of epistemic mistrust and credulity by nurturing epistemic trust [9,45,46].…”