Psychiatry investigation · 2026
Cognitive Flexibility as a Mediator Between Mentalization and Symptom Severity in Generalized Anxiety Disorder.
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Mavi Cansu Ünsal, Kaymakçı Esma Çörekli, Durgungöz Zeliha Büşra, Hekimsoy Hatice Kübra Çiçek
Аннотация
OBJECTIVE: Mentalization and cognitive flexibility are key constructs in contemporary models of anxiety psychopathology; however, their interrelationship in clinically diagnosed generalized anxiety disorder (GAD) remains insufficiently delineated. This study aimed to examine whether cognitive flexibility mediates the association between mentalization and anxiety severity.
METHODS: In this cross-sectional study, 110 patients with GAD, diagnosed according to DSM-5 criteria, completed the Mentalization Scale, Cognitive Flexibility Inventory, and Generalized Anxiety Disorder-7. Associations were assessed using Pearson correlation analyses, and mediation was examined using bias-corrected bootstrapping (5,000 resamples).
RESULTS: Cognitive flexibility was moderately negatively associated with GAD severity (r=-0.421, p<0.001), whereas mentalization showed a weaker but significant negative association (r=-0.293, p=0.002). In addition, mentalization and cognitive flexibility were strongly positively correlated (r=0.636, p<0.001). Mediation analysis revealed a significant indirect effect of mentalization on anxiety severity through cognitive flexibility (B=-0.083, 95% confidence interval [-0.132, -0.042], p=0.001), while the direct effect was not statistically significant.
CONCLUSION: Cognitive flexibility significantly mediated the association between mentalization and anxiety severity; however, given the cross-sectional design, this finding should be interpreted as statistical mediation rather than evidence of a causal mechanism. Although causal inferences cannot be established due to the cross-sectional design, cognitive flexibility may represent a clinically relevant target for reducing anxiety symptoms. Future longitudinal and interventional studies are warranted to clarify the directionality and clinical implications of these findings.
METHODS: In this cross-sectional study, 110 patients with GAD, diagnosed according to DSM-5 criteria, completed the Mentalization Scale, Cognitive Flexibility Inventory, and Generalized Anxiety Disorder-7. Associations were assessed using Pearson correlation analyses, and mediation was examined using bias-corrected bootstrapping (5,000 resamples).
RESULTS: Cognitive flexibility was moderately negatively associated with GAD severity (r=-0.421, p<0.001), whereas mentalization showed a weaker but significant negative association (r=-0.293, p=0.002). In addition, mentalization and cognitive flexibility were strongly positively correlated (r=0.636, p<0.001). Mediation analysis revealed a significant indirect effect of mentalization on anxiety severity through cognitive flexibility (B=-0.083, 95% confidence interval [-0.132, -0.042], p=0.001), while the direct effect was not statistically significant.
CONCLUSION: Cognitive flexibility significantly mediated the association between mentalization and anxiety severity; however, given the cross-sectional design, this finding should be interpreted as statistical mediation rather than evidence of a causal mechanism. Although causal inferences cannot be established due to the cross-sectional design, cognitive flexibility may represent a clinically relevant target for reducing anxiety symptoms. Future longitudinal and interventional studies are warranted to clarify the directionality and clinical implications of these findings.