How epistemic trust, mistrust and credulity relate to mental health, personality pathology, treatment engagement and relationship in psychotherapeutic and psychiatric settings.

Epistemic mistrust and credulity showed consistent relationships with markers of psychopathology including internalising symptoms, personality functioning, and maladaptive traits.

• Sample consisted of 912 participants recruited via a mental health app in a naturalistic design.
• Participants completed the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ) along with self-reports capturing internalising symptoms, personality functioning, and maladaptive traits.
• Both epistemic mistrust and credulity were associated with greater psychopathology markers.
• The study assessed these relationships retrospectively over the previous 6 months.

Epistemic trust correlated with more positive ratings of the therapeutic relationship, while epistemic mistrust correlated with more negative ratings.

• Therapeutic relationship aspects assessed included genuineness, realism, expectations, congruence, and responsivity.
• Higher epistemic trust was associated with more positive ratings across these therapeutic relationship dimensions.
• Higher epistemic mistrust was associated with more negative ratings across these same dimensions.
• These associations were assessed retrospectively over the past 6 months of therapeutic contact.

Epistemic trust positively predicted the amount of psychotherapy sessions utilized in the past year.

• The prediction of psychotherapy session count by epistemic trust was controlled for personality dysfunction.
• This finding was assessed retrospectively over the past year.
• The result suggests that greater capacity for epistemic trust facilitates greater engagement with psychotherapeutic treatment.

Epistemic mistrust negatively predicted treatment-seeking behaviour, controlled for personality dysfunction.

• Treatment-seeking behaviour was explored in both psychotherapeutic and psychiatric contexts.
• The negative prediction of treatment-seeking by epistemic mistrust was maintained even after controlling for personality dysfunction.
• This was assessed retrospectively over the past year.
• The authors suggest patients with epistemic mistrust may enter 'a self-reinforcing cycle of reduced openness and ineffective mentalizing, potentially impacting therapeutic effectiveness.'

Epistemic credulity predicted mental health app use in the past year.

• Mental health app use was among the treatment-seeking behaviours explored alongside psychotherapy and psychiatric service utilization.
• Epistemic credulity — characterized as excessive reliance on others as sources of information — specifically predicted use of mental health apps.
• This finding was assessed retrospectively over the past year.
• The result distinguishes credulity's relationship to treatment engagement from that of trust and mistrust.

Epistemic disruption, manifesting as either heightened mistrust or excessive credulity, is theorized to affect mentalizing abilities and increase vulnerability to psychopathology and maladaptive personality traits.

• Epistemic trust is described as 'the capacity to appropriately identify others as reliable and relevant sources of information, an ability closely linked to attachment and social learning.'
• Epistemic disruption can manifest as heightened suspicion (mistrust) or excessive reliance (credulity) toward others.
• These dynamics are described as 'interdependent and multidirectional' and 'pivotal to therapeutic learning, and thus to therapeutic change.'
• Interventions targeting epistemic disruption and impaired personality functioning are described as 'crucial for improving therapeutic outcomes, including psychopharmacological treatment effectiveness.'