(2019) - Keeping Culture in Mind A Systematic Review and Initial Conceptualization of Mentalizing From A Cross-Cultural Perspective

Received: 10 January 2019
| Revised: 17 June 2019

| Accepted: 4 July 2019
DOI: 10.1111/cpsp.12300
L I T E R AT U R E R E V I E W
Keeping culture in mind: A systematic review and initial

conceptualization of mentalizing from a cross‐cultural
perspective
Erez Aival-Naveh | Lily Rothschild‐Yakar | Jenny Kurman
Department of Psychology, University of
Haifa, Israel
Abstract
In this review, we call for a cross‐cultural examination of mentalizing. To this end,
Correspondence we first outline theoretical directions for understanding mentalizing in the context
Erez Aival-Naveh, Department of
Psychology, University of Haifa, 199 Aba of the universalism–relativism debate. Next, we systematically review cross‐cultural
Khoushy Ave., Mount Carmel, Haifa, studies of five concepts, each of which overlaps with separate dimensions of mental-
3498838 Israel.
izing: Theory of Mind, empathy, perspective‐taking, alexithymia, and mindfulness.
Email: [email protected]
Based on healthy and clinical samples investigated across more than 45 cultures, we
draw several conclusions. First, mentalizing profiles may vary between cultures (e.g.,
self > other mentalizing in individualistic cultures, self < other mentalizing in col-
lectivistic cultures). Second, linguistic factors, value preferences, and parenting char-
acteristics may explain these differences. Finally, the data generally support the link
between mentalizing and mental health across cultures, yet further research is needed.
KEYWORDS
alexithymia, culture, empathy, mentalizing, mentalization, mindfulness, reflective‐functioning, Theory
of Mind
1 | IN T RO D U C T ION 2018; Katznelson, 2014). Nevertheless, to the best of our

knowledge, no attempt has been made to understand men-
In this review, we focus on the model of mentalizing talizing from a cross‐cultural perspective. Our overarching
(Fonagy, Gergely, Jurist, & Target, 2002; Fonagy & Target, aim in this paper is to raise awareness of this disparity—
1996) from a cross‐cultural perspective. In recent years, that is, to point out the need to keep culture in mind and
deficits in mentalizing—namely, in the ability to inter- examine mentalizing from a cross‐cultural perspective.
pret behavior in terms of internal mental states, such as Additionally, we aim to offer possible directions for future
thoughts, feelings, and intentions—have attracted the at- research in order to do so. To this end, we begin by de-
tention of both researchers and clinicians. A rapidly grow- scribing the model of mentalizing. Then, we clarify spe-
ing body of empirical evidence supports the notion that cific questions of interest in examining mentalizing from
deficient mentalizing is a psychological mechanism un- a cross‐cultural perspective. Next, we outline several theo-
derlying various psychopathologies (Fonagy & Bateman, retical directions for answering those questions. After that,
Public Health Significance: Difficulties in mentalizing, the capacity to perceive internal mental states, are related to adverse mental health outcomes in
individualistic cultures. This review of mentalizing capacities across cultures suggests cultural variations in mentalizing, due to differences in language,
parenting practices, and values. The results provide initial support for a possible link between mentalizing and mental health across cultures, pointing to its
universal importance; yet overall, this review emphasizes the need to further investigate mentalizing cross‐culturally.
© 2019 American Psychological Association. Published by Wiley Periodicals, Inc., on behalf of the American Psychological Association.
All rights reserved. For permissions, please email: [email protected]
Clin Psychol Sci Pract. 2019;26:e12300. |

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2 of 25 AIVAL-NAVEH et al.
we systematically review empirical data taken from cross‐ rather as comprising several specific psychological abilities.
cultural studies on five concepts that overlap with mental- As these two core assumptions of the model are central to
izing: Theory of Mind (ToM), empathy, perspective‐taking understanding mentalizing from a cross‐cultural perspective,
(PT), alexithymia, and mindfulness. Finally, we discuss the we will discuss them in detail in the following sections.
results of the review while proposing directions for future
research and highlighting several clinical implications.
1.1.1 | Mentalizing as a
multidimensional concept
1.1 | The model of mentalizing
As a multidimensional construct, mentalizing is seen as com-
Mentalizing is defined as the psychological capacity to re- prising several dimensions (Fonagy & Luyten, 2009). The
flect and understand one's own behavior and that of others self versus other dimension refers to the two objects of men-
in terms of internal mental states (Fonagy & Target, 1996). talizing. It differentiates between one's ability to perceive the
Through the ability to “keep a mind in mind,” and attribute mental states of others and the metacognitive thinking pro-
mental states to people's actions, mentalizing enables us to cesses that enable one to think about one's own mental states.
make sense of another's behavior. At the same time, as a form The cognitive versus affective dimension refers to the way
of higher‐order thinking, it enables thinking about one's own in which mental states are perceived, whether through un-
thoughts, emotions, or wishes (Bateman & Fonagy, 2012). derstanding them or by empathizing with them. The implicit
By going beyond the apparent in individuals’ behavior, this versus explicit dimension of mentalizing addresses the two
capacity to interpret internal mental states makes human be- modes of functioning in mentalizing. Understanding men-
havior meaningful. Thus, similar to other models of social tal states can be automatic, fast, and uncontrolled (implicit),
cognition (e.g., Baron‐Cohen, Leslie, & Frith, 1985; Frith & or deliberate, effortful, and conscious (explicit).1 Based on
Frith, 2005; Leslie, 1987), mentalizing is seen as crucial to this conceptualization of mentalizing as a multidimensional
the way people make sense of themselves and navigate their construct, individual differences exist in people's mentaliz-
social world. ing profile, namely in their set of strengths and weaknesses
Fonagy and his collaborators' model conceptualized men- regarding each dimension (Luyten, Fonagy, Lowyck, &
talizing as a developmental achievement—evidently depen- Vermote, 2012). Additionally, as a broad construct, there is a
dent on constitutional dictated neuro‐cognitive infrastructure conceptual overlap between mentalizing and other concepts
(Frith & Frith, 2003; Lieberman, 2007; Uddin, Iacoboni, (Allen & Fonagy, 2006). Different concepts overlap with dif-
Lange, & Keenan, 2007)—yet also heavily related to our ferent dimensions of mentalizing (Choi‐Kain & Gunderson,
early interpersonal environment (i.e., the quality attachment 2008); thus, for example, affective empathy, when defined
relationship; Fonagy et al., 2002). The model incorporates as one's emotional reactivity toward the feelings of another
advances in our understanding of infants' early social‐cog- (Decety & Jackson, 2004), overlaps with other (as opposed
nitive development (e.g., the ability of very young infants to self) and affective (as opposed to cognitive) mentalizing.
to understand basic mental states; Csibra, 2008; Onishi &
Baillargeon, 2005), and seminal theoretical considerations
1.1.2 | Deficits in mentalizing,
on the cognitive mechanisms underlying social communi-
psychopathology, and mentalizing‐
cation (e.g., epistemic trust, namely—one's willingness to
based treatment
consider knowledge from another person as trustworthy and
relevant; Sperber et al., 2010). The model therefore offers a The model conceptualizes mentalizing as a psychological
broad perspective on the development of mentalizing, taking mechanism underlying psychopathology. The rationale for
into account the developmental interplay between the triad this conceptualization is twofold. First, mentalizing is seen
of mentalizing, attachment, and epistemic trust (Fonagy & as the basis for self‐regulation and is perceived as essential
Allison, 2014). It is suggested that the attachment bond— for experiencing a cohesive and viable sense of self (Fonagy
rooted in a developmental history of feeling accurately un- & Luyten, 2009). Second, proper development of mentaliz-
derstood by an attachment figure—not only provides optimal ing, alongside with the ability to establish epistemic trust, is
conditions for advancing infants' mental states understand- seen as indispensable for social cognition underlying com-
ing, but also paves the way for the establishment of epistemic munication—and therefore for the ability to create meaning-
trust (Fonagy, Luyten, & Allison, 2015). ful and mutual relationships (Allen & Fonagy, 2006; Fonagy
At the heart of the model lies the assumption that psycho- et al., 2015). With this regard, the model specifically empha-
pathology emerges when this development goes awry, men- sizes the role of ruptures in mentalizing under attachment‐re-
talizing capacity becomes deficient, and the ability to suspend lated stress. The activation of the attachment system results
epistemic mistrust is damaged. A second central claim is that in failures in the ability to accurately mentalize (Fonagy &
mentalizing itself should not be seen as a single capacity, but Luyten, 2009); these ruptures in mentalizing, most notable in
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individuals with insecure types or disorganized attachment discussing three theoretical orientations in the understanding
(Luyten et al., 2012), further promote epistemic mistrust, of psychological phenomena from a cross‐cultural perspec-
thus deepening difficulties in social communication (Fonagy tive: universalism, relativism, and an intermediate approach
& Allison, 2014). between the two.
To test the model's assumptions, Fonagy and his colleagues
operationalized mentalizing as Reflective Functioning (RF)
1.2.1 | Mentalizing from a universalist
(Fonagy et al., 2016; Fonagy, Target, Steele, & Steele, 1998).
perspective
In line with the model's assumptions, lower RF scores are
consistently associated with psychopathology, most notably The universalist approach relies on the assumption that cul-
Borderline Personality Disorder (BPD; see Katznelson, 2014 ture plays only a small role in shaping psychological phe-
for a review). Accordingly, Mentalizing‐Based Treatment nomena (Berry, Poortinga, Segall, & Dasen, 2002). Hence,
(MBT) was developed as a psychotherapeutic approach for similar psychological processes, and also belief systems con-
the treatment of BPD (Bateman & Fonagy, 2004, 2008), cerning them, can be found across cultures. This approach
yet later evolved to include interventions for other psycho- posits that findings concerning cultural variations, if any,
pathologies (Bateman & Fonagy, 2012). It has further been merely reflect differences related either to presentational
suggested that promoting mentalizing may serve as a com- concerns that vary between cultures or to measurement is-
mon factor across different therapeutic approaches (Fonagy sues. Those advocating the universalist view will posit that
& Allison, 2014), specifically among dialectical behavioral individuals in different cultures have a similar basic capacity
therapy and transference‐focused psychotherapy for BPD to mentalize; cultural variations in mentalizing, if any, are
(Goodman, 2013). For example, in a study that evaluated the likely related only to differences in the perceived capacity to
mechanism of change in transference‐focused psychother- mentalize or to reporting differences. Likewise, the expecta-
apy for BPD (Levy et al., 2006), it was found that one year tion is that mentalizing is associated with mental health in
of therapy resulted in both an increase in the number of pa- collectivistic and individualistic cultures alike.
tients classified as securely attached and a higher RF score. This perspective is in line with several evolutionally
However, despite the accumulation of empirical support for based views of people's capacity to perceive mental states
MBT and its underlying model, the understanding of men- and is also somewhat consistent with findings concerning its
talizing from a cross‐cultural perspective is still lacking; in known neural basis (e.g., Lieberman, 2007). Gerrans (2002),
the following section, we will focus on questions specifically for example, describes an innate modality for mind‐reading
arising from this perspective, followed by several directions capacity, and Liotti and Gilbert (2011) have emphasized the
for possible answers. evolutionary functions of mentalizing in promoting coopera-
tion and negotiating competition. Also, consistent with this
view, relying on contemporary evolutionary theories of so-
1.2 | Mentalizing from a cross‐cultural
cial cognition, Fonagy et al. (2015) propose that the devel-
perspective
opment of mentalizing provides an evolutionary advantage
Cross‐cultural research has led to considerable advances because it enables suspension of epistemic mistrust; this, in
in our understanding of psychopathology and its underly- turn, provides a key advantage for human's social cognition
ing psychological mechanisms (Kirmayer & Ryder, 2016). as it constitutes a channel through which social learning itself
Consequently, over the last few decades we have been pro- is made possible.
gressively moving toward acknowledging the importance
of a cross‐cultural perspective in both research and practice
1.2.2 | Mentalizing from a relativist
(Bernal & Sáez‐Santiago, 2006; Sue & Sue, 2012). We there-
perspective
fore contend that mentalizing should also be examined from
a cross‐cultural perspective. Such an examination can be In sharp contrast to universalism, the relativist perspective
broken down into three general questions that serve as the suggests that all psychological phenomena are basically
focus of the current review: (a) Are there any cultural dif- culture‐dependent (Berry et al., 2002). Relativist thinkers
ferences in mentalizing profiles? (e.g., Does the tendency of would likely suggest that people from different cultures
individuals to focus on their own mental states as opposed to will differ in their mentalizing capacity. Furthermore, the
those of others vary across cultures?); (b) What explains cul- generality of its link with psychopathology across cul-
tural differences in mentalizing, if any? (i.e., Which factors tures should be questioned. This perspective is in line with
mediate the relationship between culture and mentalizing?); Lillard's (1998) conceptualization of ToM from a cultural
and (c) Does the link between mentalizing and psychopa- perspective. Lillard argues that basic beliefs regarding the
thology exist across cultures? In the following sections, we mind fundamentally differ between cultures. In individual-
outline possible directions for addressing these questions, by istic cultures, the mind is contrasted with the body, is seen
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as internal, and is perceived as the seat of mental states; order to adapt themselves to their wishes and expectations
mental states are perceived as the main motive for peo- (Markus & Kitayama, 1991).
ple's actions and are therefore of great importance. In con- Hence, contrary to the relativist perspective, the inter-
trast, collectivistic cultures usually refrain from making the mediate perspective sees the importance of mentalizing as
Cartesian mind‐body split and thus tend to equate the mind universal, yet in contrast to the universalistic approach, it
with the body. Mental states are not seen as a central mo- suggests that different aspects of mentalizing may be more
tive for people's behavior. Instead, social roles and norms, important depending upon culture. Consequently, it can be
along with ethereal causes (e.g., gods and spirits), are seen expected that different cultures will exhibit different men-
as the main cause of actions. talizing profiles: Better mentalizing with regard to the self
People in collectivistic cultures may thus attribute behav- rather than others will be prevalent in individualistic cultures,
ior to external factors more than to internal mental states. whereas the mentalizing profile in collectivistic cultures will
Yet unlike in individualistic cultures, these tendencies are demonstrate an opposite pattern. Correspondingly, deficient
not a sign of deficit but rather reflect an adaptive, culture‐ mentalizing can be expected to be linked to psychopathology
specific characteristic of social cognition. Hence, it can be across cultures yet in a different manner, so that different as-
assumed that different cultures will exhibit differences in pects of mentalizing will be more strongly associated with
mentalizing capacity (e.g., lower mentalizing in collectivis- symptomatology in each culture.
tic cultures), with mentalizing of greater importance in the
West. Accordingly, mentalizing's link with psychopathology
1.3 | Cross‐cultural studies on
may be less prominent in collectivistic than in individualistic
overlapping concepts
cultures.
To examine the extent to which these directions are consist-
ent with current empirical data, we will review cross‐cultural
1.2.3 | Mentalizing from an
studies on five concepts that overlap with mentalizing: ToM,
intermediate perspective between
empathy, PT, alexithymia, and mindfulness. As each of these
universalism and relativism
concepts overlap with separate aspects of mentalizing (e.g.,
Some have posited that universalism and relativism should Allen & Fonagy, 2006; Choi‐Kain & Gunderson, 2008),
not be considered as dichotomous perspectives, but rather as measuring tools originally designed to assess these overlap-
two ends of a continuum (Berry et al., 2002). In the mid- ping concepts are now used to assess mentalizing (Luyten et
dle, there is an intermediate perspective, assuming that basic al., 2012). Hence, by integrating cross‐cultural findings taken
psychological processes are similar across cultures, yet that from studies on these concepts—while addressing each con-
culture can heavily influence their development and presen- cept's specific overlap with mentalizing—we will be able to
tation. Such an intermediate approach suggests that though shed initial light on the dimensions of mentalizing from a
individuals in all cultures show a basic capacity to perceive cross‐cultural perspective. Nevertheless, to understand what
mental states, different cultures exhibit different mentalizing can (and cannot) be learned about mentalizing from these
profiles. concepts, we first turn to describe each concept and clarify
This possibility is compatible with the conceptualization its relationship with mentalizing.
of mentalizing as a multidimensional construct (Fonagy &
Luyten, 2009), when coupled with Markus and Kitayama's
1.3.1 | Theory of Mind
(1991) seminal distinction between typical self‐construal in
dissimilar cultures: independent self‐construal, typical of This term is identified mostly with the developmental field,
individualistic cultures, is defined by its internal character- where it is used to refer to children's developing capacity
istics; in contrast, interdependent self‐construal, which is for understanding mental states (e.g., Frith & Frith, 2005;
typical of collectivistic cultures, is defined by its relationship Leslie, 1987). More specifically, ToM refers to the capac-
with others. Independent self‐construal leads to a view of ity to create theories concerning the minds of others (Brüne
one's self as separate and unique and therefore motivates peo- & Brüne‐Cohrs, 2006)—namely, the ability to make infer-
ple to discover and express their inner thoughts and feelings. ences about other people's emotions (i.e., affective ToM),
Consequently, self‐realization is expected of individuals with and about their thoughts and intentions (cognitive ToM). A
an independent self. Interdependent self‐construal, on the well‐known measure of ToM is the False‐Belief (FB) task.
other hand, leads to a view of one's self as part of a broader Though this task has various versions, it basically assesses an
social context and therefore motivates people to be attentive individual's ability to make a reasonable prediction regard-
to others and to adjust harmoniously to their social surround- ing a protagonist's behavior or expectation in cases in which
ings. Consequently, individuals with an interdependent self the protagonist holds a false belief about a certain occurrence
must be able to read other people's thoughts and feelings in (e.g., moving an object from one place to another without
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the knowledge of the given protagonist). Another widely neuroimaging measures. With regard to mentalizing, both
used measure is the Reading the Mind in the Eyes test (RME; concepts overlap with other‐mentalizing. Yet, each concept
Baron‐Cohen, Wheelwright, Hill, Raste, & Plumb, 2001). It also differentially overlaps with the cognitive (PT/cogni-
consists of pictures depicting only the eye region, based on tive empathy) and affective (affective empathy) mentalizing
which participants are asked to recognize different mental (Luyten et al., 2012). As with ToM, the overlap of empathy
states. and PT with explicit versus implicit mentalizing is dictated
With regard to its overlap with mentalizing, ToM concep- by methodology. Self‐report measures tap into explicit as-
tually overlaps with other‐mentalizing (Luyten et al., 2012). pects, most performance‐based tasks capture both aspects,
Nevertheless, some measures require differentiating between and neuroimaging studies seems to be closer to the implicit
self and other, as in the FB task in which an individual must aspect of mentalizing.
be able to inhibit his or her own (false) belief to understand
the (correct) belief of the other (Flynn, O'Malley, & Wood,
1.3.3 | Alexithymia
2004). Therefore, ToM also overlaps with self‐mentalizing,
though to a lesser degree. Additionally, cognitive and affec- This concept evolved mainly in the clinical field as a possible
tive ToM overlap with cognitive mentalizing. Note that while explanation for psychosomatic diseases and with reference
both cognitive and affective ToM refer to understanding to people's suitability for insight‐oriented psychotherapy
mental states, they differ in the object being perceived (i.e., (Nemiah, Freyberger, & Sifneos, 1976; Taylor & Bagby,
thoughts or feelings; Kalbe et al., 2010). This is in contrast to 2004). Alexithymia is seen as a multifaceted concept that re-
cognitive–affective mentalizing, which differs in the way in fers to (a) deficits in the ability to identify one's emotions,
which mental states are perceived (i.e., through understand- (b) difficulty in describing emotions, (c) an externally ori-
ing or identification). ToM's overlap with explicit‐implicit ented cognitive style, and (d) constricted imaginal processes
mentalizing relies mostly on methodology; some tasks were (Taylor, Bagby, & Parker, 1991).
specifically designed to capture implicit FB reasoning, some The vast majority of studies focusing on alexithymia rely
seem to capture mainly explicit aspects, and others tap into on the self‐report Toronto Alexithymia Scale (TAS; Bagby,
both. Parker, & Taylor, 1994). The TAS focuses on the first three
components of alexithymia. Its three‐factor structure was val-
idated in clinical and healthy samples (Bagby et al., 1994),
1.3.2 | Empathy and perspective‐taking
also across cultures (Taylor, Bagby, & Parker, 2003). With re-
These concepts gained the most research attention in the field gard to its overlap with mentalizing, alexithymia as measured
of social psychology (e.g., with reference to people's prosocial with the TAS overlaps with self and affective mentalizing,
behavior and various aspects of intergroup relations; Stephan though also taping into cognitive mentalizing to a lesser de-
& Finlay, 1999). Here we refer to empathy as one's emotional gree (Luyten et al., 2012). As a self‐report measure, the TAS
reactivity toward the social or physical pain of others (Cheon, overlaps with explicit mentalizing.
Mathur, & Chiao, 2010; Decety & Jackson, 2004). This is in
contrast to people's PT ability, namely the ability to “step into
1.3.4 | Mindfulness
the shoes of another” and see things from the other's point
of view, by understanding the other's thoughts and emotions Rooted in Buddhist thinking and Eastern meditation prac-
(Davis, 1983; Kurdek, 1978). These two concepts are often tices, the concept of mindfulness has been widely adopted
intertwined and are sometimes referred to as two different in various Western clinical approaches (e.g., Kabat‐Zinn,
aspects of empathy (i.e., cognitive empathy and affective 1982; Linehan, 1993). It has been defined as deliberately
empathy). Following Davis (1983, 2018), we refer here to bringing attention to one's internal and external experi-
cognitive empathy and PT as synonymous. Note, however, ences, nonjudgmentally, as they occur in the present mo-
that whereas PT emphasizes the ability to see things from the ment (Brown & Ryan, 2003). More specifically, Bishop et
perspective of another in a nonegocentric manner, cognitive al. (2004) operationally defined mindfulness as a two com-
empathy places more emphasis on the ability to achieve an ponent ability: (a) self‐regulation of attention on one's expe-
accurate understanding of the thoughts and feelings of others. riences in the present moment, and (b) a specific orientation
A variety of methodological tools are used to exam- toward these experiences (i.e., acceptance, openness, and
ine empathy and PT: self‐report questionnaires (e.g., the curiosity). Assessment of mindfulness relies most often on
Interpersonal Reactivity Index [IRI]; Davis, 1980; and the self‐report questionnaires (Baer, 2011), such as the Mindful
Empathy Quotient [EQ]; Baron‐Cohen & Wheelwright, Attention Awareness Scale (MAAS; Brown & Ryan, 2003),
2004); performance‐based tasks (e.g., visuospatial PT tasks and the Five Facet Mindfulness Questionnaire (FFMQ;
to assess PT, or the empathic accuracy paradigm to as- Baer et al., 2008). With respect to its overlap with mental-
sess cognitive empathy; Ickes, 2001); and nonbehavioral izing, mindfulness was described as overlapping with self,
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and both cognitive and affective mentalizing (Choi‐Kain & mindfulness. A separate search was conducted for each one of
Gunderson, 2008); additionally, it is seen as overlapping these concepts. In each search, possible combinations of the
with explicit mentalizing, yet it should be noted that mind- word "culture" (e.g., culturally, cultural, cross‐cultural) were
fulness is also related to implicit processes (specifically, its used together with each overlapping concept term. Search
acceptance sub‐component; Sauer et al., 2011). There are, terms were "theory of mind," "mind‐reading," "false‐belief,"
however, several differences with mentalizing that should be "empathy," "perspective‐taking," "alexithymia," and "mind-
noted. Whereas mindfulness emphasizes awareness to men- fulness." Second, the reference lists of articles were scanned
tal states in the present moment, mentalizing encompasses and possible relevant papers were extracted. The publica-
a wider time frame that is not limited to the present (Allen tion lists of leading scholars in the field were also scanned in
& Fonagy, 2006). Nonetheless, mindfulness covers a wider search of further relevant papers. The search ended on March
scope of objects, as it refers not only to mental states, but to 14, 2019 and yielded 247 articles. Next, the abstracts of the
any object—both physical (e.g., one's breathing sensations) articles were screened. Full texts were retrieved when study
and mental (Allen, Fonagy, & Bateman, 2008). Moreover, as details were ambiguous.
noted mindfulness focuses on the self; however, its emphasis
on the role of the self seems to be rather complex (Jurist,
2.2 | Inclusion criteria
2018): From the one hand, mindfulness is intended to en-
hance self‐observance and self‐awareness, yet from the other Articles were assessed for eligibility and filtered according
hand, it also promotes self transcendence (i.e., overcoming to the following inclusion criteria: (a) published in a peer‐
self‐involvement and self‐immersing). Whereas the former is reviewed journal, (b) between 1995 and 2019, and (c) full
similar to Western, individualistic views underlying mental- text is available in English. Additionally, (d) only articles re-
izing, the latter is closer to collectivistic, Eastern views on the porting empirical examinations were included. Furthermore,
self (Figure 1; Table 1). (e) the specific concept under investigation (e.g., ToM) must
be stated explicitly in the rationale for the empirical testing.
Finally, (f) the article must have a clear cross‐cultural or cul-
2 | M E T H OD tural focus in its investigation of the overlapping concept: a
comparison between two or more cultures and/or an exami-
2.1 | Search strategy and data extraction
nation of cultural aspects (e.g., values) within cultures. Based
The systematic review was conducted according to the on these inclusion criteria, 135 articles were excluded, thus
Preferred Reporting Items for Systematic Reviews and Meta‐ leaving 112 in the review (see Figure 2).
Analyses (PRISMA) statement (Moher, Liberati, Tetzlaff,
& Altman, 2009). First, the electronic databases Web of
2.3 | Risk of bias
Science, PsycINFO, PubMed, and Google Scholar were
searched systematically for papers concerning cross‐cultural Due to studies' large heterogeneity in terms of methodology,
empirical studies on ToM, empathy, PT, alexithymia, and we followed the approach of synthesizing risk of bias cri-
teria taken from several prominent checklists (Protogerou
& Hagger, 2018). To this end, we adopted criteria from
the NIH Study Quality Assessment Tool for Observational
Cohort and Cross‐Sectional Studies (National Institutes of
Health, 2014), the Newcastle‐Ottawa Scale (NOS) adapted
version for Cross‐Sectional Studies (Wells et al., 2011), the
Joanna Briggs Institute (JBI) Critical Appraisal Tools for
Cohort, Prevalence, and Randomized Controlled Studies
(Porritt, Gomersall, & Lockwood, 2014), and the Mixed
Methods Appraisal Tool (MMAT; Pace et al., 2012). We
generated three more criteria to evaluate key aspects of
methodology in cross‐cultural research (i.e., translation is-
sues, cultural validation of measures, and testing of measure
invariance). The final checklist included 11 yes or no ques-
tions (see Table A1 in Appendix 1). Based on this checklist,
the first author evaluated studies' risk of bias. Scores were
calculated as the percentage of total negative answers; thus,
F I G U R E 1 Conceptual overlap between mentalizing's a lower score indicates a lower risk of bias. To examine the
dimensions and other concepts rating's reliability, the third author independently rated 30
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T A B L E 1 Summary of overlapping
Concept Conceptualized ability/deficit Common measures
concepts' key characteristics
Theory of Mind Capacity to create theories on oth- False‐belief (FB) tasks, Reading the
(ToM) ers' minds, namely, to perceive Mind in the Eyes (RME) test.
the thoughts or intentions (cogni-
tive ToM) and feelings (affective
ToM) that underlie people's
behavior.
Empathy and One's emotional reactivity toward Interpersonal Reactivity Index (IRI),
Perspective‐ others' pain (affective empathy); empathic accuracy paradigm, PT
Taking (PT) understanding others' thoughts tasks.
and feelings (cognitive empathy)
by seeing things from their point
of view (perspective‐taking).
Alexithymia Deficit in the ability to identify Toronto Alexithymia Scale
one's own emotions, difficulties (TAS−20).
in describing affects, and exter-
nally oriented thinking style.
Mindfulness The deliberate bringing of atten- Five Facet Mindfulness
tion to one's internal and external Questionnaire (FFMQ)
experiences, nonjudgmentally,
as they occur in the present
moment.
F I G U R E 2 Systematic review search

and screening process
studies. Inter‐rater reliability was excellent (ICC = 0.94). conclusions, based on the above‐mentioned three questions
Risk of bias scores is presented in an Electronic Supplement of interest, namely (a) cultural variations in mentalizing, (b)
(Table S1). the potential mediators for the relationship between culture
and mentalizing, and (c) the relationship between mental-
izing and mental health across cultures. These conclusions
2.4 | Synthesis of the results
are summarized in Table 2. As will be noted below, some
The synthesis of the results comprised of three steps. First, specific inconsistencies were found with respect to studies
we extracted key findings and categorized them in accord- using self‐report measures of affective empathy; therefore,
ance with our five overlapping concepts (i.e., ToM, empa- we further examined these studies while focusing on results'
thy, PT, alexithymia, and mindfulness). These findings are strength (in studies indicating conflicting results, effect sizes
summarized in Table S1. Second, we descriptively evalu- were manually calculated when not originally reported).
ated these findings with respect to mentalizing, based on These studies are presented in Table S2. Two studies with a
the above‐mentioned specific overlap each concept has high risk of bias score (higher than 25%)2 were not included
with mentalizing's aspects. Finally, we recategorized our in the synthesis of the results.
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T A B L E 2 Cross‐cultural studies on overlapping concepts: summary of key findings (number of papers)
ToM Empathy & PT Alexithymia Mindfulness

Cultural differences and similarities
FB Self‐report (e.g., IRI, EQ)c Self‐report (TAS−20) Self‐report (e.g., FFMQ)
• People from individualistic • People from collectivistic • People from collectiv- • People from collectivistic
cultures had better/faster develop- cultures had higher empathic istic cultures had higher cultures had lower overall
ment of FB understanding than concern than people from in- alexithymia than people mindfulness score than people
people from collectivistic cultures dividualistic cultures (1 + 1d) from individualistic cultures from individualistic cultures
(13 + 1 a,b + 2b) • People from individualistic (9 + 2e) (1)
• No cultural differences in FB cultures had higher empathic • Similar alexithymia rates • People from collectivistic
understanding (4) concern than people from col- between cultures (1) cultures had lower nonjudg-
• People from collectivistic cultures lectivistic cultures (3) ing and describing scores, yet
had better performance in non‐ • People from collectivistic higher scores on acting with
verbal FB than in verbal FB tasks cultures had higher personal awareness, compared with
(3b) distress than people from col- people from individualistic
• Similar performance in different lectivistic cultures (2) cultures (1)
FB task across cultures (3) • Similar personal distress
• Conflicting results (2) scores across cultures (1)
Wellman and Liu's scale • People from individualistic
• Different developmental trajec- cultures had higher general
tory between cultures (6 + 1a) empathy than people from
• People from collectivistic cul- collectivistic cultures (1)
tures had faster development of Empathic accuracy
knowledge‐access understanding • People from collectivistic
than people from individualistic cultures were more accurate
cultures (1) than people from individualis-
RME tic cultures (2 + 1b)
• People from individualistic Neuroimaging
cultures had higher scores than • Culturally distinct brain activ-
people from collectivistic cultures ity during empathy‐related
(1) task (4 + 1b)
• Similar performance between PT tasks
cultures (1) • People from collectivistic cul-
Neuroimaging tures had better performance
Culturally distinct brain activity dur- than people from individualis-
ing ToM‐related task (1) tic cultures (1 + 3b)
Similar brain activity during ToM‐ • Similar performance between
related task (1) cultures (1)
Other measures
People from individualistic cultures
had higher parental mind‐minded-
ness than people from collectivis-
tic cultures (1)
Similar scores between cultures in
Happé task (1)
Variables explaining cultural differences
• Linguistic factors • Linguistic factors (1) • Value preferences (3 + 1e) • None
(5 + 1a+3b + 1b) • Parenting characteristics (1) • Parenting characteristics (2)
• Parenting characteristics (5 + 1b) • Value preferences (1)
• Value preferences (1 + 1b) • Personality traits (1)
• Other mediators (e.g., executive‐
functioning, temperament; 5)
(Continues)
AIVAL-NAVEH et al.
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T A B L E 2 (Continued)
ToM Empathy & PT Alexithymia Mindfulness

Link with mental health in collectivistic cultures
• ASD (3e; Chinese, Indians, • ASD (2e; Japanese, Indians) • Positively correlated with • Negatively correlated with
Cubans) • Negatively correlated with symptoms of anxiety depression and anxiety, and
peer relationship problems, (1 + 2e; Chinese, Kyrgyz, positively correlated with
but unrelated to conduct or Turkish) general psychological distress,
ADHD symptoms (1; East • Positively correlated with in a Chinese sample (1)
Asians Americans symptoms of depression • Positive results (e.g., decrease
(1 + 2e; Japanese, Chinese) in negative affect) in mind-
• Positively correlated with fulness‐based interventions
symptoms of PTSD (1 + 1e; targeting collectivistic samples
North‐Koreans, Iraqis) (2b; Chinese, Latino and Asian
• Positively correlated with American)
somatization (2; Asians
Americans, Chinese)
• Positively correlated with
symptoms of EDs (1;
Japanese)
• Positively correlated
with self‐harm (1;
South‐Koreans)
• Positively correlated with
alcohol dependence (1e;
Turkish)
• Negatively correlated with
well‐being/life satisfaction
(2; Iranians, East Asians)
• Negatively correlated with
adaptive coping (1; Turkish)
• Unrelated to symptoms of
EDs (1; Turkish)
Abbreviations: ADHD, Attention Deficit Hyperactivity Disorder; ASD, Autism Spectrum Disorder; EDs, Eating Disorders; EQ, Empathy Quotient; FB, False Belief;
FFMQ, Five Facets Mindfulness Questionnaire; IRI, Interpersonal Reactivity Index; PT, Perspective‐Taking. ; PTSD, Post Traumatic Stress Disorder; RME, Reading
the Mind in the Eyes test; TAS‐20, the 20‐item Toronto Alexithymia Scale; ToM, Theory of Mind.
a
Longitudinal study.
b
Experimental design.
c
See Table S2 for further elaboration on studies using self‐report measures of affective empathy.
d
Large‐scale study (N > 100,000).
e
Clinical sample. Two studies with a high risk of bias are not presented (see Risk of Bias section).
timing across cultures (Wellman, Cross, & Watson, 2001).

3 | R E S U LTS More recent studies, however, have demonstrated cultural
differences in the timing of ToM acquisition (Heyes & Frith,
In the following sections, we provide the results of cross‐
2014). For example, using the FB task for assessing ToM,
cultural data found on ToM, PT, empathy, alexithymia, and
researchers found that children from China (Liu, Wellman,
mindfulness. For each concept, we begin by describing the
Tardif, & Sabbagh, 2008), Pakistan (Nawaz, Hanif, & Lewis,
cultural differences and similarities found in healthy and
2015), Samoa (Mayer & Träuble, 2014), the Philippines
clinical populations and briefly discuss explanations pro-
(Gracia, Peterson, & Rosnay, 2016), and Japan (Naito &
posed for the observed cross‐cultural findings.
Koyama, 2006) exhibited a delay in the development of their
ability to understand mental states compared with children
3.1 | Theory of mind from individualistic cultures. Although there are a few ex-
ceptions (see study number 6 in Table S1), this pattern of
3.1.1 | Studies on healthy samples cultural differences is robust (Slaughter & Perez‐Zapata,
2014) and is even accompanied by variability in the neural
Early empirical evidence lends support for the assumption
correlates of ToM across cultures (Kobayashi & Temple,
that ToM is a universal capacity, with similar developmental
|
2009; Kobayashi, Glover, & Temple, 2006; Koelkebeck et that Japanese children performed significantly better on a
al., 2011). Such findings have led some to conclude that peo- nonverbal FB task than on a verbal one. Heyes and Frith
ple in collectivistic cultures have lower ToM capacity than in (2014) have therefore suggested that ToM operates through
individualistic cultures (Fiebich, 2016). Naito and Koyama two distinct systems, or levels—an implicit nonverbal level
(2006) suggested that whereas people from individualistic and an explicit verbal level; whereas cultural differences in
cultures tend to attribute behavior to internal mental states, ToM are widely exhibited on the explicit level, the implicit
people from collectivistic cultures tend to attribute behavior functions of ToM seem to be less culture‐dependent.
to external and situational cues.
Nevertheless, this conclusion can be questioned based on
3.1.2 | Studies on clinical and
the methodology used in the above‐mentioned studies. Some
subclinical samples
have suggested that cultural differences may stem from the
specific type of FB task (e.g., Yazdi, German, Defeyter, & Several studies point to delayed development of ToM in indi-
Siegal, 2006). Others have criticized the assessment of ToM viduals with autistic spectrum disorders (ASD) from collec-
using FB tasks altogether, due to the overly simplistic nature tivistic cultures. For example, Sotgiu et al. (2011) examined
of these tasks (Bloom & German, 2000). Indeed, when more children diagnosed with ASD from Cuba and Italy. Using FB
sophisticated methodology is used, a more complex picture tasks, they found that children with ASD in both cultures had
emerges. For example, studies relying on Wellman and Liu's a similar delay in their ToM development compared with typi-
(2004) scale—which consists of five separate tasks to assess cally developing children. These results are not limited to the
ToM—demonstrate different sequences in the developmental use of FB tasks. Similar findings emerged in an Indian sam-
trajectory of ToM in children from individualistic and collec- ple of children with ASD in a study that used Baron‐Cohen
tivistic cultures (Shahaeian, Peterson, Slaughter, & Wellman, et al. (2001) RME test (Rudra, Ram, Loucas, Belmonte, &
2011; Wellman, Fang, Liu, Zhu, & Liu, 2006). It is interest- Chakrabarti, 2016) and in a Chinese sample in which the
ing to note that the ability of children from collectivistic cul- Wellman and Liu (2004) scale was used to assess the devel-
tures to understand the lack of knowledge of others preceded opmental trajectory of ToM (Zhang, Shao, & Zhang, 2016).
their ability to understand diverse beliefs between self and
others, whereas the opposite developmental order was found
3.1.3 | Studies on mediating factors
in children from individualistic cultures.
This culture‐specific sequence was later replicated in sev- Several explanations have been suggested for these cross‐cul-
eral other collectivistic cultures (see study numbers 12 and 41 tural findings. Some have focused on the role of language,
in Table S1) and has also received important support in two showing that linguistic differences may stand behind the ob-
longitudinal studies (Tsuji, 2011; Wellman, Fang, & Peterson, served cultural differences in FB understanding. For example,
2011), thus strengthening the possibility of culture‐specific Shatz, Diesendruck, Martinez‐Beck, and Akar (2003) found
developmental pathways in acquiring an understanding of that linguistic differences in lexical explicitness—namely, lan-
mental states. Furthermore, a cross‐cultural comparison of guages that contain specific verbs for falsely believing some-
each separate stage revealed that apart from a different se- thing—affect children's performance on FB tasks. Turkish
quence within each culture, different timing for the acquisition and Puerto Rican Spanish, languages with explicit terms for
of each stage was documented between cultures. Specifically, FB, facilitated children's performance on FB tasks (compared
understanding the lack of knowledge of others among children with children who speak Brazilian Portuguese or English, lan-
from collectivistic cultures not only preceded different stages, guages without such explicit terms). Another linguistic factor
but also developed faster than among their peers from individ- found to affect ToM is the existence in a language of gram-
ualistic cultures (Shahaeian et al., 2011). maticalized epistemic concepts (i.e., whether the language has
Other studies, however, that focused on nonverbal tasks grammatical means of marking one's certainty about beliefs;
to assess ToM tend to show a somewhat different pattern Matsui, Rakoczy, Miura, & Tomasello, 2009).
of results. Wang, Low, Jing, and Qinghua (2012) tested Several other studies point to the role of parenting.
Chinese preschoolers with two FB tasks (unexpected Kuntoro, Peterson, and Slaughter (2017), for example,
transfer task and unexpected content task). Aside from found that in a collectivistic, Indonesian sample, authori-
the children's verbal judgments on these tasks, Wang et tarian parenting style was linked to children's slower ToM
al. (2012) examined anticipatory looking among the chil- development (yet see also study number 51 in Table S1
dren by measuring eye gaze. The results showed a clear for somewhat conflicting results). Another study focused
dissociation between verbal and nonverbal understand- on a different aspect of parenting—parents' use of mental
ing. Unlike their verbal judgments, children showed ac- state language. The study found that the preference among
curate anticipatory looking across all FB tasks. Similarly, middle‐class, Western parents for causally elaborated
Moriguchi, Okumura, Kanakogi, and Itakura (2010) found mental state language is linked to their children's ToM
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capacity (Ebert, Peterson, Slaughter, & Weinert, 2017). Some cross‐cultural comparisons show that people from
Lastly, Hughes, Devine, and Wang (2017) examined par- collectivistic cultures tend to exhibit higher empathic con-
ent–child dyads from Hong‐Kong and the United Kingdom. cern than people from individualistic cultures. For example,
Alongside measuring children's ToM, these researchers a large‐scale study that surveyed 104,365 adults across 63
measured parents' “mind‐mindedness” (i.e., the proclivity countries found that people from collectivistic countries tend
to view one's child as a mental agent; Meins et al., 2002). to report higher levels of empathic concern than people from
In line with previous studies, Hughes et al. (2017) found individualistic cultures (Chopik, O’Brien, & Konrath, 2016).
that Chinese children tend to have a significant delay in This result is not limited to the use of self‐report question-
FB understanding compared to their peers from the UK. naires. The results of several cross‐cultural neuroimaging
Nonetheless, parental mind‐mindedness was positively as- studies that exposed participants to stimuli of the physical
sociated with ToM in both cultures and mediated the ob- and social pain of others are consistent with these findings.
served cultural difference in ToM between cultures. For example, compared to Americans, Korean participants
reported greater empathy and revealed stronger brain activity
in a region associated with mental state inference (the left
3.1.4 | Summary
temporo‐parietal junction; Cheon et al., 2010). Likewise,
A large number of studies indicate cultural differences in upon exposing participants to a similar stimulus, Cheon et
ToM ability. As can be seen in Table 2 that summarizes the al. (2013) found that a tendency to be more other‐focused is
results, 16 out of 20 studies indicated that children from col- associated with stronger activity within the affective pain ma-
lectivistic cultures exhibit a delay in their FB understanding. trix (the anterior cingulate cortex and insula) among Korean
These results can be interpreted as indicating lower (general) Americans than among Caucasian Americans.
mentalizing in collectivistic cultures; nonetheless, seven Nevertheless, other studies show conflicting results.
studies that used Wellman and Liu's scale to assess ToM in- Melchers et al. (2016), for example, found that German stu-
dicated that people in collectivistic cultures have a different, dents tend to report higher empathy levels than Chinese.
not necessarily delayed, course of development of ToM. In Additionally, relying on a sample of adolescents and young
adults, there were mixed findings, as two studies that used adults, Cassels, Chan, and Chung (2010) distinguished be-
the RME task had conflicting results. Two additional studies tween the two types of affective empathy: participants' self‐
indicated that cultural differences seem to be more apparent report measures of empathic concern and their personal
in the verbal (i.e., explicit) function of ToM, as opposed to distress in response to others' negative emotions. The results
the nonverbal (i.e., implicit) function. With respect to our indicated that East Asians had lower empathic concern than
second question of interest, concerning factors that can ex- those from individualistic cultures, but on the other hand East
plain observed cultural differences, nine studies indicated Asians scored higher on personal distress than their Euro‐
the mediating role of linguistic variables, and six additional American peers (see also study number 68 in Table S1 for
studies support parenting characteristics as a potential me- similar results). Atkins, Uskul, and Cooper (2016) examined
diator (of particular relevance to the developmental model similar variables using a different methodology. After watch-
of mentalizing, parents' tendency to think of their child in a ing video clips depicting physical and social pain, a British
mentalistic manner was associated with ToM development group reported higher empathic concern and higher personal
across cultures). Lastly, and with respect to our third ques- distress than an East Asian group. Yet when compared with
tion of interest on ToM's link with psychopathology, three affective aspects of empathy, cultural differences in cognitive
studies indicated that children from collectivistic cultures empathy went in the opposite direction: British students were
with a diagnosis of ASD had a delay in ToM development. less accurate in inferring the mental states of others than their
East Asian counterparts (see study number 76 in Table S1 for
similar results; but see also study number 72 for an important
3.2 | Empathy and perspective‐taking
distinction between close versus nonfamiliar others).
Cultural comparisons in PT or cognitive empathy reveal
3.2.1 | Studies on healthy samples
fewer conflicting results. Upon examining actual interactions
The difficulty people experience in empathizing with out‐ in a communication task, Wu and Keysar (2007) found that
group members has been extensively studied (e.g., Cikara, Chinese adults have a greater ability to consider the perspec-
Bruneau, & Saxe, 2011). This dominant line of research is tive of others than Americans. Several replications of these
also evident in the cross‐cultural study of empathy, which results have led to the conclusion that whereas Westerners
documents people's lower empathic responses toward indi- tend to show an egocentric bias with regard to their ability for
viduals from other cultures (Adams et al., 2010). Only later PT, East Asians show another‐oriented bias (Kessler, Cao,
did the possibility that empathy itself is a culturally shaped O’Shea, & Wang, 2014, see also Bradford et al., 2018). The
phenomenon attract researchers' attention (Hollan, 2012). aggregation of findings therefore shows that Easterners have
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a clear advantage in their PT ability compared to Westerners. similar, as all studies have medium effect sizes (see Table
These finding also received support in an experimental de- S2). Studies breaking affective empathy into subcompo-
sign. Luk, Xiao, and Cheung (2012) showed that culture nents, (e.g., empathic concern and personal distress), tend
affected the ability to take another person's perspective: to reveal that people from collectivist cultures report higher
Bicultural individuals made more errors in PT after priming personal distress than people from individualistic cultures.
with individualistic cultural icons than with Chinese icons. With respect to our second question of interest, concerning
factors that can explain observed cultural differences, three
studies found linguistic characteristics and value prefer-
ences as mediating factors. Lastly, and with respect to our
subclinical samples
third question of interest concerning psychopathology, two
We found very few cross‐cultural studies on empathy and studies indicated lower empathy in children from collectiv-
PT in clinical populations, yet these lend support for the re- istic cultures with a diagnosis of ASD, compared to healthy
lationship between deficits in empathy and ASD in collec- controls.
tivistic samples. For example, Wakabayashi et al. (2007)
found that Japanese adults diagnosed with ASD scored sig-
3.3 | Alexithymia
nificantly lower on a self‐report measure of empathy (the
EQ; Baron‐Cohen & Wheelwright, 2004) than the general
population and healthy university student controls.
Cultural investigations using the TAS‐20 have consistently
found higher alexithymia scores in healthy samples from
3.2.3 | Studies on mediating factors
collectivistic cultures than in those from individualistic cul-
Cheon et al. (2013) suggested that the psychological pro- tures. Specifically, cultural comparisons have yielded higher
cesses underlying PT and empathy are to a large extent alexithymia scores in healthy adults from China (Zhu et al.,
culturally dependent: Since socialization and value prefer- 2007), Japan (Fukunishi, Nakagawa, Nakamura, Kikuchi,
ences in collectivistic cultures encourage relatedness and & Takubo, 1997), Korea (Lee, Rim, & Lee, 1996), India
influence individuals to be more other‐oriented, they are (Pandey, Mandal, Taylor, & Parker, 1996), and Peru (Loiselle
more prone to take others’ perspective and empathize with & Cossette, 2001). Likewise, a comparison between two col-
others’ emotions. This led some researchers to conclude lectivistic cultures in Chile—rural‐indigenous and urban‐
that people from collectivistic cultures may be less egocen- Hispanic—found higher alexithymia in indigenous people
tric (Kessler et al., 2014). However, using a sophisticated (Kamm, Sepulveda, & Brosig, 2016). In contrast, however,
time‐series analysis of an eye‐tracking measure, Wu, Barr, a comparison between Aboriginal and non‐Aboriginal sam-
Gann, and Keysar (2013) showed that Chinese individuals ples in Canada found only a small, nonsignificant difference
in fact tend to have egocentric interference similar to that (Parker, Shaughnessy, Wood, Majeski, & Eastabrook, 2005).
of Americans during the first moments of a PT task, yet
they managed to suppress this interference earlier and more
effectively.
subclinical samples
Unlike in the case of ToM, empathy, and PT, cultural studies
3.2.4 | Summary
on alexithymia and psychopathology are prevalent. Although
It seems that people from collectivistic cultures tend to be most focus on a single collectivistic culture sample (i.e., they
more other‐oriented than people in individualistic cultures, lack an individualistic comparison group) and are therefore
as East Asians were found to have better PT ability (four somewhat limited, they generally seem to support the re-
out of five studies) and showed better performance on em- lationship between pathology and alexithymia. For exam-
pathic accuracy tasks (three studies) than Euro‐Americans. ple, alexithymia was found to be positively associated with
However, when comparing people's emotional reactiv- psychosomatic symptoms (Chunfang, Chankuan, & Zhang,
ity (i.e., affective mentalizing), a more complex picture 1993), somatization (Chio & Zaroff, 2015), and depressive
emerges. Two studies—including one large‐scale study— symptoms (Zhu, Hu, & Yi, 2005) in Chinese samples. Similar
showed that people in collectivistic cultures tend to report links were found between alexithymia and depressive symp-
on higher empathic concern than people in individualistic toms in Korean (Kim et al., 2008) and Japanese (Kojima,
cultures, yet three different studies showed the opposite Senda, Nagaya, Tokudome, & Furukawa, 2003) samples,
pattern of results. One additional study found a higher gen- and with eating disorder symptoms in a Japanese sample
eral level of self‐report empathy in an individualistic cul- (Sasai, Tanaka, & Hishimoto, 2010; but see study number
ture. The strength of these conflicting results is generally 81 in Table S1 for conflicting results). Similarly, focusing on
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North Korean adult refugees living in South Korea, Park et externally oriented thinking was negatively predicted by
al. (2015) found that two subscales of the TAS‐20 question- modernization and Euro‐American values, difficulty in iden-
naire (difficulties in identifying and in describing feelings) tifying and in describing feelings was not related to cultural
moderated the link between number of reported traumatic values. Indeed, studies that distinguished between alexithy-
experiences and symptoms of PTSD. Other studies linking mia components in psychopathology are compatible with
alexithymia to nonsuicidal self‐harm in Korea (Lee, 2016), to this study. For example, externally oriented thinking was not
Aboriginal offenders (Parker et al., 2005), and to alcoholism related to psychosomatic symptoms in Chinese (Chunfang et
in Turkish outpatients (Uzun, 2003) provide further support al., 1993) or in Japanese (Nakao, Barsky, Kumano, & Kuboki,
for the association between alexithymia and psychopathol- 2002) participants. Likewise, this component was unrelated
ogy in collectivistic cultures. to PTSD symptoms in a Korean sample (Park et al., 2015).
3.3.3 | Possible explanations for the cultural 3.3.4 | Summary

findings on alexithymia
There is robust evidence that people from collectivistic cul-
An early explanation for the observed differences in alex- tures tend to have a higher rate of alexithymia than people
ithymia between cultures focused on parental emotion from individualistic cultures, with 11 studies supporting this
socialization, namely—parents' practices with respect conclusion. As alexithymia mainly overlaps with self‐men-
to their children's regulation and expression of emotions talizing, these results further support the supposition that
(Eisenberg, Cumberland, & Spinrad, 1998). In a compari- people from collectivistic cultures focus less on their own
son between European‐American, Asian American, and mental states, in comparison with individualistic cultures.
Malaysian healthy adult samples, Le, Berenbaum, and With respect to our second question of interest, concerning
Raghavan (2002) found higher alexithymia levels in both factors that can explain observed cultural differences, four
Asian groups. However, participants' retrospective reports studies support the notion that value preferences explain cul-
on parental socialization of emotions—such as parents' tural differences found in alexithymia, and two additional
tendency to verbalize negative and positive emotions—me- studies indicated parenting characteristics (e.g., parental
diated cultural differences found in alexithymia (see study emotion socialization) as another potential mediator. Lastly,
number 99 in Table S1 for similar results concerning pa- and with respect to our third question of interest concerning
rental perceived overprotection). the concept's link with psychopathology, 14 out of 15 studies
A second explanation for the cultural differences in alex- found alexithymia to be positively associated with psychopa-
ithymia focuses on value preferences. The rationale for this thology in collectivistic cultures, although this link usually
explanation relies in part on a critical understanding of alex- does not include the externally oriented thinking component
ithymia from culture–sensitive approaches, as some have of alexithymia.
criticized alexithymia for being an ethnocentric concept
heavily rooted in Western values and norms (e.g., Kirmayer,
3.4 | Mindfulness
1987). This claim has received support in a comparison be-
tween healthy Canadian and Chinese adults: Chinese were
found to have higher alexithymia (specifically the externally
oriented thinking component of alexithymia). Nevertheless, Originally rooted in Eastern thinking, some theoretical cri-
the level of endorsement of Western values fully mediated the tiques were made on the Westernization of mindfulness—
link between cultural affiliation and alexithymia (Dere, Falk, as it has been suggested that essential meanings were lost
& Ryder, 2012). Examinations of Asian values in mediating when the concept was adopted in the West (e.g., Sharf,
cultural differences in alexithymia yielded similar results. 2015). Indeed, an examination focusing on measurement
Confucian values (e.g., respect for social order) mediated invariance of several mindfulness measures was unable to
the cultural differences found in alexithymia scores between establish equivalence across American and Thai students
Asian and non‐Asian Canadians (Lo, 2014). (Christopher, Charoensuk, Gilbert, Neary, & Pearce, 2009).
How can these findings be reconciled with the fact that Authors concluded that different cultures might have a dif-
alexithymia was found to be positively associated with vari- ferent conceptualization of mindfulness, thus compounding
ous psychopathologies in collectivistic samples? A possible the risk of comparing apples with oranges in cross‐cultural
solution may be related to the multifaceted nature of alexithy- examinations of this concept.
mia. The association between alexithymia and values seems Nonetheless, a different study showed somewhat different
to be limited to the externally oriented thinking component of results. Examining Iranian and American students, Ghorbani,
alexithymia. Focusing on a Chinese clinical sample of outpa- Watson, and Weathington (2009) showed overall adequate
tients with depression, Dere et al. (2013) found that whereas invariance between cultures. Similarly, using the FFMQ,
|
Raphiphatthana, Jose, and Chobthamkit (2018) established Further elaboration on specific conflicting results from stud-
measure invariance between students from New Zealand and ies using self‐report measures of affective empathy is depicted
Thailand. This study also indicated interesting differences be- in Table S2. Individual studies' key findings, methodological
tween mindfulness aspects across cultures: Students from New characteristics, and risk of bias are presented in Table S1.
Zealand reported higher levels of nonjudging and describing
(i.e., noting internal experiences with words), yet lower levels of
acting with awareness, relative to Thai students. There were no 4 | DISCUSSION
cultural differences in other mindfulness aspects (i.e., nonreact-
ing and observing) and in students' overall mindfulness score. In this paper, we endeavored to make the case that mentaliz-
In a different study, however, American students were found to ing should be examined cross‐culturally, and to offer possible
have higher overall mindfulness than Turkish students (Özyeşil, directions in doing so. To this end, we distinguished between
2012), yet measure invariance was not established in this study. three questions of interest concerning (a) cultural variations
in mentalizing, (b) the potential mediators for the relation-
ship between culture and mentalizing, and (c) the relation-
ship between mentalizing and mental health across cultures.
subclinical samples
Then, we outlined some possible directions in answering
Using the FFMQ, Deng, Liu, Rodriguez, and Xia (2011) those questions while referring to basic theoretical orienta-
found that Chinese students that reported lower levels of tions in the cross‐cultural field: universalism, relativism, and
describing, acting with awareness, nonjudging, and non- an intermediate approach between the two. Finally, we sys-
reacting, had higher levels of self‐reported depression and tematically reviewed empirical cross‐cultural studies on five
anxiety. However, observing was unrelated to depression or concepts that overlap with mentalizing: ToM, empathy, PT,
anxiety; this scale also had a small yet significant positive re- alexithymia, and mindfulness.
lation with general psychological and symptomatic distress. The results of this review have several points of concern.
In a different study, Fung, Guo, Jin, Bear, and Lau (2016) First and foremost, an ample body of evidence indicates sub-
found that a 12‐week mindfulness intervention resulted in a stantial cultural variations in all five overlapping concepts.
reduction of externalizing problems in Latino‐American and These findings, taken from cross‐cultural examinations
Asian American middle‐school students. This intervention across more than 45 cultures, seem to support the general
included mindful‐of‐thought and emotion modules; yet, since premise of this paper, as they emphasize the need to address
a measure of various aspects of mindfulness was not reported, mentalizing from a cultural perspective: It is evident that we
it is difficult to conclude whether positive results are due to cannot simply assume that people across cultures have a sim-
mentalizing similar aspects of mindfulness. A randomized ilar ability, or need, to perceive internal mental states. At the
controlled trial of mindfulness intervention targeting Chinese same time, however, cultural variations in overlapping con-
and British healthy adults showed similar results (Ivtzan et cepts are also somewhat conflicting. Moreover, as will be de-
al., 2018): In both cultures, there was a significant reduction scribed below, some inconsistencies in methodology between
in reported negative affect in the intervention groups, com- studies limit the interpretation of the results. Thus, overall,
pared with wait‐list control groups. A measure of different the results portray a complex picture. We consider the follow-
mindfulness aspects was not included. ing conclusions drawn from it not as answers to the questions
raised above, but rather as potentially fruitful directions for
future investigations.
3.4.3 | Summary
Despite its unique cultural roots, cross‐cultural investigations
4.1 | Possible cultural variations in
of mindfulness are scant. An ongoing debate on the similarity
mentalizing profile
of the concept's meaning across cultures makes the existing
results from two studies difficult to interpret. The associations When the results are integrated across all five concepts, while
of mindfulness with psychopathology show mixed results (1 taking into account each concept's specific overlap with the
study), and mindfulness‐based interventions in collectivistic dimensions of mentalizing, the findings can be schemati-
populations show positive results, yet these are difficult to cally summarized as follows: (a) People from individualistic
interpret in terms of mentalizing (2 studies). cultures tend to focus more on mental states within the self
than on the mental states of others. In contrast, people from
collectivistic cultures tend to focus more on others' mental
3.5 | General summary
states than on their own. Furthermore, (b) there is evidence of
The results taken from cross‐cultural studies on ToM, empathy, cultural variations in the way in which people from different
PT, alexithymia, and mindfulness are summarized in Table 2. cultures tend to perceive mental states; some evidence points
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to higher emotional reactivity in people from collectivistic These findings can help in addressing the second question
than in individualistic cultures (e.g., higher empathic concern concerning explanatory factors for cultural variations in men-
in collectivistic cultures; Chopik et al., 2016), yet these find- talizing. First, linguistic factors were found to be a possible
ings are inconsistent, as some studies indicate the opposite explanation for cultural differences in ToM. Specifically,
(e.g., Atkins et al., 2016). Lastly, (c) the observed cultural these factors include differences in lexical explicitness (i.e.,
differences, especially with respect to ToM, seem to be more whether a language contains specific verbs for falsely be-
apparent in verbal (i.e., explicit) measures than in nonverbal lieving something; Shatz et al., 2003) or in grammaticalized
(implicit) ones. epistemic concepts (i.e., whether a language has grammati-
These results can help in addressing the first question con- cal means of marking one's certainty about beliefs; Matsui et
cerning variations in mentalizing across cultures. In light of al., 2009). A second relevant factor seems to be value prefer-
the conceptualization of mentalizing as a multidimensional ences. Relying on a relativist approach, studies that examined
construct, these findings raise the possibility that individuals the role of values in alexithymia indicate that cultural dif-
in different cultures tend to differ in their mentalizing profiles. ferences in alexithymia are mediated through people's value
More specifically, the findings indicate that higher mentalizing preferences—both Western values (e.g., Dere et al., 2012)
ability regarding the self than regarding others may be more and Eastern values (e.g., Lo, 2014).
prevalent in collectivistic cultures, whereas people from indi- However, the nature of the relationship between values
vidualistic cultures may exhibit an opposite pattern. It is also and mentalizing is not yet sufficiently understood. With re-
possible that people from collectivistic cultures rely more on spect to alexithymia, for example, it is still unclear why only
affective than on cognitive mentalizing. Nonetheless, the data its externally oriented thinking aspect is related to value pref-
concerning cognitive–affective mentalizing are not consistent: erences, while other aspects (i.e., difficulties in identifying
Studies have overall mixed results and, moreover, vary consid- and in describing feelings) are not (Ryder, Sunohara, Dere,
erably in terms of methodology (e.g., self‐report, performance‐ & Chentsova‐Dutton, 2018). In our opinion, further pursuing
based tasks and neuroimaging studies, not all of which allow to the mediating role of values is of particular importance, as
separate cognitive–affective from self‐other mentalizing). it enables a more in‐depth understanding that goes beyond
Additionally, it seems that the degree of these cultural dichotomous comparisons between “Western” and “Eastern”
variations (i.e., level of cultural effect on mentalizing) may cultures. Furthermore, such examinations can help in ex-
depend upon the implicit–explicit dimension of mentalizing. tracting the “active cultural ingredients” (Matsumoto & Yoo,
This notion is consistent with Heyes and Frith's (2014) in- 2006) responsible for cultural variations, by linking observed
fluential account concerning cultural variations in people's cultural differences in mentalizing with specific cultural as-
mind‐reading ability. These researchers suggest that when pects (e.g., values) that may account for those differences.
interpreting cross‐cultural findings on mind‐reading ability, Lastly, several studies have examined the role of parental
a distinction should be made similar to the implicit–explicit practices and characteristics. Naturally, these studies are of
dimension in mentalizing: Cultural variations are more sig- particular relevance to the model of mentalizing, as it empha-
nificant in the explicit capacity—namely in the effortful, sizes the influence of attachment figures on the development
slow, and verbal aspects of people's mind‐reading. Yet when of mentalizing (Fonagy et al., 2002). For example, Le et al.
we observe people's automatic, fast, and nonverbal ability to (2002) found that parental emotion socialization mediates
perceive mental states, it seems that the influence of culture cultural differences in alexithymia. Likewise, parents' use of
becomes less prominent. mentalistic language (Ebert et al., 2017) as well as parental
Overall, then, the results are compatible with the above‐ mind‐mindedness (Hughes et al., 2017) mediated differences
mentioned intermediate perspective, whereby mentalizing is in ToM between cultures. Hence, it seems that whereas cul-
seen as a fundamental and basic human ability across cultures may differ in the mentalizing profiles of their members,
tures, yet individuals in diverse cultures tend to exhibit differ- the role of parenting in the development of mentalizing may
ences in their mentalizing profile. Mind reading can therefore be universal.
be seen as similar to print reading (Heyes & Frith, 2014): There are therefore good reasons to postulate that paren-
based on fundamentally similar brain mechanisms across cul- tal mentalizing, or mind‐mindedness, is related to the devel-
tures, yet heavily influenced by each culture's language(s), opment of mentalizing in collectivistic cultures. However,
and its unique literacy practices. is parental mentalizing also related to epistemic trust across
cultures? Fonagy and his collaborators have suggested
that feeling understood within the specific context of a se-
4.2 | Potential mediators for the relationship
cure attachment relationship, by an attachment figure that
between culture and mentalizing
can keep the child's mind in mind, is a key factor in the es-
A modest yet growing body of empirical data points to several tablishment of epistemic trust (Fonagy & Allison, 2014).
factors that are related to the observed cultural differences. Nonetheless, a cultural perspective raises the possibility that
|
the suspension of epistemic mistrust may be dependent not as a prevailing way to experience and express distress (i.e.,
only on accurate mentalizing and ostensive cueing from an idiom of distress; Keyes & Ryff, 2003) in collectivistic
attachment figure (Fonagy et al., 2015), but also on norms cultures might question this conclusion. As people from
and social roles, most notably—filial piety and respect. Thus, diverse cultures differ in the way they experience and com-
we believe that future research can benefit from addressing municate psychopathology (e.g., somatic symptoms in the
the role of respect, alongside trust, on social learning and East and psychological symptoms in the West; Ryder et al.,
communication across cultures. 2008), somatization and mentalizing might be seen merely
To conclude, when the results are integrated across all as different idioms of distress (see Ryder, Yang, & Heine,
mediating factors, they seem to lend further support to an 2002). Therefore, we believe that overall, despite the exis-
intermediate view of mentalizing. The relationship between tence of preliminary positive evidence, the results mainly
culture and mentalizing appears to be a complex one, com- underscore the need for further research on mentalizing
prising both universal and culture‐dependent aspects. Hence, and mental health across cultures.
future studies should go beyond the universalism–relativism
debate in examining mentalizing across cultures by taking
4.4 | Methodological considerations for
into consideration the interplay between universal and cul-
further research
ture‐dependent factors.
Before concluding this discussion, we would like to high-
light several points regarding methodology. First, this
4.3 | Mentalizing as a possible mechanism of
review emphasizes that future research should entail: (a)
mental health across cultures
studies that focus on clinical populations, specifically—
Cross‐cultural findings on the relationship between the using performance‐based measure(s) of mentalizing; (b)
overlapping concepts of mentalizing and mental health are studies that rely on an experimental design (e.g., by using
lacking. Most of the existing studies focus on alexithymia culture‐priming; see Luk et al., 2012); and lastly, (c) “un-
and mindfulness, and many include only a within‐culture packing‐studies” (Matsumoto & Yoo, 2006) that focus on
examination and rely merely on self‐report measures. Thus, factors that can explain cultural differences. The lack of the
the third question concerning the generality of the link be- latter is most notable regarding mindfulness. Second, we
tween mentalizing and psychopathology across cultures can encourage future research to pay specific attention to rigor-
only be considered on a limited basis. Nonetheless, it seems ous cultural adaptation of measures, with respect to the fol-
that the majority of the existing studies tend to support the lowing: (a) proper translation of self‐report questionnaires
link between overlapping concepts and mental health in col- (see Beaton, Bombardier, Guillemin, & Ferraz, 2000 for
lectivistic cultures. Alexithymia was found to be associated a detailed account of the translation process); (b) ensur-
with eating disorders (Sasai et al., 2010), psychosomatic dis- ing validation of tools in the relevant culture(s); (c) estab-
orders (Chunfang et al., 1993), depression (Kim et al., 2008; lishing measure invariance (see Boer, Hanke, & He, 2018
Zhu et al., 2005), PTSD (Park et al., 2015), and nonsuicidal for a review that includes novel, less strict approaches for
self‐harm (Lee, 2016) in various collectivistic samples. testing invariance); and lastly, (d) using a multimethod ap-
Consistent with these studies, cross‐cultural mindfulness in- proach for measurement, in order to overcome the limita-
tervention programs show positive preliminary results (Fung tions of self‐report questionnaires (e.g., cultural differences
et al., 2016; Ivtzan et al., 2018). Similarly, there is evidence in response style; Smith et al., 2016). We further highlight
of deficiencies in ToM and empathy in people diagnosed below relevant aspects of cultural adaptation, with respect
with ASD from collectivistic cultures (e.g., Rudra et al., to several key measures.
2016; Wakabayashi et al., 2007).
These studies are not consistent with the relativist per-
4.4.1 | Self‐report measures
spective that sees deficits in mentalizing as culture‐de-
pendent. In other words, they lend preliminary support There are numerous self‐report questionnaires for the evalu-
for cultural generality in the link between mentalizing and ation of concepts that overlap with mentalizing (see Luyten
mental health. Taking a different perspective, known ele- et al., 2012 for a detailed summary); of these, it seems that
vated levels of somatization in collectivistic cultures (e.g., the TAS in its 20‐item version (TAS‐20; Bagby et al., 1994)
Kirmayer & Young, 1998) can be interpreted as further is the most widely used in cultural contexts. The TAS‐20
supporting this possibility. If people from collectivistic was translated into multiple languages and was validated
cultures consistently show both higher levels of alexithy- in a large number of cultures (see Taylor et al., 2003 for a
mia and somatization, it can follow that affective self‐ review). Additionally, several studies have established the
mentalizing is indeed related to psychopathology in these TAS‐20's invariance (e.g., Dere et al., 2012). These make the
cultures. Nonetheless, a conceptualization of somatization TAS‐20 an appropriate choice for conducting cross‐cultural
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examinations of mentalizing. Nonetheless, concerns have clinical experience in working with clients from traditional
been made with respect to the externally oriented think- and collectivistic societies, we have learned that an invitation
ing factor, as this subscale tends to have low internal con- to focus on thoughts and feelings—especially, with respect to
sistency in collectivistic populations (Ryder et al., 2018). attachment figures—can sometimes be experienced by cli-
Additionally, as the TAS‐20 focuses on alexithymia, it does ents as far from their world, irrelevant, or even offensive. In
not enable a comprehensive evaluation of mentalizing as a other words, a culturally insensitive mentalistic talk can make
multidimensional concept. We therefore encourage future it difficult to establish epistemic trust, as it can be seen as a
studies to rely on a combination of measures that encompass violation of filial respect. It is not our intention that we should
several aspects of mentalizing alongside with the TAS‐20. refrain from talking with clients from collectivistic cultures
about mental states; instead, we wish to encourage clinicians
to adopt a general stance of awareness about cultural aspects
4.4.2 | Performance‐based measures
of mentalizing in practice.
Investigations of ToM rely almost exclusively on perfor- Good mentalizing relies on the ability to understand others
mance‐based measures, out of which FB tasks are most no- in a nonegocentric manner; when mentalizing properly, we
table. However as mentioned, classic FB tasks are limited in acknowledge that people's minds are basically opaque, and
evaluating ToM in cultural contexts; it seems that other tools, therefore, we can only assume when trying to perceive others'
such as Wellman and Liu's (2004) scale—which consists of thoughts, emotions, and intentions (Fonagy et al., 1996). A
five separate tasks to assess ToM, and was developed spe- basic stance of unknowing, alongside interest and curiosity,
cifically with reference to cultural contexts—are more suit- is therefore considered to be the hallmark of good mentaliz-
able for cross‐cultural research. The RME test (Baron‐Cohen ing (Bateman & Fonagy, 2012). We would like to offer that
et al., 2001) is also widely used in cross‐cultural investi- we need to adopt a similar approach in our practice: a noneth-
gations. However, the use of this tool specifically demon- nocentric view of people's minds across cultures, aware of its
strates the importance of a rigorous cultural validation: using limited perspective, but which is nonetheless curious about
Caucasian‐eyes stimuli in cross‐ethnic comparisons (e.g., clients' unique cultural meanings concerning mentalizing.
Dehning et al., 2013) raises concerns with respect to valid-
ity, due to in/out‐group bias. It is therefore preferable to use
4.6 | Limitations
adapted versions of the RME (see Adams et al., 2010 for a
Japanese version), or similar tools that include ethnic and This review has several limitations. First, it does not include
culturally diverse stimuli (e.g., the Cambridge Mindreading a meta‐analytic comparison, as studies vary considerably in
Face‐Voice Battery; Golan, Baron‐Cohen, & Hill, 2006). terms of conceptual definition and methodology. Second, it
is based on five concepts that overlap with mentalizing and
studied cross‐culturally; other concepts (e.g., psychological
4.5 | Clinical implications
mindedness), which did not receive much cross‐cultural at-
There is a widespread consensus on the necessity of a cultur- tention, were not included in this review. Despite significant
ally sensitive approach in psychotherapy, both in terms of similarities between mentalizing and included overlapping
ethics (Sue, Arredondo, & McDavis, 1992; Sue & Sue, 2012) concepts, there are some differences: mentalizing pays spe-
and treatment efficacy (e.g., Roysircar, 2009). Although a de- cific attention to an individual's ability to mentalize in situ-
tailed account on MBT's cultural sensitivity goes beyond the ations that involve emotional arousal, especially with regard
scope of this paper, we wish to offer some preliminary impli- to attachment figures (Luyten et al., 2012). Additionally, the
cations for clinical practice. First, cultural complexities con- model distinguishes between different types of impairment in
cerning mentalizing are highly relevant to the assessment of mentalizing (e.g., under‐mentalizing and hyper‐mentalizing)
mentalizing in clinical context. The evaluation of a mental- and links each of them to different types of pathology (Sharp
izing profile is an important first step of MBT (Luyten et al., & Venta, 2012). It is therefore important that future cross‐cul-
2012); we encourage clinicians to consider clients' cultural tural studies will culturally validate and use tools that were
background when doing so. Most notably, mentalizing pro- originally designed to measure mentalizing, such as the RF
files should be understood with reference to clients' cultural scale; (Fonagy et al., 1996) and the Reflective Functioning
background (e.g., lower self‐mentalizing in collectivistic cul- Questionnaire (RFQ; Fonagy et al., 2016).
tures) and should not necessarily be equated with pathology.
Second, and more broadly, we believe that lack of knowl-
4.7 | Summary and conclusions
edge on a culture's specific norms and values concerning
mentalizing may raise difficulties on the initial establishment Cultural variations found in ToM, empathy, PT, alexithymia,
of the therapeutic relationship. Here, we return to the concept and mindfulness across more than 45 cultures support the no-
of epistemic trust (Fonagy & Allison, 2014). From our own tion that mentalizing should be examined cross‐culturally.
|
An intermediate approach that transcends the two sides of Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer,
the universalism–relativism debate appears to provide a use- S., … Williams, J. M. G. (2008). Construct validity of the Five Facet
ful framework for such examination. The results of the cur- Mindfulness Questionnaire in meditating and nonmeditating sam-
ples. Assessment, 15(3), 329–342. https ://doi.org/10.1177/10731
rent review raise several possibilities that need to be further
91107313003
studied: First, individuals in different cultures seem to vary Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty‐item
in their mentalizing profile; second, linguistic factors, value Toronto Alexithymia Scale—I. Item selection and cross‐validation
preferences, and parenting characteristics might explain these of the factor structure. Journal of Psychosomatic Research, 38(1),
cultural variations. Lastly, data on the relationship between 23–32.
mentalizing and mental health across cultures are limited, yet Baron‐Cohen, S., Fukushima, M., French, D., Hadwin, J., Cross, P., &
preliminary evidence tends to support the mentalizing model. Sotillo, M. (1996). Reading the mind in the face: A cross‐cultural
and developmental study. Visual Cognition, 3(1), 39–60. https://doi.
In concluding this review, it is evident that much remains
org/10.1080/713756728
unknown. We believe that unanswered questions are likely to
Baron‐Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic
yield both valuable clinical implications and significant theo- child have a “theory of mind”? Cognition, 21(1), 37–46. https://doi.
retical contributions. The current paper therefore emphasizes org/10.1016/0010-0277(85)90022-8
the need to keep culture in mind and incorporate cultural Baron‐Cohen, S., & Wheelwright, S. (2004). The empathy quotient:
thinking on mentalizing into research and practice. An investigation of adults with Asperger syndrome or high func-
tioning autism, and normal sex differences. Journal of Autism
and Developmental Disorders, 34(2), 163–175. https ://doi.
ORCID org/10.1023/B:JADD.0000022607.19833.00
Erez Aival-Naveh https://orcid. Baron‐Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001).
The “Reading the Mind in the Eyes” test revised version: A study
org/0000-0001-5072-4427
with normal adults, and adults with Asperger syndrome or high‐
Lily Rothschild‐Yakar https://orcid. functioning autism. Journal of Child Psychology and Psychiatry,
org/0000-0003-3272-9042 42(2), 241–251. https://doi.org/10.1111/1469-7610.00715
Barrett, H. C., Broesch, T., Scott, R. M., He, Z., Baillargeon, R., Wu, D.,
Jenny Kurman https://orcid.org/0000-0001-8192-1749
Laurence, S. (2013). Early false‐belief understanding in traditional
non‐Western societies. Proceedings of the Royal Society of London:
ENDNOTES Biological Sciences, 280(1755), 1–9. https ://doi.org/10.1098/
rspb.2012.2654.
1
A fourth dimension, describing internal versus external mentalizing, Bateman, A. W., & Fonagy, P. (2004). Mentalization‐based treatment
is sometimes also included in the model. As evidence supporting this of BPD. Journal of Personality Disorders, 18(1), 36–51. https://doi.
dimension is somewhat lacking, we follow previous reviews on men- org/10.1521/pedi.18.1.36.32772
talizing (e.g., Choi‐Kain & Gunderson, 2008) and focuses only on the Bateman, A. W., & Fonagy, P. (2008). 8‐year follow‐up of patients treated
self‐other, cognitive–affective, and implicit–explicit dimensions. for borderline personality disorder: Mentalization‐based treatment
2
We chose a relatively high cutoff since the criteria for cultural adaptation versus treatment as usual. American Journal of Psychiatry, 165(5),
proved to be rather strict; for example, only 7 out of 112 studies have 631–638. https://doi.org/10.1176/appi.ajp.2007.07040636
examined measure invariance (this is consistent with a previous review, Bateman, A. W., & Fonagy, P. (Eds.) (2012). Handbook of mentaliz-
indicating that cross‐cultural studies still tend to neglect this examination, ing in mental health practice. Arlington, VA: American Psychiatric
despite its very high importance; Boer, Hanke, & He, 2018). Publishing Inc..
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000).
Guidelines for the process of cross‐cultural adaptation of self‐report
R E F E R E NC E S measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007
632-200012150-00014
Adams, R. B., Rule, N. O., Franklin, R. G., Wang, E., Stevenson, M. Bernal, G., & Sáez‐Santiago, E. (2006). Culturally centered psychoso-
T., Yoshikawa, S., … Ambady, N. (2010). Cross‐cultural read- cial interventions. Journal of Community Psychology, 34(2), 121–
ing the mind in the eyes: An fMRI investigation. Journal of 132. https://doi.org/10.1002/jcop.20096
Cognitive Neuroscience, 22(1), 97–108. https ://doi.org/10.1162/ Berry, J. W., Poortinga, Y. H., Segall, M. H., & Dasen, P. R. (2002).
jocn.2009.21187 Cross‐cultural psychology: Research and applications. New York,
Allen, J. G., & Fonagy, P. (Eds.) (2006). The handbook of mentalization‐ NY: Cambridge University Press.
based treatment. Hoboken, NJ: John Wiley & Sons. Besharat, M. A. (2007). Reliability and factorial validity of a Farsi ver-
Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clini- sion of the 20‐item Toronto Alexithymia Scale with a sample of
cal practice. Arlington, VA: American Psychiatric Publishing. Iranian students. Psychological Reports, 101(1), 209–220. https://
Atkins, D., Uskul, A. K., & Cooper, N. R. (2016). Culture shapes em- doi.org/10.2466/pr0.101.1.209-220
pathic responses to physical and social pain. Emotion, 16(5), 587. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D.,
https://doi.org/10.1037/emo000016 Carmody, J., … Devins, G. (2004). Mindfulness: A proposed opera-
Baer, R. A. (2011). Measuring mindfulness. Contemporary Buddhism: tional definition. Clinical Psychology: Science and Practice, 11(3),
An Interdisciplinary Journal, 12(1), 241–261. https ://doi. 230–241. https://doi.org/10.1093/clipsy.bph077
org/10.1080/14639947.2011.564842
AIVAL-NAVEH et al.
|
19 of 25
Bjornsdottir, R. T., & Rule, N. O. (2016). On the relationship be- and English. Child Development, 75(4), 1155–1170. https ://doi.
tween acculturation and intercultural understanding: Insight from org/10.1111/j.1467-8624.2004.00731.x
the Reading the Mind in the Eyes test. International Journal of Cheung, H., Mak, W., Luo, X., & Xiao, W. (2010). Sociolinguistic
Intercultural Relations, 52, 39–48. https ://doi.org/10.1016/j.ijint awareness and false belief in young Cantonese learners of English.
rel.2016.03.003 Journal of Experimental Child Psychology, 107(2), 188–194. https
Bloom, P., & German, T. P. (2000). Two reasons to abandon the false ://doi.org/10.1016/j.jecp.2010.05.001
belief task as a test of theory of mind. Cognition, 77(1), 25–31. https Chio, P. H., & Zaroff, C. M. (2015). Traditional Chinese medicinal
://doi.org/10.1016/S0010-0277(00)00096-2 herbal tea consumption, self‐reported somatization, and alexithymia.
Boer, D., Hanke, K., & He, J. (2018). On detecting systematic measure- Asia‐Pacific Psychiatry, 7(2), 127–134. https ://doi.org/10.1111/
ment error in cross‐cultural research: A review and critical reflec- appy.12161
tion on equivalence and invariance tests. Journal of Cross‐Cultural Choi‐Kain, L. W., & Gunderson, J. G. (2008). Mentalization: Ontogeny,
Psychology, 49(5), 713–734. https://doi.org/10.1177/0022022117 assessment, and application in the treatment of borderline personal-
749042 ity disorder. American Journal of Psychiatry, 165(9), 1127–1135.
Bradford, E. E., Jentzsch, I., Gomez, J. C., Chen, Y., Zhang, D., & Su, https://doi.org/10.1176/appi.ajp.2008.07081360
Y. (2018). Cross‐cultural differences in adult theory of mind abili- Chopik, W. J., O’Brien, E., & Konrath, S. H. (2016). Differences in
ties: A comparison of native‐English speakers and native‐Chinese empathic concern and perspective taking across 63 countries.
speakers on the self/other differentiation task. Quarterly Journal Journal of Cross‐Cultural Psychology, 48(1), 23–38. https://doi.
of Experimental Psychology, 71(12), 2665–2676. https ://doi. org/10.1177/0022022116673910
org/10.1177/1747021818757170 Christopher, M. S., Charoensuk, S., Gilbert, B. D., Neary, T. J., &
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Pearce, K. L. (2009). Mindfulness in Thailand and the United States:
Mindfulness and its role in psychological well‐being. Journal A case of apples versus oranges? Journal of Clinical Psychology,
of Personality and Social Psychology, 84(4), 822. https ://doi. 65(6), 590–612. https://doi.org/10.1002/jclp.20580
org/10.1037/0022-3514.84.4.822 Chunfang, W., Chankuan, X., & Zhang, N. (1993). Alexithymia in the
Brüne, M., & Brüne‐Cohrs, U. (2006). Theory of mind: Evolution, on- psychosomatic and neurotic patients. Chinese Journal of Nervous
togeny, brain mechanisms and psychopathology. Neuroscience & and Mental Diseases, 2, 1–15.
Biobehavioral Reviews, 30(4), 437–455. https://doi.org/10.1016/j. Cikara, M., Bruneau, E. G., & Saxe, R. R. (2011). Us and them:
neubiorev.2005.08.001 Intergroup failures of empathy. Current Directions in Psychological
Callaghan, T., Rochat, P., Lillard, A., Claux, M. L., Odden, H., Itakura, Science, 20(3), 149–153. https://doi.org/10.1177/0963721411
S., … Singh, S. (2005). Synchrony in the onset of mental‐state rea- 408713
soning: Evidence from five cultures. Psychological Science, 16(5), Csibra, G. (2008). Goal attribution to inanimate agents by 6.5‐month‐
378–384. https://doi.org/10.1111/j.0956-7976.2005.01544.x old infants. Cognition, 107(2), 705–717. https://doi.org/10.1016/j.
Cassels, T. G., Chan, S., & Chung, W. (2010). The role of cul- cognition.2007.08.001
ture in affective empathy: Cultural and bicultural differences. Davis, M. H. (1980). A multidimensional approach to individual dif-
Journal of Cognition and Culture, 10(3), 309–326. https ://doi. ferences in empathy. JSAS Catalog of Selected Documents in
org/10.1163/156853710X531203 Psychology, 10(8), 2–19.
Celikel, F. C., Cumurcu, B. E., Koc, M., Etikan, I., & Yucel, B. (2008). Davis, M. H. (1983). Measuring individual differences in empa-
Psychologic correlates of eating attitudes in Turkish female college thy: Evidence for a multidimensional approach. Journal of
students. Comprehensive Psychiatry, 49(2), 188–194. https://doi. Personality and Social Psychology, 44(1), 113. https ://doi.
org/10.1016/j.comppsych.2007.09.003 org/10.1037/0022-3514.44.1.113
Chasiotis, A., Kiessling, F., Hofer, J., & Campos, D. (2006). Theory Davis, M. H. (2018). Empathy: A social psychological approach. New
of mind and inhibitory control in three cultures: Conflict inhibi- York, NY: Routledge.
tion predicts false belief understanding in Germany, Costa Rica de Greck, M., Shi, Z., Wang, G., Zuo, X., Yang, X., Wang, X., … Han,
and Cameroon. International Journal of Behavioral Development, S. (2011). Culture modulates brain activity during empathy with
30(3), 249–260. https://doi.org/10.1177/0165025406066759 anger. NeuroImage, 59(3), 2871–2882. https ://doi.org/10.1016/j.
Cheon, B. K., Im, D.‐M., Harada, T., Kim, J.‐S., Mathur, V. A., Scimeca, neuroimage.2011.09.052
J. M., … Chiao, J. Y. (2013). Cultural modulation of the neural cor- Decety, J., & Jackson, P. L. (2004). The functional architecture of
relates of emotional pain perception: The role of other‐focusedness. human empathy. Behavioral and Cognitive Neuroscience Reviews,
Neuropsychologia, 51(7), 1177–1186. https ://doi.org/10.1016/j. 3(2), 71–100. https://doi.org/10.1177/1534582304267187
neuropsychologia.2013.03.018 Dehning, S., Gasperi, S., Tesfaye, M., Girma, E., Meyer, S., Krahl, W.,
Cheon, B. K., Mathur, V. A., & Chiao, J. Y. (2010). Empathy as cultural … Siebeck, M. (2013). Empathy without borders? Cross‐cultural
process: Insights from the cultural neuroscience of empathy. World heart and mind‐reading in first‐year medical students. Ethiopian
Cultural Psychiatry Research Review, 32–42. Journal of Health Sciences, 23(2), 113–122.
Cheung, H. (2006). False belief and language comprehension Deng, Y. Q., Liu, X. H., Rodriguez, M. A., & Xia, C. Y. (2011). The
in Cantonese‐speaking children. Journal of Experimental Five Facet Mindfulness Questionnaire: Psychometric properties
Child Psychology, 95(2), 79–98. https ://doi.org/10.1016/j. of the Chinese version. Mindfulness, 2(2), 123–128. https://doi.
jecp.2006.05.002 org/10.1007/s12671-011-0050-9
Cheung, H., Hsuan‐Chih, C., Creed, N., Ng, L., Ping Wang, S., & Dere, J., Falk, C. F., & Ryder, A. G. (2012). Unpacking cultural dif-
Mo, L. (2004). Relative roles of general and complementation lan- ferences in alexithymia: The role of cultural values among Euro‐
guage in theory‐of‐mind development: Evidence from Cantonese Canadian and Chinese‐Canadian students. Journal of Cross‐Cultural
|
Psychology, 43(8), 1297–1312. https://doi.org/10.1177/0022022111 questionnaire. PLoS ONE, 11(7), e0158678. https://doi.org/10.1371/
430254 journal.pone.0158678
Dere, J., Tang, Q., Zhu, X., Cai, L., Yao, S., & Ryder, A. G. (2013). Fonagy, P., & Target, M. (1996). Playing with reality: I. The International
The cultural shaping of alexithymia: Values and externally ori- Journal of Psycho‐Analysis, 77(2), 217–233.
ented thinking in a Chinese clinical sample. Comprehensive Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective‐func-
Psychiatry, 54(4), 362–368. https ://doi.org/10.1016/j.compp tioning manual for application to adult attachment interviews (5th
sych.2012.10.013 version). London, UK: University College London.
Dion, K. L. (1996). Ethnolinguistic correlates of alexithymia: Toward Frith, C., & Frith, U. (2005). Theory of mind. Current Biology, 15(17),
a cultural perspective. Journal of Psychosomatic Research, 41(6), R644–R645. https://doi.org/10.1016/j.cub.2005.08.041
531–539. https://doi.org/10.1016/S0022-3999(96)00295-4 Frith, U., & Frith, C. D. (2003). Development and neurophysiology of
Dixson, H., Komugabe‐Dixson, A. F., Dixson, B. J., & Low, J. (2017). mentalizing. Biological Sciences, 358(1431), 459–473. https://doi.
Scaling theory of mind in a small‐scale society: A case study org/10.1098/rstb.2002.1218
from Vanuatu. Child Development, 89(6), 2157–2175. https://doi. Fukunishi, I., Nakagawa, T., Nakamura, H., Kikuchi, M., & Takubo,
org/10.1111/cdev.12919 M. (1997). Is alexithymia a culture‐bound construct? Validity
Duh, S., Paik, J., Miller, P. H., Gluck, S. C., Li, H., & Himelfarb, I. and reliability of the Japanese versions of the 20‐item Toronto
(2016). ToM and executive function in Chinese preschool chil- Alexithymia Scale and modified Beth Israel Hospital Psychosomatic
dren. Developmental Psychology, 52(4), 582–591. https ://doi. Questionnaire. Psychological Reports, 80(3), 787–799. https://doi.
org/10.1037/a0040068 org/10.2466/pr0.1997.80.3.787
Ebert, S., Peterson, C., Slaughter, V., & Weinert, S. (2017). Links among Fung, J., Guo, S., Jin, J., Bear, L., & Lau, A. (2016). A pilot random-
parents’ mental state language, family socioeconomic status, and ized trial evaluating a school‐based mindfulness intervention for
preschoolers’ theory of mind development. Cognitive Development, ethnic minority youth. Mindfulness, 7(4), 819–828. https ://doi.
44, 32–48. https://doi.org/10.1016/j.cogdev.2017.08.005 org/10.1007/s12671-016-0519-7
Eisenberg, N., Cumberland, A., & Spinrad, T. L. (1998). Parental so- Gauvain, M., & Munroe, R. L. (2014). Development of perspective taking
cialization of emotion. Psychological Inquiry, 9(4), 241–273. https in relation to age, education, and the presence of community features
://doi.org/10.1207/s15327965pli0904_1 associated with industrialization: A four‐culture study. Cross‐Cultural
Fiebich, A. (2016). Narratives, culture, and folk psychology. Research, 48(1), 32–44. https://doi.org/10.1177/1069397113502164
Phenomenology and the Cognitive Sciences, 15(1), 135–149. https Gerrans, P. (2002). The theory of mind module in evolutionary psy-
://doi.org/10.1007/s11097-014-9378-7 chology. Biology and Philosophy, 17(3), 305–321. https ://doi.
Flynn, E., O'Malley, C., & Wood, D. (2004). A longitudinal, microge- org/10.1023/A:1020183525825
netic study of the emergence of false belief understanding and in- Ghorbani, N., Watson, P. J., & Weathington, B. L. (2009). Mindfulness
hibition skills. Developmental Science, 7(1), 103–115. https://doi. in Iran and the United States: Cross‐cultural structural complex-
org/10.1111/j.1467-7687.2004.00326.x ity and parallel relationships with psychological adjustment.
Fonagy, P., & Allison, E. (2014). The role of mentalizing and epistemic Current Psychology, 28(4), 211–224. https ://doi.org/10.1007/
trust in the therapeutic relationship. Psychotherapy, 51(3), 372. s12144-009-9060-3
https://doi.org/10.1037/a0036505 Golan, O., Baron‐Cohen, S., & Hill, J. (2006). The Cambridge
Fonagy, P., & Bateman, A. W. (2018). Mechanisms of change in men- Mindreading (CAM) FaceVoice Battery: Testing complex emotion
talization‐based treatment of borderline personality disorder. In R. recognition in adults with and without Asperger syndrome. Journal
Doctor, & R. Lucas (Eds.), The organic and the inner world (pp. of Autism and Developmental Disorders, 36(2), 169–183. https://
23–55). New York, NY: Routledge. doi.org/10.1007/s10803-005-0057-y
Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regula- Goodman, G. (2013). Is mentalization a common process factor in trans-
tion, mentalization and the development of the self. New York, NY: ference‐focused psychotherapy and dialectical behavior therapy ses-
Routledge. sions? Journal of Psychotherapy Integration, 23(2), 179–192. https
Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, ://doi.org/10.1037/a0032354
G., … Gerber, A. (1996). The relation of attachment status, psy- Gracia, M., Peterson, C. C., & Rosnay, M. (2016). A cultural conun-
chiatric classification, and response to psychotherapy. Journal of drum: Delayed false‐belief understanding in Filipino children.
Consulting and Clinical Psychology, 64(1), 22–31. https ://doi. Journal of Cross‐Cultural Psychology, 47(7), 929–940. https://doi.
org/10.1037/0022-006X.64.1.22 org/10.1177/0022022116655790
Fonagy, P., & Luyten, P. (2009). A developmental, mentalization‐based Heyes, C., & Frith, C. (2014). The cultural evolution of mind reading.
approach to the understanding and treatment of borderline personal- Science, 344(6190), 1–6. https://doi.org/10.1126/science.1243091
ity disorder. Development and Psychopathology, 21(4), 1355–1381. Hollan, D. (2012). Emerging issues in the cross‐cultural study of em-
https://doi.org/10.1017/S0954579409990198 pathy. Emotion Review, 4(1), 70–78. https://doi.org/10.1177/17540
Fonagy, P., Luyten, P., & Allison, E. (2015). Epistemic petrification and 73911421376
the restoration of epistemic trust: A new conceptualization of bor- Hughes, C., Devine, R. T., & Wang, Z. (2017). Does parental mind‐
derline personality disorder and its psychosocial treatment. Journal mindedness account for cross‐cultural differences in preschoolers’
of Personality Disorders, 29(5), 575–609. https://doi.org/10.1521/ theory of mind? Child Development, 89(4), 1296–1310. https://doi.
pedi.2015.29.5.575 org/10.1111/cdev.12746
Fonagy, P., Luyten, P., Moulton‐Perkins, A., Lee, Y.‐W., Warren, F., Ickes, W. (2001). Measuring empathic accuracy. In J. A. Hall, & F. J.
Howard, S., … Lowyck, B. (2016). Development and validation Bernieri (Eds.), Interpersonal sensitivity: Theory and measurement
of a self‐report measure of mentalizing: The reflective functioning (pp. 219–241). Mahwah, NJ: Lawrence Erlbaum Associates.
AIVAL-NAVEH et al.
|
21 of 25
Ivtzan, I., Young, T., Lee, H. C., Lomas, T., Daukantaitė, D., & Kjell, workers. Psychotherapy and Psychosomatics, 72(6), 307–314. https
O. N. (2018). Mindfulness based flourishing program: A cross‐cul- ://doi.org/10.1159/000073027
tural study of Hong Kong Chinese and British participants. Journal Konrath, S., Grynberg, D., Corneille, O., Hammig, S., & Luminet,
of Happiness Studies, 19(8), 2205–2223. https://doi.org/10.1007/ O. (2011). On the social cost of interdependence: Alexithymia is
s10902-017-9919-1 enhanced among socially interdependent people. Personality and
Jurist, E. (2018). Minding emotions: Cultivating mentalization in psy- Individual Differences, 50(2), 135–141. https://doi.org/10.1016/j.
chotherapy. New York, NY: Guilford Publications. paid.2010.09.008
Kabat‐Zinn, J. (1982). An outpatient program in behavioral med- Kuntoro, I., Peterson, C., & Slaughter, V. (2017). Culture, parenting,
icine for chronic pain patients based on the practice of mind- and children’s theory of mind development in Indonesia. Journal
fulness meditation: Theoretical considerations and preliminary of Cross‐Cultural Psychology, 48(9), 1389–1409. https ://doi.
results. General Hospital Psychiatry, 4(1), 33–47. https ://doi. org/10.1177/0022022117725404
org/10.1016/0163-8343(82)90026-3 Kuntoro, I., Saraswati, L., Peterson, C., & Slaughter, V. (2013). Micro‐
Kalbe, E., Schlegel, M., Sack, A. T., Nowak, D. A., Dafotakis, M., cultural influences on ToM development: A comparative study
Bangard, C., … Kessler, J. (2010). Dissociating cognitive from af- of middle‐class and pemulung children in Jakarta. Indonesia.
fective theory of mind: A TMS study. Cortex, 46(6), 769–780. https International Journal of Behavioral Development, 37(3), 266–273.
://doi.org/10.1016/j.cortex.2009.07.010 https://doi.org/10.1177/0165025413478258
Kamm, S. G., Sepulveda, E., & Brosig, B. (2016). Adolescent alex- Kurdek, L. A. (1978). Perspective taking as the cognitive basis of chil-
ithymia research: Indigenous sample compared to Hispanic sam- dren's moral development: A review of the literature. Merrill‐Palmer
ple in southern Chile. Psychology, 7(7), 992–1003. https ://doi. Quarterly of Behavior and Development, 24(1), 3–28.
org/10.4236/psych.2016.77100 Lane, J. D., Wellman, H. M., Olson, S. L., Miller, A. L., Wang, L., &
Katznelson, H. (2014). Reflective functioning: A review. Clinical Tardif, T. (2013). Relations between temperament and theory of mind
Psychology Review, 34(2), 107–117. https ://doi.org/10.1016/j. development in the United States and China: Biological and behavioral
cpr.2013.12.003 correlates of preschoolers’ false‐belief understanding. Developmental
Kessler, K., Cao, L., O'Shea, K. J., & Wang, H. (2014). A cross‐cul- Psychology, 49(5), 825–836. https://doi.org/10.1037/a0028825
ture, cross‐gender comparison of perspective taking mechanisms. Le, H. N., Berenbaum, H., & Raghavan, C. (2002). Culture and
Proceedings of the Royal Society of London B: Biological Sciences, alexithymia: Mean levels, correlates and the role of paren-
281(1785), 20140388. https://doi.org/10.1098/rspb.2014.0388 tal socialization of emotions. Emotion, 2(4), 341. https ://doi.
Keyes, C. L., & Ryff, C. D. (2003). Somatization and mental health: org/10.1037/1528-3542.2.4.341
A comparative study of the idiom of distress hypothesis. Social Lecce, S., & Hughes, C. (2010). “The Italian job?”: Comparing the-
Science & Medicine, 57(10), 1833–1845. https://doi.org/10.1016/ ory of mind performance in British and Italian children. British
S0277-9536(03)00017-0 Journal of Developmental Psychology, 28(4), 747–766. https://doi.
Kim, J. H., Lee, S. J., Rim, H. D., Kim, H. W., Bae, G. Y., & Chang, S. org/10.1348/026151009X479006
M. (2008). The relationship between alexithymia and general symp- Lee, K., Olson, D. R., & Torrance, N. (1999). Chinese children's un-
toms of patients with depressive disorders. Psychiatry Investigation, derstanding of false beliefs: The role of language. Journal of
5(3), 179–185. https://doi.org/10.4306/pi.2008.5.3.179 Child Language, 26(1), 1–21. https://doi.org/10.1017/S030500099
Kirmayer, L. J. (1987). Languages of suffering healing: Alexithymia as a 8003626
social and cultural process. Transcultural Psychiatric Research Review, Lee, W. K. (2016). Psychological characteristics of self‐harming behav-
24(2), 119–136. https://doi.org/10.1177/136346158702400204 ior in Korean adolescents. Asian Journal of Psychiatry, 23, 119–
Kirmayer, L. J., & Ryder, A. G. (2016). Culture and psychopathol- 124. https://doi.org/10.1016/j.ajp.2016.07.013
ogy. Current Opinion in Psychology, 8, 143–148. https ://doi. Lee, Y. H., Rim, H. D., & Lee, J. Y. (1996). Development and valida-
org/10.1016/j.copsyc.2015.10.020 tion of a Korean version of the 20‐item Toronto Alexithymia Scale
Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, (TAS‐20K). Journal of the Korean Neuropsychiatric Association,
epidemiological, and ethnographic perspectives. Psychosomatic 35(35), 888–899.
Medicine, 60(4), 420–430. https://doi.org/10.1097/00006842-19980 Leslie, A. M. (1987). Pretense and representation: The origins of "the-
7000-00006 ory of mind". Psychological Review, 94(4), 412–426. https://doi.
Kobayashi, F. C., Glover, G. H., & Temple, E. (2006). Cultural and lin- org/10.1037/0033-295X.94.4.412
guistic influence on neural bases of ‘Theory of Mind’: An fMRI Levy, K. N., Meehan, K. B., Kelly, K. M., Reynoso, J. S., Weber, M.,
study with Japanese bilinguals. Brain and Language, 98(2), 210– Clarkin, J. F., & Kernberg, O. F. (2006). Change in attachment pat-
220. https://doi.org/10.1016/j.bandl.2006.04.013 terns and reflective function in a randomized control trial of trans-
Kobayashi, F. C., & Temple, E. (2009). Cultural effects on the neural ference‐focused psychotherapy for borderline personality disorder.
basis of theory of mind. Progress in Brain Research, 178, 213–223. Journal of Consulting and Clinical Psychology, 74(6), 1027–1040.
https://doi.org/10.1016/S0079-6123(09)17815-9 https://doi.org/10.1037/0022-006X.74.6.1027
Koelkebeck, K., Hirao, K., Kawada, R., Miyata, J., Saze, T., Ubukata, Li, Y., & Yu, D. (2015). Development of emotion word comprehen-
S., … Murai, T. (2011). Transcultural differences in brain activation sion in Chinese children from 2 to 13 years old: Relationships
patterns during theory of mind (ToM) task performance in Japanese with valence and empathy. PLoS ONE, 10(12), 1–18. https://doi.
and Caucasian participants. Social Neuroscience, 6(5–6), 615–626. org/10.1371/journal.pone.0143712
https://doi.org/10.1080/17470919.2011.620763 Lieberman, M. D. (2007). Social cognitive neuroscience: A review of
Kojima, M., Senda, Y., Nagaya, T., Tokudome, S., & Furukawa, T. A. core processes. Annual Review of Psychology, 58, 259–289. https://
(2003). Alexithymia, depression and social support among Japanese doi.org/10.1146/annurev.psych.58.110405.085654
|
Lillard, A. (1998). Ethnopsychologies: Cultural variations in theo- Matsumoto, D., & Yoo, S. H. (2006). Toward a new generation of cross‐
ries of mind. Psychological Bulletin, 123(1), 3–32. https ://doi. cultural research. Perspectives on Psychological Science, 1(3), 234–
org/10.1037/0033-2909.123.1.3 250. https://doi.org/10.1111/j.1745-6916.2006.00014.x
Lim, A. K., Williams, J. M., Cebula, K. R., & Annaz, D. (2010). Mayer, A., & Träuble, B. E. (2014). Synchrony in the onset of men-
Cross‐cultural variations in naive psychology among 2‐year‐olds: tal state understanding across cultures? A study among children in
A comparison of children in the United Kingdom and Singapore. Samoa. International Journal of Behavioral Development, 37(1),
Journal of Cognition and Culture, 10(3–4), 221–251. https://doi. 21–28. https://doi.org/10.1177/0165025412454030
org/10.1163/156853710X531177 Mayer, A., & Träuble, B. (2015). The weird world of cross‐cultural false‐
Linehan, M. (1993). Skills training manual for treating borderline per- belief research: A true‐and false‐belief study among Samoan chil-
sonality disorder. New York, NY: Guilford Press. dren based on commands. Journal of Cognition and Development,
Liotti, G., & Gilbert, P. (2011). Mentalizing, motivation, and social 16(4), 650–665. https://doi.org/10.1080/15248372.2014.926273
mentalities: Theoretical considerations and implications for psy- Meins, E., Fernyhough, C., Wainwright, R., Das Gupta, M., Fradley,
chotherapy. Psychology and Psychotherapy: Theory, Research E., & Tuckey, M. (2002). Maternal mind–mindedness and at-
and Practice, 84(1), 9–25. https://doi.org/10.1348/147608310X tachment security as predictors of theory of mind under-
520094 standing. Child Development, 73(6), 1715–1726. https ://doi.
Liu, D., Wellman, H. M., Tardif, T., & Sabbagh, M. A. (2008). Theory org/10.1111/1467-8624.00501
of mind development in Chinese children: A meta‐analysis of false‐ Melchers, M. C., Li, M., Haas, B. W., Reuter, M., Bischoff, L., &
belief understanding across cultures and languages. Developmental Montag, C. (2016). Similar personality patterns are associated with
Psychology, 44(2), 523. https://doi.org/10.1037/0012-1649.44.2.523 empathy in four different countries. Frontiers in Psychology, 290(7),
Liu, Y., Wang, Y., Luo, R., & Su, Y. (2014). From the external to the 1–12. https://doi.org/10.3389/fpsyg.2016.00290
internal: Behavior clarifications facilitate theory of mind (ToM) de- Mizokawa, A., & Lecce, S. (2017). Sensitivity to criticism and theory
velopment in Chinese children. International Journal of Behavioral of mind: A cross cultural study on Japanese and Italian children.
Development, 40(1), 21–30. https://doi.org/10.1177/0165025414 European Journal of Developmental Psychology, 14(2), 159–171.
562484 https://doi.org/10.1080/17405629.2016.1180970
Lo, C. (2014). Cultural values and alexithymia. SAGE Open, 4(4), 1–6. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred
https://doi.org/10.1177/2158244014555117 reporting items for systematic reviews and meta‐analyses: The
Loiselle, C. G., & Cossette, S. (2001). Cross‐cultural validation of the PRISMA statement. Annals of Internal Medicine, 151(4), 264–269.
Toronto Alexithymia Scale (TAS‐20) in US and Peruvian pop- https://doi.org/10.7326/0003-4819-151-4-200908180-00135
ulations. Transcultural Psychiatry, 38(3), 348–362. https ://doi. Moriguchi, Y., Okumura, Y., Kanakogi, Y., & Itakura, S. (2010).
org/10.1177/136346150103800305 Japanese children’s difficulty with false belief understanding:
Lu, H., Su, Y., & Wang, Q. (2008). Talking about others facilitates the- Is it real or apparent? Psychologia: An International Journal of
ory of mind in Chinese preschoolers. Developmental Psychology, Psychology in the Orient, 53(1), 36–43. https ://doi.org/10.2117/
44(6), 1726–1736. https://doi.org/10.1037/a0013074 psysoc.2010.36
Luk, K. K., Xiao, W. S., & Cheung, H. (2012). Cultural effect on per- Naito, M., & Koyama, K. (2006). The development of false‐belief under-
spective taking in Chinese‐English bilinguals. Cognition, 124(3), standing in Japanese children: Delay and difference? International
350–355. https://doi.org/10.1016/j.cognition.2012.05.016 Journal of Behavioral Development, 30(4), 290–304. https://doi.
Luyten, P., Fonagy, P., Lowyck, B., & Vermote, R. (2012). Assessment org/10.1177/0165025406063622
of mentalization. In A. W. Bateman, & P. Fonagy (Eds.), Handbook Nakao, M., Barsky, A. J., Kumano, H., & Kuboki, T. (2002). Relationship
of mentalizing in mental health practice (pp. 43–65). Washington, between somatosensory amplification and alexithymia in a Japanese
DC: American Psychiatric Publication. psychosomatic clinic. Psychosomatics, 43(1), 55–60. https ://doi.
Luzumlu, U., & Esen, K. (2017). An investigation of Turkish univer- org/10.1176/appi.psy.43.1.55
sity students’ strategies of coping with stress and their level of National Institutes of Health (2014). Study quality assessment tools.
alexithymia. Studies on Ethno‐Medicine, 11(1), 77–81. https://doi. Retrieved from https://www.nhlbi.nih.gov/health-pro/guidelines/
org/10.1080/09735070.2017.1311695 in-develop/cardiovascular-risk-reduction/tools
Ma‐Kellams, C., & Blascovich, J. (2012). Inferring the emotions of Nawaz, S., Hanif, R., & Lewis, C. (2015). ‘Theory of mind’ develop-
friends versus strangers: The role of culture and self‐construal. ment of Pakistani children: Do preschoolers acquire an understand-
Personality & Social Psychology Bulletin, 38(7), 933–945. https:// ing of desire, pretence and belief in a universal sequence? European
doi.org/10.1177/0146167212440291 Journal of Developmental Psychology, 12(2), 177–188. https://doi.
Mamatova, M., & Wille, D. E. (2012). Cross‐cultural study of emotional org/10.1080/17405629.2014.973843
expression: The problem of alexithymia. Psychology Research, 2(3), Nemiah, J. C., Freyberger, H., & Sifneos, P. E. (1976). Alexithymia:
196–200. A view of the psychosomatic process. In O. W. Hill (Ed.), Modern
Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications trends in psychosomatic medicine. London, UK: Butterworths.
for cognition, emotion, and motivation. Psychological Review, Norimatsu, H., Blin, R., Hashiya, K., Sorsana, C., & Kobayashi, H.
98(2), 224–253. https://doi.org/10.1037/0033-295X.98.2.224 (2014). Understanding of others’ knowledge in French and Japanese
Matsui, T., Rakoczy, H., Miura, Y., & Tomasello, M. (2009). children: A comparative study with a disambiguation task on 16–38‐
Understanding of speaker certainty and false‐belief rea- month‐olds. Infant Behavior and Development, 37(4), 632–643.
soning: A comparison of Japanese and German preschool- https://doi.org/10.1016/j.infbeh.2014.08.006
ers. Developmental Science, 12(4), 602–613. https ://doi. Oh, S., & Lewis, C. (2008). Korean preschoolers’ advanced inhib-
org/10.1111/j.1467-7687.2008.00812.x itory control and its relation to other executive skills and mental
AIVAL-NAVEH et al.
|
23 of 25
state understanding. Child Development, 79(1), 80–99. https://doi. Ryder, A. G., Sunohara, M., Dere, J., & Chentsova‐Dutton, Y. E. (2018).
org/10.1111/j.1467-8624.2007.01112.x The cultural shaping of alexithymia. In O. Luminet, R. M. Bagby,
Ohtsubo, Y. (2007). Japanese children's development of false belief & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory,
understanding. Psychological Reports, 100(1), 87–97. https://doi. and clinical practice (pp. 33–48). Cambridge, U.K.: Cambridge
org/10.2466/pr0.100.1.87-97 University Press.
Onishi, K. H., & Baillargeon, R. (2005). Do 15‐month‐old infants un- Ryder, A. G., Yang, J., & Heine, S. J. (2002). Somatization vs. psychol-
derstand false beliefs? Science, 308(5719), 255–258. https://doi. ogization of emotional distress: A paradigmatic example for cul-
org/10.1126/science.1107621 tural psychopathology. Online Readings in Psychology and Culture,
Özyeşil, Z. (2012). Mindfulness and psychological needs: A cross‐cul- 10(2), 3. https://doi.org/10.9707/2307-0919.1080
tural comparison. Elementary Education Online, 11(1), 151–160. Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby,
Pace, R., Pluye, P., Bartlett, G., Macaulay, A. C., Salsberg, J., Jagosh, J., R. M. (2008). The cultural shaping of depression: Somatic symp-
& Seller, R. (2012). Testing the reliability and efficiency of the pilot toms in China, psychological symptoms in North America?
Mixed Methods Appraisal Tool (MMAT) for systematic mixed stud- Journal of Abnormal Psychology, 117(2), 300–313. https ://doi.
ies review. International Journal of Nursing Studies, 49(1), 47–53. org/10.1037/0021-843X.117.2.300
https://doi.org/10.1016/j.ijnurstu.2011.07.002 Sabbagh, M. A., Xu, F., Carlson, S. M., Moses, L. J., & Lee, K. (2006).
Pandey, R., Mandal, M. K., Taylor, G. J., & Parker, J. D. (1996). Cross‐ The development of executive functioning and theory of mind. A
cultural alexithymia: Development and validation of a Hindi trans- comparison of Chinese and U.S. preschoolers. Psychological Science,
lation of the 20‐item Toronto alexithymia scale. Journal of Clinical 17(1), 74–81. https://doi.org/10.1111/j.1467-9280.2005.01667.x
Psychology, 52(2), 173–176. https ://doi.org/10.1002/(SICI)1097- Sasai, K., Tanaka, K., & Hishimoto, A. (2010). Alexithymia and its re-
4679(199603)52:2<173:AID-JCLP8>3.0.CO;2-V lationships with eating behavior, self esteem, and body esteem in
Park, J., Jun, J. Y., Lee, Y. J., Kim, S., Lee, S. H., Yoo, S. Y., & Kim, S. college women. Kobe Journal of Medical Science, 56(6), 231–238.
J. (2015). The association between alexithymia and PTSD follow- Sauer, S., Walach, H., Schmidt, S., Hinterberger, T., Horan, M., & Kohls,
ing multiple exposures to traumatic events in North Korean refu- N. (2011). Implicit and explicit emotional behavior and mindful-
gees. Journal of Psychosomatic Research, 78(1), 77–81. https://doi. ness. Consciousness and Cognition, 20(4), 1558–1569. https://doi.
org/10.1016/j.jpsychores.2014.09.007 org/10.1016/j.concog.2011.08.002
Parker, J. D., Shaughnessy, P. A., Wood, L. M., Majeski, S. A., & Schwanenflugel, P. J., Martin, M., & Takahashi, T. (1999). The organi-
Eastabrook, J. M. (2005). Cross‐cultural alexithymia: Validity of zation of verbs of knowing: Evidence for cultural commonality and
the 20‐item Toronto Alexithymia Scale in North American aborigi- variation in theory of mind. Memory & Cognition, 27(5), 813–825.
nal populations. Journal of Psychosomatic Research, 58(1), 83–88. https://doi.org/10.3758/BF03198534
https://doi.org/10.1016/j.jpsychores.2004.06.003 Shahaeian, A. (2015). Sibling, family, and social influences on chil-
Pellerone, M., Tomasello, G., & Migliorisi, S. (2017). Relationship dren’s theory of mind understanding: New evidence from diverse
between parenting, alexithymia and adult attachment styles: A intracultural samples. Journal of Cross‐Cultural Psychology, 46(6),
cross‐sectional study on a group of adolescents and young adults. 805–820. https://doi.org/10.1177/0022022115583897
Clinical Neuropsychiatry: Journal of Treatment Evaluation, 14(2), Shahaeian, A., Henry, D., Razmjoee, M., Teymoori, A., & Wang, C.
125–134. (2014). Towards a better understanding of the relationship between
Porritt, K., Gomersall, J., & Lockwood, C. (2014). JBI's systematic re- executive control and theory of mind: An intracultural comparison
views: Study selection and critical appraisal. The American Journal of three diverse samples. Developmental Science, 18(5), 671–685.
of Nursing, 114(6), 47–52. https://doi.org/10.1097/01.NAJ.00004 https://doi.org/10.1111/desc.12243
50430.97383.64 Shahaeian, A., Nielsen, M., Peterson, C. C., Aboutalebi, M., &
Prevost, M., Carrier, M.‐E., Chowne, G., Zelkowitz, P., Joseph, L., & Slaughter, V. (2014). Knowledge and belief understanding among
Gold, I. (2014). The Reading the Mind in the Eyes test: Validation Iranian and Australian preschool children. Journal of Cross‐Cultural
of a French version and exploration of cultural variations in a multi‐ Psychology, 45(10), 1643–1654. https ://doi.org/10.1177/00220
ethnic city. Cognitive Neuropsychiatry, 19(3), 189–204. https://doi. 22114548484
org/10.1080/13546805.2013.82385 Shahaeian, A., Nielsen, M., Peterson, C. C., & Slaughter, V. (2014a).
Protogerou, C., & Hagger, M. S. (2018). A case for a study quality ap- Cultural and family influences on children’s theory of mind develop-
praisal in survey studies in psychology. Frontiers in Psychology, 9, ment: A comparison of Australian and Iranian school‐age children.
2788. https://doi.org/10.3389/fpsyg.2018.02788 Journal of Cross‐Cultural Psychology, 45(4), 555–568. https://doi.
Raphiphatthana, B., Jose, P., & Chobthamkit, P. (2018). The associa- org/10.1177/0022022113513921
tion between mindfulness and grit: An East vs. West cross‐cultural Shahaeian, A., Nielsen, M., Peterson, C. C., & Slaughter, V. (2014b). Iranian
Comparison. Mindfulness, 10(1), 146–158. https://doi.org/10.1007/ mothers’ disciplinary strategies and theory of mind in children: A focus
s12671-018-0961-9 on belief understanding. Journal of Cross‐Cultural Psychology, 45(7),
Roysircar, G. (2009). Evidence‐based practice and its implica- 1110–1123. https://doi.org/10.1177/0022022114534772
tions for culturally sensitive treatment. Journal of Multicultural Shahaeian, A., Peterson, C., Slaughter, V., & Wellman, H. M. (2011).
Counseling and Development, 37(2), 66–82. https ://doi. Culture and the sequence of steps in theory of mind develop-
org/10.1002/j.2161-1912.2009.tb00092.x ment. Developmental Psychology, 47(5), 1239–1247. https://doi.
Rudra, A., Ram, J. R., Loucas, T., Belmonte, M. K., & Chakrabarti, B. org/10.1037/a0023899
(2016). Bengali translation and characterisation of four cognitive and Sharf, R. H. (2015). Is mindfulness Buddhist? (And why it mat-
trait measures for autism spectrum conditions in India. Molecular ters). Transcultural Psychiatry, 52(4), 470–484. https ://doi.
Autism, 7(1), 50–58. https://doi.org/10.1186/s13229-016-0111-y org/10.1177/1363461514557561
|
Sharp, C., & Venta, A. (2012). Mentalizing problems in children and languages and cultures. Journal of Psychosomatic Research, 55(3),
adolescents. In N. Midgley, & I. Vrouva (Eds.), Minding the child: 277–283.
Mentalization‐based interventions with children, young people and Tsuji, H. (2011). Development of mentalizing ability in Japanese chil-
their families (pp. 35–53). New York, NY: Routledge. dren. Psychological Studies, 56(2), 167. https ://doi.org/10.1007/
Shatz, M., Diesendruck, G., Martinez‐Beck, I., & Akar, D. (2003). The s12646-011-0083-0
influence of language and socioeconomic status on children's under- Tutkun, H., Savas, H. A., Zoroglu, S. S., & Esgi, K. (2004). Relationship
standing of false belief. Developmental Psychology, 39(4), 717–729. between alexithymia, dissociation and anxiety in psychiatric outpa-
https://doi.org/10.1037/0012-1649.39.4.717 tients from Turkey. The Israel Journal of Psychiatry and Related
Shen, Y. L., Carlo, G., & Knight, G. P. (2013). Relations between paren- Sciences, 41(2), 118.
tal discipline, empathy‐related traits, and prosocial moral reasoning: Uddin, L., Iacoboni, M., Lange, C., & Keenan, J. (2007). The self and
A multicultural examination. Journal of Early Adolescence, 33(7), social cognition: The role of cortical midline structures and mirror
994–1021. https://doi.org/10.1177/0272431613479670 neurons. Trends in Cognitive Sciences, 11(4), 153157. https://doi.
Slaughter, V., & Perez‐Zapata, D. (2014). Cultural variations in the de- org/10.1016/j.tics.2007.01.001
velopment of mind reading. Child Development Perspectives, 8(4), Uzun, Ö. (2003). Alexithymia in male alcoholics: Study in a Turkish
237–241. https://doi.org/10.1111/cdep.12091 sample. Comprehensive Psychiatry, 44(4), 349–352. https ://doi.
Smith, P. B., Vignoles, V. L., Becker, M., Owe, E., Easterbrook, M. J., org/10.1016/S0010-440X(03)00009-9
Brown, R., … Harb, C. (2016). Individual and culture‐level compo- Valanides, C., Sheppard, E., & Mitchell, P. (2017). How accurately can
nents of survey response styles: A multi‐level analysis using cultural other people infer your thoughts—And does culture matter? PLoS
models of selfhood. International Journal of Psychology, 51(6), ONE, 12(11), 1–14. https://doi.org/10.1371/journal.pone.0187586
453–463. https://doi.org/10.1002/ijop.12293 Vinden, P. G. (1999). Children's understanding of mind and emotion: A
Söndergaard, H. P., & Theorell, T. (2004). Alexithymia, emotions and multi‐culture study. Cognition & Emotion, 13(1), 19–48. https://doi.
PTSD; Findings from a longitudinal study of refugees. Nordic Journal org/10.1080/026999399379357
of Psychiatry, 58(3), 185–191. https://doi.org/10.1080/0803948041 Vinden, P. G. (2001). Parenting attitudes and children’s understanding
0006214 of mind: A comparison of Korean American and Anglo‐American
Sotgiu, I., Galati, D., Manzano, M., Gandione, M., Gómez, K., Romero, families. Cognitive Development, 16(3), 793–809. https ://doi.
Y., & Rigardetto, R. (2011). Parental attitudes, attachment styles, org/10.1016/S0885-2014(01)00059-4
social networks, and psychological processes in autism spectrum Vu, T.‐V., Finkenauer, C., Huizinga, M., Novin, S., & Krabbendam, L.
disorders: A cross‐cultural perspective. The Journal of Genetic (2017). Do individualism and collectivism on three levels (coun-
Psychology, 172(4), 353–375. https ://doi.org/10.1080/00221 try, individual, and situation) influence theory‐of‐mind efficiency?
325.2010.544342 A cross‐country Study. PLoS ONE, 12(8), e0183011. https://doi.
Sperber, D., Clément, F., Heintz, C., Mascaro, O., Mercier, H., Origgi, org/10.1371/journal.pone.0183011
G., & Wilson, D. (2010). Epistemic vigilance. Mind & Language, Wakabayashi, A., Baron‐Cohen, S., Uchiyama, T., Yoshida, Y., Kuroda,
25(4), 359–393. https://doi.org/10.1111/j.1468-0017.2010.01394.x M., & Wheelwright, S. (2007). Empathizing and systemizing in
Stephan, W. G., & Finlay, K. (1999). The role of empathy in improving adults with and without autism spectrum conditions: Cross‐cultural
intergroup relations. Journal of Social Issues, 55(4), 729–743. https stability. Journal of Autism and Developmental Disorders, 37(10),
://doi.org/10.1111/0022-4537.00144 1823–1832. https://doi.org/10.1007/s10803-006-0316-6
Sue, D. W., Arredondo, P., & McDavis, J. (1992). Multicultural Wang, B., Hadi, N. S. A., & Low, J. (2015). Limits on efficient human
counseling competencies and standards: A call to the profession. mindreading: Convergence across Chinese adults and Semai chil-
Journal of Counseling & Development, 70(4), 477–486. https://doi. dren. British Journal of Psychology, 106(6), 724–740. https://doi.
org/10.1002/j.1556-6676.1992.tb01642.x org/10.1111/bjop.12121
Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory Wang, B., Low, J., Jing, Z., & Qinghua, Q. (2012). Chinese pre-
and practice. Hoboken, NJ: John Wiley & Sons. schoolers’ implicit and explicit false‐belief understanding. British
Tardif, T., & Wellman, H. M. (2000). Acquisition of mental Journal of Developmental Psychology, 30(1), 123–140. https://doi.
state language in Mandarin‐ and Cantonese‐speaking chil- org/10.1111/j.2044-835X.2011.02052.x
dren. Developmental Psychology, 36(1), 25–43. https ://doi. Wang, Q. (2016). Why should we all be cultural psychologists? Lessons
org/10.1037/0012-1649.36.1.25 from the study of social cognition. Perspectives on Psychological
Tardif, T., Wellman, H. M., & Cheung, K. M. (2004). False belief Science, 11(5), 583–596. https://doi.org/10.1177/1745691616645552
understanding in Cantonese‐speaking children. Journal of Child Wang, Z., Devine, R., Wong, K., & Hughes, C. (2016). Theory of
Language, 31(4), 779–800. https://doi.org/10.1017/S030500090 mind and executive function during middle childhood across cul-
4006580 tures. Experimental Child Psychology, 149, 6–22. https ://doi.
Taylor, G. J., & Bagby, R. M. (2004). New trends in alexithymia re- org/10.1016/j.jecp.2015.09.028
search. Psychotherapy and Psychosomatics, 73(2), 68–77. https:// Wang, Z., Wong, R. K. S., Wong, P. Y. H., Ho, F. C., & Cheng, D. P. W.
doi.org/10.1159/000075537 (2017). Play and theory of mind in early childhood: A Hong Kong
Taylor, G. J., Bagby, R. M., & Parker, J. D. (1991). The alexithy- perspective. Early Child Development and Care, 187(9), 1389–
mia construct: A potential paradigm for psychosomatic medi- 1402. https://doi.org/10.1080/03004430.2016.1146261
cine. Psychosomatics, 32(2), 153–164. https ://doi.org/10.1016/ Wellman, H. M., Cross, D., & Watson, J. (2001). Meta‐analy-
S0033-3182(91)72086-0 sis of theory‐of‐mind development: The truth about false
Taylor, G. J., Bagby, R. M., & Parker, J. D. (2003). The 20‐Item Toronto belief. Child Development, 72(3), 655–684. https ://doi.
Alexithymia Scale: IV. Reliability and factorial validity in different org/10.1111/1467-8624.00304
AIVAL-NAVEH et al.
|
25 of 25
Wellman, H. M., Fang, F., Liu, D., Zhu, L., & Liu, G. (2006). Zhang, T., Shao, Z., & Zhang, Y. (2016). Developmental steps in theory
Scaling of theory‐of‐mind understandings in Chinese chil- of mind of typical Chinese children and Chinese children with au-
dren. Psychological Science, 17(12), 1075–1081. https ://doi. tism spectrum disorder. Research in Autism Spectrum Disorders, 23,
org/10.1111/j.1467-9280.2006.01830.x 210–220. https://doi.org/10.1016/j.rasd.2015.10.005
Wellman, H. M., Fang, F., & Peterson, C. C. (2011). Sequential Zhu, X. Z., Hu, S. Y., & Yi, J. Y. (2005). Alexithymia in patients with a
progressions in a theory‐of mind scale: Longitudinal per- depressive episode. Chinese Journal of Behavioral Medical Science,
spectives. Child Development, 82(3), 780–792. https ://doi. 14, 1073–1074.
org/10.1111/j.1467-8624.2011.01583.x Zhu, X., Yi, J., Yao, S., Ryder, A. G., Taylor, G. J., & Bagby, R. M.
Wellman, H. M., & Liu, D. (2004). Scaling of theory‐of‐mind (2007). Cross‐cultural validation of a Chinese translation of the 20‐
tasks. Child Development, 75(2), 523–541. https ://doi. item Toronto Alexithymia Scale. Comprehensive Psychiatry, 48(5),
org/10.1111/j.1467-8624.2004.00691.x 489–496. https://doi.org/10.1016/j.comppsych.2007.04.007
Wells, G. A., Shea, B., O'Connell, D., Peterson, J., Welch, V., Losos,
M., & Tugwell, P. (2011). The Newcastle‐Ottawa Scale (NOS) for
assessing the quality of nonrandomized studies in meta‐analysis.
Ottawa, ON: Ottawa Hospital Research Institute. Retrieved from SUPPORTING INFORMATION
http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
Additional supporting information may be found online in
Wu, S., Barr, D., Gann, T., & Keysar, B. (2013). How culture influ-
ences perspective taking: Differences in correction, not integra-
the Supporting Information section at the end of the article.
tion. Frontiers in Human Neuroscience, 7(822), 1–7. https://doi.
org/10.3389/fnhum.2013.00822
Wu, S., & Keysar, B. (2007). The effect of culture on perspec- How to cite this article: Aival-Naveh E, Rothschild‐
tive taking. Psychological Science, 18(7), 600–606. https ://doi. Yakar L, Kurman J. Keeping culture in mind: A
org/10.1111/j.1467-9280.2007.01946.x systematic review and initial conceptualization of
Yazdi, A. A., German, T. P., Defeyter, M. A., & Siegal, M. (2006). mentalizing from a cross‐cultural perspective. Clin
Competence and performance in belief‐desire reasoning across two Psychol Sci Pract. 2019;26:e12300. https://doi.
cultures: The truth, the whole truth and nothing but the truth about org/10.1111/cpsp.12300
false belief? Cognition, 100(2), 343–368. https://doi.org/10.1016/j.
cognition.2005.05.004
APPENDIX 1
T A B L E A 1 Risk of bias criteria
Criterion Source
1. Was the study population clearly specified and defined? NIH
2. Is the sample representative of the population understudy? MMAT
3. Was a sample size justification, power description, or variance and effect estimates provided? NIH
4. Were the outcomes measured in a valid and reliable way?/ Was a standard instrument used? JBI/MMAT
5. Were measures properly translated? (at least one method is mentioned, for example, using back translation or
bilingual translators). New criteria for cross‐
6. Did the study use measures that were validated in the relevant culture(s)? cultural research
7. Was measure invariance established? (at least on one level, that is, configural, metric, scalar, strict invariance).
8. If cross‐sectional: Subjects in different outcome groups are comparable, based on the study design or analysis? NOS
Are confounding factors controlled for?
9. If longitudinal: Was loss to follow‐up after baseline 20% or less? NIH
10. If experimental: JBI
a. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demograph-
ics, risk factors, comorbid conditions)?
b. Were study participants and providers blinded to treatment group assignment?
c. Were treatment groups treated identically other than the intervention of interest?
d. Was the differential dropout rate (between treatment groups) at endpoint 15 percentage points or lower?
11. Was appropriate statistical analysis used? JBI
Note: Each question is answered with a yes, no, un‐applicable, or unclear.

(2019) - Keeping Culture in Mind A Systematic Review and Initial Conceptualization of Mentalizing From A Cross-Cultural Perspective

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(2019) - Keeping Culture in Mind A Systematic Review and Initial Conceptualization of Mentalizing From A Cross-Cultural Perspective

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(2019) - Keeping Culture in Mind A Systematic Review and Initial Conceptualization of Mentalizing From A Cross-Cultural Perspective

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Received: 10 January 2019

| Revised: 17 June 2019

Keeping culture in mind: A systematic review and initial

Erez Aival-Naveh | Lily Rothschild‐Yakar | Jenny Kurman

1 | IN T RO D U C T ION 2018; Katznelson, 2014). Nevertheless, to the best of our

Clin Psychol Sci Pract. 2019;26:e12300. |

F I G U R E 2 Systematic review search

T A B L E 2 Cross‐cultural studies on overlapping concepts: summary of key findings (number of papers)

ToM Empathy & PT Alexithymia Mindfulness

ToM Empathy & PT Alexithymia Mindfulness

timing across cultures (Wellman, Cross, & Watson, 2001).

3.3.3 | Possible explanations for the cultural 3.3.4 | Summary

T A B L E A 1 Risk of bias criteria

You might also like

(2019) - Keeping Culture in Mind A Systematic Review and Initial Conceptualization of Mentalizing From A Cross-Cultural Perspective

Uploaded by

Copyright:

Available Formats

(2019) - Keeping Culture in Mind A Systematic Review and Initial Conceptualization of Mentalizing From A Cross-Cultural Perspective

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Original Title

Copyright

Available Formats

Share this document

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Did you find this document useful?

Is this content inappropriate?

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(2019) - Keeping Culture in Mind A Systematic Review and Initial Conceptualization of Mentalizing From A Cross-Cultural Perspective

Uploaded by

Copyright:

Available Formats

Received: 10 January 2019

| Revised: 17 June 2019

Keeping culture in mind: A systematic review and initial

Erez Aival-Naveh | Lily Rothschild‐Yakar | Jenny Kurman

1 | IN T RO D U C T ION 2018; Katznelson, 2014). Nevertheless, to the best of our

Clin Psychol Sci Pract. 2019;26:e12300. ﻿ |

F I G U R E 2 Systematic review search

T A B L E 2 Cross‐cultural studies on overlapping concepts: summary of key findings (number of papers)

ToM Empathy & PT Alexithymia Mindfulness

ToM Empathy & PT Alexithymia Mindfulness

timing across cultures (Wellman, Cross, & Watson, 2001).

3.3.3 | Possible explanations for the cultural 3.3.4 | Summary

T A B L E A 1 Risk of bias criteria

You might also like

Clin Psychol Sci Pract. 2019;26:e12300. |