Attachment, mentalisation and expressed emotion in carers of people with long-term mental health difficulties

Abstract

BackgroundExpressed emotion (EE) is a global index of familial emotional climate, which is comprised of emotional over-involvement (EOI) and critical comments (CC)/hostility. Although EE is an established predictor of negative outcomes for both people with long-term mental health difficulties and their family carers, its psychological underpinnings remain relatively poorly understood. This paper examined associations between attachment, mentalisation ability and aspects of EE.MethodsCarers of people with long-term mental health difficulties (n = 106) completed measures of adult attachment (the Experiences in Close Relationships-Short Form questionnaire), mentalisation (the Reading the Mind in the Eyes Test and the Emotional Self-Efficacy Scale) and EE (the Family Questionnaire). Data were analysed using hierarchical multiple regression.ResultsAttachment avoidance and facets of mentalisation were directly and uniquely positively associated with CC/hostility, with attachment avoidance and other-directed emotional self-efficacy (one facet of mentalisation) each significantly predicting CC/hostility scores after controlling for the effects of EOI and demographic variables. However, no associations were observed between EOI, attachment anxiety and mentalisation. Furthermore, no indirect effects from attachment to EE via mentalisation was found.ConclusionsAlthough it would be premature to propose firm clinical implications based on these findings, data indicate that it may be beneficial for clinicians to consider attachment and mentalisation in their conceptualisation of carers’ criticism and hostility. However, further research is needed to clarify the magnitude of these associations and their direction of effect before firm conclusions can be drawn.

Perceived Expressed Emotion in the Illness Narratives of Individuals with Chronic Gastrointestinal Disorders

“…This control could result in critical settings in the family, which has a poor impact on disease outcomes. This explanation supports other findings reported by Cherry et al (2018), postulating that EE results from beliefs about the controllability of health-related difficulties. However, previous findings relate controllability as a robust predictor of EE in carers.…”

High Expressed Emotion and Warmth among Families of Patients with Schizophrenia in Greece

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Risk and Resiliency Factors Related to Dementia Caregiver Mental Health

“…While our study did not find a difference in each component of EE's relationship to mental health, other studies have found that these constructs sometimes function differently in certain contexts. For example, in a sample of carers of people with long-term mental health difficulties, Cherry et al (2018) found that while criticism was related to adult attachment and facets of mentalization, no associations were observed between EOI and adult attachment nor between EOI and mentalization in this sample. In a similar vein, a recent study in early psychosis further found that criticism was more consistently related to relative stress and burden than emotional overinvolvement (Hinojosa-Marqu es, Dom ınguez-Mart ınez, Kwapil, & Barrantes-Vidal, 2019).…”