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

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          Abstract

          Background

          Expressed 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.

          Methods

          Carers 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.

          Results

          Attachment 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.

          Conclusions

          Although 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.

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          Most cited references20

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          The Experiences in Close Relationship Scale (ECR)-short form: reliability, validity, and factor structure.

          We developed a 12-item, short form of the Experiences in Close Relationship Scale (ECR; Brennan, Clark, & Shaver, 1998) across 6 studies. In Study 1, we examined the reliability and factor structure of the measure. In Studies 2 and 3, we cross-validated the reliability, factor structure, and validity of the short form measure; whereas in Study 4, we examined test-retest reliability over a 1-month period. In Studies 5 and 6, we further assessed the reliability, factor structure, and validity of the short version of the ECR when administered as a stand-alone instrument. Confirmatory factor analyses indicated that 2 factors, labeled Anxiety and Avoidance, provided a good fit to the data after removing the influence of response sets. We found validity to be equivalent for the short and the original versions of the ECR across studies. Finally, the results were comparable when we embedded the short form within the original version of the ECR and when we administered it as a stand-alone measure.
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            Attachment Stability From Infancy to Adulthood: Meta-Analysis and Dynamic Modeling of Developmental Mechanisms

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              The measurement of expressed emotion in the families of psychiatric patients.

              In a series of studies of the influence of family life on the course of an established schizophrenic illness, it has been shown that the level of emotion expressed by relatives shortly after a schizophrenic patient is admitted to hospital is strongly associated with symptomatic relapse during the nine months following discharge (Brown et al., 1962, 1972). This paper states the case for an abbreviated version of the primary research instrument used in these studies, the Camberwell Family Interview Schedule. In the 1972 study the single most important measure contributing to the overall expressed emotion index proved to be the number of critical remarks made about the patient by the relative when interviewed alone. An analysis of 15 tape-recorded interviews from this study showed that the majority of critical comments were produced within the first hour and there was virtually no relationship between total number of critical comments and length of interview (r = 0.08). This analysis supported the use of a shortened interview in which the areas most likely to produce any criticism were given priority in the sequence of questioning. This abbreviated version has been used successfully in a replication and extension of the 1972 study. A group of 37 schizophrenic patients is being compared with a group of 31 depressed neurotic patients. Patterns of emotional response of these patients' relatives are discussed.
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                Author and article information

                Contributors
                gcherry@liv.ac.uk
                peter.taylor-2@manchester.ac.uk
                s.l.brown@liv.ac.uk
                b.sellwood@lancaster.ac.uk
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                16 August 2018
                16 August 2018
                2018
                : 18
                : 257
                Affiliations
                [1 ]ISNI 0000 0004 1936 8470, GRID grid.10025.36, Division of Clinical Psychology, , University of Liverpool, ; Whelan Building, Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
                [2 ]ISNI 0000000121662407, GRID grid.5379.8, Division of Psychology & Mental Health, , University of Manchester, ; Zochonis building, Manchester, M13 9PL UK
                [3 ]ISNI 0000 0004 1936 8470, GRID grid.10025.36, Department of Psychological Sciences, , University of Liverpool, ; Whelan Building, Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
                [4 ]ISNI 0000 0000 8190 6402, GRID grid.9835.7, Division of Health Research, , University of Lancaster, ; Furness Building, Bailrigg, Lancaster, LA1 4YW UK
                Author information
                http://orcid.org/0000-0001-9490-1747
                Article
                1842
                10.1186/s12888-018-1842-4
                6097417
                30115039
                c23db6cf-730e-46cd-9eed-ad81bb0a414f
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 16 May 2017
                : 8 August 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Clinical Psychology & Psychiatry
                attachment,mentalisation,expressed emotion,carers,cross-sectional,quantitative,criticism,hostility,emotional over-involvement

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