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.
Highlights
Expressed emotion (EE) is a global index of familial emotional climate, which is comprised of emotional over-involvement (EOI) and critical comments (CC)/hostility
Females scored significantly higher than males on total EE (M = 58.61, SD = 8.34 and M = 51.37, SD = 6.35 respectively, t(101) = − 3.56, p < .01), EOI (M = 28.79, SD = 4.91 and M = 24.68, SD = 4.58 respectively, t(101) = − 4.10, p < .01) and CC/hostility (M = 29.82, SD = 4.21 and M = 26.68, SD = 3.85 respectively, t(101) = − 3.14, p < .01)
No significant associations were noted between Reading the mind in the eyes questionnaire (RMET) scores and Emotional Self-Efficacy Scale (ESES) subscale scores
Summary
Expressed emotion (EE) is a global index of familial emotional climate, which is comprised of emotional over-involvement (EOI) and critical comments (CC)/hostility. 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. Approximately 13% (equivalent to one in 10 people in the UK) provide care to someone with a long-term mental health difficulty, saving the UK economy an estimated 17 billion per year [2]. Cherry et al BMC Psychiatry (2018) 18:257 particular attitudes, emotions and behaviours expressed by family carers towards the person (s) to whom they provide care [6]. Key components include emotional over-involvement (EOI), critical comments (CC), and hostility [6]. Emotional over-involvement is characterised by overly self-sacrificing and/or intrusive behaviours and exaggerated emotional responses, whereas the term ‘CC/ hostility’ is commonly used to refer to critical, negative or blaming attitudes or statements towards service-users [6]
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