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Title: Psychological processes associated with expressed emotion in carers of people with long-term mental health difficulties
Author: Cherry, M. G.
ISNI:       0000 0004 6059 6352
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2016
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Approximately six and a half million people in the United Kingdom (UK) provide unpaid care to others, typically family members or close friends, with this number projected to rise to nine million by 2037 (Carers UK, 2014). Of these, 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 (Yeandle & Buckner, 2015). Caring for someone with a long-term mental health difficulty can be a challenging and emotional experience, with carers often displaying higher levels of anxiety, depression, and general psychological distress than members of the general population (Kuipers, Onwumere, & Bebbington, 2010; Perlick et al., 2007). As such, a strong moral and financial argument can be made for developing effective, flexible and inclusive services and interventions which support carers in their roles and safeguard their wellbeing (Department of Health, 2014). Family interventions (FIs) are currently the main avenue of professional support recommended for carers of people with long-term mental health difficulties (American Psychiatric Association, 2004; Bucci, Berry, Barrowclough, & Haddock, 2016; Galletly, et al., 2016; National Institute for Health and Care Excellence, 2014). Their development emerged from research demonstrating the important role that family factors, specifically the family environment, plays in influencing psychological outcomes for both carers and service-users (Barrowclough & Hooley, 2003; Hooley, 2000, 2007). This began in the mid-20th century, as the notion of the 'schizophrenogenic mother'2 gained widespread popularity within the psychiatric profession (Fromm-Reichmann, 1948; Lidz, Cornelison, & Singer, 1964). Around the same time, Bateson and colleagues (1956; 1963) proposed that the communication difficulties often considered characteristic of individuals with a diagnosis of schizophrenia may actually arise as a result of 'double bind' communication patterns within families, rather than as a result of underlying abnormal brain pathology. To this end, Bateson and colleagues (1956) advocated that particular family constellations could be identified as aetiological factors for schizophrenia. Developments in psychological and psychiatric theory, coupled with a changing sociocultural landscape, meant that by the mid-1970s the notion of the 'schizophrenogenic mother' was largely discredited. However, rather than ceasing, research into the importance of the family environment gained increasing momentum with the progression of deinstitutionalisation. To date, the most influential body of research in this area has focused upon 'expressed emotion'. This term emerged from a series of research studies investigating the influence that the family environment had upon the relapse rates of men diagnosed with schizophrenia following their return to the community after a period of hospitalisation (Brown, Carstairs, & Topping, 1958; Brown, 1959; Brown, Monck, Carstairs, & Wing, 1962; Brown & Rutter, 1966; Brown, Birley, & Wing, 1972; Leff & Vaughn, 1985; Rutter & Brown, 1966; Vaughn & Leff, 1976a, 1976b). In a series of seminal studies, Brown and colleagues (1958; 1959) noted significantly higher relapse and re-admission rates among service-users who had returned to live either in large hostels or with their parents or wives than among those who had returned to live with their siblings or in lodgings. This finding could not be accounted for by factors such as the service-user's age or clinical presentation, leading Brown (1959) to initially conclude that "it may not always be in the schizophrenic patient's best interests for him to be returned to his family" (pp. 128). In a series of further studies, Brown and colleagues (1962; 1966; 1972) identified four indices of family environment associated with post-discharge relapse rates: emotional over-involvement (EOI), critical comments (CC), hostility and warmth (Table 1).
Supervisor: Sellwood, W. ; Brown, S. ; Taylor, P. Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral