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Attributions and expressed emotion: a review.
Christine Barrowclough1, Jill M Hooley
1Academic Division of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, Education and Research Building (2nd floor), Wythenshawe Hospital, M23 9LT, Manchester, UK. christine.barrowclough@man.ac.uk
Clinical Psychology Review
|October 8, 2003
Summary
Critical relatives, often displaying high expressed emotion (EE), blame patients more, potentially increasing relapse risk. Interventions focusing on flexible attributions may help reduce patient stress and improve outcomes.
Area of Science:
- Psychiatry
- Clinical Psychology
- Family Studies
Background:
- Expressed emotion (EE) is a known predictor of patient relapse in various mental health conditions.
- Attributional styles of relatives and carers may influence patient outcomes, but this link requires further examination.
Purpose of the Study:
- To review the contribution of an attribution-based framework to understanding expressed emotion (EE) and patient relapse.
- To synthesize findings from studies assessing attributions of high- and low-EE relatives and carers.
Main Methods:
- Systematic review of published studies assessing attributions of high- and low-EE relatives and carers.
- Analysis of the association between carer attributions and patient relapse.
Main Results:
- Critical relatives more frequently hold patients responsible for their difficulties compared to low-EE relatives.
- Attributions of emotionally overinvolved relatives resemble those of low-EE relatives.
- Carer beliefs can influence relapse through mechanisms like controlling behavior, increased patient stress, or reduced self-worth.
Conclusions:
- Attributional frameworks offer valuable insights into EE and patient relapse.
- Cross-sectional data limits causal inference between EE and attributions.
- Interventions promoting less blaming and more flexible carer attributions, potentially using cognitive-behavioral reattribution techniques, are warranted.