Relatives' attachment anxiety mediates the association between perceived loss and expressed emotion in early psychosis
Hinojosa-Marqués, Lídia (Universitat Autònoma de Barcelona. Departament de Psicologia Clínica i de la Salut)
Domínguez-Martínez, Tecelli (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz)
Sheinbaum Frank, Tamara (University of Southern California. Department of Psychology)
Cristóbal Narváez, Paula (Parc Sanitari Sant Joan de Déu)
Kwapil, Thomas (University of Illinois at Urbana-Champaign)
Barrantes-Vidal, Neus (Universitat Autònoma de Barcelona. Departament de Psicologia Clínica i de la Salut)

Date:	2019
Abstract:	A common reaction experienced by family members of patients with psychosis is grief for the loss of their healthy relative. Importantly, high levels of perceived loss have been related to the manifestation of high expressed emotion (EE), which includes the negative attitudes expressed by relatives toward an ill family member. However, the mechanisms underlying the relationship between relatives' perceived loss and EE attitudes in the early stages of psychosis are still not fully understood. In this regard, attachment theory has been suggested as a useful framework for understanding this link. The current study aimed to examine: (1) whether relatives' perceived loss was associated with relatives' EE dimensions (i. e. , criticism and emotional over-involvement (EOI)), and (2) whether such associations were mediated by relatives' attachment dimensions (i. e. , anxiety and avoidance). Seventy-eight relatives of patients with early psychosis completed the Mental Illness Version of the Texas Inventory of Grief for the assessment of loss reactions. Attachment dimensions and EE attitudes were assessed by the Psychosis Attachment Measure and the Family Questionnaire, respectively. Findings indicated that relatives' perceived loss was associated with EE dimensions. Relatives' attachment anxiety, but not avoidance, mediated the relationship of perceived loss with both criticism and EOI. Findings highlight the importance of examining the role of relatives' attachment characteristics for understanding how perceptions of loss might impact the manifestation of EE attitudes in the early stages of psychosis. Family interventions aimed at assisting relatives to improve their management of negative emotional reactions to loss are fundamental to prevent impairing loss reactions and the entrenchment of high-EE attitudes.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Psychological adaptation ; Adult ; Anxiety ; Family ; Female ; Grief ; Humans ; Male ; Middle aged ; Object attachment ; Psychotic disorders
Published in:	PloS one, Vol. 14, núm. 10 (2019) , p. e0223425, ISSN 1932-6203

DOI: 10.1371/journal.pone.0223425
PMID: 31589647

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