Guilt, Shame and Expressed Emotion in Mental Health Caregiving: Interventions and a Validated Scale

Noir, Laura and Sellwood, Bill (2025) Guilt, Shame and Expressed Emotion in Mental Health Caregiving: Interventions and a Validated Scale. PhD thesis, Lancaster University.

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Abstract

While caring for a loved one with a long-term mental health condjavascript:void(0);ition often brings fulfilment, it also carries the burden of complex emotions such as guilt and shame. These emotions can affect caregivers' well-being and relationships with those they support. Expressed Emotion (EE) examines how family members' attitudes and emotions impact the mental health outcomes of their loved ones, and this thesis explores the roles of guilt and shame within this context. Section One presents a systematic literature review (SLR) that synthesises quantitative studies on interventions aimed at reducing guilt among caregivers. Due to the scarcity of interventions in mental health caregiving, the review incorporated studies from dementia caregiving literature to outline the current research landscape. Findings suggest that addressing dysfunctional thoughts may be a promising approach for mental health caregiving, however, the field lacks a standardised measure to assess this fully. Section Two reports an empirical study focused on refining and validating the Care and Related Emotions (CARE) scale. Modifications were made based on cognitive interview feedback to ensure the scale effectively captures guilt, shame, and related emotions in mental health caregiving. Statistical analyses demonstrated strong content and structural validity, reliability, and predictive validity with EE components. While validated as a strong research tool, areas of further refinement are divergent validity and intra-rater reliability. Section Three explores the implications of the research decisions and suggests future directions for the development of the CARE. By extending the focus on guilt and shame to incorporate the underlying attributions and beliefs that contribute to EE, the scale could provide a framework for clinicans to tailor interventions for caregivers. In summary, this thesis contributes to the understanding of guilt and shame in caregiving, offering validated tools and highlighting areas for future research to enhance support for caregivers and their loved ones.