An exploration of psychological processes that may contribute to functional impairment in serious mental health problems

  • Elisabeth Pearse

Student thesis: Doctor of Clinical Psychology


Functional impairments, including global and social functioning, are reportedly prevalent in people who experience serious mental health problems (SMI), including people who receive diagnoses of psychosis, bipolar disorder and personality disorders. Impairments in functioning can have wide-reaching implications, both for the individual and for mental health professionals working with SMI. Given the impact on functional impairments on a person’s mental health and well-being, it is important to explore potential psychological factors that might contrite to impairments in functioning to inform psychological assessment, formulation and intervention for people with SMI. Paper 1 presents a systematic literature review investigating the association between attachment and functioning for people who experience SMI. A comprehensive systematic search of the literature returned 10 empirical research studies. A critical appraisal of the studies was conducted whilst synthesising the findings. The findings were mixed: secure attachment was associated with better functioning, whilst an insecure attachment style was associated with impaired functioning in some studies but not in others reviewed. The studies were largely heterogeneous in terms of population, design and measures used. The findings are considered in relation to methodological limitations, clinical implications and recommendations for future research. Paper 2 is an original empirical study focusing specifically on the SMI population of psychosis. The study investigated the potential mediating role of insecure attachment and emotion recognition in the relationship between childhood trauma and social functioning. Sixty participants with psychosis were recruited to the study and completed measures of childhood trauma, attachment, emotion recognition and social functioning. Childhood trauma was associated with social functioning; however, neither insecure attachment nor emotion recognition mediated this relationship. The findings are discussed in light of methodological limitations and clinical implications are presented. Paper 3 provides a critical evaluation of the research process including reflections on decisions made regarding the design, methodology, recruitment process, and analysis of papers one and two. Personal reflections on conducting the research are also presented.
Date of Award31 Dec 2019
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKatherine Berry (Supervisor) & Sandra Bucci (Supervisor)

Cite this