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PubMed1986

Social control and expressed emotion.

Research shows a higher risk of relapse among schizophrenics in high "expressed emotion" families. In this paper, the measure called "expressed emotion" is conceptualized as an indicator of family attempts to socially control the schizophrenic person's behavior in a particular way. This social control conceptualization is supported by a review of the type of information in the measure. Hypotheses following from this view are examined to assess the construct validity of the measure conceptualized as a type of social control. First, attempts at control are hypothesized to be ways anxious and fearful families try to cope. Second, the family's recognition of the schizophrenic's problem as mental illness is hypothesized to reduce the fearful and anxious family's likelihood of an intense interpersonal social control coping response. This type of social control of involuntary illness behaviors would be abandoned as unjust and unlikely to be effective. Data from the pioneering 1972 study by Brown, Birley, and Wing (Br. J. Psychiatry 121:241-258) provide support for these hypotheses and thus provide support for this social control conceptualization.

Anxiety↗
PubMed1997

Expressed emotion and social function.

We examined whether expressed emotion (EE) influenced the social functioning of schizophrenia. Twenty-nine subjects meeting the diagnostic criteria of ICD-9 or DSM-III-R participated in the study. The Camberwell Family Interview was conducted to evaluate EE, and subjects were divided into high EE and low EE groups. The subjects had been followed up for 9 months and their social functioning was compared between the two groups as assessed with the Katz Adjustment Scales. In the high EE group, levels of both performance of socially-expected activities and free-time activities slightly declined at follow-up. In contrast, those in the low EE group improved and the score increase in the level of performance of socially-expected activities was significant (P < 0.05). We confirmed the relationship of families' EE status with social functioning in schizophrenia.

Adult↗
PubMed1999

Relatives' expressed emotion (EE) and PTSD treatment outcome.

BACKGROUND: Expressed emotion (EE) is a measure that has been used to assess the quality of the relationship between patient and their key relative. It has been shown to be strongly predictive of clinical outcome in a range of psychiatric and medical disorders. This study investigated the effect of EE on treatment outcome in chronic post-traumatic stress disorder (PTSD). METHODS: A prospective design was adopted. The key relatives of 31 PTSD patients participating in a treatment trial comparing imaginal exposure with cognitive therapy were interviewed and rated on EE prior to treatment allocation. The effect of EE on post-treatment clinical outcomes was assessed. RESULTS: Sixteen patients (52%) had high EE and 15 (48%) low EE relatives. Patients with high EE relatives showed lesser change scores on the main outcome variable of the trial, the total CAPS score, and on all the secondary outcome variables than those with low EE relatives. Using different multiple regression models the EE scales of criticism and hostility predicted just under 20% of the outcome variance. These two scales were highly correlated and criticism marginally predicted the greatest variance (19.7%). CONCLUSIONS: The results highlight the importance of the quality of the patient's social environment in influencing their response to cognitive and behavioural treatments.

Adult↗
PubMed1989

Predictors of relapse in unipolar depressives: expressed emotion, marital distress, and perceived criticism.

The predictive validity of expressed emotion (EE) and two conceptually related but more easily measured alternatives--marital distress, and patients' perceptions of criticism from spouses--were examined in a sample of hospitalized unipolar depressives. All three psychosocial variables were significantly associated with 9-month relapse rates. Expressed emotion and marital distress predicted the same proportion of variance in patients' outcomes. The single best predictor of relapse, however, was a patient's response to the question "How critical is your spouse of you?" Patients who relapsed rated their spouses as significantly more critical than did patients who remained well. Alone, the perceived criticism variable accounted for more of the variance in relapse rates than that explained by EE and marital distress combined. The results suggest that asking depressed patients how critical they believe their relatives are may facilitate the identification of individuals at high risk for relapse subsequent to hospital discharge.

Adaptation, Psychological↗
PubMed1989

Lateralization of emotional expression under a neuroleptic drug.

Sixteen student volunteers were administered placebo and 50 mg of chlorpromazine (CPZ) in tablet form, on separate occasions, two hours before testing. Whilst volunteers related pleasant and unpleasant personal life events, the frequency and intensity of expressions on the left and right sides of the face were rated by independent observers. Subsequently the valence of the narration was also rated. Similar to a previous study facial expressions during negative emotions were expressed more often and intensely in the left face but positive emotions were bilaterally represented. CPZ neutralised the emotion on both sides of the face, irrespective of whether it was positive or negative. However, because negative emotions were almost completely lateralised to the left face the drug's effect on this emotion was most pronounced on this side. Independent ratings of the narration of the life events showed CPZ made them more pleasant. It is suggested that emotional arousal increases the asymmetry of behaviours when these are unilaterally represented or controlled. CPZ may equalize the symmetry of behaviour by reducing emotional arousal rather than by blocking all behaviour.

Adolescent↗
PubMed2002

Predictors of components of expressed emotion in major caregivers of Turkish patients with schizophrenia.

BACKGROUND: Expressed emotion (EE) is a concept reflecting the emotional atmosphere of the home environment. Specific components of EE, namely criticism, hostility and emotional over-involvement, have been found to be important predictors of relapse for schizophrenic patients. The main aim of this study was to examine the predictive power of patient and caregiver characteristics and caregivers' perceptions of frequency, coping, distress/discomfort, control of symptom behaviours by the patient, and attributions on locus of causality for the development of the illness on two components of EE (criticism/hostility and emotional over-involvement) in a sample of major caregivers of Turkish schizophrenic patients. METHODS: Seventy-two caregivers of schizophrenic patients were administered a set of questionnaires tapping socio-demographic and illness-related variables, the family questionnaire tapping perceived frequency, distress/discomfort, coping and control of symptom behaviours, causal attributions for illness and, finally, the Expressed Emotion Scale in the hospital setting. RESULTS: The results showed that caregivers' perceptions of coping with specific symptom behaviours decreased criticism/hostility (C/H), whereas perceptions of higher frequency of symptom behaviours increased C/H. For emotional over-involvement (EOI), the number of individuals living in the household, being the mother, father or the spouse, perceptions of coping with symptom behaviours and reported distress/discomfort about symptom behaviours were significant predictors. CONCLUSIONS: Caregivers' perceptions of their ability to cope with symptom behaviours and their reported distress due to these behaviours are important variables related to components of EE and need to be targets in intervention studies. The cultural and clinical implications of the results for the management of schizophrenia and for support for the caregivers are discussed.

Adolescent↗
PubMed1999

Recognition of facial emotional expressions from moving and static displays by individuals with mental retardation.

Moving and static videotaped and photographic displays of posed emotional expressions were presented to 12 adults with mental retardation and 12 without mental retardation to investigate the role of movement in the recognition of facial expressions of emotion. Participants chose the corresponding emotion portrayed by the displays from among six written and pictorial labels of the emotions. Results indicated that individuals with mental retardation were significantly poorer at identifying anger, fear, disgust, and surprise. Both groups performed significantly better on the moving as opposed to the static videotaped displays of the emotions sad and angry. Visual-perceptual limitations are likely contributors to the poorer performance of the group with mental retardation in recognizing moving and static facial expressions of emotion.

Adult↗
PubMed2000

Evaluation of expressed emotion (EE) status in mood disorders in japan: inter-rater reliability and characteristics of EE.

The reliability of expressed emotion (EE) ratings by the Camberwell Family Interview (CFI) and characteristics of EE were evaluated in families of patients with mood disorders in Japan. The subjects were 27 patients with mood disorders and 31 members of their families. The CFI was carried out with the family members. EE was rated by two raters independently, and the inter-rater reliability was evaluated according to Spearman's correlation coefficient by ranks and the kappa-value. The distribution of subscales of EE in these subjects was compared with that in families of patients with schizophrenia in Japan and families of patients with mood disorders abroad. Concerning critical comments (CC), hostility (H), and emotional over-involvement (EOI), which are important for EE rating, Spearman's correlation coefficient and the kappa-values were 0.4-0.8, and the reliability of EE ratings in mood disorders was not high. The proportion of positive agreement was particularly low in H and EOI. CCs were fewer in families of Japanese patients with mood disorders than in those with schizophrenia or families of American or European patients with mood disorders. Re-evaluation of the inter-rater reliability of EE ratings in mood disorders is needed. Expressed emotion was more suppressed in families of patients with mood disorders than in those of patients with schizophrenia. Expressed emotion was also more reserved in the Japanese subjects than in their Western counterparts.

Adult↗
PubMed2006

Psychoeducation and expressed emotion by parents of children with learning disorders.

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program (n=46) or to a regular treatment group (n=35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.

Affect↗
PubMed1998

Right hemisphere damage impairs the ability to process emotional expressions of unusual faces.

Patients with focal brain damage, right and left hemisphere damage, and nonpatient controls were asked to match photographs of emotion expressions that were depicted in unusual (line drawings, strange, and schematic) and normal (usual) representations of faces with the target emotion expressions of normal face. Nonpatient controls were significantly superior to right hemisphere damaged patients in matching photographs of emotion expressions that were depicted in line drawings of normal face and schematic face.

Adult↗
PubMedDate not supplied

Emotion expression processes in children's peer interaction: the role of peer rejection, aggression, and gender.

The goal of the current study was to investigate sociometric status, aggression, and gender differences in children's expression of anger, happiness, and sadness. Participants were 111 second-grade African American boys and girls, half rejected and half average sociometric status, and half aggressive and half nonaggressive as assessed by their peers. Children interacted with a confederate in two standardized competitive game paradigms. Participants' expressions of anger, happiness, and sadness were observationally coded across facial, verbal intonation, and nonverbal modalities. Rejected children expressed more facial and verbal anger than average-status children. Rejected children also expressed more nonverbal happiness than average children, but only during turns of the game that were favorable to the participant. Finally, boys expressed more facial, verbal, and nonverbal anger than girls.

Black or African American↗
PubMed2004

Time course and specificity of event-related potentials to emotional expressions.

To clarify the time course of neural responses to faces with different emotional expressions, we used event-related potential (ERP) and reaction time measures. Faces expressing four different emotions (happy, neutral, fearful, disgusted) and houses were shown in both upright and inverted orientations while subjects performed an immediate-repeats task. Results indicated that upright fearful expressions enhanced the frontocentral P200. However, emotional effects on the N170 and late positive component interacted with face orientation and were not selective for any specific expression. A unique negative component for upright disgust faces was observed at approximately 300 ms at occipital regions. These results provide evidence for emotion-specific ERPs associated with fear and disgust, distinct from other non-specific configurational and attentional effects.

Adult↗
PubMed1994

The Nithsdale Schizophrenia Surveys. XIII. Parental rearing patterns, current symptomatology and relatives' expressed emotion.

BACKGROUND: A population of adult schizophrenic patients was assessed to discover how the patients viewed their childhood, whether their view differed from non-schizophrenic adults, and to determine any association between parental rearing practices as perceived by the patient, childhood personality as perceived by the mother, and current symptoms. Type and level of expressed emotion shown by parents towards patients was also examined. METHOD: Parental attitudes, as perceived by 50 schizophrenic patients, were assessed by the EMBU scale. Patients' premorbid personality and social adjustment were assessed through interviews with patients' mothers by the Scale for the Assessment of Premorbid Schizoid and Schizotypal Traits and the Premorbid Social Adjustment Scale. Current symptoms were assessed by the Positive and Negative Syndrome Scale and Subjective Deficit Syndrome Scale. RESULTS: Patients saw little difference between fathers' and mothers' attitudes. There was a positive correlation between parental rejection and overprotection, and a negative correlation between rejection and warmth. There were no significant correlations between parental rearing attitudes and patients' childhood personality; there was a significant correlation between parental attitudes and current symptoms. Rejection and overprotection were associated with more severe, warmth with less severe symptoms, especially so for positive schizophrenic symptoms and general psychopathology. Although there was no association between the general level of expressed emotion shown by the parent towards the adult patient, and patients' perceived parental rearing attitudes, parents with high expressed emotion on the basis of hostility had higher rejection scores on the parental rearing attitudes scale. CONCLUSIONS: Schizophrenic patients saw their parents as showing much less warmth, and the severity of currents symptoms was associated with perceived parental rearing attitudes. The hostility component of high expressed emotion may be a parental trait which exists before the illness begins.

Adult↗
PubMed2003

Carers' expressed emotion, appraisal of behavioural problems and stress in children attending schools for learning disabilities.

BACKGROUND: Expressed emotion (EE) has been found to be high in families with children suffering from conduct disorder as well as a variety of childhood psychiatric disorders. Expressed emotion has been associated with high levels of stress in carers. However, behavioural problems in children do not automatically lead to stress in carers. Carers' beliefs and behaviour could affect how they appraise and cope with their child's behaviour. Furthermore, the perceived adequacy of social support can also be an important factor in determining the family's level of stress. The study investigates the relationship between EE variables and carers' appraisal and coping with the child's behaviour, stress and social support. METHODS: Forty-seven carers were recruited from schools for moderate to severe learning disabilities. Carers filled in questionnaires and took part in the Camberwell Family Interview for EE status. Carers' EE status was determined by a rater blind to the carers' questionnaires scores. RESULTS: There was no difference between high and low EE groups in the descriptive information of the child's independence, communication skills, or the frequency of behavioural problems. However, high EE carers appraised more of their children's behaviour as definite problems and their available social support to be less adequate. High warmth was found to relate to more positive reappraisal and less escape-avoidance coping. A multiple regression analysis indicated that carers' EE, psychological well-being, appraisal of their children's behaviour, their children's communication skills and respite usage predicted 62% of the variance in their perceived stress scores. CONCLUSION: It is important to consider optimal use of respite care and psychosocial intervention to encourage positive appraisal and problem solving.

Adaptation, Psychological↗
PubMed1997

Predictive power and construct validity of the Level of Expressed Emotion (LEE) scale. Depressed out-patients and couples from the general community.

BACKGROUND: The Level of Expressed Emotion scale (LEE) is a questionnaire designed to measure the perception of expressed emotion, an important predictor of the course of several psychiatric disorders. METHOD: In this study, the scale's predictive and construct validity were examined in a sample of 26 clinically depressed out-patients and their partners, and in a sample of 40 couples from the general community. RESULTS: In the sample of depressed out-patients, the LEE was predictive of depression improvement at six-month follow-up. With regard to the construct validity, results in both samples showed quite strong relationships between the LEE and depressive symptomatology, relational dissatisfaction, and coping styles. CONCLUSIONS: The LEE may be a useful tool in the study of interpersonal processes and depression, both in clinical and research settings.

Adaptation, Psychological↗
PubMed1996

Stereotypes of emotional expressiveness of northerners and southerners: a cross-cultural test of Montesquieu's hypotheses.

Montesquieu argued that residents of warmer climates are more emotionally expressive than those living in cooler ones. More than 2,900 college students from 26 countries completed a brief questionnaire assessing the degree to which they considered Northerners and Southerners within their own countries to be emotionally expressive. In addition, individuals rated themselves on their own degree of expressiveness. In partial confirmation of Montesquieu's hypothesis, it was found that large within-country North-South stereotypes exist. Especially in Old World countries, Northerners are viewed as less emotionally expressive than Southerners. Regression and other analyses revealed that self-ratings of expressiveness were, in fact, related to being from the South and to warmer mean temperatures. Several possible explanations for these effects are discussed.

Adult↗
PubMed1990

[Schizophrenic patients and the emotional climate in the family. Causes, consequences and treatment of intensely expressed emotions of close relatives].

In recent years it has been shown that the course of schizophrenia is influenced by the attitudes and behaviour of the close relatives with whom the schizophrenic person lives. In particular, there is greater risk of relapse if family members show a high degree of criticism, hostility, or emotional over-involvement in relation to the schizophrenic; these attitudes have been described as high expressed emotion (High EE) and are usually assessed by means of the Camberwell family interview. However, as discussed in this paper, there are still many unsettled questions regarding content, validity, causes, effects, and treatment of High EE.

Attitude to Health↗
PubMed1989

The development of emotion expression during the first two years of life.

This study examines the course of emotion expression development over the first 2 years of life in a sample of full-term and preterm children. 58 mother/infant pairs were videotaped at infant ages of 2 1/2, 5, 7 1/2, and 22 months, recording face-to-face interaction involving play and separation/reunion sessions. The tapes were coded on a second-to-second basis using Izard's facial affect coding system. Data analysis focused on (1) differences in expressive behavior at 22 months as a function of risk status, gender, attachment status, and patterns of earlier maternal contingency behavior; (2) stability of specific emotional expressive patterns across assessment periods; and (3) the relation of expressive behavior and security of attachment at 2 years to qualities of earlier affective interchange. Mother's contingency behavior (both general level and specific contingency patterns) appeared to have a material effect on the course of emotional development, as did birth status and gender. Prematurity was associated with differential socioemotional development well into the second year, much in contrast to the "catch-up effect" observed in linguistic and cognitive functioning. Discrete emotions analysis of attachment groups yielded differentiation along a broad negative/positive dimension, but it also showed that insecurely attached children can be characterized as showing inhibited anger expression. The results of this study are discussed within the framework of organizational models of infant affective development; attachment theory and discrete emotions approaches were found to yield different yet equally informative data on the course of socioemotional development.

Adult↗