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PubMed2000

The low prevalence of high levels of expressed emotion in Bali.

The present study contrasts the expressed emotion (EE) status in family members of schizophrenic patients between Bali (Indonesia) and Tokyo (Japan), the former being a non-industrialized society and the latter an industrialized society in Asia. The EE ratings of each key relative for 62 consecutively hospitalized schizophrenic patients at the Bangli State Mental Hospital (Bali) and 33 consecutively admitted schizophrenics at Komagino Hospital (Tokyo) were obtained using the Five Minute Speech Sample (FMSS) method. A significantly lower prevalence of high EE (12.9%) was observed in Bali compared with Tokyo (36.4%) (P<0.01). This result may explain the better social adjustment of schizophrenics in Bali. In addition, in Bali, to clarify the EE effect in this non-industrialized society, we examined the relationship between each key relative's EE and the patient's psychotic symptoms at admission, as assessed by the Brief Psychiatric Rating Scale (BPRS) and the Scales for the Assessment of Negative Symptoms (SANS). Moreover, the association between each family member's EE and a patient's rate of re-admission over the 1-year period following discharge was evaluated. The EE value was significantly related to the anxious-depression factor score in the BPRS, but not to either of the other factor scores in the BPRS or SANS subscales. Furthermore, EE status was not a reliable predictor of patient re-admission over the 1-year period following discharge in Bali.

Adolescent↗
PubMed2003

The impact of maternal depression on adolescent adjustment: the role of expressed emotion.

The present study evaluated the role of expressed emotion (EE) as a predictor of child symptomatology and functional impairment in a sample of nearly 800 adolescent children of mothers with varying histories of depression or who were nondepressed. Structural equation modeling was used to test the hypothesized associations in half of the sample, and all models were cross-validated on the other half of the study sample. Results indicated that EE criticism and degree of maternal depression both had independent predictive associations with youths' externalizing symptoms and functional impairment. In addition, high EE criticism served as an intervening variable between maternal depression and child functioning (externalizing symptoms and functional impairment). Results are discussed in terms of the mutual effects of depressed mothers and dysfunctional youths on each other.

Adolescent↗
PubMedDate not supplied

Psychoeducation for the families of patients with eating disorders and changes in expressed emotion: A preliminary study.

Psychosocial variables such as expressed emotion (EE) have prognostic significance, and family psychoeducation has been developed to aid in the treatment of various psychiatric disorders. This study reports relationships among EE, family factors, and symptoms observed while conducting multifamily psychoeducation for eating disorders. Group sessions were held once a month for the relatives of patients with DSM-IV eating disorders, and the group met for five sessions that included both education and problem-solving. Thirty-seven relatives volunteered to participate in our program, and of these, 28 completed the program. EE (as measured by the Five-Minute Speech Sample [FMSS]), family function (as measured by the Family Adaptability and Cohesion Evaluation Scales [FACES]), the family's mental state (as measured by the Profile of Mood States [POMS]), and patient's symptoms (as measured by the Eating Disorder Evaluation Scales [EDES] and Global Assessment of Functioning [GAF] on clinician evaluations, and by the Anorexic Behavior Observation Scale [ABOS] assessment of the family) were administered at both the first and final sessions. The rates of high-EE relatives tended to decrease (especially high emotional overinvolvement [EOI]), and families' assessment of symptoms was also significantly improved. Twice-repeated multivariate analysis of variance (MANCOVA) showed that EOI, ABOS, and POMS scores were changed significantly during the sessions. Psychoeducation for the family members of patients with eating disorders might help lower distress and encourage positive interactions within the family. EE is an important measure in evaluations of psychoeducation. However, a randomized, controlled trial is needed to clarify the efficacy of this treatment.

Adaptation, Psychological↗
PubMed2001

Expressed emotion in staff-patient relationships: the professionals' and residents' perspectives.

BACKGROUND: Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staff-patient dyad as measured by the concept of EE. METHODS: EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS, residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders. RESULTS: Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI. CONCLUSIONS: The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.

Adult↗
PubMed1997

Relatives' locus of control and expressed emotion in schizophrenia and related psychoses.

OBJECTIVES: Knowledge of what predicts relatives' expressed emotion (EE) may contribute to improved family work in schizophrenia. In the present study we examined locus of control (LOC) beliefs as determinants of EE components. DESIGN: This study is observational, prospective and partly cross-sectional, partly longitudinal (stability of LOC). METHODS: In a Norwegian sample of 47 recently hospitalized patients (schizophrenia or schizophreniform disorder) and 70 relatives, the relatives' EE was assessed by the Camberwell Family Interview and LOC by Levenson's Internality, Powerful Others and Chance scales. RESULTS: Confirmatory multiple regression analyses showed that Chance LOC was positively related to emotional overinvolvement (p < .005). Powerful Others LOC, especially 'wish to ingratiate' items, were positively linked to criticism and, among workers/lower grade employees only, to emotional overinvolvement. Internal LOC was not linked to any EE scale. CONCLUSIONS: This study indicates that LOC beliefs may be determinants of emotional overinvolvement and criticism, and should be taken into account in family work that aims at modifying relatives' EE.

Adult↗
PubMed1979

Facial patterning and infant emotional expression: happiness, surprise, and fear.

Although recent studies have convincingly demonstrated that emotional expressions can be judged reliably from actor-posed facial displays, there exists little evidence that facial expressions in lifelike settings are similar to actor-posed displays, are reliable across situations designed to elicit the same emotion, or provide sufficient information to mediate consistent emotion judgments by raters. The present study therefore investigated these issues as they related to the emotions of happiness, surprise, and fear. 27 infants between 10 and 12 months of age (when emotion masking is not likely to confound results) were tested in 2 situations designed to elicit hapiness (peek-a-boo game and a collapsing toy), 2 to elicit surprise (a toy-switch and a vanishing-object task), and 2 to elicit fear (the visual cliff and the approach of a stranger. Dependent variables included changes in 28 facial response components taken from previous work using actor poses, as well as judgments of the presence of 6 discrete emotions. In addition, instrumental behaviors were used to verify with other than facial expression responses whether the predicted emotion was elicited. In contrast to previous conclusions on the subject, we found that judges were able to make all facial expression judgments reliably, even in the absence of contextual information. Support was also obtained for at least some degree of specificity of facial component response patterns, especially for happiness and surprise. Emotion judgments by raters were found to be a function of the presence of discrete facial components predicted to be linked to those emotions. Finally, almost all situations elicited blends, rather than discrete emotions.

Emotions↗
PubMed2000

The five minute speech sample in children with asthma: deconstructing the construct of expressed emotion.

OBJECTIVE: To use the Five Minute Speech Sample (FMSS) to assess Expressed Emotion (EE) in various samples of children with asthma in order to clarify (1) developmental and validity issues for the EE construct and (2) the use of the FMSS technique, specifically, in children with chronic medical illness. METHOD: Data were collected on a sample of 84 adolescents with severe, chronic asthma who had failed outpatient management. In addition, a sample of 30 children with asthma, ages 6-9. were recruited from an outpatient pediatric clinic. A comparison sample of 15 children without any chronic illness, ages 6 9, were recruited by notices posted in the community. The primary caregiver of each child was assessed using the FMSS. RESULTS: FMSS interviews were reliability coded in all samples. Rates of high Criticism (FMSS CRIT), Emotional Overinvolvement (FMSS EOI), and EE were comparable to rates previously reported in child and adolescent samples. Although the validity for ratings of FMSS CRIT was well supported, the validity of FMSS EOI ratings and the overall EE construct were more problematic. CONCLUSIONS: The FMSS is a useful and largely valid measure in children with asthma. Ratings of FMSS CRIT were found to have strong validity. There was little problem shifting the context of FMSS administration from chronic mental to chronic medical illness, but a variety of developmental considerations arose, especially regarding FMSS EOI ratings. Although we raise concerns about viewing EE as a valid construct, it may remain a useful predictive index.

Adolescent↗
PubMed1998

Intimacy as a determinant of expressed emotion in carers of people with Alzheimer's disease.

BACKGROUND: Although high expressed emotion (EE) has been found to be an important predictor of poor prognosis in a wide range of conditions such as schizophrenia, anorexia and depression no complete explanation exists for individual differences in EE responses. The aim of this paper is to investigate the role of intimacy in determining the level of EE in carers of people with dementia. METHODS: Ninety-nine carers of people with dementia who presented to Old Age Psychiatry Services in South and Central Manchester completed questionnaires to ascertain past and current levels of intimacy. Camberwell Family Interviews (CFIs) were carried out to ascertain levels of EE. RESULTS: Current intimacy was found to be strongly related to EE such that low current intimacy was associated with high EE and there was a significant difference between high and low intimacy groups on measures of criticism and hostility, though not warmth. CONCLUSIONS: The association found between intimacy and EE indicates that high EE may be a characteristic of low intimacy relationships between the carer and the cared-for-person. Since the assessment of EE is time intensive, perhaps a measure of intimacy will provide a short-hand screen for identifying critical and hostile caring environments.

Aged↗
PubMed2001

Expressed emotion and the course of schizophrenia in Iran.

BACKGROUND: The influence of expressed emotion (EE) on the course of the schizophrenia has been studied in different countries. Cultural influence on the level of EE has shown the importance of examination of EE in different cultures. The present study examined the distribution of components of EE and influence of EE on the course of schizophrenia in Iran. METHODS: Two psychiatric centers from two dissimilar cities, Tehran and Hamedan, were chosen. Seventy-eight patients who suffered from schizophrenia based on the diagnostic criteria of DSM-III-R were selected. Interviews with 97 key family members were conducted using the Camberwell Family Interview. Psychiatrists who were blind to the EE status of the family household evaluated patients' symptoms based on a cohort study design during the 9-months follow-up. RESULTS: Sixty percent of the patients were living in a high EE household. The relapse rate in the high EE group was higher, but did not reach statistical significance. However, male patients as well as chronic patients were significantly more likely to relapse in the high EE group (P = 0.05). CONCLUSIONS: The results suggested that high EE is a risk factor on the course of schizophrenia in Iran. The distribution of the components of EE showed differences compared to other cross-cultural studies. The results of this study can be used in planning appropriate psychoeducational programs for families of patients in Iran and culturally similar populations.

Adolescent↗
PubMed1993

The validity of the Five-Minute Speech Sample as an index of Expressed Emotion in parents of eating disorder patients.

This article examines the concurrent validity of the Five-Minute Speech Sample (FMSS) as an index of Expressed Emotion in a Dutch sample of 84 parents of adolescents suffering from anorexia or bulimia nervosa. The Camberwell Family Interview (CFI), the criterion measure of EE, and the FMSS were conducted on the same day. The levels of Expressed Emotion in these families were low when compared with the EE ratings from the schizophrenia studies. The FMSS and CFI-EE ratings showed a limited degree of overlap. Whether the limited association between the two methods is due to the low levels of criticism in our sample, to cultural differences and/or to differences in the psychopathology under study remains unclear.

Adolescent↗
PubMed1988

Family expressed emotion and outcome of schizophrenics: a study in a French cultural environment.

This is the first attempt in a french cultural environment to relate family characteristics and expressed emotion to clinical course of schizophrenics. patients were studied during a two year period after their first or second hospital stay. Critical comments on subcategory of classical expressed emotion is associated with relapse, rehospitalization and work capacity but not with a broad measure of social activity.

Cultural Characteristics↗
PubMed2006

Affective evaluations of objects are influenced by observed gaze direction and emotional expression.

Gaze direction signals another person's focus of interest. Facial expressions convey information about their mental state. Appropriate responses to these signals should reflect their combined influence, yet current evidence suggests that gaze-cueing effects for objects near an observed face are not modulated by its emotional expression. Here, we extend the investigation of perceived gaze direction and emotional expression by considering their combined influence on affective judgments. While traditional response-time measures revealed equal gaze-cueing effects for happy and disgust faces, affective evaluations critically depended on the combined product of gaze and emotion. Target objects looked at with a happy expression were liked more than objects looked at with a disgust expression. Objects not looked at were rated equally for both expressions. Our results demonstrate that facial expression does modulate the way that observers utilize gaze cues: Objects attended by others are evaluated according to the valence of their facial expression.

Adult↗
PubMed1998

Decoding of facially expressed emotions in patients with psychosomatic gastrointestinal disorders.

The hypothesis that individuals with psychosomatic conditions are lacking in empathy was tested by investigating decoding abilities of facially expressed emotions. Fourteen subjects with psychosomatic gastrointestinal disorders and 14 matched controls participated. Slides of one male and one female model's facial expressions of anger, disgust, fear, happiness, sadness, and surprise, and a neutral face, were presented to subjects, with exposure durations of 1/60, 1/15, and 4 seconds. Subjects had to decide whether the face presented was neutral or expressed one of the basic emotions. There were no significant group differences in decoding neutral expressions, but significant differences resulted in decoding emotional expressions. This was mainly due to the significantly poorer performance of the psychosomatic group in decoding disgust. Subjects' responding was found to be reliable. The findings show that at least certain subgroups of psychosomatic patients tend to misinterpret another person's facial expressions that signal unpleasantness or interpersonal conflict.

Adult↗
PubMed2005

A cross-cultural study on expressed emotion in carers of people with dementia and schizophrenia: Japan and England.

Expressed emotion (EE) research has been productive in investigating the influence of the interpersonal environment on a range of disorders. The majority of EE research on the influence of carers has been carried out in the west. This is the first EE study of the carers of people with dementia in Japan. The aim of this study was to investigate the relationships between EE status and aspect of burden through cross-cultural comparison of the two countries, Japan and England, with large cultural and linguistic differences. Comparisons were made between samples of EE of carers of dementia and schizophrenic patients. In total, data on 80 carer/relative-patient dyads were collected and examined: (1) 20 Japanese carers of people with dementia (JD), (2) 20 English carers of patients with Alzheimer's disease (ED), (3) 20 Japanese relatives of patients with schizophrenia (JS), and (4) 20 English relatives of patients with schizophrenia (ES). The Camberwell Family Interview was administered in each country to ascertain levels of EE. Large differences between Japan and England were found in the frequency of critical comments, in which ES>ED>JS>JD. EE correlated significantly with burden in the JD sample alone. With an operational cut-off of 2CC (CC, critical comments), EE correlated significantly with cognitive impairment as well as with clinical severity in the JD sample. There was a tendency for lower expression of both positive and negative emotional reactions towards family members in the Japanese sample. The results of this study indicate that EE is an appropriate measure for use with carers of sufferers of dementia and can be utilized across different cultures. However, flexibility with the cut-offs may be required in Eastern cultures. This needs to be tested on larger samples with sensitivity to illness and cross-cultural differences.

Adolescent↗
PubMed1987

Expressed emotion and schizophrenic outcome among Mexican-American families.

This study has demonstrated that among low-income, relatively unacculturated Mexican-American households, a high level of expressed emotion on the part of key relatives significantly increases the risk of relapse for remitted schizophrenics who return home to live with their families after hospital discharge. This cross-cultural replication of earlier research findings in London and southern California suggests that critical, hostile, or emotionally overinvolved attitudes and behaviors may be general major stressors that adversely influence the fragile adaptation of schizophrenic individuals in diverse cultural settings. The finding of a lower prevalence of high levels of expressed emotion among Mexican-American compared to Anglo-American and British households lends support to the hypothesis that intrafamilial behaviors may account for different schizophrenic outcomes in different cultures.

Attitude to Health↗
PubMed1996

Stress and its relationship to expressed emotion in community mental health workers.

A small opportunistic study of Stress and Expressed Emotion was undertaken with community mental health workers, who were all case managers or keyworkers to clients with severe mental illness. It was hypothesised that a range of EE ratings would be found in staff, and that they would have high levels of burnout and stress. Job satisfaction was also measured. Ten staff were interviewed about 28 clients. Thirty nine percent of interviewees were rated as high EE (7/10 staff were high EE about at least one client), with low EE interviews showing significantly more warmth. Emotional exhaustion, depersonalisation and GHQ levels were above norms for the general population, and were similar to those found in other inner city community teams, but were not related to EE levels. Nevertheless personal accomplishment and job satisfaction were high. High EE interviews were related to increased client symptomatology. Implications for long term community care are discussed.

Adult↗
PubMed2003

Assessing expressed emotion in mothers of preschool AD/HD children: psychometric properties of a modified speech sample.

OBJECTIVE: To examine the reliability and validity of a modified coding measure of expressed emotion (Preschool Five Minute Speech Sample [PFMSS]), suitable for parents of preschool AD/HD children. DESIGN: Mothers of preschool AD/HD children identified through a three-stage screening programme were compared with mothers of non-AD/HD children on the PFMSS. METHOD: Mothers of 80 AD/HD and 20 non-AD/HD children participated in the PFMSS. They had 10 mins of play interaction with their child and completed the Feelings on Parenting scales from the Family Impact Questionnaire. RESULTS: With the exception of emotional over-involvement, the PFMSS demonstrated acceptable code-recode and inter-rater reliability, and adequate test-retest reliability. It also demonstrated acceptable validity, being associated with less affection and greater maternal direction during play interaction and discriminated between the parents of preschool AD/HD and non-AD/HD children. CONCLUSION: This study shows that in a revised form, the Five Minute Speech Sample can provide a useful measure of expressed emotion during the preschool period.

Adult↗
PubMed1997

Expressed emotion and schizophrenia: the efficacy of a staff training programme.

The presence of expressed emotion (EE) in five community care facilities was investigated and levels of high EE were found in some staff-client relationships. A training programme was developed drawing on a variety of research findings and based on a successful community psychiatric nurse training package for work with families. Its aims were to enable community mental health workers to increase their knowledge about schizophrenia and repertoire of strategies for managing a variety of difficulties in addition to decreasing levels of EE present in their relationships with clients. A small but non-significant increase in knowledge was achieved, in addition to increases in the use of strategies aimed at effecting change and involving the use of resources. No significant changes in EE levels were reported.

Adult↗