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PubMed1997

Expressed emotion and causal attributions in the spouses of depressed patients.

High levels of expressed emotion are thought to be related to the attributions relatives make about the causes of a patient's illness and problem behaviors. Causal attributions occurring during spontaneous speech in 43 spouses of depressed patients were examined. Consistent with theoretical prediction and with previous research in schizophrenia, high critical spouses were more likely than low critical spouses to attribute patients' symptoms and negative behaviors to factors that were controllable by and personal to the patients. High critical spouses also made more attributions that implied that they held patients responsible for their difficulties. Although predictive of spouses' criticism, these attribution dimensions did not predict patient relapse. The results suggest that causal attributions are important for understanding spouses' criticism but are of limited predictive validity with respect to depressive relapse.

Adult↗

PubMed1983

Life events, relatives' expressed emotion and maintenance neuroleptics in schizophrenic relapse.

Data from two studies, one naturalistic and the other a controlled trial, were analysed to clarify the relationships between independent life events. Expressed Emotion of a key relative, maintenance neuroleptics and the relapse of schizophrenia. It was found that patients in the community who are unprotected by medication are vulnerable either to acute stress in the form of life events or to chronic stress in the form of living with a high Expressed Emotion relative. Patients on regular medication are protected against one or other stress, but are very likely to relapse if the two forms of stress occur together. A model of schizophrenic susceptibility to environmental stress is constructed to incorporate these observations.

Adult↗

PubMed1993

Parental perception of emotional expressiveness in children with autism.

Parents' perceptions of their children's emotional expressiveness, and possible bases for these perceptions, were investigated in a study comparing older, nonretarded autistic and normal children and in another study comparing young autistic, mentally retarded, and normal children. Both groups of autistic children were perceived as showing more negative emotion and less positive emotion than comparison children. In the younger sample, parental perceptions correlated with the children's attention and responsiveness to others' displays of emotion in 2 laboratory situations. Findings contradict the view that autism involves the "absence of emotional reaction" (American Psychiatric Association, 1987, p. 35).

Affective Symptoms↗

PubMed2006

Adult attachment and the perception of emotional expressions: probing the hyperactivating strategies underlying anxious attachment.

According to adult attachment theory, individual differences in attachment-related anxiety reflect variation in individuals' vigilance to cues relevant to appraising and monitoring the availability and responsiveness of significant others. To investigate this assumption, the authors adopted a morph movie paradigm in which participants were shown movies of faces in which an emotional facial expression changed gradually to a neutral one (Study 1) or a neutral expression changed to an emotional one (Studies 2-4). Participants were asked to judge the point at which the emotional expression had disappeared or emerged, respectively. Individuals who were highly anxious with respect to attachment were more likely to perceive the offset (Study 1) as well as the onset (Studies 2 and 3) of the facial expressions of emotion earlier than other people. Moreover, this heightened state of vigilance may have led to poorer accuracy in judging facial expressions of emotion (Study 3), an effect that was reversed when anxious individuals were required to watch the movies for the same length of time as less anxious participants (Study 4). The results indicate that variation in attachment anxiety reflects, in part, differences in vigilance to cues of social and emotional significance.

Adult↗

PubMed1993

Equivalent perceptual asymmetries for free viewing of positive and negative emotional expressions in chimeric faces.

Research employing chimeric stimuli (in which smiling and neutral half-faces are paired) has demonstrated greater influence of the left half-face in determining perceived intensity of expression. To date, no studies have examined how emotional expressions other than happiness are perceived in this format. Right-handed subjects viewed chimeric faces depicting both positive (happiness, pleasant surprise) and negative (sadness, anger) emotions in a free vision task. Results indicated a left half-face bias for all four emotions, supporting the hypothesis of a greater right hemisphere role in emotional perception. The lack of differences in strength of left half-face bias as a function of the specific emotion depicted suggests that results obtained with typical chimeric half-face paradigms can be generalized to emotions other than happiness.

Adult↗

PubMed1991

Attribution and expressed emotion in the relatives of patients with schizophrenia.

Indexes of expressed emotion (EE) in 58 relatives of patients with schizophrenia were related to those relatives' spontaneously expressed causal beliefs about the illness and about related symptoms and behaviors. Relatives made attributions predominantly to factors external, universal, and uncontrollable from their own perspective, and to factors internal, universal, and uncontrollable from the patient's perspective. Low-EE relatives were similar in their attributions to emotionally overinvolved relatives. Compared with these two groups, critical and/or hostile relatives made more attributions to factors personal to and controllable by the patient. Subsequent analyses suggested that hostile relatives were further characterized by making more attributions to factors internal to the patient and by making attributions with fewer causal elements.

Adolescent↗

PubMed2006

Emotional expression and diurnal cortisol slope in women with metastatic breast cancer in supportive-expressive group therapy: a preliminary study.

We examined coded emotional expression during an initial therapy session and its association with a known physiological risk factor for early death, aberrant diurnal cortisol slope, in women with metastatic breast cancer. Out of 64 women with metastatic breast cancer randomized to a multi-site clinical intervention trial of supportive-expressive group therapy (SET), a subsample of 29 met eligibility criteria for this study. We tested whether longer mean durations of primary negative affect (fear, sadness, and anger) expression were associated with steeper diurnal cortisol slopes after adjusting for speaking time, repressive-defensiveness, anxiety, and the interaction between repressive-defensiveness and anxiety. We found that steeper cortisol slopes were related to lower repressive-defensiveness and greater primary negative affect expression in line with a priori hypotheses. Additionally we explored whether coded positive affect, defensive/hostile affect, constrained anger, and the interaction between primary negative affect and repressive-defensiveness explained additional variance in diurnal cortisol patterns.

Adult↗

PubMed2003

Determinants of expressed emotion in mothers of schizophrenia patients.

Our objectives were to determine the extent to which symptoms in the schizophrenia patient and personality in the mother lead to a sense of subjective burden in the mother, and to explain variance in two components of Expressed Emotion. Data on symptom severity (PANSS), mothers' personality (NEO-PI), subjective burden (SBAS), and Expressed Emotion (CFI) were gathered from 41 schizophrenia outpatients and their mothers. Approximately one quarter of the variance in Critical Comments (CCs) and Emotional Overinvolvement (EOI) was explained using path analysis. Mothers' CCs were associated with more severe excitement in the patient, with lower Neuroticism, and greater burden in the mother. Higher EOI was explained by greater Conscientiousness and burden in the mother; patient depression had a weak indirect effect on maternal EOI. These results characterize the high EE mother as low in neuroticism and high in conscientiousness with a particular sensitivity to excitement and depression in the patient.

Adult↗

PubMed1999

Lateralization of facial emotional expression in schizophrenic and depressed patients.

This study examined facial emotional expressions produced by schizophrenic (SZ), unipolar depressed (UD), and normal control (NC) righthanded adults. Hypotheses regarding right-hemisphere activation in UD and suppression in SZ were addressed, as well as hypotheses about emotion and laterality. Subjects were videotaped while posing positive, neutral, and negative facial expressions to verbal command and to visual imitation. Naive judges rated hemiface stimuli for intensity in original and mirror-reversed orientations. Overall, SZs produced expressions with diminished intensity relative to UDs and NCs. Across subject groups, expressions were more intense in the visual than the verbal condition. In general, approach expressions were produced with greater right-hemiface intensity, and withdrawal expressions with greater left-hemiface intensity. UDs showed more pronounced facial asymmetry than SZs or NCs. An unanticipated right-hemispace perceptual bias among the judges may reflect the analytical, detailed rating procedure used and the presumably greater reliance by the judges on left-than right-hemisphere strategies.

Adult↗

PubMed1993

Expressed emotion in the investigation of eating disorders: a review.

Expressed Emotion (EE) is a measure of family interaction that has been shown to be useful for the investigation of many psychiatric disorders. This paper describes why it is appropriate to use it for the investigation of eating disorders. There is discussion of the findings that the levels tend to vary between the different eating disorders. The relationship between EE and treatment response is discussed. Suggestions are made for further research.

Adolescent↗

PubMed1988

Expressed emotion research in schizophrenia: theoretical and clinical implications.

The expressed emotion (EE) measure is a robust predictor of relapse in schizophrenia. At least twelve studies from a range of cultures have now shown this, although the authors of one maintain their findings are the result of confounding factors. A thirteenth study which failed to demonstrate a predictive effect was seriously weakened by methodological defects. There is now also evidence for the construct validity of EE, which has been shown to reflect ongoing family interactions. High EE relatives display less effective coping responses, and may adversely affect the patient by creating an unpredictable environment. EE may change with time, and probably reflects the interaction of external stresses, the real problems with the patient, and inappropriate coping responses. The association of high EE with arousal in the patient, as indicated by skin conductance abnormalities, has now been replicated. Although the EE phenomenon can be subsumed under a vulnerability-stress model, the way in which it might mediate relapse has not as yet been specified. Interventions have been successful in reducing relapse, and do so by increasing the tolerance and coping skills of the relatives, and by establishing more realistic expectations. As most have also involved the patient in the process of treatment, they have not fully resolved the question of causal direction. Future studies will clarify these issues, but will not detract from the value that EE has already had in energizing research. It has also provided a framework within which clinicians have begun to recognize and deal with the disabling problems that beset schizophrenic patients and their families.

Emotions↗

PubMed1988

The assessment of psychophysiological reactivity to the expressed emotion of relatives of schizophrenic patients.

The measure of expressed emotion (EE) of the relative has been found to be an important predictor of schizophrenic relapse. Electrodermal measures were recorded when the schizophrenic patient was talking to an experimenter, and when the patient was talking to a relative. Although there were no differences during the relative-absent period, patients with a high-EE relative present exhibited significantly higher frequencies of non-specific skin-conductance responses (NS-SCRs) than patients with a low-EE relative present. Patients show a significant decrease in NS-SCRs on the entry of low-EE, but not high-EE relatives. Patients with high-EE relatives show overall higher levels of skin-conductance levels (SCLs) than patients with low-EE relatives. Although patients with high-EE relatives rate themselves significantly more tense and anxious on self-rating scales, there are no significant correlations between self-ratings and electrodermal measures. The use of electrodermal reactivity as an assessment measure of relapse risk is discussed.

Adolescent↗

PubMed1997

Expressed emotion and the course of late-life depression.

This study examined rates of expressed emotion (EE) indexed by the Five Minute Speech Sample (FMSS; A. B. Magana et al., 1986) in adult children or spouses of 54 elderly patients hospitalized for major depressive disorder. It also examined whether EE was related to course of psychiatric illness in these elderly patients over 1 year. Among the family members, 40% were classified as high EE. EE was not significantly related to relapse in the total sample. However, there was an interaction between EE and relationship to the patient (i.e., spouse or adult child) on 1-year clinical outcomes of the elderly. Among adult children caring for older patients, high-EE status predicted higher rates of patient relapse and lower rates of complete and sustained recovery from depression than low EE. In contrast, there was a trend association among spouses between high EE and lower rates of relapse as well as higher rates of complete and sustained recovery.

Adult↗

PubMed1998

Expressed emotion and interactional patterns in the families of bipolar patients.

The predictive validity of expressed emotion (EE) may derive in part from its relationship to important interactional processes in families of patients with major psychiatric disorders. The authors examined the relationship between relatives' EE attitudes, assessed during patients' bipolar, manic, or mixed episodes, and the interactional behavior of bipolar patients (n = 48) and their relatives as revealed in problem-solving discussions during the postepisode period. High-EE relatives were more verbally negative than low-EE relatives in these discussions. Patients from high-EE families were more nonverbally negative than those from low-EE families, whereas patients from low-EE families were more nonverbally positive than those from high-EE families. Sequential analyses revealed that high-EE families engage in negative interchanges of up to 3 volleys. Thus, levels of EE are associated with stressful patterns of interaction between bipolar patients and their relatives during the postepisode period.

Adult↗

PubMed1997

The relationships between expressed emotion, affective style and communication deviance in recent-onset schizophrenia.

The relationships between expressed emotion (EE), affective style (AS) and communication deviance (CD) were studied during hospitalization and after discharge. EE was measured with both the Camberwell Family Interview (CFI) and the Five-Minutes Speech Sample (FMSS). The study subjects were patients with recent-onset schizophrenia and related disorders, who were consecutively admitted to an in-patient unit for adolescents, and their parents. The results revealed that CFI/EE was significantly correlated with AS criticism scores during hospitalization, but did not predict AS scores after discharge. FMSS/EE correlated significantly with AS criticism when both measures were administered after discharge. During hospitalization, FMSS/EE was not significantly correlated with AS. No consistent relationship was found between CD and both affective factors (EE and AS). It is concluded that EE and AS overlap with regard to level of criticism when both measures are administered over a short period of time and independent of the time of assessment. In addition, the results indicate that affective and communication factors identify independent family attributes.

Adolescent↗

PubMed1993

Influence of patient caregivers on course of patient illness: "expressed emotion" and alternative measures.

The influence of the quality of care that patients receive during the course of their illness has been the subject of special scrutiny in the area of mental health. The concept of "expressed emotion" (EE) evolved in an effort to understand the impact of family and social environment on the vulnerability to relapse of schizophrenic patients. A semistructured interview, the Camberwell Family Interview, was developed to assess expressed emotion. This article examines the historical context, generalizability, methodological strengths and limitations of the construct of EE and the Camberwell Family Interview, as well as the nature and effects of treatment intervention programs designed to neutralize adverse effects of patient caretaker attitudes.

Caregivers↗

PubMed1993

[Visual evoked potentials and face recognition. Influence of celebrity and emotional expression].

Visual evoked potentials (VEP) were recorded in the right and left parietal and occipital regions of 40 right-handed controls in a facial recognition task. VEP were studied first according to the renown of the faces, then according to their emotional expression. Asymmetry was noted between the hemispheres: P100 was of greater amplitude and longer latency in the left occipital region. Later components (P400 and P600) were of greater amplitude and longer latency in the right parietal region in all situations. P100 latency on the left side was shorter for renowned faces than for non-renowned faces (P = 0.05). P600 latency was shorter on the right (P < 0.03) and left (P < 0.05) sides for smiling than for non-smiling faces. When the subjects were asked to look for emotional expression of the face (smiling or non-smiling) P400 was very ample and P600 of little amplitude. When the subjects were asked to recognize the face (renowned or not renowned) P600 was very ample and P400 of little amplitude. Thus, there seems to be a differential treatment of information: automatic and rapid to detect emotion (P400), controlled, tardy (P600) and involving memory in the search for renown.

Adult↗

PubMed1989

Posed emotional expression in unilateral brain damaged patients.

The facial expressions of six basic emotions were posed by two groups of right (N = 23) and left (N = 34) brain damaged patients and by a control group of normal subjects (N = 28). The posed expressions were examined by means of the Facial Action Coding System (FACS) which provides analytical and objective scoring, as by a subjective scale of appropriateness of expression. Results indicated no difference between controls and patients with a lesion in the right or left hemisphere. These findings are inconsistent with the hypothesis that the right hemisphere plays a specific role in the control of posed facial expression. No relationship was observed between posed emotional expressions and facial paralysis or the presence of oral apraxia.

Affect↗