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PubMed2002

Maternal expressed emotion, attributions and depression and entry into therapy for children with behaviour problems.

OBJECTIVES: Maternal expressed emotion (EE), attributions, depression and parenting stress in mothers of children with behaviour problems referred for therapy were tested for associations with entry to therapy. METHOD: In all, 57 mothers were assessed prior to first appointment using the Camberwell Family Interview coded for EE and attributions (LACS), and completed the Beck Depression Inventory (BDI) and Parenting Stress Index (PSI). RESULTS: Mothers who did not attend scored higher on EE dimensions of critical comments, hostility or emotional over-involvement, BDI or PSI. CONCLUSIONS: Some of the most distressed families referred may not attend, and need a different approach to engagement.

Adult↗
PubMed1999

Confirmatory factor analysis of the Level of Expressed Emotion (LEE) scale.

A confirmatory analysis of a previously reported structure for the Level of Expressed Emotion (LEE) scale was conducted with data from 75 volunteers. Three principal components were extracted and rotated to maximum congruence with a target based on previous research. The fit was found to be highly significant and retest correlations for the subscales of the LEE were good. However, the revised LEE scale could probably be improved, especially by the addition of a subscale designed to measure perceived criticism.

Adult↗
PubMedDate not supplied

[Modification of family expressed emotion after a psychosocial intervention: stability in time].

INTRODUCTION: There is some controversy about whether expressed emotion (EE) tends to remain stable or fluctuates in time and there are very few studies on EE evolution and its subscales once a family intervention has been performed. Better knowledge about its behavior in time would have important theoretical and clinical implications. METHODS: We have studied changes in EE and its subscales that are produced in a cohort of 37 relatives of schizophrenic patients to whom a familiar intervention orientated to reducing environmental stress was performed. Changes were analyzed according to three cross-sectional moments of evaluation: one moment previous to intervention, another one when it was finished and finally, one at five years of finishing it. RESULTS: In this work, the EE levels tend to vary in time. These changes are mainly produced in the period when the family intervention is carried out, at the expense of decreasing the levels of emotional overinvolvement. Between the end of therapy and the analysis carried out five years later, levels remain stable. The few changes that take place in this period, if any, are associated to variables of clinical severity and social adjustment. CONCLUSIONS: Family intervention appears as the determining factor for reducing EE levels, whereas productive clinical severity and the patient's social adjustment condition increases in their levels.

Adult↗
PubMed2003

Expressed emotion in the relatives of people with epileptic or nonepileptic seizures.

PURPOSE: This study investigated Expressed Emotion (EE) in relatives of people with epileptic or nonepileptic seizures (NES). METHODS: In a cross-sectional study, we used the Five-Minute Speech Sample to explore EE in the key relative of people with epilepsy (n = 36) and those with NESs (n = 21), as well as levels of anxiety and depression and use of coping strategies. RESULTS: A significantly greater proportion of relatives of NES than epilepsy patients were rated as high EE. Hostility was evident in more high-EE epilepsy than high-EE NES relatives, whereas emotional overinvolvement and positive relationship ratings tended to be more common in high-EE NES relatives. High- and low-EE epilepsy relatives used problem-focused as opposed to emotion-focused coping strategies significantly more than half the time. High EE and seizure frequency were not associated. Age at onset of the disorder was higher in epilepsy patients with high- than with low-EE relatives. CONCLUSIONS: Irrespective of etiology, carers for people with seizure disorders may find it hard to adjust to the difficulties these disorders create. Interventions that encourage problem-solving, reappraisals of "loss" and education regarding the causes of some of the patients' behavioral and mood problems seem likely to be beneficial.

Adaptation, Psychological↗
PubMed2004

Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy.

BACKGROUND: Levels of expressed emotion (EE) in relatives are consistent predictors of relapse among bipolar and other mood disordered patients followed naturalistically. However, few studies have examined whether levels of EE predict the course of illness for patients engaged in psychosocial interventions. METHODS: This study examined whether EE levels among caregivers moderated the success of family-based psychosocial interventions for patients with bipolar disorder. EE was examined as a predictor of symptomatic outcome in two groups: (1) bipolar patients receiving family-focused psychoeducational treatment (FFT) or integrated family and individual treatment (IFIT), and (2) bipolar patients receiving crisis management (CM), a less intensive intervention designed to emulate community care. Bipolar patients (N = 125) began the study in an acute illness episode, were stabilized on standard pharmacotherapy regimens, and followed for up to 2 years. RESULTS: Family EE status was not associated with time to relapse in either group. However, patients with high EE relatives reported higher levels of depression over the 2-year term of follow-up, regardless of treatment condition. An examination of the dimensions of EE (critical comments and emotional overinvolvement) indicated that a higher frequency of critical comments predicted higher levels of mania and depression at follow-up. Additionally, the association between EE criticism and levels of mania symptoms was stronger among patients in CM than among patients in family treatment. LIMITATIONS: The participants were recruited from two separate treatment protocols. Patients in the IFIT protocol were not randomly assigned to treatments. CONCLUSIONS: EE is a predictor of symptom severity among bipolar patients undergoing pharmacological and psychosocial treatments, but family intervention may mitigate this association.

Adult↗
PubMed2004

Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients.

BACKGROUND: The expressed emotion (EE) construct has predicted clinical outcomes in schizophrenia and depression, but few studies have been conducted with bipolar patients. Moreover, there is a particular dearth of information regarding the prediction of depressive versus manic episodes in bipolar patients. Questions also remain about the utility of EE compared to other variables (perceived criticism, relationship negativity, and chronic strain in close relationships) that more directly evaluate interpersonal stress and about specific predictions of mania or depression. METHODS: Forty-seven outpatients with bipolar I disorder participated in a 1-year longitudinal study. A close collateral of the patient completed the Five Minute Speech Sample (FMSS) to assess EE, and participants completed perceived criticism and negativity ratings of collaterals. Clinical outcomes and chronic interpersonal stress were assessed by interview at 3-month intervals. RESULTS: High EE predicted depressive, but not manic recurrence. Other variables of close interpersonal relationships were not significant predictors of recurrence. LIMITATIONS: Participants nominated collaterals, and those who did not have such a confidant were excluded. CONCLUSIONS: The FMSS was sensitive to even mild negativity by the collateral that predicted later depressive episodes. This is the first study to demonstrate polarity-specific effects of EE on the prediction of recurrence in bipolar disorder.

Adult↗
PubMed2004

Show your pride: evidence for a discrete emotion expression.

Three experiments provide converging evidence that pride has a distinct, recognizable expression. Experiment 1 showed that judges can agree in identifying a posed expression as showing pride and can reliably distinguish pride expressions from expressions of related emotions such as happiness. Experiment 2 showed that judges can identify the pride expression when the task uses an open-ended response format that does not cue them with the label "pride." Experiment 3 showed that the pride expression includes a small smile, with head tilted slightly back, visibly expanded posture, and arms raised above the head or hands on hips. Overall, these findings challenge the assumption that all positive emotions share the same expression, and suggest that pride may be added to the pantheon of basic emotions generally viewed as evolved responses.

Affect↗
PubMed1990

A preliminary characterization of lexical emotional expression in right and left brain-damaged patients.

Disorders in nonverbal communication of emotion have been documented in patients with right hemisphere pathology; lexical expression of emotion is virtually unstudied. In this preliminary investigation, emotionally laden slides were used to elicit discourse from right brain-damaged (RBD), left brain-damaged (LBD), and normal control (NC) subjects. New techniques were developed to examine the ability of these subjects to express emotion in words; formalistic and pragmatic analyses of the discourse were conducted. RBDs, relative to NCs and LBDs, were less successful in using words to convey emotion and produced words of lower emotional intensity. LBD aphasics, despite their linguistic deficits, were comparable to NCs in conveying emotional valence. The data tend to support the speculation that the right hemisphere is dominant for lexical expression of emotion. This study has implications for the neuropsychological investigation of language, emotion, and the brain.

Brain Damage, Chronic↗
PubMed2006

Schizophrenic patients' perceptions of stress, expressed emotion, and sensitivity to criticism.

This study was designed to get an "insider's view" of expressed emotion (EE) from the perspective of schizophrenic patients. Thirty-two patient and "influential other" pairs participated in the study. Patients' perceptions of EE attitudes in influential others were examined to determine whether they corresponded with actual EE ratings. Patients also rated how "stressed" they felt when interacting with their influential others, and patients' general sensitivity to criticism (STC) was assessed. As predicted, patients' perceptions of critical attitudes were related to actual EE ratings of criticism, although patients' perceptions of emotional overinvolvement (EOI) were not related to EOI ratings. Patients reported feeling more stressed when interacting with high-EE influential others, supporting an "EE as stressor" hypothesis. Finally, patients' STC influenced the level of stress they reported.

Adult↗
PubMed1996

Expressed emotion and the prediction of outcome in adolescent eating disorders.

OBJECTIVE: This study examines whether parental Expressed Emotion (EE) ratings, based on the Camberwell Family Interview (CFI), are predictive of the course of illness in a sample of Dutch families with an adolescent eating disorder patient. Levels of EE at first assessment and at the termination of treatment are reported. METHOD: The study was designed as a prospective follow-up study and involved 49 adolescent eating disorder patients (DSM-III-R) and their parents. Patient and family assessments were conducted at intake (T1), at the termination of treatment (T2), and at follow-up (T3) 1 year later. The Morgan-Russell Outcome Assessment Schedule, which was adjusted to accommodate bulimics, yielded the average outcome score (AOS) which served as our outcome measure. RESULTS: The levels of parental EE at first assessment were low. During the treatment period the levels decreased further. We used a stepwise multiple regression analysis, with the parental EE variables as independent variables, to predict the AOS at T2 and T3. This way we showed that the mothers' Critical Comments (CC) rating explained 28 to 34% of the outcome variance. The mothers' CC rating was also the best predictor of outcome when compared to other possible predictor variables. DISCUSSION: The results underscore the importance of involving the family in the treatment of adolescent eating disorders. Specific attention should be given to the mother's thoughts, feelings, and behavior concerning her ill daughter. Helping the mother and daughter to differentiate and separate through a constructive noncritical approach to the presenting problems may be a crucial factor in breaking through the perpetuating cycle of criticism and illness.

Adolescent↗
PubMed2006

Maternal distress and expressed emotion: cross-sectional and longitudinal relationships with behavior problems of children with intellectual disabilities.

Mothers of children with intellectual disability were assessed at two time points, 2 years apart (n = 75 at Time 1, n = 56 at Time 2). Data were gathered on maternal distress, mental health, expressed emotion, and the child's internalizing and externalizing behavior problems. Consistent with previous research with families of children who have intellectual disability, maternal distress and children's behavior problems entered into a bidirectional relationship over time. This relationship was found to be specific to externalizing problems. Exploratory analyses also suggest that maternal distress and depression had a bidirectional longitudinal relationship. In terms of maternal expressed emotion, criticism and not emotional over-involvement was cross-sectionally but not longitudinally related to children's externalizing behavior problems and to maternal distress.

Adolescent↗
PubMed2002

Expressed emotion attitudes and individual psychopathology among the relatives of bipolar patients.

This study investigated the relationships between expressed emotion (EE) and individual psychopathology among 82 biological and non-biological relatives of 66 patients with bipolar I disorder. Relatives' psychopathology was assessed via the Structured Clinical Interview for DSM-III-R, Patient Version (SCID-P) and the General Behavior Inventory (GBI), a self-report measure of lifetime subsyndromal mood disturbances. We hypothesized that relatives who held high-EE critical, hostile, and/or overinvolved attitudes toward their bipolar family member, as measured via the Camberwell Family Interview, would be more likely to have DSM-III-R Axis I diagnoses on the SCID, as well as more mood and temperamental disturbances on the GBI, than those who held low-EE attitudes. The findings did not support a significant relationship between overall EE status and psychopathology in family members. However, relatives without significant Axis I pathology scored significantly higher than those with Axis I pathology on one measure of EE, emotional overinvolvement. The findings are discussed with reference to explanations for the genesis of high-EE attitudes.

Adult↗
PubMed1989

Emotional expression in cancer onset and progression.

Despite the intensive biomedical research in oncology since World War II, recent studies show a steady increase in age-adjusted mortality for all kinds of cancer. This findings gives impetus to the efforts of researchers who have adopted the biopsychosocial model. Systematic research using such a model has shown several psychosocial factors to be associated with cancer onset and progression, and Temoshok has recently suggested a theoretical model which unifies these findings. In this paper, I consider the evidence that one of these psychosocial factors, emotional expression, may be directly involved in cancer onset and progression. I review 18 relevant studies, discuss how one might operationalize the term 'emotional expression', and make 12 suggestions for future research.

Adaptation, Psychological↗
PubMedDate not supplied

Memory bias in generalized social phobia: remembering negative emotional expressions.

In two experiments, the authors examined memory for facial emotional expressions in patients with generalized social phobia (GSP) and in nonanxious control (NAC) participants. Three main questions were addressed. First, do patients with GSP differ from NAC participants in their overall memory for facial expressions? Second, do patients with GSP exhibit a memory bias for negative versus nonnegative expressions? Third, if such a bias exists, is it specific to angry expressions? The results of both experiments indicated that patients with GSP have better memory for all facial expressions than do NAC participants. Results of experiment 2 suggest that patients with GSP exhibit enhanced recognition for negative compared with nonnegative expressions; in contrast, NAC participants did not exhibit such enhancement. Results concerning specificity were equivocal. The importance of examining cognitive biases in patients with GSP via the use of facial expression is discussed.

Adult↗
PubMed1991

Determinants of expressed emotion in families of disturbed and normal children.

Both high expressed emotion (EE) and psychiatric disorders were frequent in the parents of children and adolescents with disruptive behavior disorder (DBD, N = 34) and obsessive compulsive disorder (OCD, N = 49) compared to normal controls (NC, N = 41). Parental psychiatric diagnosis was significantly related to high-EE in fathers (p = .0002) and mothers (p = .0001) of all groups combined, and in parents of the ill groups (p = .03). Absence of diagnosis was associated with low-EE in fathers (p = .0006) and mothers (p = .04) of the controls. Psychiatric diagnosis was the only significant predictor for high-EE in fathers, while for mothers child's diagnosis was a stronger predictor.

Adolescent↗
PubMed1999

Racial and gender differences in expressed emotion and interpersonal control in families of persons with schizophrenia.

Expressed Emotion (EE) has been shown to be predictive of course or severity in many illnesses, but the studies have been largely of white middle-class patients. This study examined gender and racial differences in parental EE level and communication patterns between the parent and patient with schizophrenia, using data from the NIMH Treatment Strategies in Schizophrenia study. Dialogues (n = 140) from 54 patient-parent dyads were coded into the Relational Control Coding System. Resultant data (n = 13,605 sequences) were analyzed with log-linear models. Results show that the relationship between control and EE level was stronger in African American families compared to Caucasians. Gender differences were as expected, with daughters less competitive and more deferential to their parents. Although the total number of high-EE parents with daughters was small, patterns in these families showed parents who responded submissively in contrast to the competitive symmetry in families with male patients.

Adolescent↗
PubMed1992

Expressed emotion research in Europe.

The results of increased research into Expressed Emotion (EE) in Europe over the past five years reinforce the significance of the measure, show that it is not culturally specific and can be used with different carers including staff, and across different languages. This continuing and productive research is reviewed and new questions and issues are identified. In addition, outcome studies in schizophrenia, research in other conditions; intervention studies, methodological issues and theoretical aspects are focused on.

Attitude to Health↗
PubMed2000

Schizophrenia outpatients' perceptions of their parents: is expressed emotion a factor?

The factors that mediate the association between expressed emotion (EE) and relapse in schizophrenia patients are still unknown. Many researchers hypothesize that interactions with high-EE individuals are stressful for patients, leaving them vulnerable to relapse. It would be useful to investigate whether patients perceive interactions with high-EE parents as stressful. In this study, associations were examined between levels of EE in parents and the types of personal memories patients had about these parents. EE ratings were obtained for both parents of 27 schizophrenia outpatients, and patients were asked to describe "happy, nonstressful" memories and "unhappy, stressful" memories during 2 interviews. Patients recounted fewer nonstressful memories and more stressful memories about high-versus low-EE parents. Implications of these results are discussed.

Adult↗