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PubMed2006

Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia.

This study examined significant others' expressed emotion (EE) and a closely related construct, perceived criticism, as predictors of cognitive-behavioral therapy outcome in a sample of 40 patients with social phobia (social anxiety disorder). Patients enrolled in group therapy for social phobia completed pre- and post-treatment questionnaire measures of perceived criticism and anxious and depressive symptoms. Designated significant others were assessed for the components of high EE (criticism, hostility and emotional overinvolvement) using the Camberwell Family Interview. It was hypothesized that these high-EE components and patients' perceived criticism would be associated with poorer treatment outcome, and results ran counter to these expectations. Controlling for initial social phobia severity, lower levels of perceived criticism predicted treatment dropout. There was also a nonsignificant trend for participants with a significant other rated as high in emotional overinvolvement to show less change on a composite symptom measure. Findings from this study suggest that close relationships impact the outcome of cognitive-behavioral interventions for social phobia.

Adolescent↗
PubMed2003

Attributions and expressed emotion: a review.

This review examines the contribution of an attribution-based framework to our understanding of both expressed emotion (EE) and the process of patient relapse. It considers all published studies that have assessed the attributions of high- and low-EE relatives and carers. Across these studies, a great deal of consistency is apparent. Critical relatives are more likely to hold patients responsible for their difficulties. On the other hand, attributions made by emotionally overinvolved relatives are similar to the attributions made by those who are low EE. In reviewing the association between attributions and patient relapse, it is concluded that carers' beliefs may play a role in the relapse process in a variety of ways. These include mediating controlling behavior, which may serve to increase patient stress or decrease patients' sense of self-worth. A major limitation of research in this area is the cross-sectional and correlational nature of the data. This makes it impossible to draw conclusions about directions of effect in the association of EE and attributions. Nonetheless, an argument can be made for the development and evaluation of interventions designed to help relatives adopt less blaming and more flexible beliefs about the nature of patients' problems. Particularly helpful in this regard may be interventions that use verbal and behavioral reattribution techniques similar to those described in the cognitive behavioral treatment of emotional disorders.

Adolescent↗
PubMed1986

Expressed emotion and relapse.

The relatives of 82 patients in a study of first episodes of schizophrenia were interviewed within six weeks of the index admission; 77 patients were subsequently discharged, and were followed to relapse or readmission. Analysis of relapse-free survival time was used to examine whether the components of 'expressed emotion' predicted relapse or response to neuroleptic medication: 'critical comments' by relatives was the only component present often enough to be used and was inversely related to 'social contact'. When preadmission duration of illness, and neuroleptic medication following discharge (identified previously as significant predictors of outcome) were taken into account, neither 'critical comments' nor 'social contact' were related to outcome nor to response to medication. The constellation of factors suggested as pathogenic was present only in a minority of cases: many patients lived alone and of those that were with families, most were not in high face-to-face contact with other members. The failure of the components of 'expressed emotion' to predict outcome or response to neuroleptic medication suggests that at best, such factors are weak predictors of liability to relapse. Their influence is unlikely to be comparable in magnitude to that of neuroleptic medication.

Adolescent↗
PubMed2001

Is expressed emotion a specific risk factor for depression or a nonspecific correlate of psychopathology?

Five Minute Speech Sample Expressed Emotion (FMSS-EE) was examined in families of youth with depressive disorders, nondepressed youth with attention deficit/hyperactivity disorder (ADHD), and community controls screened for the absence of depression and ADHD. Consistent with the hypothesis that FMSS-EE shows some specificity as a risk factor for depression, rates of critical EE were significantly higher among mothers of youth with depression as compared to mothers of nondepressed youth with ADHD, or mothers of controls. When both mothers' and fathers' scores were used to generate family EE ratings, rates of overall EE and critical EE were significantly higher for the depressed group than the control group, but the nondepressed ADHD group did not differ significantly from the other groups. Results support the hypothesis that critical EE in mothers shows some specificity as a risk factor or correlate of depression in youth.

Adolescent↗
PubMed2001

Expressed emotion of families and the course of mood disorders: a cohort study in Japan.

BACKGROUND: Findings on expressed emotion (EE) of the family and the course of mood disorders have not been consistent. There has also been no report on these problems from Asia. METHODS: The subjects were 32 patients diagnosed to have mood disorders on the basis of DSM-IV and ICD-10 and 36 principal members of their families. EE was evaluated using Camberwell Family Interview (CFI). A cohort study was conducted for 9 months after discharge of the patients. The patients were divided into a high-EE group and a low-EE group using a few cut-off points concerning the number of critical comments (CCs) and emotional over-involvement (EOI), the 9-month relapse risks were compared, and the relapse risk ratio and its 95% confidence interval were calculated. Also, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and the optimal cut-off point was evaluated. Multiple logistic regression analysis was performed to control the effects of potential confounding factors. RESULTS: When the subjects with three or more CCs, or an EOI score of three or higher were regarded as a high-EE group, and the others as a low-EE group, the nine-month relapse risks were 83.3% (5/6) and 19.2% (5/26), respectively, and the relapse risk ratio (95% confidence interval) was 4.3 (1.8-12.2). The values of the validity parameters were the highest with these cut-off points. The effect of EE was also significant on multiple logistic regression analysis. LIMITATIONS: Small sample size and severity of the patients. CONCLUSIONS: Families' EE based on CFI correlated with relapse also in Japan.

Adult↗
PubMed1997

Hopelessness in inpatient youths: a closer look at behavior, emotional expression, and social support.

OBJECTIVE: To examine the individual and family characteristics of children and adolescents with high levels of hopelessness. METHOD: One hundred inpatient youngsters participated in the study. Several measures, including the Hopelessness Scale for Children, Problem Behavior Scale of the Scales of Independent Behavior, Social Support Questionnaire-Revised, Pediatric Anger Expression Scale, and Differential Emotions Scale, were used to compare differences between youngsters who scored high or low on hopelessness. RESULTS: The results indicated that youngsters with high hopelessness scores tended to perceive their families and peers as providing little support, to express their anger overtly and aggressively, and to demonstrate more negative emotions than youngsters with low hopelessness scores. CONCLUSIONS: Hopelessness in youths appears to be associated with a specific pattern of behavioral and emotional problems. Clinical implications of the findings include integrating anger management, emotional expression interventions, and involving the family in treatment to enhance the social support network of youngsters with high levels of hopelessness.

Adolescent↗
PubMed1999

The measurement of expressed emotion in relationships between staff and service users: the use of short speech samples.

OBJECTIVES: Research on expressed emotion (EE) has demonstrated a remarkable consistency across cultures and over time; the psychosocial climate in relationships is important in determining the course of problems in mental health. The rating of EE might be described as the least accessible aspect of this literature to those who have not undertaken a training course. The purpose of this study was twofold: first, to obtain EE ratings for staff-patient relationships via interview and speech sample methods, in order to estimate the validity of the shorter method (the Five-Minute-Speech-Sample, FMSS); second, to examine the generalizability of the FMSS rating method to raters who were not previously trained to rate EE. DESIGN AND METHOD: Staff (N = 15) working in a day hospital service for people with enduring mental health problems were interviewed about their work with at least one patient (N = 32), and also asked to provide an FMSS on each relationship. Ratings of FMSS-EE were subsequently compared with the Camberwell Family Interview-EE ratings. Following an hour-long training period, the FMSS-EE ratings of five postgraduate students were then compared with those of a criterion rater. RESULTS: Correspondence between the two measures of EE was found to be good, with overall agreement achieved in 89.7% of cases. Raters with very limited training in the concept and rating of EE were accurate in identifying the overall rating of the relationship in question, but less accurate in identifying specific critical comments. CONCLUSION: The FMSS technique can be used reliably to identify negative relationships even by raters given very limited training. Clinical and research applications are suggested.

Adult↗
PubMed2002

The course of parental expressed emotion and psychotic episodes after family intervention in recent-onset schizophrenia. A longitudinal study.

The stability of parental expressed emotion (EE) is analysed over about 9 years, and related to course of illness in patients with recent-onset schizophrenia. Families, who participated in a 15-month intervention, were randomised over two intervention conditions. Psychotic episodes were measured over 5 years after discharge. The Five Minute Speech Sample (FMSS) EE was elicited two times during the 12-month outpatient intervention and two times over 8 years after discharge on average. EE is expressed as criticism/dissatisfaction (CRIT), emotional overinvolvement (EOI), and as the classical dichotomous index. EE is not stable over the years. Intervention condition had no differential effect on EE as measured with CRIT and the dichotomous index. For EOI, an interaction between intervention condition and time was found. EE as assessed during intervention does not predict psychotic episodes during follow-up. An association was found between psychotic episodes and CRIT as assessed at 34 months after discharge. Family intervention may inhibit the development of high EOI for a limited period. Our results may be in support of the hypothesis that psychotic episodes in patients can affect the critical attitude in parents.

Adolescent↗
PubMed1994

Styles of inhibiting emotional expression: distinguishing repressive coping from impression management.

Although repressors' avoidant coping style seems genuinely defensive, an alternative hypothesis is that repressors are actually distress-prone impression managers who provide "socially desirable" verbal reports. To establish discriminant validity, 30 repressors and 30 self-identified impression managers participated in a timed phrase-completion task. Half of the subjects were encouraged to be emotionally expressive and half to be restrained. Repressors were highly defensive regardless of the social demand, and impression managers only managed to match the repressors' level of distancing during the first segment of the inhibitive condition. Repressors were as physiologically reactive when they made defensive claims as they were when they made more negative disclosures to others. Moreover, when confronted, only the repressors denied that their heart rate elevations might be related to their emotional responses. These findings suggest that repressors' limited emotional expression is more determined by defenses against awareness of affect than by self-presentational concerns.

Adaptation, Psychological↗
PubMed2004

Gender differences: emotional expression and feelings of personal inauthenticity.

This survey study examined the emotional expression content of human resources jobs and how the content varies by gender. On the basis of findings, it appeared that women more often conform to feminine display rules, which require the suppression of negative emotions and the simulation of positive emotions. In contrast, men more often adopted masculine display rules, which require the suppression of positive emotions and the simulation of negative ones. For both men and women, emotional dissonance generated by a feminine display-rule pattern was positively correlated with feelings of personal inauthenticity at work. Gender modified the relationship between emotional dissonance and gender only in that women who adopted the masculine display-rule pattern reported feeling the least personally inauthentic of all.

Adult↗
PubMed1999

Expressed emotion and behavior therapy outcome: a prospective study with obsessive-compulsive and agoraphobic outpatients.

The relationship of expressed emotion (EE) to behavior therapy outcome for obsessive-compulsive disorder (n = 60) and panic disorder with agoraphobia (n = 41) was investigated. Relatives' emotional overinvolvement and hostility predicted higher rates of treatment dropout. Higher hostility, as assessed by the Camberwell Family Interview (CFI), was related to poorer outcome for target ratings and for the Social Adjustment Scale; higher perceived criticism was also predictive of worse response on target ratings. In contrast, nonhostile criticism on the CFI was associated with better outcome on the behavioral avoidance test. In general, the relationship of EE to outcome was not moderated by type of relative, diagnosis, amount of contact with the relative, or use of psychotropic medication.

Adult↗
PubMed2000

Applications of the expressed emotion construct to young children with externalizing behavior: stability and prediction over time.

We explored the utility of the Expressed Emotion (EE) construct with a community sample of young children (N = 91), studying the stability of EE scores over a 2-year period and the extent to which EE was associated with simultaneous and subsequent disruptive behavior. As part of a longitudinal study, families were assessed when the child was in preschool, 1st grade, and 3rd grade. Maternal EE was measured at preschool and 1st grade using the Five Minute Speech Sample and behavior ratings were obtained using the Child Behavior Checklist. At 3rd grade, the Diagnostic Interview Schedule for Children was used to determine DSM-IV diagnoses. The stability of the EE rating over the 2-year period from preschool to 1st grade was statistically significant although modest. At 1st grade, EE ratings were significantly related to the extent of externalizing behavior problems. Regression analyses that controlled for maternal stress levels determined that preschool EE ratings predicted classification of ADHD over 4 years later, at 3rd grade. The relationships between EE and child problem behavior were almost exclusively determined by the EE criticism dimension; the emotional overinvolvement dimension was not related to child behavior. The implications of these findings are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed2002

Expressed emotion is not associated with disorder severity in first-episode mental disorder.

A family atmosphere characterized by expressed emotion (EE) is a robust predictor of clinical outcome of patients with schizophrenia and mood disorders. However, there is ongoing discussion as to whether EE is more a cause of clinical outcome or a parental reaction to disorder severity. This cross-sectional study examines a sample of 42 consecutive first-episode patients from a defined geographical area with severe mental disorders (schizophrenia-related disorders, psychotic mood disorders, and non-psychotic mood disorders). Their 42 relatives were interviewed, and the relationships between EE variables derived with the five-minute speech sample method (FMSS) and the patients' demographic, premorbid and clinical measures were analyzed. A high EE score was found in 40% of the relatives. High EE was associated with the interviewed relative's not being a spouse and the patient's being young and unmarried. It was not associated with premorbid characteristics, symptom dimensions or the diagnostic group of the patient. These results do not support the hypothesis that EE is a reaction to the clinical features of the patient. Instead, demographic factors may partly mediate the effect of EE on prognosis.

Adult↗
PubMed2002

Parental expressed emotion in depressed adolescents: prediction of clinical course and relationship to comorbid disorders and social functioning.

BACKGROUND: High expressed emotion (EE) predicts worse clinical course for a number of disorders. High EE is more frequent in parents of disordered children than normal controls. It is uncertain whether EE and its components are disorder-specific, whether EE is more closely related to parent characteristics or child characteristics, and whether EE predicts clinical course independently of clinical variables that reflect severity of disorder. EE has not been investigated in adolescent depression. METHOD: The 57 participants in this study were a sub-sample of a longitudinal study of the clinical course of depression. Adolescents and parents were recruited from consecutive referrals to all psychiatric outpatient clinics and inpatient units in a geographic catchment area. The association between EE and one-year clinical outcome of major depressive disorder was tested and associations between EE and characteristics of the adolescent, the parent, and the family were examined. RESULTS: EE was independent of socio-demographic characteristics, comorbid diagnoses, and parental depression. High EE was associated with worse adolescent social functioning according to either adolescent or parent report. High EE was associated with the presence of more depression symptoms. Low EE predicted major depression remission in participants without comorbid attention-deficit/hyperactivity disorder (ADHD), but this association was not independent of the association between social functioning and depression remission. CONCLUSIONS: The findings indicate a need to examine possible protective effects of low EE. Relationships between EE, social functioning, and depression persistence and remission require further examination.

Adolescent↗
PubMed1990

Hemispheric specialization for emotional expression: a reexamination of results from intracarotid administration of sodium amobarbital.

Emotional and behavioral responses to sodium amobarbital injection were examined in 44 epilepsy surgery candidates. Thirty-three emotional reactions occurred in 26 patients, 44% of the reactions following right hemisphere injection and 32% after injection of the left hemisphere. Among all patients examined, laughter/elated mood was statistically more frequent following right hemisphere injection while crying was statistically associated with left hemisphere injections. These observed effects were not related to amobarbital dose, sex, bilateral hemispheric inactivation (angiographic crossflow), general cognitive status, or side of seizure onset. These results support differing specialization of emotional expression in the right and left cerebral hemispheres and their subcortical connections.

Adolescent↗
PubMed1987

Personality, type A behavior, and coronary heart disease: the role of emotional expression.

The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial issues in the field of psychology and health. Although there is still a great deal of conceptual confusion, progress is being made in refining the key components of a predisposition to heart disease. In this article we examine the construct of a coronary-prone personality in the context of the relations among personality, emotional expression, and disease. Special consideration is given to mode of measurement of the Type A behavior pattern--Structural Interview (SI) versus Jenkins Activity Survey (JAS)--and to components and non-Type A correlates of the general coronary-prone construct. Fifty middle-aged men who had had a myocardial infarction were compared with 50 healthy controls in terms of relevant aspects of their psychological functioning. Results indicate that the SI is better than the JAS as a predictor of coronary heart disease (CHD) because of its attention to emotional expressive style. Traditional emphases on hurry sickness in coronary proneness are deemed wholly inadequate. Furthermore, the results indicate that depression, anxiety, or both may relate to CHD independently of and in addition to Type A behavior. Other aspects of personality and social support are also discussed in the context of improving the construct of coronary proneness.

Adaptation, Psychological↗
PubMed1991

Expressed emotion: a Swedish version of the Camberwell Family Interview.

A Swedish version of the Camberwell Family Interview (CFI), a psychiatric, semistructured interview schedule for assessing a family's emotional atmosphere, is described. Thirty-two relatives of patients with schizophrenic disorders, according to DSM-III criteria, were interviewed. Eighteen relatives were interviewed twice, before and after one part of a psychoeducational programme. The total number of interviews analysed was 50. Two independent investigators rated the audiotape-recorded interviews to test the interrater reliability of 5 different measures of expressed emotion (critical remarks, hostility, emotional overinvolvement, warmth and positive remarks). High interrater reliabilities were found for the frequency scales, i.e. critical remarks and positive remarks. For the global scales the interrater reliabilities were lower. The use of only one interviewer, the interviewer being one of the raters and shortage of co-training probably influence the reliability. The CFI schedule could probably gain in clarity, structure and shortness in a revised form, although the interview time cannot be reduced to less than 1.5 h. The ratings of measures of expressed emotion are quite complicated and require extensive and specific training of the raters. The total procedure is complex, time-consuming and not easily learned. In its present form, the CFI probably discourages clinicians and researchers from using it.

Activities of Daily Living↗
PubMed2005

A face to remember: emotional expression modulates prefrontal activity during memory formation.

Emotion can exert a modulatory role on episodic memory. Several studies have shown that negative stimuli (e.g., words, pictures) are better remembered than neutral ones. Although facial expressions are powerful emotional stimuli and have been shown to influence perception and attention processes, little is known about their effect on memory. We used functional magnetic resonance imaging (fMRI) in humans to investigate the effects of expression (happy, neutral, and fearful) on prefrontal cortex (PFC) activity during the encoding of faces, using a subsequent memory effect paradigm. Our results show that activity in right PFC predicted memory for faces, regardless of expression, while a homotopic region in the left hemisphere was associated with successful encoding only for faces with an emotional expression. These findings are consistent with the proposed role of right dorsolateral PFC in successful encoding of nonverbal material, but also suggest that left DLPFC may be a site where integration of memory and emotional processes occurs. This study sheds new light on the current controversy regarding the hemispheric lateralization of PFC in memory encoding.

Adult↗