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PubMed2006

The relationship of relatives' attributions to their expressed emotion and to patients' improvement in treatment for anxiety disorders.

In a test of Hooley's (1987) attributional model of expressed emotion (EE), attributions for negative behaviors and events in patients' lives were examined in relatives of 74 outpatients with panic disorder with agoraphobia or obsessive-compulsive disorder. Attributions were extracted from 10-minute problem-solving interactions between relatives and patients, whereas EE was assessed during a separate interview with the relative. Consistent with prior findings in relatives of individuals with other disorders, relatives who made greater proportions of attributions of patient responsibility demonstrated significantly higher levels of EE-hostility. In addition, nonspousal relatives (mostly parents) who attributed any negative behaviors or events to a patient's disorder were significantly higher in emotional overinvolvement (EOI); no such relationship was found for spouses. Finally, patients with relatives who made attributions to the patient's disorder received less benefit from behavior therapy than did those whose relatives made no such attributions, even when EE variables were controlled.

Adult↗
PubMed1999

What predicts the course of expressed emotion in relatives of patients with schizophrenia or related psychoses?

The expressed emotion (EE) index may not be as stable as it was once believed to be. The aim of this study was to identify variables associated with spontaneous change from low to high and from high to low levels of EE and EE subscales--critical comments (CC), hostility (H), emotional overinvolvement (EOI). Using a longitudinal, prospective study design, of 59 relatives having at least weekly face-to-face contact with 40 patients with an acute episode or relapse into schizophrenia (DSM-III-R) were interviewed by means of the Camberwell Family Interview (CFI) at admission and at 4 1/2 months after discharge. The results showed that high-high or unstable levels of CC, H or EE were associated with the patient not working or studying prior to admission. Relatives with low-high and high-high EOI patterns had more weekly face-to-face contact with the patient prior to admission than relatives with a low-low EOI pattern. Patients whose relatives had low-high CC and EE patterns were less ill at admission than patients whose relatives had low-low patterns. Higher perceived family burden was associated with, at admission, an unstable pattern of CC, and at follow-up, high-high EOI or EE patterns rather than low-low patterns. Our study suggests that it is possible to identify which relatives will have a stable and which a changing EE level, allowing for more focused intervention.

Adolescent↗
PubMed1994

A study of expressed emotion in the parental primary carers of adolescents with intellectual impairment.

Expressed emotion (EE) was measured in the parental primary carer (carer) of 92 adolescents with intellectual impairment to examine its associated characteristics. High EE was mainly a result of high levels of emotional overinvolvement. High EE was associated with psychological illhealth, poor-quality marriage and poor practical social support of the carer, and psychiatric disorder in the adolescent with intellectual impairment. This suggests that EE may be a useful indicator of coping difficulties in these families. The subgroup of high EE emotional overinvolvement was associated with a carer with more psychological illhealth, a worse-quality marriage, less practical social support, greater professional support and an insecure style of respite care usage for an adolescent of greater intellectual impairment. The subgroup of criticism have an adolescent of less severe intellectual impairment, more behavioural disturbance and yet the carer has less professional support. Appreciation of the quality of the relationship of the carer with their dependent family member may enable greater understanding of how to improve the quality of life for both the carer and the cared for.

Adaptation, Psychological↗
PubMed1989

Expressed emotion and reciprocal affective relationships in families of disturbed adolescents.

Relatives' expressed emotion (EE) is a known risk factor for relapse among recovering psychiatric patients. Recent research has focused on the behavioral correlates of EE, seeking better understanding of the family processes associated with this important variable. The present study used sequence analysis to explore interactions of high-EE and low-EE parent-child dyads in a sample of disturbed adolescents. High-EE mother-child interactions were characterized by bidirectional influence, and, in contrast to adolescents in low-EE dyads, adolescents in high-EE dyads had an oppositional style of responding. In Low-EE mother-child interactions, the adolescents showed more temporal consistency (stability) of affect than their high-EE counterparts. Overall, the results suggest that high-EE mother-child dyads constitute more tightly joined emotional systems than low-EE dyads. Consequently, interventions designed to reduce this connectedness might also reduce the risk of adolescent psychiatric problems.

Adolescent↗
PubMed1990

Family expressed emotion: concepts, dilemmas and the Israeli perspective.

Family characteristics of high "expressed emotion" (EE) have been found to be predictive of relapse in schizophrenia and other psychiatric disorders. A causal relationship has been postulated between relapse and components of EE as assessed in the relatives with whom the patient has close social contact. Recently, conceptual and methodological aspects of the EE paradigm have become the focus of controversy. We present the dilemmas under debate and discuss the implications relevant to the study of EE in Israel.

Emotions↗
PubMed1992

[The five-minute interview. A brief method for assessing expressed emotion status].

The Camberwell Family Interview (CFI) has been developed to assess the expressed emotion status (EE), a measure of the attitudes and feelings that a relative expresses about a schizophrenic family member. The EE measure has shown to be a good predictor of relapses in the course of schizophrenia, and has proved valid in a number of different cultures. However, the extensive, semistructured CFI is so time-consuming, that it only has been employed in a few specialized research centers. Therefore a brief method for assessing the EE index has been developed on the basis of a 5-minute speech sample (FMSS), which showed a reasonable correspondence with EE ratings derived from the CFI. The present article describes the development of a German version of the FMSS. The correspondence between blind EE ratings derived from the FMSS and the CFI was investigated on a sample of 176 interviews of relatives of schizophrenics. The relationship between the procedures to assess the EE index was significantly close. These results show the validity of the FMSS as a brief EE screening procedure for German-speaking populations.

Emotions↗
PubMed2003

[Expressed emotion and the outcome of child and adolescent psychiatric disorders].

OBJECTIVE: The review discusses empirical research on the association of "Expressed Emotion" (EE) and the outcome of child and adolescent psychiatric disorders. METHOD: A comprehensive search in the databases Medline, PsycINFO and PSYNDEX was performed. Moreover, publications cited in the reference sections were taken into consideration. RESULTS: Empirical data suggest that EE is a predictor of the outcome of depressive and eating disorders in childhood and adolescence, but not of behavioural disorders and ADHD. There are no studies on EE and its influence on anxiety disorders and - surprisingly - only two case studies on EE and schizophrenia in childhood and adolescence. Across psychiatric groups there is an association between behavioural disturbances of the child and parental criticism and an association of child anxiety and parental emotional over involvement. Data suggest that EE is not a stable variable. There is some evidence that a high-EE-status of parents transforms from a state into a trait variable. CONCLUSION: Further studies on the predictive validity of EE for the outcome of child adolescent psychiatric disorders are warranted, as well as studies on variables of the parents and their offspring, which are associated with EE and with the entrenchment of EE with the progress of the disorder. Child and adolescent psychiatrists may contribute to a large research area with studies on the early development of high-EE. The mutual goal is the development of effective early family interventions.

Adolescent↗
PubMed2005

Expressed emotion as an adaptation to loss: prospective study in first-episode psychosis.

BACKGROUND: The factors influencing the development of expressed emotion (EE) are still unclear. Understanding the carer and patient appraisals operating during the initial adaptation to psychosis may help to clarify the early ontogenesis of EE. METHOD: Fifty patients and key carers were followed-up over 9 months and their appraisals of loss and burden were measured in relation to the evolution of high emotional overinvolvement (EOI) and critical (CC) relationships. RESULTS: The appraisal of loss was linked to high EOI but not high CC relationships at baseline. Loss reduced by 9-month follow-up in those changing from high EOI to high CC or low EE. Subjective burden of carers was linked to loss but not to EE status. Patients' and relatives' appraisals of loss were strongly correlated, particularly in high EOI relationships. Longer duration of untreated psychosis was associated with high CC. CONCLUSIONS: The results are consistent with Bowlby's attachment theory, where EOI and coercive criticism may be understood as adaptive reactions to perceived loss. Implications for family intervention in first-episode psychosis and the prevention of high EE are discussed.

Adaptation, Psychological↗
PubMed2002

Expressed emotion and attributions in the carers of patients with Alzheimer's disease: the effect on carer burden.

Burden of care, expressed emotion (EE), causal attributions, and salivary cortisol were assessed in 100 carers of patients with Alzheimer's disease. Forty-one carers were rated high EE, which was associated with higher scores of carer distress and strain, and greater reports of noncognitive features in the patient, but not with cortisol levels. High EE carers made more attributions personal to, and controllable by, the patient for negative events. Critical carers made more attributions of the patient's behavior that was idiosyncratic. Warmth toward the patient was associated with the opposite of this pattern. Overinvolved carers made attributions of the patient's behavior to causes external to the patient and internal to themselves. Cortisol levels were associated with self-reports of strain and distress.

Adaptation, Psychological↗
PubMed2004

Expressed emotion at first-episode psychosis: investigating a carer appraisal model.

BACKGROUND: Even at the first episode of psychosis, high expressed emotion (EE) characterises over half of patient-carer relationships. This study compared a carer appraisal model of EE with the ability of illness factors to predict EE at the first episode. AIMS: To investigate the utility of a carer appraisal model of EE in first-episode psychosis. METHOD: We compared high- and low-EE carers of people who had first-episode psychosis (n=46). RESULTS: High EE in carers was associated with higher avoidant coping, higher subjective burden and lower perceived patient interpersonal functioning. Patient illness factors and carers' distress levels were not associated with EE. CONCLUSIONS: Even at the first episode, carers' psychological appraisal, not patient illness factors, is influential in determining high EE. Carers' appraisal of their situation should be a primary target to lower or prevent high EE in early intervention for psychosis.

Adaptation, Psychological↗
PubMed2006

Expressed emotion and family interactions in Mexican Americans with schizophrenia.

Patients with schizophrenia who are exposed to family environments high in expressed emotion (EE) are at increased risk of relapse. EE is usually measured by an interview with one family member and does not include a direct assessment of family interaction. To understand better the key processes that underlie the relationship between EE and course of illness, we applied a well-validated measure of family interaction, the Structural Family Systems Ratings (SFSR), to 28 Mexican-Americans with schizophrenia and their families. The relationships among EE indices, SFSR components, and relapse were examined. Although measures of EE and family interactions were not related, both EE and one component of the SFSR, family resonance, were associated with a psychotic relapse within 1 year of the assessment. The results suggest that Mexican Americans with schizophrenia benefit from living with families that are able to adapt to the ever-changing circumstances and needs of their ill relatives.

Adaptation, Psychological↗
PubMed1997

Expressed emotion toward children with behavioral inhibition: associations with maternal anxiety disorder.

OBJECTIVE: To examine the role of maternal psychopathology in influencing "expressed emotion" (EE) directed toward children with behavioral inhibition (BI) or psychiatric disorders. METHOD: Maternal EE was assessed via Five-Minute-Speech-Sample in two samples of children previously evaluated for child and maternal lifetime prevalence of DSM-III disorders and assessed via laboratory observations for BI. The authors previously reported that maternal EE was associated with BI and with the number of child behavior and mood disorders in these samples. The at-risk sample (N = 30) consisted of mothers with panic disorder and psychiatric controls and their 4-through 10-year-old children. The Kagan sample (N = 41) consisted of children selected at age 21 months as BI or uninhibited and followed through age 11. RESULTS: Interaction effects were found: in mothers with anxiety disorders, but not those without, maternal criticism (a component of EE) was significantly associated with child BI, independently of the child's number of disorders. Similarly, in mothers with anxiety disorders only, maternal criticism was significantly associated with a high number of child disorders. CONCLUSIONS: The relationships between mothers who have anxiety disorders and their children who have BI or psychiatric disorders may be marked by criticism or dissatisfaction. If confirmed, these findings offer opportunities for appropriate interventions.

Anxiety Disorders↗
PubMed1993

An attributional analysis of expressed emotion in Mexican-American families with schizophrenia.

In this study we tested an attributional model of expressed emotion (EE) among Mexican-American families. A sample of 46 key family members of schizophrenic patients were measured on three dimensions: affect toward patient, controllability attributions, and level of EE. Consistent with an attributional model, we found that high EE families (defined on the basis of critical comments) viewed the illness and associated symptoms as residing within the patient's personal control, more so than did low EE families. We also found that attributions held by family members are related to their affective reactions. Specifically, family members who perceived the patient as having control over the symptoms of schizophrenia tended to express greater negative emotions such as anger and annoyance toward the patient than did family members who viewed the symptoms as beyond the patient's personal control. An examination of the types of affects found and their relationship to EE status is discussed, along with implications for this research.

Adult↗
PubMed1993

Purging the emotions: the lack of emotional expression in subfertility and in the care of the dying.

The paper examines emotional expression by drawing on data from patients in two contrasting situations; interview data from couples attending fertility clinics, and audio-recorded conversations with terminally ill patients being cared for at home. Although the literature on subfertility and terminal illness frequently uses a bereavement model to argue for the importance of overt grieving, patients in these studies did not express a wish to discuss their feelings. This finding raises questions about how patients' needs are defined, and whether emotions may be created by discourse.

Adaptation, Psychological↗
PubMed2001

Processing of facial emotional expression: spatio-temporal data as assessed by scalp event-related potentials.

Event-related potentials (ERPs) were recorded in 10 adult volunteers, who were asked to view pictures of faces with different emotional expressions, i.e. fear, happiness, disgust, surprise and neutral expression [Ekman, P. & Friesen, W.V. (1975). Pictures of Facial Affect. Consulting Psychologist Press, Palo Alto, CA]. ERPs were recorded during two different tasks with the same stimuli. Firstly, subjects were instructed to pay attention to the gender of the faces by counting males or females. Secondly, they had to focus on facial expressions by counting faces who looked surprised. The classical scalp 'face-related potentials', i.e. a vertex-positive potential and a bilateral temporal negativity, were recorded 150 ms after the stimulus onset. Significant differences were found, firstly between late-latency ERPs to emotional faces and to neutral faces, between 250 and 550 ms of latency and, secondly, among the ERPs to the different facial expressions between 550 and 750 ms of latency. These differences appeared only during the expression discrimination task, not during the gender discrimination task. Topographic maps of these differences showed a specific right temporal activity related to each emotional expression, some particularities being observed for each expression. This study provides new data concerning the spatio-temporal features of facial expression processing, particularly a late-latency activity related to specific attention to facial expressions.

Adult↗
PubMedDate not supplied

[Hemispheric asymmetry of visual evoked potentials during human recognition of facial emotional expressions].

Visual evoked potentials (VEP) in standard 16 EEG derivations were recorded in 26 young men and 20 women during recognition of facial emotional expressions and geometric figures. The stimuli were presented on a computer screen in the center of the visual field or randomly in the right or left vision hemifields. Peak VEP latency and mean amplitude in 50-ms epochs were measured; spatiotemporal VEP dynamics was analyzed in a series of topographic maps. The right hemisphere was shown to be more important in processing emotional faces. The character of the asymmetry was dynamic: at earlier stages of emotion processing the electrical activity was higher in the right inferior temporal region compared to the left symmetrical site. Later on the activity was higher in the right frontal and central areas. The dynamic mapping of "face-selective" component N180 of VEPs revealed the onset of activation over the right frontal areas that was followed by the fast activation of symmetrical left zones. Notably, this dynamics didn't correlate with the hemifield of stimuli exposition. The degree of asymmetry was lower during presentation of figures, especially in the inferior temporal and frontal regions. The prominent asymmetry of information processes in the inferior temporal and frontal areas was suggested to be specific for recognition of facial expression.

Adolescent↗
PubMed1988

Posed facial emotional expression in brain-damaged patients.

Posed emotional facial expression was examined in brain-damaged adults with right (RBD) or left (LBD) hemisphere cerebrovascular lesions and in matched normal controls (NC). Subjects were videotaped while posing eight facial expressions (positive and negative) under two elicitation conditions (verbal command and visual imitation). Expressions were rated by four naïve judges for intensity, category accuracy, and valence accuracy. RBDs were significantly more impaired than LBDs or NCs on category and valence accuracy, while LBDs posed expressions with significantly more intensity than RBDs or NCs. These findings held for positive emotions only. The results for category accuracy replicate an earlier report (Borod et al., 1986) which utilized a different rating procedure. Finally, expressions posed to visual imitation were rated as more intense and more accurate than those posed to verbal command.

Brain Damage, Chronic↗
PubMedDate not supplied

Expressed emotion and short-term treatment outcome of outpatients with major depression.

Expressed emotion (EE) is the attitude of criticism and emotional overinvolvement of a key relative toward a patient, and is one of the family factors that contribute to the course of psychiatric illness. The relationship between EE and 6-month outcome in 40 outpatients with major depression was investigated in this study. In the nonremission group (n = 17, 43.7%), there was a higher prevalence of past history of depression (P < .01) and high-EE relatives (P < .05) than in the remission group (n = 23). On an EE profile based on a Five-Minute Speech Sample (FMSS), 15.0% (n = 6) of the cases were high-EE: three were rated as emotional overinvolvement (EOI), two as critical, and one as EOI and critical. On the critical subscale, the rate of nonremission increased gradually in response to the level of criticism (from pure low-EE, to borderline-Critical [b-critical], and then to high-critical). Multiple logistic regression analysis showed that the level of criticism and a past history of depression were significant predictors of poor outcome (P < .05). These results indicate that criticism from family members may be one factor that prolongs depressive episodes.

Depressive Disorder↗