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PubMed1999

Relatives' expressed emotion and the course of inflammatory bowel disease.

Thirty-one relatives of inflammatory bowel disease (IBD) patients referred to a specialist unit were assessed with the Camberwell Family Interview, and ratings of expressed emotion (EE) were made. These relatives were significantly less critical than relatives of psychiatric patients in previous studies (p<0.001). Outcome was assessed over a 12-month follow-up period by a clinician blinded to the EE ratings. Most patients in this study had a poor outcome, and 11 (38%) needed surgery. A significantly higher proportion of patients with low EE relatives were in the surgery outcome group (p = 0.02). Excluding the surgery group, there was a nonsignificant trend for patients with high EE relatives to have a worse outcome. Patterns of response suggested better tolerance by relatives of the more ill patients. In the group overall there was no relationship between psychiatric status and physical health, either initially or at follow-up. There was considerable agreement among relatives as to the "typical" IBD personality. A number of key findings concerning the IBD patient, patterns of relatives' EE, and how they relate to the course of the illness remain to be verified by more systematic assessment.

Adult↗
PubMed1997

Psycho-education in bipolar disorder: effect on expressed emotion.

In a waiting-list controlled study on a multi-family psycho-educational intervention in bipolar disorder, key relatives in the treatment group showed a significant change from high to low levels of expressed emotion (EE) compared with the control group. In addition, patients with low-EE key relatives had a significantly lower number of hospital admissions compared with those living with high-EE key relatives. The multi-family groups were well received by the participants, and there were only a few drop-outs.

Adult↗
PubMed1998

Expressed emotion, attributions, and schizophrenia symptom dimensions.

Using a sample of 40 Anglo American family members of schizophrenic patients, the present study replicates and lends cross-cultural support for an attribution-affect model of expressed emotion (EE). Consistent with attribution theory, the authors found that highly critical relatives (high-EE) viewed the illness and associated symptoms as residing more within the patient's personal control as compared with less critical relatives (low-EE). A content analysis classified the types of behaviors and symptoms most frequently criticized by relatives. Symptoms reflecting behavioral deficits (e.g., poor hygiene) were found to be criticized more often than symptoms reflecting behavioral excesses (e.g., hallucinations). In line with an attribution-affect framework, relatives may be less tolerant of behavioral deficits because they are viewed as intentional, whereas behavioral excesses are easily recognized as core symptoms of mental illness.

Adolescent↗
PubMed2000

Is expressed emotion cause or effect in the mothers of schizophrenic young adults?

The purpose of this study was to determine the most likely direction of influence between the symptom severity in schizophrenic young adults and the expressed emotion (EE) of their mothers. Specifically, the stability and cross-lagged effects of mothers' critical comments (CC) or emotional overinvolvement (EOI) and the severity of four symptom clusters were examined. Twenty-eight patients and their mothers were interviewed three times at 9 month intervals. Data were subjected to a form of structural equation modeling: cross-lagged panel analysis. Results suggest that maternal CCs and EOI both tend to be influenced by the patient's total symptom severity and are influenced significantly by negative symptoms, but not by positive symptoms. Also, the more severe the hostile-uncooperative symptoms in the patient, the more critical the mothers become over time. However, the greater the mother's EOI at time 1, the less severe the patient's hostile-uncooperative symptoms at time 3. The usual implication of the association between high EE and relapse, which was also found in this sample, is that high EE causes symptom exacerbation. The results of the current study suggest that CCs and EOI coded from the CFI do not reflect a noxious environment: rather, they appear to be more effect than cause.

Adult↗
PubMed2006

Negative bias in the perception of others' facial emotional expressions in major depression: the role of depressive rumination.

Depressed individuals display a negative bias in the perception of others' facial emotional expressions. The extent of this selective processing, moreover, has proven predictive of a poor outcome in depression. However, to date, little is known about the possible mechanisms that may account for this bias. This study examined the hypothesis that rumination--an analytical type of self-focused attention--would be associated with higher levels of perception of negative facial emotions in major depression. Twenty-six depressed patients (17 women) completed the Perception of Facial Expressions Questionnaire, the Ruminative Response Scale, and other measures assessing depression-related constructs. Consistent with prediction, rumination was positively related to a negative bias in the judgment of facial expressions, even when controlling for other depression-related variables. Although the correlational design of the present study limits the extent to which conclusions can be drawn on the directionality of the observed relationship, the present study reveals self-focused rumination as a possibly important causal mechanism in explaining depressed persons' negative bias in the perception of others' facial emotions.

Adult↗
PubMed2006

Does Expressed Emotion need to be understood within a more systemic framework? An examination of discrepancies in appraisals between patients diagnosed with schizophrenia and their relatives.

BACKGROUND: This study examined the relationship between discrepancies in beliefs about schizophrenia and Expressed Emotion (EE) in family dyads. METHOD: Illness beliefs were assessed in patients with a diagnosis of schizophrenia and their relatives (N=49 dyads). The degree and the direction of discrepancy were calculated, and comparisons were made between dyads in which the relative was rated as high EE and dyads in which the relative was rated as low EE. RESULTS: There was greater discrepancy between illness models of schizophrenia in dyads involving a high-EE relative than in dyads involving a low-EE relative. This difference was not accounted for by the differences in either relatives' or patients' beliefs alone. CONCLUSION: Further research is needed to understand EE in the context of discrepancies in beliefs between patients and relatives rather than focussing on relatives' beliefs alone.

Adult↗
PubMed2002

Expressed emotion in the client-professional caregiver dyad: are symptoms, coping strategies and personality related?

OBJECTIVE: The aim of this study was to investigate whether the characteristics of residents and professional caregivers are associated with the professionals' expressed emotion (EE). METHOD: Fifty-six residents in sheltered living who suffer from schizophrenia or a related psychotic disorder and their professional caregivers were enlisted. Standardised validated instruments were used to measure EE, the residents' social functioning, symptoms and social network size, and the professional caregivers' coping strategies and personality. RESULTS: There was strong evidence that high EE was associated with the residents' age, poorer social functioning and smaller network sizes. There was no significant relationship between EE and the residents' symptoms except for excitement. Concerning the professional caregivers, high EE professionals were less open than their low EE colleagues and had a lower education level. CONCLUSION: The residents' social functioning is an important correlate of the EE index.

Adaptation, Psychological↗
PubMed2000

Emotional expressiveness during peer conflicts: a predictor of social maladjustment among high-risk preschoolers.

Preschool boys' emotional displays during conflicts with mixed-sex peers were related to individual differences in peer sociometric status and teacher ratings of disruptive behavior. Participants were 60 4- to 5-year old boys from low-income families who were videotaped with a small group of classmates in a Head Start preschool classroom. Conflicts were identified and emotional displays were coded from videotape. Results indicated that conflicts were more negative in emotional tone at the end than at the beginning of the year. Furthermore, children tended to mirror each others' emotional displays at the end but not the beginning of the preschool year. In addition, gleeful taunting, a form of emotional aggression, more strongly predicted negative peer nominations and teacher ratings than anger, suggesting that anger may be a more socially accepted form of emotional expression during conflicts among preschool-age children. Implications and directions for future research and interventions are discussed.

Aggression↗
PubMed1987

Expressed emotion: a family perspective.

Although mental health professionals have shown much enthusiasm for the concept "expressed emotion (EE)," little critical analysis of the concept has appeared in the literature. Placing families in dichotomous categories of high EE and low EE amounts to stereotyping; such an approach does little to help professionals in understanding the complexities of family life with a mentally ill relative. High EE is seen as a factor that maintains mental illness in a relative. Once more, families feel hurt and alienated. Once more, families feel negatively labeled, but not empathically understood.

Emotions↗
PubMed2004

Mothers' expressed emotion towards children with and without intellectual disabilities.

OBJECTIVES: To identify factors associated with maternal expressed emotion (EE) towards their child with intellectual disability (ID). DESIGN AND METHOD: A total of 33 mothers who had a child with ID and at least one child without disabilities between the ages of 4 and 14 years participated in the study. Mothers completed self-assessment questionnaires which addressed their sense of parenting competence, beliefs about child-rearing practices, and their reports of behavioural and emotional problems of their child with ID. Telephone interviews were conducted to assess maternal EE towards the child with ID and towards a sibling using the Five Minute Speech Sample (FMSS; Magana et al. 1986), and also to assess the adaptive behaviour of the child with ID using the Vineland Adaptive Behaviour Scale (VABS; Sparrow et al. 1984). RESULTS: Mothers with high EE towards their child with ID were more satisfied with their parenting ability, and their children had more behaviour problems. Analysis of differential maternal parenting, through comparisons of EE towards their two children, showed that mothers were more negative towards their child with ID for all domains of the FMSS except dissatisfaction. CONCLUSIONS: A small number of factors associated with maternal EE towards children with ID were identified. Differences in maternal EE towards their child with ID and their other child suggest that EE is child-driven rather than a general maternal characteristic. Implications of the data for future research are discussed.

Adolescent↗
PubMed1989

Is expressed emotion an index of a transactional process? I. Parents' affective style.

The degree to which expressed emotion (EE) attitudes in key relatives reflect ongoing transactional processes in families is a topic of controversy. The associations between EE attitudes, as measured during an acute hospitalization (using the Camberwell Family Interview) and during the aftercare period (using 5-minute speech samples), and interactional behavior in parents of recent-onset schizophrenics (this article) and in patients themselves (second article), were investigated. In the first study, EE attitudes manifested by parents during the aftercare period were stronger correlates of their interactional behaviors during the aftercare period than were EE attitudes measured during the inpatient period, despite the frequent correspondence between the two EE measures. The pattern of attitudes shown between the inpatient and outpatient periods also predicted transactional styles in parents during the outpatient period, findings not accounted for by clinical attributes of patients. When high-EE attitudes persist during the aftercare period and are reflected in transactional behaviors, the risk for subsequent patient relapse may be enhanced.

Adolescent↗
PubMed1983

Characteristics of expressed emotion: its relationship to speech and looking in schizophrenic patients and their relatives.

The measure expressed emotion (EE) is an established indicator of characteristics in the relatives of schizophrenic patients which predict relapse. Despite this, little is known of its construct validity except that schizophrenic patients are less calm in the presence of high EE than low EE relatives. There is also tentative evidence that schizophrenic patients show heightened avoidance responses to aversive social stimuli. It was therefore hypothesized that acutely ill schizophrenic patients would show social behaviours characteristic of avoidance in interaction with high but not low EE relatives. This hypothesis was not confirmed as no patient difference was found, but there were differences in the behaviour of high and low EE relatives. High EE relatives spend more interview time talking and less in looking at the patients. Low EE relatives were more prepared to be silent. This is consistent with the general tendency of high EE relatives to be socially intrusive and low EE relatives to be supportive to schizophrenic patients.

Adult↗
PubMed1984

Some critical thoughts on expressed emotion.

After a brief description of the principal findings which emerge from the studies on expressed emotion (EE), the author puts forward a few critical thoughts based on a systemic orientation. He explains why the variable EE evaluated on the basis of the Camberwell Family Interview (CFI) does not sufficiently reflect the dynamic reality of the family interactions and, in particular, he criticizes the establishment of a linear causality relationship between family EE and the development of the individual illness. He shows the limitations of psycho-educational programmes while acknowledging their place in the overall supportive family therapies.

Communication↗
PubMed1989

The initial onset of schizophrenia and family expressed emotion. Some methodological considerations.

The relationships between duration of schizophrenic illness before first hospital admission, expressed emotion in key relatives, and illness course have yielded conflicting reports. This study examined the issue from a methodological perspective in a sample of first-episode schizophrenic patients. A 'best estimate' of illness onset, based on a compilation of all sources, was compared with an estimate based on parental report. Parental estimates suggested that the children of high-EE parents had been ill for significantly longer, but this difference was not confirmed by the best estimate. In most cases, the ill children of high-EE parents were living at home before hospital admission and their parents' estimates of duration were quite accurate. In the few cases in which the child was living away from home, high-EE parents strikingly overestimated duration. Children of low-EE families were more likely to be living away from home, but this factor did not explain the consistent underestimates of duration made by their parents. Although duration of illness did not relate to EE, successful engagement in out-patient before in-patient treatment was more common among children from low-EE families.

Adolescent↗
PubMed1993

["Covert criticism"--a new criterion for determining the expressed emotion index in a five-minute speech sample of partners of depressed patients].

The expressed emotion (EE) index is a measure of affective attitudes held by relatives toward a mentally ill family member. In several studies it has been shown to be a predictor of relapse in the course of schizophrenia and depression. Since the Camberwell Family Interview (CFI) as the traditional method for assessing EE is time-consuming, a brief method--the Five-Minute Speech Sample (FMSS)--has been developed as an alternative for research and clinical work. The FMSS is also suitable for repeated application. Reliability and concurrent validity of the FMSS-EE have been demonstrated in cross-cultural samples of families with a schizophrenic member. However, application of the FMSS coding system to relatives of depressed patients in our sample proved to be problematic. Criticism, the most important EE-component, could not be assessed using the existing rating procedure. Therefore a modified version of the rating system has been developed. A new category named "covert criticism" has been defined which also includes indirect criticism. In an ongoing study a high degree of interrater reliability was achieved with the new system. Available data concerning concurrent validity indicate that clinically meaningful results can be derived by using the EE-ratings based on "covert criticism".

Adult↗
PubMed1991

Hemispheric asymmetry in conditioning to facial emotional expressions.

In the present experiment, we report a right hemisphere advantage for autonomic conditioning to facial emotional expressions. Specifically, angry, but not happy, facial expressions showed significantly more resistance to extinction when presented initially to the right as compared to the left hemisphere. Slides of happy and angry faces were used as conditioned stimuli (CS+ and CS-) with shock as the unconditioned stimulus (UCS). Half of the subjects (n = 15) had the angry face as CS+ (and the happy face as CS-), the other half had the happy face as CS+ (and the angry face as CS-). During acquisition, the CSs were presented foveally. During extinction, using the Visual Half-Field (VHF) technique, half of the CS+ and CS- trials were randomly presented in the right visual half-field (initially to the left hemisphere), and half of the trials were presented in the left half-field (initially to the right hemisphere). Stimuli were presented for 210 ms during acquisition, and for 30 ms during extinction. Bilateral skin conductance responses (SCRs) were recorded. The results showed effects of acquisition only for the angry CS+ group. During extinction, there was a significant Conditioning X Half-field interaction which was due to greater SCRs to the CS+ angry face when it was presented in the left half-field. It is concluded that the present results reveal hemisphere asymmetry effects in facial emotional conditioning.

Adult↗
PubMed1996

Communication patterns and expressed emotion in families of persons with mental disorders.

Interaction in 40 families of persons with bipolar disorders or schizophrenia was analyzed as a stochastic process to examine communication patterns between patients and parents relative to parents' level of expressed emotion (EE). Interaction sequences were coded with the Relational Control Coding System, and Markov process characteristics of order (degree of sequential dependency), stationarity, and role homogeneity were assessed with log-linear analysis. Communication patterns in high-EE families with both disorders showed more serial dependence--were more "tightly joined"--than low-EE families. However, both low- and high-EE families of persons with bipolar disorders competed for control, while there were marked differences in control patterns in low- and high-EE families of persons with schizophrenia, with low-EE families not at all competitive and high-EE families highly competitive. Difference in both responsiveness and competition for control were much stronger in dual-parent families. It was concluded that high-EE families have a family system that combines over-responsiveness with conflict about "who's in charge".

Adolescent↗
PubMed2003

Expressed emotion, family environment, and parental bonding in bulimia nervosa: a 6-year investigation.

As part of a prospective, long-term treatment study, 30 in-patients with bulimia nervosa (BN) were divided into groups with high and low expressed emotion (EE) family backgrounds according to the Camberwell Family Interview, and followed for a period of six years. The high EE group initially showed significantly more psychopathology than the low EE group. No group x time interactions were found, but the high EE group showed a worse outcome on the "conflict" and "organisation" subscales of the Family Environment Scale. They also showed significantly more eating disorder pathology according to the Eating Disorder Inventory (EDI) and the Structured Interview for anorexia nervosa (AN) and BN before treatment at discharge, after two years and, to some degree, even after six years. Depth of depression (Beck Depression Inventory) was significantly higher in the high EE group at admission (moderate depression), discharge and after the 6-year follow-up (still slight depression). The Parental Bonding Instrument (PBI) showed no differences between the high EE and low EE groups, but the individuals with "affectionless control" according to the PBI had more negative scores on three of the subscales of the Family Environment Scale (FES). In brief, the high EE individuals with BN were initially sicker and did not fully catch up over time in comparison with the symptomatic recovery of the low EE individuals. These data suggest that EE status upon admission to in-patient treatment is a relevant predictor of the severity and course of BN and depressive symptoms.

Bulimia↗