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PubMed1987

Expressed emotion: a call for partnership among relatives, patients, and professionals.

The emotional climate within the home is a powerful predictor of relapse and remission in schizophrenic disorders. Research has focused on "expressed emotion" (EE), a measure of relatives' expressed attitudes about the patient. Recently, EE has become a focus of controversy. Correcting a misperception that EE research blames families of schizophrenic patients, we clarify the concepts and data base that underlie EE research, provide an operational definition of EE, and briefly review the history of EE research in schizophrenia and other disorders. Then, methodological and conceptual issues in the interpretation of these data are discussed, and implications for clinical practice and mental health policy are considered.

Attitude↗
PubMed2006

Expressed emotion, adaptation, and patient survival among couples coping with chronic heart failure.

Previous research (J. C. Coyne et al., 2001) that showed that marital functioning predicted mortality among patients with chronic heart failure (CHF) led to an examination of whether expressed emotion (EE) captured negative marital influences on patient survival. The authors assessed EE using 5-min speech samples obtained from patients (137 men and 47 women) and their spouses. Prevalence of EE was low, and patient and spouse EE were unrelated. Spouse EE was not associated with survival, after the authors controlled for severity of illness. Among patient EE variables, high EE status predicted survival, but in the opposite direction of what was anticipated. Overall, relations between EE and self-report measures of adaptation were weak and inconsistent. Despite the strength of findings concerning EE and psychiatric outcomes, EE does not show promise in predicting adaptation to CHF, and researchers and clinicians should instead seek to identify positive marital factors that may promote patient survival.

Adaptation, Psychological↗
PubMed2006

Expressed emotion and anorexia nervosa: the validation of the Five-Minute Speech Sample in reference to the Camberwell Family Interview.

OBJECTIVE: The goal of the current study was to test whether the Five-Minute Speech Sample (FMSS) assessments of expressed emotion (EE) in families with a daughter with anorexia nervosa (AN) are valid in comparison to the Camberwell Family Interview (CFI). METHOD: The sample included parents of hospitalized patients with AN. Assessments were conducted at the time of patients' discharge from the hospital. The participants (n = 40) were assessed individually with the FMSS and then the CFI. FMSS-EE ratings were classified as high or low for Emotional Overinvolvement (EOI), Critical EE, and Final EE (overall rating). For the CFI, average EE scores were computed on the same subscales. RESULTS: Comparisons of FMSS subgroups on the CFI mean scores revealed that parents rated high EE on the FMSS subscales (EOI and Final EE) had significantly greater mean scores on the CFI than parents rated low EE on the FMSS (EOI: p = .02; Final EE: p = .04). Furthermore, FMSS-EE ratings were positively correlated to CFI-EE ratings for EOI EE (r = .38, p = .01), Critical EE (r = .31, p = .05), and Final EE (r = .29, p = .07). CONCLUSION: The FMSS can reliably measure EE in reference to the CFI in terms of Final EE and EOI EE. For the Critical EE subgroup, further investigation is needed with a bigger sample size.

Adolescent↗
PubMed1995

Nine-month changes of maternal expressed emotion in conduct and emotional disorders of childhood: a follow-up study.

In this follow-up study, mothers of 28 children with conduct disorders (CD) and 29 children with emotional disorders (ED) of 6-11 years of age, were interviewed and rated for expressed emotion 9 months after their first clinical assessment. Mothers of children with CD expressed significantly less criticism and higher warmth after 9 months. Initial externalizing scores in the CD group and initial internalizing scores in the ED group at the first assessment predicted symptomatic change, in contrast with EE scales. Initial externalizing scores and low levels of maternal warmth predicted presence of conduct disorder at the last contact with the clinician. The implications of the findings on the development of treatment techniques are discussed.

Affective Symptoms↗
PubMed1995

The use of the Expressed Emotion Index as a predictor of outcome in first admitted schizophrenic patients in a French speaking area of Switzerland.

A 5 year prospective study of 44 first admission schizophrenic patients was conducted in Geneva, in order to evaluate the prognostic value of Expressed Emotion (EE). The predictive power of the EE index was tested on 3 variables of outcome: relapse rates, social adaptation and hospital stays. The EE index and the outcome measures tended to be associated. After the third year, patients living with high EE relatives were significantly more maladjusted and relapsed more than those living with low EE relatives. At intake, the patients presenting more premorbid features lived in high EE households. Our results show that initial measure of EE in a first episode cohort is predictive of outcome over a five-year period. This may not be causal, as it cannot be excluded that poorer premorbid functioning alone may result in poorer outcome, and may also elicit high EE in the relative.

Expressed Emotion↗
PubMed1998

["Expressed emotion", marital quality and risk of recurrence in depressed patients].

Long-term course of depression appears to be clearly correlated to marital quality and quality of the relationship with spouses. Aim of the present study is the replication of results, indicating that expressed emotion (EE) is an important factor in prediction of relapse in depression. Additionally, the correlation between EE shown by spouses and the severeness of depressive symptomatology as well as the importance of martial quality as seen by patients for relapse are investigated. Results of our study indicate that spouses EE does not predict relapse, and status of EE does not correlate with the extent of depressive symptoms. However, patient self ratings of satisfaction with marital relationship and of perceived criticism are related to relapse frequency. Additionally, discrepant ratings of marital satisfaction given by spouses predict relapse to some extent. Implications for research in affective disorders and clinical practice are discussed.

Adult↗
PubMed2005

Global-local precedence in the perception of facial age and emotional expression by children with autism and other developmental disabilities.

Global information processing and perception of facial age and emotional expression was studied in children with autism, language disorders, mental retardation, and a clinical control group. Children were given a global-local task and asked to recognize age and emotion in human and canine faces. Children with autism made fewer global responses and more errors when recognizing human and canine emotions and canine age than children without autism. Significant relationships were found between global information processing and the recognition of human and canine emotions and canine age. Results are discussed with respect to the relationship between global information processing and face perception and neural structures underlying these abilities.

Affect↗
PubMed1986

A brief method for assessing expressed emotion in relatives of psychiatric patients.

A measure of the attitudes and feelings that a relative expresses about a mentally ill family member, termed expressed emotion (EE), is derived from an extensive, semistructured interview, the Camberwell Family Interview (CFI). The present article describes a method for the assessment of EE attitudes that uses a variation of the 5-minute speech sample, originally developed by Gottschalk and Gleser (1969). The measure is derived from responses made by a patient's key relative when prompted to give thoughts and feelings about the patient for a 5-minute period. A coding system was developed to score behaviors analogous to those rated on the CFI, such as criticism and emotional overinvolvement. The relationship between blind EE ratings derived from the 5-minute speech samples and those from the CFI was investigated with two separate samples of relatives of schizophrenics. The relationship between the sets of ratings was very close and supports the value of the 5-minute speech sample as a brief EE screening procedure.

Attitude↗
PubMed2002

Interpersonal control, expressed emotion, and change in symptoms in families of persons with schizophrenia.

This study examined the relationships of expressed emotion (EE), change in symptoms in schizophrenia, and interpersonal control patterns in relatives over a 2-year period. Subjects were 56 persons with schizophrenia and their relatives who participated in the NIMH Treatment Strategies in Schizophrenia (TSS) longitudinal study. The relationships among EE, interpersonal control as measured by the Relational Control Coding System (RCCS), and levels of symptoms at each assessment point were analyzed longitudinally with hierarchical linear modeling (HLM). No relationship was found between EE and symptoms, nor did control appear to contribute to symptoms. High-EE relatives reacted more strongly to symptom change than low-EE relatives and in opposite directions. EE may be an indicator of responsiveness rather than either a cause or result of symptoms. Understanding how EE attitudes impact the struggles patients and relatives have in coping with schizophrenia is crucial to knowing how clinicians can support these families most effectively.

Adult↗
PubMed1993

Does expressed emotion in spouses predict subsequent problems among care recipients with Alzheimer's disease?

Researchers have observed that Expressed Emotion (i.e., criticism; EE) in caregivers is predictive of poorer functioning in psychiatric care recipients over time. Few studies have examined, however, whether EE has predictive validity for the decline of care recipients with a clearly defined organic illness such as Alzheimer's disease. This study evaluated whether Alzheimer's disease care recipient problems [in cognition, activities of daily living (ADLs), and negative behaviors] were predicted longitudinally by caregiver EE. As hypothesized, caregiver EE was not predictive of care recipient cognitive or ADL decline; however, data suggested that EE was predictive of increased negative behaviors over time. The specific predictions of negative care recipient behaviors, and not care recipient cognitive/ADL decline, suggest that the former outcomes may be determined by environmental factors as well as the organicity of the disease. These data may be important because researchers have reported that caregivers are more distressed by negative care recipient behaviors than by care recipient cognitive/ADL decline.

Activities of Daily Living↗
PubMed2006

[Expressed emotions (EE) towards schizophrenic patients among staff members of psychiatric wards and hostels: comparison and clinical implications].

Expressed emotion (EE) is an interactive criterion that describes the amount and quality of emotional communication between schizophrenic patients and their families or institutional care takers. EE is empirically related to the prognosis of the disease across cultures and therapeutic settings. This study compares results of EE assessments among psychiatric wards staff and hostels staff members. Our findings indicate that in each therapeutic milieu there is correlation between the institutional culture and the expected roles and behaviors of the patient. In the psychiatric hospital the most rejected patient is the psychotic patient presenting disturbances in thought and behavior, while the patient that is not rejected is the withdrawn non-active and not disturbing individual. In the hostel, the situation differs: the expectations from the patients are high functional levels in all fields, and therefore, the most rejected patients are those who are less functional in their initiative and occupational skills. Our findings also relate to the ability of staff members to change their attitudes towards patients in the two milieus. The findings of the comparison we performed indicate the advantages of the hostel staff's characteristics in the treatment of schizophrenia patients, and suggest specific recommendations for staff training in both milieus. The study highlights issues to be considered to ensure optimal functioning of the hostel as an appropriate setting for the treatment of schizophrenic patients.

Attitude to Health↗
PubMed1994

[The relationship between expressed emotion and daily life functioning of families who take care of the schizophrenics members].

The relationship between Expressed Emotion (EE) and daily life functioning of families who took care of the schizophrenics members was analyzed, to make clear the conceptual substance and psycho-social background of EE, and to get the practical guideline how to offer the effective family support programs. The research was conducted at 3 psychiatric hospitals in Chiba. 72 out of 93 cases were followed up after 9 months, and 64 cases were respondents of the inquiry at the discharge which was conducted to get the information of daily life functioning of families. In the inquiry, we used Family Support Behavior Scale (FSB), representing the family support function as a caretaker, and Disfunction in the Ordinary Family Life Scale (DFL), representing the disfunction of the family life function for a caretaker as a subject who realized his/her own self. The results were as followings. DFL had relatively strong correlation to EE. And a distinctive feature of EE subscales' distribution was observed among 4 groups divided by the median of FSB and DFL. That is, "Critical Comments (CC)" and "Hostility (H)" were high in the "loFSB-hiDFL" group in which both family functions did not operate effectively. "Emotional Over-Involvement (EOI)" was extremely high and CC was moderately high in the "hiFSB-hiDFL" group which had the difficulty only in the ordinary family life function. And the relapse rate of both groups, particularly of "loFSB-hiDFL" was high up to 61.5% after the follow-up period. So far, it was suggested that the disfunction of the ordinary family life was closely related to the whole substance of EE scales, which were the congeries of family factors to predict the relapse, and which had not the internal consistency of the scale. Adding the disfunction of family support to that, had the appearance of EE sub-scales changed, and made the family environment severely related to the relapse.

Emotions↗
PubMed1997

Talking about feelings: young children's ability to express emotions.

OBJECTIVE: The aim is to establish which emotion-descriptive language is used by children at different ages. METHOD: Fifty-six children (aged 5 to 11 years) were presented with a set of plastic playpeople. Scenarios were enacted using the toys to elicit emotion descriptive vocabulary in response to the interviewer's question: How do you think s/he feels about that? Eight adult subjects participated as a control. RESULTS: Children under the age of 8 years have a limited repertoire of labels to describe emotions. Even 11-year-olds are unable to produce vocabulary which expresses emotion concepts described by adults. The implications of our findings for child-police interviews are discussed.

Adult↗
PubMed2005

Processing emotional expression and facial identity in schizophrenia.

Previous studies showed that schizophrenic patients have a deficit in facial information processing. The purpose of the present study was to test the abilities of patients with schizophrenia and normal controls in emotion and identity matching when these two dimensions were varied orthogonally. Subjects (20 schizophrenic patients and 20 controls) had to report if two faces had the same emotion or belonged to the same person. When the task concerned one type of information (i.e. emotion or identity), the other one was either constant (same person or same emotion) or changed (different person or different emotion). Schizophrenic patients performed worse than controls for both kinds of facial information. Their deficit was more important when the secondary factor was changed. In particular, they performed at chance level when they had to match one emotion expressed by two distinct persons. Finally, correlation analysis indicated that performance/deficit in identity and emotion matching co-varied and that in such tasks performance is negatively correlated with the severity of negative symptoms in patients. Schizophrenic patients present a generalised deficit for accessing facial information. A facial emotion and an identity-processing deficit are related to negative symptoms. Implications for face-recognition models are discussed.

Adult↗
PubMed1996

Distress, expressed emotion, and attributions in relatives of schizophrenia patients.

This article investigates the level of distress in relatives at the time of an acute episode of illness in the schizophrenia sufferer. Guided by attributional literature on the prediction of distress and depression, the association between relatives' distress and their explanations and beliefs concerning the illness is examined in the context of the expressed emotion status of the relative. The study found that although distress levels were unrelated to the relatives' beliefs about the patient's role in negative events, beliefs that illness events were caused by factors internal to the relatives themselves ("self-blaming" beliefs) were associated with distress in the relatives. The authors argue that understanding the cognitive appraisal processes involved in how caregivers perceive schizophrenia is important to understanding their response to the illness and helping them to adapt to the problems.

Acute Disease↗
PubMed1997

Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia.

BACKGROUND: It is argued that coping theory may be useful in attempting to understand how relatives adopt to the demands of living with a schizophrenia sufferer. METHOD: In a prospective study, univariate and multivariate relationships were explored between appraisal variables (appraisal of symptom threat (primary appraisal) and perceived symptom control (secondary appraisal)) and (a) expressed emotion, and (b) psychological distress in relatives of schizophrenic patients. The profile of relatives who showed sustained distress over time was also examined. RESULTS: The appraisal variables were found to be related to both the concurrent distress (GHQ scores), EE ratings of relatives at the time of the patients' relapse and hospitalization, as well as the subsequent GHQ scores of relatives when the patient was discharged back home. Relatives who showed sustained distress were likely to show high EE and have a longer caring history. CONCLUSIONS: The study gives some support to the theory that appraisal processes underlie how relatives react to having a family member with schizophrenia, and may have implications both for identifying those at risk of poor adaptation, and for understanding strategies that improve well-being.

Adaptation, Psychological↗
PubMed2000

Expressed emotion and psychoeducational intervention for relatives of patients with schizophrenia: a randomized controlled study in Japan.

The benefit of single-family treatment (SFT) in addition to short educational sessions (SES) consisting of multiple-family treatment was investigated. The study design was a randomized controlled study. Subjects were 30 patients suffering from schizophrenia with at least one of their family members showing high expressed emotion (EE) in the Camberwell Family Interview. After the SES, the patients were randomly allocated to two groups: those who received routine individual outpatient treatment and those who received additional SFT and routine treatment. The two groups were followed for 9 months after discharge, and the relapse risks were compared. The relapse risk was lower in the SES+SFT group than in the SES group (23.1% vs. 35.3%). However, the difference was not significant. When high-EE families were classified into those with many critical comments (high-CC) or a high score of emotional overinvolvement (high-EOI), the relapse risk was 0% in the patients living with a high-CC family not only in the SES+SFT group but also in SES group. In the patients living with a high-EOI family, the relapse risk was lower in the SES+SFT group than in the SES group (42.9% vs. 60.0%). These findings suggest that high-EE families should receive at least SES, and additional SFT should be given to families with specific needs.

Adult↗
PubMed1992

Expressed emotion, relapse rate and utilization of psychiatric inpatient care in schizophrenia. A study from Czechoslovakia.

The link between expressed emotion (EE), relapse rate and the length of rehospitalization in the 12 months after index discharge was investigated in a sample of 125 patients with a diagnosis of schizophrenia or schizoaffective psychosis. The results showed that EE was the best single predictor of relapse and that patients from high EE families spent three times as long in hospital as patients from low EE families. The protective impact of regular antipsychotic medication and low face-to-face contact with relatives was found in patients both from high and low EE families.

Adolescent↗