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PubMed1991

Cross-national reliability, concurrent validity, and stability of a brief method for assessing expressed emotion.

The Five-Minute Speech Sample (FMSS; Magana et al., 1986) is a brief method designed to assess the "expressed emotion" (EE) status of a respondent. The FMSS-EE rating is derived from statements made by a patient's key relative during a 5-minute monologue, with codes similar to those used in the original EE rating system (e.g., criticism and emotional overinvolvement). Rating is done from the audiotape and takes about 15-30 minutes. The article reports on the results of a cross-national study carried out in Germany using the FMSS with a sample of 60 relatives of schizophrenic patients. Results indicated that (1) German investigators could readily learn the system and could achieve a high degree of interrater reliability; (2) the association with the original index of EE, the Camberwell Family Interview, was comparable to that found by Magana et al.; and (3) the method yields very stable data over a 4-5 week retest period.

Adolescent↗
PubMed2001

Predicting expressed emotion: a study with families of obsessive-compulsive and agoraphobic outpatients.

The authors used structural equation modeling to examine expressed emotion (EE) in relatives of outpatients with panic disorder with agoraphobia (n = 42) or obsessive-compulsive disorder (n = 60). EE was examined as a function of patients' illness and personality and as a function of characteristics of relatives themselves. EE was operationalized in terms of hostility on the Camberwell Family Interview (C. E. Vaughn & J. P. Leff, 1976) and patients' ratings of their relatives' criticism (perceived criticism). Key findings include the identification of a characteristic of the relative (self-reported angry thoughts, feelings, and behaviors) that is directly linked to both hostility toward the patient and to perceived criticism, as well as a direct path between relatives' low rates of observed problem solving and their hostility toward the patient. Patient Pathology predicted perceived criticism but not observer-rated hostility.

Adolescent↗
PubMed1993

One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion.

The association between 1-year post-hospitalization outcome and the brief Five Minute Speech Sample (FMSS) measure of expressed emotion (EE) was examined among children with depressive disorders. Results indicated a strong association between 1-year outcome and the FMSS-EE measure. Whereas children returning to high EE homes were likely to show persistent mood disorder, recovery was more common among children returning to low EE homes. This predictive relationship was independent of possible mediating variables such as treatment regimen and clinical characteristics. Results provide the first reported demonstration that (1) the brief FMSS-EE measure predicts clinical outcome, and (2) EE measures predict 1-year outcome for children with depressive disorders.

Adolescent↗
PubMed1990

Daughters of people with dementia. Expressed emotion, strain and coping.

Twenty-five women who were the primary carers for a parent with dementia rated for expressed emotion (EE) and then divided into two groups: 11 with low-EE ratings and 14 with high-EE ratings. Although there were no differences between these groups in the levels of their parents' cognitive impairment, when such impairment was taken into account, high-EE subjects were found to report higher levels of strain and distress. More efficient coping strategies were reported by subjects who made fewer critical comments and more positive remarks. High-EE subjects more frequently had no living siblings, and were more likely to have had a respite break from caring. EE status was not associated with continuing care in the community at a nine-month follow-up.

Adaptation, Psychological↗
PubMed2000

Attitudes towards emotional expression, relational competence and psychological distress.

The association between life events and psychological distress was found to be mediated by attitudes towards emotional expression for those with low social support but not for those with high social support. Passive interpersonal behaviour significantly accounted for additional variance in psychological distress to that accounted for by life events and attitudes.

Adult↗
PubMedDate not supplied

Assessment of expressed emotion in families of patients with eating disorders: using the Camberwell Family Interview on a Spanish sample.

INTRODUCTION: The level of expressed emotion (EE) in the family members has been related to several clinical and outcome related factors in patients with eating disorders. This study aimed to study the levels of EE in families of patients with eating disorders using the Camberwell Family Interview (CFI) in order to determine whether they were similar to those reported in other studies developed outside Spain. METHODS: Seventy-one parents of 43 eating disorders patients were evaluated using a Spanish version of the CFI. RESULTS: In our sample, 46.5 % of the families had EE high levels. There were no significant differences between mothers and fathers in global scores, but mothers tended to have higher emotional overinvolvement with the patient. CONCLUSIONS: The percentage of families that had high EE in our sample was lower than that reported for families with a member with schizophrenia and slightly higher than that detected in other studies on eating disorders. Mothers tended to have higher EE levels than fathers.

Adolescent↗
PubMed2002

Stigma and expressed emotion: a study of people with schizophrenia and their family members in China.

BACKGROUND: The most damaging effect of stigma is the internalisation of others' negative valuations. AIMS: To explore the factors that mediate patients' emotional and cognitive responses to stigma. METHOD: Based on responses to 10 open-ended questions about stigma appended to the Chinese version of the Camberwell Family Interview, trained coders rated the effect of stigma on both patients and family members in 1491 interviews conducted with 952 family members of 608 patients with schizophrenia at 5 sites around China from 1990 to 2000. RESULTS: Family members reported that stigma had had a moderate to severe effect on the lives of patients over the previous 3 months in 60% of the interviews, and on the lives of other family members in 26% of the interviews. The effect of stigma on patients and family members was significantly greater if the respondent had a high level of expressed emotion, if the patient had more severe positive symptoms, if the respondent was highly educated and if the family lived in a highly urbanised area. CONCLUSIONS: Clinicians should assess the effect of stigma as part of the standard work-up for patients with mental illness, and help patients and family members reduce the effect of stigma on their lives.

Adult↗
PubMed1995

Expressed emotion and a hypothetical model of relapse in schizophrenia.

A hypothetical model is proposed that connects the risk of relapse in schizophrenia and expressed emotion in relatives with genetic factors in the individual, familial schizophrenia, severity of illness, family psychopathology, age of onset of the illness, and length of family exposure to a psychotic relative.

Age of Onset↗
PubMed1990

Expressed emotion as a predictor of schizophrenic relapse: an analysis of aggregated data.

We examine published data from 12 studies assessing the capacity of Expressed Emotion (EE) status to predict schizophrenic relapse. Analysis of aggregated data, for 908 subjects, established a 3.7 times greater likelihood of relapse in those categorized as high EE, and a somewhat waning predictive strength EE over the publication interval, 1962-88.

Data Interpretation, Statistical↗
PubMed1995

Emotional expression in upside-down faces: evidence for configurational and componential processing.

In two experiments, a total of 126 subjects judged the seven emotional expressions of Ekman & Friesen's (1976) pictures of facial affect presented upright or inverted. Inversion reduced accuracy for sad, fear, anger and disgust, and sad was identified as neutral. However, happy was identified almost perfectly on upright and inverted faces, and both anger and disgust were identified significantly often on inverted faces. In addition, the classic confusions between surprise and fear and between disgust and anger occurred on both upright and inverted faces. It is argued that expressions are difficult to identify on inverted faces when they are based on configural information. However, accurate performance on inverted faces and similar confusions on upright and inverted faces are due to componential processing.

Adult↗
PubMed2000

Exploring Hindu Indian emotion expressions: evidence for accurate recognition by Americans and Indians.

Subjects were presented with videotaped expressions of 10 classic Hindu emotions. The 10 emotions were (in rough translation from Sanskrit) anger, disgust, fear, heroism, humor-amusement, love, peace, sadness, shame-embarrassment, and wonder. These emotions (except for shame) and their portrayal were described about 2,000 years ago in the Natyasastra, and are enacted in the contemporary Hindu classical dance. The expressions are dynamic and include both the face and the body, especially the hands. Three different expressive versions of each emotion were presented, along with 15 neutral expressions. American and Indian college students responded to each of these 45 expressions using either a fixed-response format (10 emotion names and "neutral/no emotion") or a totally free response format. Participants from both countries were quite accurate in identifying emotions correctly using both fixed-choice (65% correct, expected value of 9%) and free-response (61% correct, expected value close to zero) methods.

Adolescent↗
PubMed1995

Expressed emotion and language disturbances in parents of stable schizophrenia patients.

Nineteen healthy parents of long-term schizophrenia outpatients were assessed for levels of expressed emotion (EE) and for characteristics of communication style which are putative markers of vulnerability to schizophrenia. We administered measures of communication deviance, linguistic reference performance, global disorganization, and positive formal thought disorder. Parents high in EE showed significantly poorer linguistic reference performance and greater disorganization in their speech than parents low in EE. These findings support the idea that high EE in some individuals may be associated with cognitive characteristics indicative of a vulnerability to schizophrenia, and this may account in part for the well-established association between EE level in parents and prognosis in patients.

Adult↗
PubMed1992

Parental expressed emotion and psychophysiological reactivity in disturbed and normal children.

Increased spontaneous fluctuations in skin conductance (SC) in adult schizophrenics have been associated with high expressed emotion (EE) in their relatives. This is the first study in children where parental EE, parental psychopathology, and autonomic activity, indexed by SC levels and reactivity, have been assessed. The subjects were children and adolescents with disruptive behaviour disorders (DBD, n = 35), a psychiatric contrast group with obsessive-compulsive disorders (OCD, n = 42) and normal controls (NC, n = 45). Children living in homes with two high-EE parents had higher SC activity during rest period and slower adaptation to relaxation. Fathers' EE and maternal psychiatric diagnosis were related to higher SC activity, especially for the OCD group.

Adaptation, Psychological↗
PubMed2002

Infants' ability to connect gaze and emotional expression to intentional action.

Four studies investigated whether and when infants connect information about an actor's affect and perception to their action. Arguably, this may be a crucial way in which infants come to recognize the intentional behaviors of others. In Study 1 an actor grasped one of two objects in a situation where cues from the actor's gaze and expression could serve to determine which object would be grasped, specifically the actor first looked at and emoted positively about one object but not the other. Twelve-month-olds, but not 8-month-olds, recognized that the actor was likely to grasp the object which she had visually regarded with positive affect. Studies 2, 3, and 4 replicated the main finding from Study 1 with 12- and 14-month-olds and included several contrasting conditions and controls. These studies provide evidence that the ability to use information about an adult's direction of gaze and emotional expression to predict action is both present, and developing at the end of the first year of life.

Cognition↗
PubMed2002

Correlates of expressed emotion in mothers of clinically-referred youth: an examination of the five-minute speech sample.

BACKGROUND: Most studies applying the adult-derived 'expressed emotion' (EE) measure to children have combined criticism (CRIT) and emotional overinvolvement (EOI). Yet, some of the parent behaviors coded as EOI and shown to have negative implications for parents and their adult children (e.g., multiple positive comments about the son or daughter) may be normative and benign for parents and their juvenile children. Thus, EOI, as currently operationalized, may not be related to child psychopathology in the way CRIT is. METHOD: We tested this possibility, separating CRIT and EOI and examining the individual scoring criteria for each in relation to psychopathology factors in a sample of 258 clinically-referred children aged 7-17. RESULTS: Whereas each of the four CRIT criteria related positively to maternal reports of child psychopathology, especially externalizing problems, only two of the five EOI criteria were positively related to child psychopathology, and one (positive comments) was negatively related. Structural Equation Modeling findings supported a model in which CRIT partially mediates the relation between maternal psychopathology and child externalizing symptoms. CONCLUSIONS: Overall, the results suggest that EE may contribute to the study of parent-child relations and child psychopathology, but that a developmental adjustment may be required in the way EE is operationalized for use with juvenile samples.

Adolescent↗
PubMed2001

Comorbidity fails to account for the relationship of expressed emotion and perceived criticism to treatment outcome in patients with anxiety disorders.

This study was designed to test the hypothesis that comorbidity mediates the relationship between expressed emotion, perceived criticism (PC), and treatment outcome in anxiety disorders. Although comorbid major depression and Axis II traits were related to poor outcome in agoraphobic and obsessive-compulsive outpatients, these variables did not prove to be mediators of drop-out or treatment outcome. A secondary aim was to examine whether PC predicted change in symptoms of depression. Even when posttreatment anxiety severity and comorbidity were controlled, PC accounted for a significant proportion of the variance in change on the Symptom Checklist-90-R depression scale.

Affect↗
PubMed1987

Expressed emotion and perceived family interaction in the key relatives of elderly patients with dementia.

Four groups of families were investigated using an interview designed to assess expressed emotion (EE) in relatives of psychiatric patients and a family interaction questionnaire (FIQ) based upon the Leary and Benjamin schemes for coding interpersonal behaviour. The families included 25 containing a psychiatric patient aged between 18 and 46, and three groups of 12 families each, all containing a patient over 60 (patients with dementia, a functional psychiatric disorder, or a chronic physical disorder respectively). In all cases data were obtained from key relatives. The FIQ clearly separated out the group of dementia relatives who reported the most dominant and protective behaviours and the highest levels of hostile-dominance and the lowest levels of affection. EE was not found to be so sensitive to interactions occurring in families with a member with dementia, and the possible reasons for this are discussed.

Adaptation, Psychological↗
PubMed1990

Supplementing behavioral marital therapy with cognitive restructuring and emotional expressiveness training: an outcome investigation.

The current study investigated whether the effectiveness of behavioral marital therapy (BMT) would be increased by the addition of cognitive restructuring (CR) and/or emotional expressiveness training (EET) for maritally distressed couples. Sixty such couples were randomly assigned to 1 of 3 therapists and 1 of 5 treatment conditions (BMT Alone, CR + BMT, BMT + EET, CR + BMT + EET, or waiting list) for 12 weeks of conjoint marital therapy. Within each treatment condition, couples typically improved on the variables focused on in treatment. However, comparisons among active treatment conditions showed few significant differences among treatments; the treatments were equally effective in increasing marital adjustment. Thus, the addition of CR and EET did not appear to increase the overall effectiveness of treatment. Possible reasons for the current findings are provided, and suggestions for future marital outcome investigations are outlined.

Adaptation, Psychological↗