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Expressed emotion refers to emotional aspects of speech for which ratings have been derived. In the relatives of discharged schizophrenic patients, these ratings are predictive of outcome suggesting the importance of social and family factors on the prognosis of schizophrenics living with their families. The development, measurement and current use of the concept are discussed.
Expressed emotion (EE) has substantial scientific support as a predictor of relapse of positive symptoms. The median relapse rate in a high-EE environment is 48%, compared with 21% in a low-EE environment. This effect does not seem to be due to confounding with other variables, but it is subject to limitations in its scope of application. EE probably determines relapse through its effect on emotions and symptom control. A stress-vulnerability model of relapse is advanced that incorporates biological factors as well as cycles of mutual influence between symptomatic behaviour, life events, and EE. Aversive types of behaviour in patients and their relatives are seen as understandable reactions to stress that are moderated by social perceptions and coping skills. Families have made positive achievements, including the provision of non-invasive support.
Continua of vocal emotion expressions, ranging from one expression to another, were created using speech synthesis. Each emotion continuum consisted of expressions differing by equal physical amounts. In 2 experiments, subjects identified the emotion of each expression and discriminated between pairs of expressions. Identification results show that the continua were perceived as 2 distinct sections separated by a sudden category boundary. Also, discrimination accuracy was generally higher for pairs of stimuli falling across category boundaries than for pairs belonging to the same category. These results suggest that vocal expressions are perceived categorically. Results are interpreted from an evolutionary perspective on the function of vocal expression.
OBJECTIVE: Emotional expression is an important means of coping with stressful experiences such as cancer. Social barriers to expression may have adverse effects. Research has suggested that men are less likely to express their emotions and have different patterns of social support compared to women. We examined whether male cancer patients have a lower tendency to express emotions, are less likely to perceive social barriers to expression, and are differentially affected by social barriers from different support sources as compared to women. DESIGN: Questionnaires were administered to 41 women and 41 men using a cross-sectional study design. METHOD: Patients diagnosed with gynaecological or prostate cancer within the past 5 years completed questionnaires on moods, intrusive thoughts, social constraints and emotional expressivity. RESULTS: There was a trend towards greater emotional expressivity in women as compared to men, but no significant gender differences in perceptions of social constraints from spouse/partner or others. Multiple regression analyses revealed that men experienced significantly greater distress in association with social constraints from their spouse/partner than did women. CONCLUSION: Men may be more vulnerable to social barriers to expression than previously assumed. Gender differences in emotional expressivity may be less important than the social context in which expression takes place.
Parental emotions and behaviors that contribute to continuity and change in preschool children's externalizing problems were examined. Mothers and fathers were observed interacting with their children, and child-rearing styles were reported. Teachers, mothers, and children reported children's antisocial, oppositional behavior. Externalizing problems showed strong continuity 2 and 4 years later. Proactive parenting (i.e., supportive presence, clear instruction, and limit setting) predicted fewer behavior problems over time, after controlling for initial problems; the converse was true for parental anger. In contrast, the hypothesized ameliorative contribution of parents' positive emotion was not found. Parental contributions were most influential for children whose initial problems were in the clinical range. In particular, parental anger predicted continuation of problems over time. Paternal, as well as maternal, influences were identified. Examination of parental emotions and inclusion of fathers is important to research and intervention with young antisocial children.
Evolutionary theory reveals that punishment is effective in promoting cooperation and maintaining social norms. Although it is accepted that emotions are connected to punishment decisions, there remains substantial debate over why humans use costly punishment. Here we show experimentally that constraints on emotion expression can increase the use of costly punishment. We report data from ultimatum games, where a proposer offers a division of a sum of money and a responder decides whether to accept the split, or reject and leave both players with nothing. Compared with the treatment in which expressing emotions directly to proposers is prohibited, rejection of unfair offers is significantly less frequent when responders can convey their feelings to the proposer concurrently with their decisions. These data support the view that costly punishment might itself be used to express negative emotions and suggest that future studies will benefit by recognizing that human demand for emotion expression can have significant behavioral consequences in social environments, including families, courts, companies, and markets.
The Emotion Expression Scale for Children (EESC) is a new self-report scale designed to examine 2 aspects of deficient emotion expression: lack of emotion awareness and lack of motivation to express negative emotion. Validity was assessed using self-report measures of emotion regulation and self- and peer-report of internalizing and externalizing symptoms. Using a community sample of 208 fourth- and fifth-grade children, reliability analyses revealed high internal consistency and moderate test-retest reliability of the EESC. The results provide initial support for concurrent validity for the EESC factors evidenced by relations with measures of emotion management. Associations were found between the EESC and measures of internalizing symptoms.
Expressed emotion is a robust and reliable predictor of psychiatric relapse across a range of psychopathological conditions and diagnoses. Theoretical speculation about the expressed emotion construct has suggested that high levels of criticism in relatives might be linked to attributions and beliefs about the patient's ability to control his or her symptoms or problem behaviors. Although there is some empirical support for this notion, no study to date has examined relatives' beliefs about their own abilities to control problem situations. This study compared high- and low-critical relatives of patients with schizophrenia on a measure of locus of control. Consistent with prediction, the locus of control scores of high-critical relatives were indicative of a more internal locus of control, whereas those of the low-critical relatives were indicative of a more external locus of control.
Expressed emotion, a measure of family attitudes toward psychiatric patients that is predictive of relapse, has attracted renewed attention recently as interest in the chronic psychiatric patient has widened. The authors review the development of the concept and the limits of its meaning. In seeking the core clinical construct underlying the expressed emotion variable, the authors also review recent studies of the relationship of expressed emotion to family interaction patterns, physiological arousal states, precipitants of relapse, and parental personality style. While family intervention studies are necessary to demonstrate that expressed emotion influences outcome in psychiatric patients, methodological limitations in currently available studies leave this issue unresolved.
OBJECTIVES: Expressed emotion (EE) and attributions towards challenging behaviour (CB) were explored amongst a group of staff working within a residential and day service placement for people with learning disabilities. DESIGN: Using a cross-sectional related-samples design, EE and attributions were measured amongst all staff working with one client with CB, and one client without CB. METHODS: Fifteen staff members completed the attributional questionnaire and the 5-minute speech sample (FMSS) to allow for EE ratings concerning staff relationships with two clients. One client exhibited CB, while the other did not, giving 2 samples. Attributional and EE ratings for each group were compared. This study did not employ vignette methodology. RESULTS: Staff working with a client with learning disabilities and CB attributed the CB as internal to the client and controllable by the client. Staff reported high levels of EE and made more critical comments towards the client with CB as compared with the client without CB. Furthermore, staff who reported high EE attributed CB as internal to the client and controllable by the client. CONCLUSIONS: Staff working with a client with challenging behaviour appeared to be making the 'fundamental attribution error'. The relationship between expressed emotion and attribution theory is discussed along with the methodological benefits of not relying on vignette methodology in research that examines challenging behaviour.
Several studies have examined relationships between levels of expressed emotion in relatives of individuals with schizophrenia and the coping strategies these relatives employ. In an attempt to elucidate these relationships, 44 parents were assessed using the Camberwell Family Interview and the Strategic Approach to Coping Scale. Associations between these measures were examined. Additionally, interactions between parent coping style and patient aggression were assessed with respect to expressed emotion. The results indicate that scores on the coping scale generally were not directly related to levels of expressed emotion. However, an interaction was found between parent coping style and patient behavior which predicted level of expressed emotion. This finding supports the idea that research into the variables underlying expressed emotion should include the assessment of both parent and patient characteristics and examine the interactions between these variables.
The level of expressed emotion (EE) as assessed in the Camberwell Family Interview (CFI) has proved to be one of the best predictors of relapse in schizophrenia. The present study describes the development and validation of the Family Questionnaire (FQ), a brief self-report questionnaire measuring the EE status (criticism, emotional overinvolvement) of relatives of patients with schizophrenia. The FQ classifications in the initial sample of relatives (N=76) correlated significantly with the ratings in the CFI subcategories 'criticism' (78% correct classifications) and 'emotional overinvolvement' (71% correct classifications), as well as with the overall CFI EE ratings (74% correct classifications). A validation study in an independent second sample (N=79) yielded similar results. The overall correct classification rate of 74% remained unchanged. The FQ had better agreement with the CFI on emotional overinvolvement than did other short EE questionnaires.
The relations between mothers' expressed positive and negative emotion and 55-79-month-olds' (76% European American) regulation, social competence, and adjustment were examined. Structural equation modeling was used to test the plausibility of the hypothesis that the effects of maternal expression of emotion on children's adjustment and social competence are mediated through children's dispositional regulation. Mothers' expressed emotions were assessed during interactions with their children and with maternal reports of emotions expressed in the family. Children's regulation, externalizing and internalizing problems. and social competence were rated by parents and teachers, and children's persistence was surreptitiously observed. There were unique effects of positive and negative maternal expressed emotion on children's regulation. and the relations of maternal expressed emotion to children's externalizing problem behaviors and social competence were mediated through children's regulation. Alternative models of causation were tested; a child-directed model in which maternal expressivity mediated the effects of child regulation on child outcomes did not fit the data as well.
Expressed emotion (EE) has been shown in various countries to be a good predictor of the clinical course of a patient's mental illness. Because the traditional EE interview requires considerable time and effort, this study examined the reliability of a method called the five-minute speech sample (FMSS) for assessing EE. The samples of 65 subjects were rated by the FMSS-EE coding system, and the interrater reliability among four authorized raters was investigated. Of these 65 samples, 10 (15%) were rated as high-EE (high critical, 6%; high emotional over-involvement (EOI), 9%), and 19 (29%) were rated as borderline (b-)-high-EE (b-critical, 15%; b-EOI, 14%). The intraclass correlation coefficient (ICC) was 0.91 for the overall category, 0.74 for criticism, 0.85 for EOI, 0.63 for b-critical and 0.54 for b-EOI. The FMSS was shown to be reliable for the assessment of EE, even outside of Western countries. However, the lower agreement in the subcategories of EOI and b-critical has to be considered as a limitation of this brief method.
BACKGROUND: High expressed emotion (EE) in families reliably predicts relapse in schizophrenia leading to the assumption that high EE stresses patients and is the cause of relapse. Attempts at validating the stressful properties of high EE using autonomic skin conductance measures have been inconclusive. Since memory loaded vigilance tasks are sensitive to stress, we used a memory loaded version of the Continuous Performance Test (CPT) to see if test performance would change in the presence and absence of high or low EE relatives. If high EE was stressful, performance should decline in their presence of high EE relatives. If low EE was protective against stress performance should improve in the presence of low EE relatives. METHODS: The CPT was administered to 41 schizophrenic and 51 normal control participants. CPT testing was conducted in the absence, then presence, then absence of high or low EE relatives. RESULTS: Control participants had significantly greater CPT scores than schizophrenic participants; there was no effect of the relative's presence or absence on CPT performance for either the high or low EE group. Schizophrenic participants from high EE homes demonstrated significantly better, rather than worse, CPT scores than those in low EE homes. CONCLUSIONS: These findings fail to support the notion of high EE as stressor, but show that high EE and low EE patient groups perform a vigilance task significantly differently. We propose that patients from low EE groups may be underaroused relative to their high EE counterparts and that this underarousal leads to less than optimal performance on the CPT.
Expressed emotion is a measure of an individual's critical and/or emotionally overinvolved attitudes toward another person. The characteristics of parents who are high in expressed emotion are not fully understood. This study examined some variables potentially associated with expressed emotion, as measured by the Camberwell Family Interview, in 54 parents of schizophrenic young adults. Statements of (1) self-blame for the patient's illness, (2) controlling behaviors toward the patient, and (3) controlling behaviors toward others were assessed. As predicted, parents who blamed themselves for the patient's illness had higher emotional overinvolvement ratings than non-self-blaming parents. Measures of controlling behavior revealed that highly critical parents were not more controlling than less critical parents; however, parents high in emotional overinvolvement reported higher levels of patient- and other-controlling behaviors than parents low in emotional overinvolvement. These results suggest that the emotional overinvolvement component of high expressed emotion is associated with self-blaming attributions and controlling behaviors in parents, but that the criticism component is not.
Research on expressed emotion in the families of schizophrenic patients has seemed to offer a new perspective on environmental factors that cause relapse in schizophrenia. A review of the literature, however, reveals that while expressed emotion may predict relapse, there is no evidence that it causes relapse. Nor does the evidence support the continued linkage of the three components of expressed emotion--criticism, hostility, and emotional overinvolvement--in a single global variable. The authors also question the clinical significance of expressed emotion ratings and believe that treatment strategies based on them tend to blame relatives for the patient's continuing difficulties. They suggest that clinicians assess family responses in the context of the patient's behavior and life situation before helping families develop more effectual coping strategies.
To obtain a better understanding of the inhibited emotional expression often reported in breast cancer patients, the authors compared 48 breast cancer patients and 49 healthy women with respect to disturbed emotional processes (alexithymia), emotional disclosure, emotional expression, assertiveness, repression, and distress. The patient group showed significantly more ambivalence over emotional expression, more restraint, and more anxiety than the healthy controls. No differences were found between the 2 groups in alexithymia, expressing emotions in general, or willingness to talk with others about emotions. The image of the breast cancer patient that emerged in the study was that of a person who has conflicting feelings with regard to expressing emotions, is reserved and anxious, is self-effacing, and represses aggression and impulsiveness. These findings suggest that cancer patients' inhibited behavior is a reaction to the disease rather than a reflection of a personality characteristic predisposing an individual to (breast) cancer.