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PubMed2006

Bidirectional effects of expressed emotion and behavior problems and symptoms in adolescents and adults with autism.

Expressed emotion measures the emotional climate of the family and is predictive of symptom levels in a range of medical and psychiatric conditions. This study extends the investigation of the effects of expressed emotion to families of individuals with autism. A sample of 149 mothers co-residing with their adolescent or adult child with autism over an 18-month period was drawn from a large multiwave longitudinal study. High expressed emotion was related to increased levels of maladaptive behavior and more severe symptoms of autism over time. Also, characteristics of the son or daughter influenced levels of maternal expressed emotion over time. Although autism is a complex genetic disorder, the effect of the family environment in shaping the behavioral phenotype should not be underestimated.

Adolescent↗
PubMed2002

Emotional expression and body dissatisfaction.

OBJECTIVE: The purpose of this study was to examine the relation between emotional expression and body dissatisfaction in a sample of young women. METHOD: Participants were 141 female undergraduates. They were assessed for emotional expression, body dissatisfaction, nonassertiveness, and depressive symptoms. The unique relation between emotional expression and body dissatisfaction was analyzed using hierarchical multiple regression. RESULTS: Emotional expression was related inversely to body dissatisfaction. This association was significant after controlling for body mass index, nonassertiveness, and depressive symptoms. DISCUSSION: This is the first study to examine the link between emotional expression and body dissatisfaction. Findings are discussed in terms of possible strategies for modifying shape- and weight-related concerns in women.

Adolescent↗
PubMedDate not supplied

Deliberate emotional expressions of socially anxious children and their mothers.

The aim of the present study was to investigate whether socially anxious children show deficits in their deliberate facial expression of emotions. To test for potential mother-child transmission effects, the mothers' facial expressions were also assessed. Fifty socially anxious and 25 socially nonanxious children (8-12 years) and their mothers participated in a facial expression posing task. The expressions produced were coded using Ekman and Friesen's (1978) Facial Action Coding System (FACS). In addition, naive raters rated their quality of emotion. FACS analyses indicated that socially anxious children show a reduced general facial activity, have a more restricted facial repertoire and differ qualitatively from controls in their facial expression of emotions. Similarly, the global ratings indicated that the socially anxious children's posed facial expressions are less accurate. For the mothers no differences between groups were found when global ratings were used. However, the FACS data demonstrate that the facial expressions of mothers of socially anxious children are less intense compared to controls. It is possible that the decreased intensity of the mothers' facial expressiveness makes it more difficult for the socially anxious children to learn adequate facial expressions.

Adult↗
PubMed1992

Women whose mental illnesses recur after childbirth and partners' levels of expressed emotion during late pregnancy.

Expressed emotion (EE) in the partners of 25 pregnant women with a history of psychosis or severe depression and in 13 pregnant control subjects without any previous psychiatric disorder was assessed in the ninth month of pregnancy. At this time, no patient presented as a case according to RDC. Eleven subjects with a history of psychiatric disorder experienced a further episode of illness in the six months following delivery. Partners of women who became ill had made fewer critical and positive comments about their wives during the pregnancy than the partners of women who remained well. Poor self-rated social adjustment in the partners was also predictive of recurrence of illness after delivery.

Adult↗
PubMedDate not supplied

[Expressed emotion: past, present, future].

Expressed Emotion (EE) proved to be the best single predictor of relapse in schizophrenia in 1972. Since then, studies on EE were oriented in three directions: Replication of the original study in different countries, improvement of the methodology and clinical applications. The analysis of different key studies shows that EE is a powerful predictor factor, although it is influenced by other variables such as culture.

Emotions↗
PubMed2004

Maternal expressed emotion predicts children's antisocial behavior problems: using monozygotic-twin differences to identify environmental effects on behavioral development.

If maternal expressed emotion is an environmental risk factor for children's antisocial behavior problems, it should account for behavioral differences between siblings growing up in the same family even after genetic influences on children's behavior problems are taken into account. This hypothesis was tested in the Environmental Risk Longitudinal Twin Study with a nationally representative 1994-1995 birth cohort of twins. The authors interviewed the mothers of 565 five-year-old monozygotic (MZ) twin pairs and established which twin in each family received more negative emotional expression and which twin received more warmth. Within MZ pairs, the twin receiving more maternal negativity and less warmth had more antisocial behavior problems. Qualitative interviews were used to generate hypotheses about why mothers treat their children differently. The results suggest that maternal emotional attitudes toward children may play a causal role in the development of antisocial behavior and illustrate how genetically informative research can inform tests of socialization hypotheses.

Antisocial Personality Disorder↗
PubMed2000

Preventing the entrenchment of high expressed emotion in first episode psychosis: early developmental attachment pathways.

OBJECTIVE: As part of a strategy to consider the options for preventing the developmental entrenchment of expressed emotion (EE), we examine the early ontogeny of EE in a first-episode sample of individuals with psychosis and its links with the process of adaptation to change. METHODS: The key relatives of 50 first-episode psychosis patients from two locations were interviewed soon after patient referral and again 9 months later using measures of expressed emotion and loss. RESULTS: The developmental pathways of components of expressed emotion, particularly criticism and emotional over-involvement, were independent despite having a similar effect on outcome for patients. Initially, high levels of emotional over-involvement were reduced by follow up, with 37% resolving into high criticism. Overall expressed emotion status changed in 28.2% of key relatives (all parental), predominantly from high to low. High emotional over-involvement and low criticism are associated with significantly high levels of perceived loss in relatives. The metamorphosis of emotional over-involvement to criticism was linked to a reduction in perceived loss. CONCLUSIONS: Expressed emotion is not a stable index in relatives of first-episode psychosis samples. Appraisals of loss by relatives may be driving high emotional over-involvement with implications for family intervention programs. Attachment theory may help to explain some of the processes underlying resistance to change in some of the high-EE behaviours measured by expressed emotion.

Adolescent↗
PubMed2000

Attitudes to emotional expression and personality in predicting post-traumatic stress disorder.

OBJECTIVES: To test hypotheses derived from a suggestion of Williams (1989) that negative attitudes towards emotional expression act as a predisposing or maintaining factor for post-traumatic stress reactions following a traumatic event. DESIGN: The study employed a prospective design in which attitudes to emotional expression, the 'Big Five' personality factors (Costa & McCrae, 1992a) and initial symptoms and injury severity within 1 week of a road traffic accident were used to predict the development of post-traumatic stress disorder 6 weeks post-accident. METHOD: Sixty victims of road traffic accidents randomly selected from attenders at a large A&E department were assessed by questionnaire and interview. Measures comprised a 4-item scale relating to emotional expression, standardized scales for intrusion and avoidance features of traumatic experiences, and for anxiety and depression and the NEO-FFI Five Factor Personality Inventory. Forty-five of these participants responded to a postal questionnaire follow-up. In this survey the battery was repeated and also included a self-report diagnostic measure of post-traumatic stress disorder (PTSD). RESULTS: The percentage of the sample meeting DSM-IV diagnostic criteria for PTSD at 6 weeks post-trauma was 30.8%. A small but significant relationship was found for negative attitudes to emotional expression at 1 week to predict intrusive symptoms and diagnosis at 6 weeks, over and above the independent relationships of initial symptoms, initial injury severity, personality and coping. The emotional expression measure was largely stable between the two points of measurement. More negative attitudes to emotional expression were related to less openness, extraversion and agreeableness personality domains. CONCLUSIONS: Some support for the hypotheses was found in relation to the development of PTSD and for the status of attitudes to emotion as a stable trait related to personality factors. The potential importance of attitudes to emotional expression in therapy and other work is discussed.

Adolescent↗
PubMed2002

Journaling about stressful events: effects of cognitive processing and emotional expression.

The effects of two journaling interventions, one focusing on emotional expression and the other on both cognitive processing and emotional expression, were compared during 1 month of journaling about a stressful or traumatic event. One hundred twenty-two students were randomly assigned to one of three writing conditions: (a) focusing on emotions related to a trauma or stressor, (b) focusing on cognitions and emotions related to a trauma or stressor, or (c) writing factually about media events. Writers focusing on cognitions and emotions developed greater awareness of the positive benefits of the stressful event than the other two groups. This effect was apparently mediated by greater cognitive processing during writing. Writers focusing on emotions alone reported more severe illness symptoms during the study than those in other conditions. This effect appeared to be mediated by a greater focus on negative emotional expression during writing.

Adult↗
PubMed2001

Effects of emotion concepts on perceptual memory for emotional expressions.

Three experiments tested the hypothesis that explaining emotional expressions using specific emotion concepts at encoding biases perceptual memory for those expressions. In Experiment 1, participants viewed faces expressing blends of happiness and anger and created explanations of why the target people were expressing one of the two emotions, according to concepts provided by the experimenter. Later, participants attempted to identify the facial expressions in computer movies, in which the previously seen faces changed continuously from anger to happiness. Faces conceptualized in terms of anger were remembered as angrier than the same faces conceptualized in terms of happiness, regardless of whether the explanations were told aloud or imagined. Experiments 2 and 3 showed that explanation is necessary for the conceptual biases to emerge fully and extended the finding to anger-sad expressions, an emotion blend more common in real life.

Emotions↗
PubMed1992

Family-peer connections: the roles of emotional expressiveness within the family and children's understanding of emotions.

The purpose of this study was to explore patterns of parent and child emotional expressiveness within the family context, to examine links between these patterns and children's peer relations, and to examine whether these links might be mediated by children's understanding of emotions. Subjects were 61 kindergarten and first-grade white, middle-class children and their parents. Parent and child expressiveness were assessed in a laboratory ring-toss game designed to elicit a range of emotional responses. Parent expressiveness in the home was also assessed with Halberstadt's Family Expressiveness Questionnaire. The questionnaire, completed by both mother and father, assesses a range of emotions in a variety of settings typical of many families, and consists of items tapping both positive and negative expressiveness. Children were interviewed about their understanding of emotions across a broad range of areas. Results indicated that maternal expressiveness (home) and paternal expressiveness (home and laboratory) but not children's expressiveness with parents were associated with children's peer relations. Although children's understanding of emotions was generally not associated with family expressiveness, understanding predicted children's peer relations. In addition, children's understanding influenced the links between maternal expressiveness in the home and peer relations and between paternal expressiveness in the laboratory and peer relations. This pattern of results underscores the importance of the emotional climate of the family for the development of children's social relations with peers.

Child↗
PubMed1993

Expressed emotion and glucose control in insulin-dependent diabetes mellitus.

To clarify the meaning of the expressed emotion construct by testing its generalizability beyond psychiatric disorders, the authors measured family expressed emotion and glucose control in 35 diabetic patients. The critical comments component of expressed emotion significantly predicted glucose control, suggesting that the expressed emotion construct is not specific to psychiatric patients.

Adolescent↗
PubMed1996

The influence of expressed emotion, family dynamics, and symptom type on the social adjustment of schizophrenic young adults.

BACKGROUND: The goal of this study was to test a path analytic model that reflects the hypothesis that family cohesion and family adaptability underlie family members' expressed emotion (critical comments and emotional overinvolvement), that these family variables underlie the preponderance of positive symptoms in a patient with schizophrenia 9 months after relatives are interviewed, and that all of these variables influence the patient's social adjustment at follow-up. METHODS: The subjects were 69 patients who met the DSM-III-R criteria for schizophrenia and 108 of their relatives. Relatives were assessed with the Camberwell Family Interview and the Family Adaptability and Cohesion Evaluation Scales III. Patients were interviewed 9 months later with the Brief Psychiatric Rating Scale and the Social Adjustment Scale II. RESULTS: Significant amounts of variance were explained by the model for three of the five social adjustment components. Neither family cohesion nor adaptability was associated with either critical comments or emotional overinvolvement. Family cohesion was negatively associated and emotional overinvolvement was positively associated with a preponderance of positive symptoms. Greater family adaptability was associated with lower social adjustment scores, and greater emotional overinvolvement was associated with higher social adjustment. Cohesion had a significant positive indirect effect on social adjustment through its association with symptom type. CONCLUSIONS: Critics of expressed emotion will be pleased to see that one component of high expressed emotion (emotional overinvolvement) is actually associated with a better social outcome in patients. Proponents of the expressed emotion concept will be pleased to see the applicability of expressed emotion to other facets of schizophrenic outcome. The results highlight the importance of using the expressed emotion scales in their continuous rather than dichotomized state and of analyzing critical comments and emotional overinvolvement separately.

Adolescent↗
PubMed1992

Expressed emotion: conceptual, clinical, and social policy issues.

Research on schizophrenia has suggested an association between relapse of patients and high expressed emotion (EE), defined as criticism, hostility, or emotional overinvolvement of at least one family member. In international studies, however, the majority of families of persons with schizophrenia demonstrate low expressed emotion. These families are described as empathic, calm, and respectful by EE researchers, who also reject the idea of family schizophrenogenesis. The author discusses expressed emotion as a construct, its validity and stability over time, and the direction of the relationship between relatives' expressed emotion and patients' symptoms and behavior. She reviews studies indicating significant differences in levels of expressed emotion across cultures, examines the social policy implications of programming based on the construct, and suggests research on EE analogues in clinical and rehabilitative environments.

Emotions↗
PubMed2001

Emotional expressivity and intrusive cognitions in women with family histories of breast cancer: application of a cognitive processing model.

OBJECTIVES: Women with family histories of breast cancer exhibit significant distress and intrusive cognitions about cancer. The role of intrusive cognitions in adjustment to chronic stressors is unclear. While they may be a source of distress in themselves, they may also be part of a cognitive processing strategy that aids in the adaptation process, particularly if they are accompanied by more deliberate processing such as emotional expression. Applying cognitive processing models of stress, the present study examined the role of dispositional emotional expressivity in intrusive cognitions about breast cancer and distress in women dealing with the stressful experience of having a family history of breast cancer. Two competing hypotheses were tested: (1) emotional expressivity is associated with reduced intrusive cognitions and thus lower distress; (2) emotional expressivity buffers the relations between intrusive cognitions and distress. DESIGN: Using a cross-sectional design, hypotheses were addressed with multiple regression analyses according to established methods. METHOD: Healthy women (N = 104) who had one or more first-degree relatives with breast cancer were recruited from cancer screening programs. They completed questionnaires regarding family history of cancer, emotional expressivity, distress, and intrusive cognitions. RESULTS: Emotional expressivity was not associated with reduced intrusive cognitions (Hypothesis 1) but moderated the relations between intrusive cognitions and distress (Hypothesis 2). CONCLUSIONS: The data further our understanding of cognitive processing theories of stress and underline the importance of including emotional expression in interventions, helping women to process the stressful experiences associated with having family histories of breast cancer.

Journal Article↗
PubMed1985

Family expressed emotion and relapse in schizophrenia in 24 urban American patients.

The authors examined the correlation between family expressed emotion and relapse in 24 schizophrenic patients in a predominantly inner-city American setting. They found a significant correlation between relapse and high expressed emotion in family members; the level of family expressed emotion was somewhat higher than that reported in previous studies. The findings suggest that the impact of expressed emotion may vary in different sociocultural populations.

Attitude to Health↗
PubMed1983

Expressed emotion and airway conductance in children with bronchial asthma.

Fourteen asthmatic children (ages 9-11) and their controls were exposed to a stress inducing competitive achievement situation. Facial expression of emotions were systematically analyzed from video-recordings, and peak expiratory flow rate (PEFR) reduction was measured from pre-stress to post-stress. The asthmatic children showed a significantly lower frequency and duration of overall emotional expression than their controls. Specifically, the frequency and duration of expressed anger/rage, enjoyment/joy, and surprise/startle were lower in the asthmatic children. Moreover, duration of overall expressed emotion showed a significant negative correlation with PEFR reduction in the asthmatic group, indicating a relevant relationship between facial expression of emotions and breathing function.

Airway Resistance↗
PubMed2006

Influence of carer expressed emotion and affect on relapse in non-affective psychosis.

BACKGROUND: High expressed emotion in carers predicts relapse in psychosis, but it is not known why this is so. In our cognitive model of psychosis, we postulated that the effect is mediated through affective changes. AIMS: To investigate the relationships between carer expressed emotion, patients' symptoms and carer characteristics during a recent relapse of psychosis. METHOD: A total of 86 patients and carers were investigated in a cross-sectional design. RESULTS: Patients whose carers showed high expressed emotion had significantly higher levels of anxiety and depression, but not more psychotic symptoms or lower self-esteem. Linear regression showed that carers'critical comments predicted anxiety in patients. Critical comments were related to low carer self-esteem and avoidant coping strategies. Low carer self-esteem was also related to carer depression, stress and carer 'burden', and to low patient self-esteem. CONCLUSIONS: Our hypothesis was partially supported. Carer criticism was associated with patient anxiety, low carer self-esteem and poor carer coping strategies. Family interventions should focus on improving these after a relapse of symptoms of psychosis.

Adaptation, Psychological↗