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PubMed2006

Cross-cultural validation of expressed emotion in caregivers of Chinese patients with first episode psychosis in Singapore: a qualitative study.

BACKGROUND: The concept of Expressed Emotion (EE; Brown et al., 1972), a measure of criticism, over-involvement and hostility in families, has been shown to be a robust predictor of relapse in schizophrenia (Parker & Hadzi-Pavlovic, 1990). Recent criticism of using Western instruments in Asian countries has led to more stringent procedures for validation of scales. AIMS: The first aim was to establish that the concept of Expressed Emotion exists in Singapore. The second aim was to examine the Level of Expressed Emotion (LEE; Cole & Kazarian, 1988, Gerlsma & Hale, 1997) scale to ascertain the conceptual and construct operationalisation of this instrument in this culture. METHODS: This was a qualitative study. The concept of EE was examined using a Singaporean population; 10 patient-caregiver pairs were recruited and interviewed using a semi-structured interview format. Regarding the LEE, small focus-group interviews were conducted with a cross-section of Singaporeans to gain their views on the concepts in the scale and the relevance of the items in this culture. RESULTS: The interviews were analysed in light of attitudes found to discriminate between high and low EE families (Leff & Vaughn, 1985). A clear distinction between high and low EE groups was found. With regard to the LEE, the data from the focus groups, for the most part, supported the cross-cultural conceptual and operational equivalence of the scale and suggestions for additional items were made. CONCLUSION: There is support for the existence of EE among families in Singapore, and the LEE was found, for the most part, to be applicable in Singapore, with the addition of several emic items.

Adult↗
PubMed1991

Recognition of faces expressing emotions in patients with unilateral brain damage.

The experiment concerned the functional specialization of brain hemispheres in recognizing faces expressing emotions in patients with focal brain damage of the left and right hemispheres and in persons without damage of the central nervous system. Three types of faces were presented: happy i.e. expressing positive emotions, sad i.e. expressing negative emotions and neutral. The task of the subject was to recognize the test face exposed for 20 ms in the left or right visual field and point to the correct face on the response-card which contained three different faces. The errors made in recognizing of faces exposed in the right visual field (addressing the left hemisphere) and in the left one (addressing the right hemisphere) were analyzed. The patients with left hemisphere damage showed a similar pattern of hemispheric differences to that observed in the controls. In case of neutral and sad faces fewer errors were made in the left visual field exposures, in case of happy faces no significant differences between the two fields were stated. The results in patients with right hemispheric damage were different from both the other groups. In processing all the three types of faces, fewer errors were made in the left visual field presentations independently of the localization of the damage within the right hemisphere. Similar recognition level of different types of faces was also found in patients with left or right hemisphere damage as well as in controls. The above results suggest the crucial role of the right hemisphere in processing both positive and negative emotions expressed in faces.

Adult↗
PubMed1996

Expressed emotion on long-stay wards.

We examined the influence of an educational programme on nurses' level of expressed emotion (EE), on ward climate and on social functioning and psychopathology of hospitalized schizophrenic patients. Nurses and patients were from long-stay wards of six Dutch psychiatric hospitals. Despite an increase of nurses' knowledge about schizophrenia we did not find measurable effects on nurses' levels of EE. According to the five minute speech sample method, a third of the nurses participating in this study had a high level of expressed emotion, mainly consisting of criticism. This was a rather stable pattern. Patients, however, were reluctant to give their nurses high EE ratings on the level of expressed emotion scale. Psychopathology was not influenced by the educational programme, but social functioning of patients was related to EE in nurses. Moreover, we found a significant decline in the number of restrictive ward rules at follow-up. We conclude that, while it may be difficult to detect changes in EE level after an educational programme for nurses, there nevertheless appear to be measurable benefits for patients.

Adult↗
PubMed1997

Associations between expressed emotion and child behavioral inhibition and psychopathology: a pilot study.

OBJECTIVE: To examine the relationship between behavioral inhibition and child psychopathology and measures of family adversity indexed through "expressed emotion." METHOD: Maternal expressed emotion was assessed via Five-Minute-Speech-Sample in two samples of children evaluated for prevalence of DSM-III disorders and assessed via laboratory observations for behavioral inhibition. The at-risk sample (N = 30) consisted of 4- to 10-year-old children of mothers with and without panic disorder (psychiatric controls). The Kagan sample (N = 41) consisted of children selected at age 21 months as behaviorally inhibited or uninhibited and followed through age 11. RESULTS: In the at-risk sample, child behavioral inhibition was associated with high/borderline maternal criticism, independent of other measures of child psychopathology. In both samples combined, high/borderline maternal criticism was associated with child externalizing symptoms and with the number of child mood and behavior disorders. Emotional overinvolvement was significantly associated with child separation anxiety disorder in the at-risk sample. CONCLUSIONS: Results suggest that child behavioral inhibition may be associated with maternal criticism/dissatisfaction and confirm other reports of associations between criticism and child behavior and mood disorders and between emotional overinvolvement and child separation anxiety.

Adult↗
PubMed1994

Expressed emotion, perceived criticism, and relapse in depression: a replication in an Egyptian community.

OBJECTIVE: The aims of this study were to determine the value of families' expressed emotion and patients' perception of family criticism in predicting relapse in Egyptian depressed patients and to evaluate transcultural differences in assessment of these measures. METHOD: The subjects were 32 consecutive depressed patients from psychiatric clinics in Cairo and Ismailia, Egypt, who fulfilled the DSM-III-R criteria for major depression or bipolar disorder. An Arabic version of the Camberwell Family Interview was administered to key relatives of the depressed patients. Rating of expressed emotion was performed blindly by a qualified rater to assess levels of criticism, hostility, emotional overinvolvement, warmth, and positive remarks. Patient perception of family criticism (perceived criticism) was also assessed. All patients were followed up for 9 months to assess relapse and compliance with treatment. RESULTS: The relation of family criticism to relapse was statistically significant. Although this result replicates previous findings, the criticism level that best differentiated relapsers and nonrelapsers was a score of 7, which is much higher than previously reported in Western studies. This relation was not observed for other expressed emotion components. Also, no association between perceived criticism and relapse was detected. CONCLUSIONS: Expressed emotion is a prognostic factor that should be assessed with consideration of the specific culture and intrafamilial patterns. The use of perceived criticism in the prediction of relapse in depression is questionable. There is a need for a simplified, less time-consuming assessment tool that takes cross-cultural differences and specificities into consideration.

Adolescent↗
PubMedDate not supplied

The relations of parenting, effortful control, and ego control to children's emotional expressivity.

The relations of observed parental warmth and positive expressivity and children's effortful control and ego control with children's high versus low emotional expressivity were examined in a 2-wave study of 180 children (M age = 112.8 months). There were quadratic relations between adults' reports of children's emotional expressivity and effortful control; moderate expressivity was associated with high effortful control. Structural equation models supported the hypothesis that children's ego overcontrol (versus undercontrol) mediated the relation between parental warmth or positive expressivity and children's emotional expressivity, although parenting at the follow-up did not uniquely predict in children's expressivity after controlling for the relations in these constructs over time. The alternative hypothesis that children's ego overcontrol elicited positive parenting and expressivity also was supported.

Adult↗
PubMed1996

Acoustic profiles in vocal emotion expression.

Professional actors' portrayals of 14 emotions varying in intensity and valence were presented to judges. The results on decoding replicate earlier findings on the ability of judges to infer vocally expressed emotions with much-better-than-chance accuracy, including consistently found differences in the recognizability of different emotions. A total of 224 portrayals were subjected to digital acoustic analysis to obtain profiles of vocal parameters for different emotions. The data suggest that vocal parameters not only index the degree of intensity typical for different emotions but also differentiate valence or quality aspects. The data are also used to test theoretical predictions on vocal patterning based on the component process model of emotion (K.R. Scherer, 1986). Although most hypotheses are supported, some need to be revised on the basis of the empirical evidence. Discriminant analysis and jackknifing show remarkably high hit rates and patterns of confusion that closely mirror those found for listener-judges.

Adult↗
PubMedDate not supplied

The use of music in facilitating emotional expression in the terminally ill.

The expression and discussion of feelings of loss and grief can be very difficult for terminally ill patients. Expressing their emotions can help these patients experience a more relaxed and comfortable state. This paper discusses the role of music therapy in palliative care and the function music plays in accessing emotion. It also describes techniques used in assisting clients to express their thoughts and feelings. Case examples of three in-patient palliative care clients at Baycrest Centre for Geriatric Care are presented. The goals set for these patients were to decrease depressive symptoms and social isolation, increase communication and self-expression, stimulate reminiscence and life review, and enhance relaxation. The clients were all successful in reaching their individual goals.

Aged↗
PubMedDate not supplied

[A spherical model of the discrimination of the emotional expressions of a schematic human face].

The four-dimensional spherical emotional space was constructed by multidimensional scaling of visually perceived differences between emotional expressions of schematic faces. In this spherical model Euclidean distances between the points representing the schematic faces are directly proportional to perceived differences of emotional expressions. Three angles of the four-dimensional sphere correspond to specific characteristics of emotions, such as emotional modality (joy, fear, anger, etc.), intensity of emotions, and emotional fullness (saturation). At the same time Cartesian coordinates represent excitations in the neuronal channels encoding line orientations. It was shown that the structure of the emotional space is similar to the structure of color space, i.e., emotional modality corresponds to color hue, emotional intensity to brightness, and emotional fullness to color saturation. The obtained evidence suggests the common mechanisms of information coding in the visual system.

Adult↗
PubMed1998

Sex differences in emotion: expression, experience, and physiology.

Although previous studies of emotional responding have found that women are more emotionally expressive than men, it remains unclear whether men and women differ in other domains of emotional response. We assessed the expressive, experiential, and physiological emotional responses of men and women in 2 studies. In Study 1, undergraduates viewed emotional films. Compared with men, women were more expressive, did not differ in reports of experienced emotion, and demonstrated different patterns of skin conductance responding. In Study 2, undergraduate men and women viewed emotional films and completed self-report scales of expressivity, gender role characteristics, and family expressiveness. Results replicated those from Study 1, and gender role characteristics and family expressiveness moderated the relationship between sex and expressivity.

Adolescent↗
PubMed1984

Interactional correlates of expressed emotion in the families of schizophrenics.

Measures of intrafamilial expressed emotion (EE) predict relapse in schizophrenic patients, but previous research has not investigated whether EE scores are representative of ongoing family transactions. Parents of 42 hospitalized schizophrenic patients were rated for level and type of EE. Following the patient's discharge, families participated in two 10-minute direct interaction tasks. Transcripts from these interactions were coded on dimensions of affective communication. High-EE parents exhibited more negatively charged emotional verbal behaviour in direct transaction with their schizophrenic offspring than did low-EE parents. Some parents rated high-EE were distinguished by their frequent usage of critical comments during the interactions, whereas high-EE overinvolved parents used more intrusive, invasive statements. These findings support the construct validity of expressed emotion.

Adolescent↗
PubMed1987

Expressed emotion in individual and family settings: a comparative study.

Expressed emotion ratings were performed, in two separate settings, on the parents of 20 children suffering from anorexia nervosa. Ratings were made on conventional individual interviews and on videotapes of a family interview. Comparison of ratings in the two settings showed a very high correlation for 'critical comments'. Findings on the other scales were harder to interpret, but significant correlations as well as differences were noted. Expressed emotion rated in family interviews provides new possibilities for the study of families.

Adolescent↗
PubMed1990

Lesion localization in acquired deficits of emotional expression and comprehension.

This study investigated the relationship between intrahemispheric location of lesion and disturbances of emotional expression and comprehension. Twenty-eight right hemisphere strokes, 18 left hemisphere strokes, and 20 controls were examined on a standardized test of the expression, repetition, and comprehension of emotional prosody as well as the visual recognition of emotional situations and faces. The patients were classified into aprosodic syndromes according to the test scores. The lesions were independently traced, and overlapped for each aprosodic syndrome. The results, for lesions in either hemisphere, indicated involvement of the basal ganglia most frequently in aprosodic syndromes followed by anterior temporal lobe and insula lesions. Basal ganglia damage was also seen most frequently in patients with impaired comprehension of emotional facial expressions and situations. The anterior temporal lobe was also frequently involved in patients with such deficits. The basal ganglia emerged as a structure of particular importance in the mediation of emotional expression and comprehension.

Aged↗
PubMed1999

Expressed emotion and clinical outcome in borderline personality disorder.

OBJECTIVE: This longitudinal follow-up study examined the predictive validity of relatives' expressed emotion in a group of patients diagnosed with borderline personality disorder. METHOD: Thirty-five patients with DSM-III-R-diagnosed borderline personality disorder were followed up 1 year after they were discharged from a psychiatric hospital. Clinical outcome was assessed through interviews with patients and their family members. Expressed emotion in the patients' relatives, assessed at the time of the index admission, was then used to predict patients' subsequent clinical outcomes. RESULTS: Contrary to prediction, relatives' criticism and hostility did not predict how well patients did in the year after discharge. Neither did they predict rates of rehospitalization. Clinical outcome was strongly associated with family levels of emotional overinvolvement, however. Patients whose families scored higher on emotional overinvolvement had better clinical outcomes over the course of the follow-up period. CONCLUSIONS: These findings suggest that the association between expressed emotion and patient outcome may be different for patients with borderline personality disorder than it is for patients with schizophrenia or mood disorders.

Adult↗
PubMed1997

Revealing feelings: facets of emotional expressivity in self-reports, peer ratings, and behavior.

Drawing on an explicit model of emotion, we propose a multifaceted approach to emotional expressivity, defined as the behavioral (e.g., facial, postural) changes associated with emotion. Study 1 shows that self-reported expressivity has 3 facets (Impulse Strength, Negative Expressivity, Positive Expressivity). Study 2 shows that the same 3 facets emerge in peer ratings and that there are robust relations between self- and peer-rated expressivity. In Study 3, emotion-expressive behavior was videotaped and related to expressivity self-reports obtained several months earlier. As expected, Negative Expressivity predicted behavioral expressions of sadness (but not amusement), whereas Positive Expressivity predicted amusement (but not sadness). These relations remained even when subjective emotional experience and physiological response were controlled. These studies demonstrate the importance of a multifaceted approach to emotional expressivity and have implications for the understanding of personality and emotion.

Adolescent↗
PubMedDate not supplied

[Personality-related differences in recognition of facial emotional expression and cortical evoked potentials].

A correlation between some characteristics of the visual evoked potentials and individual personality traits (by the Kettell scale) was revealed in 40 healthy subjects when they recognized facial expressions of anger and fear. As compared to emotionally stable subjects, emotionally unstable subjects had shorter latencies of evoked potentials and suppressed late negativity in the occipital and temporal areas. In contrast, amplitude of these waves in the frontal areas was increased. In emotionally stable group of subjects differences in the evoked potentials related to emotional expressions were evident throughout the whole signal processing beginning from the early sensory stage (P1 wave). In emotionally unstable group differences in the evoked potentials related to recognized emotional expressions developed later. Sensitivity of the evoked potentials to emotional salience of faces was also more pronounced in the emotionally stable group. The involvement of the frontal cortex, amygdala, and the anterior cingulate cortex in the development of individual features of recognition of facial expressions of anger and fear is discussed.

Adult↗
PubMed1997

Neuropsychological aspects of facial asymmetry during emotional expression: a review of the normal adult literature.

This review focuses on facial asymmetries during emotional expression. Facial asymmetry is defined as the expression intensity or muscular involvement on one side of the face ("hemiface") relative to the other side and has been used as a behavioral index of hemispheric specialization for facial emotional expression. This paper presents a history of the neuropsychological study of facial asymmetry, originating with Darwin. Both quantitative and qualitative aspects of asymmetry are addressed. Next, neuroanatomical bases for facial expression are elucidated, separately for posed/voluntary and spontaneous/involuntary elicitation conditions. This is followed by a comprehensive review of 49 experiments of facial asymmetry in the adult literature, oriented around emotional valence (pleasantness/unpleasantness), elicitation condition, facial part, social display rules, and demographic factors. Results of this review indicate that the left hemiface is more involved than the right hemiface in the expression of facial emotion. From a neuropsychological perspective, these findings implicate the right cerebral hemisphere as dominant for the facial expression of emotion. In spite of the compelling evidence for right-hemispheric specialization, some data point to the possibility of differential hemispheric involvement as a function of emotional valence.

Adult↗
PubMed1994

Hemispheric asymmetries in adults' perception of infant emotional expressions.

Accounts of emotion lateralization propose either overall right hemisphere (RH) advantage or differential RH versus left hemisphere (LH) involvement depending on the negative-positive valence of emotions. Perceptual studies generally show RH specialization. Yet viewer emotional responses may enhance valence effects. Because infant faces elicit heightened emotion in viewers, perceptual asymmetries with chimeric infant faces were assessed. First, it was determined that chimeras must be paired with their counterparts, not their mirror images, to tap viewers' sensitivity to adult facial asymmetries. Results showed an RH perceptual bias for infant cries but bihemispheric sensitivity to asymmetries in infant smiles. This effect was not due to LH featural versus RH holistic processing and held for additional, intensity-matched, spontaneous expressions. Specialized RH sensitivity to infant cries may reflect an evolutionary advantage for rapid response to infant distress.

Adolescent↗