The Spanish validation of level of expressed emotion scale for relatives of people with eating disorders

Expressed emotion (EE) is considered a general predictor of poor outcome across a range of conditions, including eating disorders, and is valuable in measuring the effect of family interventions. There are no self-report questionnaires validated in Spanish to measure EE among relatives of patients with a psychiatric condition. The aim of this study was to examine the psychometric properties of the Spanish version of the Level of Expressed Emotion scale (LEE) among relatives of eating disorder patients. A cross-sectional study of 270 relatives of patients with an eating disorder was conducted to examine the factor structure, reliability and validity of the LEE scale. Results indicated that the LEE-S (Spanish version) did not correspond to the a priori subscales described in the original version. The refined 45-item LEE-S scale consisted of four factors which explained 25.5% of variance in EE for relatives. Reliability was acceptable (alpha ranged from .73 to .86). The discriminant validity of the subscales was moderately supported by correlations with psychological distress (GHQ-12; rho = .34) and specific caregiving experience (EDSIS; rho = .39). The LEE-S instrument has adequate psychometric properties and may be of value to assess families at risk of a negative emotional climate at home.     

Relatives' Perceptions of Their Interactional Behavior with a Schizop/hrenic Family Member

Relatives' (N = 77 ) perceptions of their recent interactional behavior with a schizophrenic family member (N = 51 ), as measured by an adjective checklist, were compared with outside observer ratings of the relatives' Affective Style (AS) and the patients' Coping Style (CS) during a family interaction task. Results indicated that, overall, the relatives in the present sample perceived their own interactional behavior toward the patient, as well as the patients' behavior toward them, in a way that paralleled their affective behavior as assessed by outside raters. Moreover, the relatives' rated their relationship with the patient in a fashion that was more predictive of the observed interactional behavior of both the relatives and the patients than were the outside observers' ratings of the relatives' Expressed Emotion (EE) measured either at the patients' index hospitalization (using the Camberwell Family Interview, CFI-EE) or during the post-discharge period (assessed with a brief Five-Minute Speech Sample method, FMSS-EE).     

Acceptance and expressed emotion in Mexican American caregivers of relatives with schizophrenia

The relation between Expressed Emotion (EE) and caregiver acceptance was tested with the use of video-recorded interactions between 31 Mexican American family caregivers and their relatives with schizophrenia. Borrowing the concept from Integrative Behavioral Couple Therapy, acceptance was defined as caregiver's engagement with the ill relative along with low levels of expectations for behavioral change. Three aspects of caregiver acceptance were measured: global acceptance of the patient, unified detachment (i.e., nonblaming but engaged problem discussion), and low aversive responses to patient behavior (e.g., criticisms and demanding change). Relative to high EE caregivers, low EE caregivers were consistently more accepting of their ill relatives across the three measures of acceptance. Unified detachment was negatively associated with emotional overinvolvement and aversive responses were positively related to criticism. Warmth was not related to acceptance. The findings suggest that the study of acceptance in family caregivers is a heuristic avenue for future research due to its potential to shed light on specifically what family members do in caring for their ill relatives with schizophrenia.     

Stress and family support as predictors of distress and rejection in people who care for a relative with schizophrenia

Relatives (N=121) of adult schizophrenia patients were interviewed to investigate predictors of their level of psychological distress and of rejecting attitudes toward the sufferer. The relatives' total stress, particularly that associated with poor communication skills in the sufferer, predicted several measures of their psychological distress, and the same variables plus turbulence of sufferer behavior (i.e., violence and disruptiveness) predicted rejection of the sufferer by the relative. In each case, adequacy of family support moderated the influence of the stressors, although this effect was more marked for distress outcomes than for rejection. The results have important implications for the sorts of professional and peer support which relatives may need to encourage their performance of this potentially burdensome role. In addition, the results fit a classic stress management model and provide a feasible alternative to the Expressed Emotion Model of the relationship between relatives' rejection and patients' illness severity.     

Revisiting the past and back to the future: Horizons of cognition and emotion research

ABSTRACT

To commemorate that Cognition & Emotion was established three decades ago, we asked some distinguished scholars to reflect on past research on the interface of cognition and emotion and prospects for the future. The resulting papers form the Special Issue on Horizons in Cognition and Emotion Research. The contributions to Horizons cover both the field in general and a diversity of specific topics, including affective neuroscience, appraisal theory, automatic evaluation, embodied emotion, emotional disorders, emotion-linked attentional bias, emotion recognition, emotion regulation, lifespan development, motivation, and social emotions. We hope that Horizons will spark constructive debates, while offering guidance for the future growth and development of research on the interface between cognition and emotion. Finally, we provide an update on how Cognition & Emotion has fared over the past year, and announce some changes in editorial policies and the editorial board.     

Emotion recognition and emotional theory of mind in chronic fatigue syndrome

Background: Difficulties with social function have been reported in chronic fatigue syndrome (CFS), but underpinning factors are unknown. Emotion recognition, theory of mind (inference of another's mental state) and ‘emotional’ theory of mind (eToM) (inference of another's emotional state) are important social abilities, facilitating understanding of others. This study examined emotion recognition and eToM in CFS patients and their relationship to self-reported social function.

Methods: CFS patients (n?=?45) and healthy controls (HCs; n?=?50) completed tasks assessing emotion recognition, basic or advanced eToM (for self and other) and a self-report measure of social function.

Results: CFS participants were poorer than HCs at recognising emotion states in the faces of others and at inferring their own emotions. Lower scores on these tasks were associated with poorer self-reported daily and social function. CFS patients demonstrated good eToM and performance on these tasks did not relate to the level of social function.

Conclusions: CFS patients do not have poor eToM, nor does eToM appear to be associated with social functioning in CFS. However, this group of patients experience difficulties in emotion recognition and inferring emotions in themselves and this may impact upon social function.     

Emotion work and job stressors and their effects on burnout

Abstract

This article reports research on emotion work, organizational as well as social variables as predictors of job burnout. In burnout research, high emotional demands resulting from interactions with clients are seen as a core characteristic of service jobs. However, these emotional demands were seldom measured in a direct manner. It was only recently that emotional demands were included in studies on burnout referring to the concept of emotion work (emotional labor). Emotion work is defined as the requirement to display organizationally desired emotions. A multi-dimensional concept of emotion work was used to analyze the relations of emotion work variables with organizational and social variables and their joint effect on burnout in five samples including employees working in children's homes, kindergartens, hotels, banks and call centers. Emotion work variables correlated with organizational stressors and resources. However, hierarchical multiple regression showed a unique contribution of emotion work variables in the prediction of burnout. Moreover, the analysis of interaction effects of emotional dissonance and organizational and social stressors showed that for service professionals, the coincidence of these stressors led to exaggerated levels of emotional exhaustion and depersonalization.     

The Self- and Other-Blame Scale (SOBS). The background and presentation of a new instrument for measuring blame in families

This article presents an account of the development and reliability of an observational instrument to measure blame: the Self- and Other-Blame Scale (SOBS). Fifty-one eating disordered patients together with eighty of their relatives were interviewed using a semi-structured family interview. Videotapes were assessed by two independent raters. Inter-rater reliability was good for both dimensions of SOBS: self-blame (SB) and other-blame (OB). One of the aims in developing the instrument was to be able to explore the relationship between self- and other-blame and criticism. Preliminary data are presented showing the distribution of SOBS scores within families rated as high or low on Expressed Emotion (EE). High EE was associated with high levels of self-blame in the parents, but not in the patients. Fathers in high EE families were more blaming of the patient than those in Low EE families but this was not true for mothers' levels of daughter blaming.     

The Relatives’ Big Five Personality Influences the Trajectories of Recovery of Patients After Severe TBI: A Multilevel Analysis

This study examines the influence of the personality of relatives on the trajectories of recovery of patients with severe traumatic brain injury (TBI). The present subsample (N = 376) of a larger population‐based, prospective, 12‐month multicenter cohort study in Switzerland (2007–2011) consists of patients with severe TBI (age ≥ 16) and their relatives. The predictors are the NEO Five‐Factor Inventory and time (trajectory of functioning of the patient over time). The outcomes are the patients’ (a) neurological functioning; (b) reported emotional, interpersonal, cognitive, and total functioning post‐injury; and (c) health‐related quality of life (HRQoL). The covariates included Abbreviated Injury Scale score of the head region and age. Results for patients > 50 are (a) relatives’ Extraversion influenced patients’ total, interpersonal, and cognitive functioning; (b) relatives’ Agreeableness influenced patients’ interpersonal functioning; and (c) relatives’ Conscientiousness influenced patients’ physical HRQoL (ps < .05). Results for patients ≤ 50 are (a) relatives’ Neuroticism influenced patients’ neurological and emotional functioning, and (b) relatives’ Extraversion influenced patients’ emotional functioning and psychological HRQoL (ps < .05). The personality traits of the relative covary with the functioning of the patient, and psychological adaptation to the loss of function may progress at a later stage after physical health improvements have been achieved. Thus, a biopsychosocial perspective on the rehabilitation process is needed.     

Family criticism and self-starvation: a study of expressed emotion

The measure Expressed Emotion (EE) has been established as an exceptionally useful indicator of relapse in people with schizophrenia and depression. EE is now also being applied more broadly for the investigation of other disorders. EE is usually rated by conducting the Camberwell Family Interview, i.e. in the course of separate individual interviews with the relatives of the symptomatic individuals. This paper reports the rating of EE in adolescents with eating disorders within a semi-structured family schedule - the Standardized Clinical Family Interview. Consecutive referrals for eating disorders were assessed prior to family therapy and again at regular intervals during therapy. EE ratings for this sample, the prognostic value of EE, and the changes in EE that took place during the course of therapy are presented and their clinical implications discussed. The findings suggest that even low levels of Critical Comments from the parents to the anorexic adolescent are associated with continuing symptoms.     

Psychometric properties of a French version of the Implicit Theories of Emotion Scale

IntroductionInspired by Carol Dweck's work on naive theories of intelligence, the implicit theory of emotions refers to beliefs regarding the general functioning of emotions, specifically, their controllability. Some individuals view emotions as uncontrollable (entity theory), while others think that emotions can be modulated (incremental theory). These beliefs guide the emotional regulation strategies that individuals use and influence subjective well-being.ObjectiveThe present study explores the psychometric properties of the French version of the Implicit Theories of Emotion Scale developed by Tamir et al. (2007).MethodOne hundred seventy-seven participants aged 18 to 72 years old (M = 34 years old) completed the Implicit Theories of Emotion Scale in conjunction with two other questionnaires: subjective well-being and emotional regulation strategies.ResultsFactor analyses identified a one-dimensional structure; the internal reliability (alpha = .81) and test-retest reliability indices (r = .69) were satisfactory. The study replicated the main results of contemporary international studies concerning the mediating role of cognitive reappraisal and further documents the pivotal role of positive reappraisal in the association between implicit theories and well-being.ConclusionThe discussion highlights clinical and theoretical interests and the usefulness of the Implicit Theories of Emotion Scale.     

Caregiver Expressed Emotion and Psychiatric Symptoms in African‐Americans with Schizophrenia: An Attempt to Understand the Paradoxical Relationship

Expressed emotion (EE) is a family environmental construct that assesses how much criticism, hostility, and/or emotional over‐involvement a family member expresses about a patient (Hooley, Annual Review of Clinical Psychology, 2007, 3, 329). Having high levels of EE within the family environment has generally been associated with poorer patient outcomes for schizophrenia and a range of other disorders. Paradoxically, for African‐American patients, high‐EE may be associated with a better symptom course (Rosenfarb, Bellack, & Aziz, Journal of Abnormal Psychology, 2006, 115, 112). However, this finding is in need of additional support and, if confirmed, clarification. In line with previous research, using a sample of 30 patients with schizophrenia and their primary caregivers, we hypothesized that having a caregiver classified as low‐EE would be associated with greater patient symptom severity. We also aimed to better understand why this pattern may exist by examining the content of interviews taken from the Five‐Minute Speech Sample. Results supported study hypotheses. In line with Rosenfarb et al. (2006), having a low‐EE caregiver was associated with greater symptom severity in African‐American patients. A content analysis uncovered some interesting patterns that may help elucidate this finding. Results of this study suggest that attempts to lower high‐EE in African Americans may, in fact, be counterproductive.     

Distraction and reappraisal efficiency on immediate negative emotional responses: role of trait anxiety

Background and Objectives: Emotion regulation involves attempts to influence emotion unfolding and may target experiential, expressive and physiological responses. Several strategies can be used, such as reappraisal (re-evaluating the emotional situation to reduce its emotional meaning) or distraction (turning the attention toward non-emotional aspects of the situation). Previous research on these regulation strategies produced contrasting results regarding their efficiency and we hypothesize that this could be due to individual differences such as trait anxiety.

Design and Methods: Participants (N?=?77) were confronted with negative pictures and we examined the differential emotional reactivity according to trait anxiety, followed by a comparison of the efficiency of reappraisal and distraction in reducing emotional responses.

Results: Results show that trait anxiety has no impact on reactivity at the experiential and expressive levels, but has an impact at the physiological level, where high anxiety individuals show increased cardiac orienting effect, as well as higher skin conductance and respiratory rate. Regarding regulation, reappraisal and distraction successfully reduce emotional experience and expressivity, but not physiological arousal.

Conclusions: Such contrasting results involve that high trait anxiety individuals might benefit from the use of other kinds of strategies than reappraisal and distraction, some that may successfully target physiological responses.     

Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms

Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients’ close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives’ physical health was predicted by relatives’ PTS symptoms (Slope=−1.76; p = .043), and mental health was predicted by both patients’ (Slope=−2.77; p = .034) and relatives’ (Slope=−6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients’ PTS symptoms (Slope=−.25; p_<.001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.     

Expressed Emotion In The Narrative Context of Family Photographs

This study aims to elucidate cognitive and contextual aspects of the EE (Expressed Emotion) concept. The EE levels of both parents of two first admission psychotic patients were rated from the Five Minute Speech Sample (FMSS), and the emotional responses were further analyzed in narratives of family photographs. The attribution model was found to provide an explanatory framework for understanding relatives' expressed emotions (EE) toward a family member suffering from psychotic disturbances. Four case reports indicated that family photographs induced parents to create narratives in which emotions, attributions, and strategies for coping with stressful aspects of the illness came forward as intertwined phenomena. The method can offer more comprehensive data for intervention strategies aiming to alter the prevailing atmosphere and interaction patterns within the high EE family.     

Do time in abstinence,emotional intelligence and psychopathology predict the sensation of craving in persons with SUD?

IntroductionSubstance use is a global health problem. Craving is one of the main predictors of relapse. If the presence of psychopathology and the deficit of emotional intelligence are combined, the course and outcome of the disease can worsen.ObjectiveThe aim is to analyze the impact of time in abstinence, psychopathology, and emotional intelligence on the sensation of the craving in people with substance use disorders in treatment, comparing two methodologies (hierarchical linear regressions and comparative qualitative analysis).MethodThe participants, after signing the informed consent, were assessed in abstinence, psychopathology (SA-45), emotional intelligence (TMMS-24), and craving.ResultsThe results showed that craving was positively associated with psychopathology, shorter abstinence times, and younger age. Increased emotional attention was associated with increased psychopathology. Craving was explained by less time in abstinence using hierarchical regression models. In QCA models, high levels of craving were predicted by the interaction between high levels of psychopathology, shorter abstinence times, lower emotional repair, and high emotional attention. Low levels of craving were due to less psychopathology, prolonged abstinence, and emotional intelligence.ConclusionThe methodologies are complementary because combining them makes it easier to understand the problem of consumption.     

Assessment of Emotional Avoidance in Adolescents: Psychometric Properties of a New Multidimensional Measure

Emotional avoidance—which includes cognitive and attentional processes that function as means of avoiding or dampening emotional experiences—may be a transdiagnostic risk and maintenance factor for emotional disorders. However, existing measures generally assess separate aspects of emotional avoidance, and few multidimensional measures exist for adolescents. The aim of the current study was to establish the psychometric properties of a new multidimensional measure of emotional avoidance for adolescents--the Emotional Avoidance Strategy Inventory for Adolescents (EASI-A; Fairholme et al. 2008)--employing an exploratory structural equation modeling framework. Analyses yielded a three-factor structure for the EASI-A, including subscales measuring Avoidance of Emotion Expression, Avoidance of Thoughts and Feelings, and Distraction. Moderate correlations were observed between the EASI-A and a measure of thought suppression, and the EASI-A was significantly associated with anxiety and depression symptoms. The EASI-A is a new, psychometrically sound measure that will aid in the assessment of avoidance as a vulnerability factor for psychopathology and as an outcome and mechanism for treatments of emotional disorders in adolescents.     

Personality and expressed emotion

Expressed emotion (EE) is an established psychosocial predictor of relapse in patients with schizophrenia and mood disorders; however, nothing is currently known about the personality characteristics of high- and low-EE relatives. A total of 45 relatives of schizophrenia patients completed the California Psychological Inventory, a widely used measure of common personality traits. Compared with low-EE relatives, high-EE relatives were more conventional in their behavior (higher norm-favoring) and less satisfied with themselves and their lives (lower self-realization). High-EE relatives were also less flexible, tolerant, and lower in empathy and achievement via independence than were low-EE relatives. Even with statistical control of potential demographic confounds, flexibility remained a significant predictor of EE status.