Is Expressed Emotion an Index of a Transactional Process? II. Patient's Coping Style

This article examines the extent to which expressed emotion (EE) indexes not only relatives' behavior toward schizophrenic patients but also patients' behavior toward their relatives. The coping styles (CS) of schizophrenic patients were assessed during interactions with their parents and were compared with parental EE attitudes assessed during an acute hospitalization and during the aftercare period. It was found that parental EE attitudes measured during the inpatient period strongly predicted patients' outpatient transactional behavior: patients interacting with low-EE relatives showed significantly fewer critical and more autonomous statements than patients interacting with high-EE relatives. Further, the dominant patient coping style (autonomous, neutral, externalizing, or internalizing) was strongly related to the relatives' interactional affective style (AS) and to their pattern of EE attitudes. Patient coping style was not related to clinical attributes of these patients themselves. This article and its preceding companion (17) together suggest that EE indexes a transactional process so that the quality of both parents' and patients' transactional behaviors may predict subsequent patient functioning.     

The relationship of relatives' attributions to their expressed emotion and to patients' improvement in treatment for anxiety disorders

In a test of Hooley's (1987) attributional model of expressed emotion (EE), attributions for negative behaviors and events in patients' lives were examined in relatives of 74 outpatients with panic disorder with agoraphobia or obsessive-compulsive disorder. Attributions were extracted from 10-minute problem-solving interactions between relatives and patients, whereas EE was assessed during a separate interview with the relative. Consistent with prior findings in relatives of individuals with other disorders, relatives who made greater proportions of attributions of patient responsibility demonstrated significantly higher levels of EE-hostility. In addition, nonspousal relatives (mostly parents) who attributed any negative behaviors or events to a patient's disorder were significantly higher in emotional overinvolvement (EOI); no such relationship was found for spouses. Finally, patients with relatives who made attributions to the patient's disorder received less benefit from behavior therapy than did those whose relatives made no such attributions, even when EE variables were controlled.     

Family transactions and relapse in bipolar disorder

This study examined whether patient symptoms and relatives' affective behavior, when expressed during directly observed family interactions, are associated with the short-term course of bipolar disorder. Twenty-seven bipolar patients and their relatives participated in two 10-minute family interactions when patients were discharged after a manic episode. Results indicated that patients who showed high levels of odd and grandiose thinking during the interactions were more likely to relapse during a 9-month followup period than patients who did not show these symptoms during the family discussions. Relapse was also associated with high rates of harshly critical and directly supportive statements by relatives. Patients' odd thinking and relatives' harsh criticism were significantly more likely to be correlated when patients relapsed (r = .53) than when they did not relapse (r = .12). Results suggest that bipolar patients who show increased signs of residual symptomatology during family transactions during the post-hospital period are at increased relapse risk. The data also suggest that relatives of relapsing patients cope with these symptoms by increasing both positive and negative affective behaviors. Moreover, a bidirectional, interactional relationship between patients' symptoms and relatives' coping style seems to capture best the role of the family in predicting relapse in bipolar disorder.     

Beyond positive or negative: variability in daily parent-adolescent interaction quality is associated with adolescent emotion dysregulation

Previous work on the contribution of family environments to adolescent emotion dysregulation has tended to focus on broad parenting characteristics (such as warmth); however, it is possible that day-to-day variability in parenting may also relate to emotion dysregulation. The current study sought to test whether inconsistency in the quality of daily parent-youth interactions related to multiple indices of emotion dysregulation in adolescents. Two-hundred-twenty-two adolescents (ages 13–16; 53% female) participated with one parent. Adolescents completed 14-days of diary reporting on the quality of interactions with their parent (negative/neutral/positive) and their emotion dysregulation experiences for each day. Analyses reveal that, beyond the effects of average interaction quality, adolescents with greater variability in the quality of their interactions with their parent reported greater average emotion dysregulation across the days of diary recording and demonstrated greater variability in their ratings of daily emotion dysregulation. Findings were not accounted for by parental warmth or hostility, parent-reported trait-level emotion regulation, or day-level associations between study variables. In these ways, greater variability – and not merely greater negativity – during interactions between parents and adolescents was related to adolescent emotion dysregulation, suggesting that consistency in parent–adolescent relationships may be an important dimension of psychosocial risk to consider within families.     

Expressed Emotion,Appraisal and Coping by Patients with Recent-onset Schizophrenia: A Pilot Investigation

This pilot study sought to follow up on indications that patients from households with high levels of expressed emotion (EE) differ from those from households with low levels of EE in ways not assessed in typical symptom rating profiles. We examined how patients appraised and coped with a prominent societal stressor. Soon after the start of the Gulf War, 22 patients with recent-onset schizophrenia living in Los Angeles appraised the stressor and completed a coping questionnaire. Results indicated that patients from high-EE homes were likely to use emotion-based confrontational methods to cope with the crisis, while patients from low-EE environments were likely to use avoidance and denial. Patients from high-EE homes thus coped with this non-familial, societal stressor in a way similar to the way in which they have been observed to cope with family conflict: they more readily expressed their anger and frustration than patients from low-EE homes. These pilot data suggest that increased attention should be directed toward those patient behaviours that may be associated with either an increase or decrease in negative affective behaviour from relatives. It may also be fruitful to consider more broadly the adaptive and maladaptive features of the preferred coping strategies of patients from high-EE and low-EE environments.     

The acute psychobiological impact of the intensive care experience on relatives

There is a growing awareness amongst critical care practitioners that the impact of intensive care medicine extends beyond the patient to include the psychological impact on close family members. Several studies have addressed the needs of relatives within the intensive care context but the psychobiological impact of the experience has largely been ignored. Such impact is important in respect to health and well-being of the relative, with potential to influence patient recovery. The current feasibility study aimed to examine the acute psychobiological impact of the intensive care experience on relatives. Using a mixed methods approach, quantitative and qualitative data were collected simultaneously. Six relatives of patients admitted to the intensive care unit (ICU) of a District General Hospital, were assessed within 48 h of admission. Qualitative data were provided from semi-structured interviews analysed using interpretative phenomenological analysis. Quantitative data were collected using a range of standardised self-report questionnaires measuring coping responses, emotion, trauma symptoms and social support, and through sampling of diurnal salivary cortisol as a biomarker of stress. Four themes were identified from interview: the ICU environment, emotional responses, family relationships and support. Questionnaires identified high levels of anxiety, depression and trauma symptoms; the most commonly utilised coping techniques were acceptance, seeking support through advice and information, and substance use. Social support emerged as a key factor with focused inner circle support relating to family and ICU staff. Depressed mood and avoidance were linked to greater mean cortisol levels across the day. Greater social network and coping via self-distraction were related to lower evening cortisol, indicating them as protective factors in the ICU context. The experience of ICU has a psychological and physiological impact on relatives, suggesting the importance of identifying cost-effective interventions with evaluations of health benefits to both relatives and patients.     

青少年地震应激反应模型

以亲历“5．12”地震的四川青川、绵竹327名青少年为被试,考察了青少年在地震情境下的应激反应,探讨了应激源与认知评价、应对方式、应激反应的关系,检验了认知评价、应对方式在应激源与应激反应间的中介作用。结果表明：青少年在地震后出现一些显著的生理反应（胸闷、食欲不佳、头晕）、心理反应（悲伤、易惹、恐惧、注意力减退）以及社会功能的退缩,且存在显著的性别差异;变量各维度间的相关分析表明,除混合型应对方式与应激源的物质丧失之间相关不显著外,其它变量各维度间均存在不同程度的相关;中介效应分析表明,认知评价、应对方式在应激源与应激反应间存在中介作用,且认知评价的中介效应大于应对方式的中介效应,而认知评价又可以通过应对方式影响应激反应。     

Parent-adolescent reciprocity in negative affect and its relation to early adult social development.

The purposes of this 9-year, prospective longitudinal study were (a) to investigate hypothesized reciprocal growth in negative emotions between parents and adolescents and (b) to examine the influence of this reciprocal process on the development of social relationships during early adulthood. The results showed that both parents' and adolescents' initial levels of negative emotion toward each other predicted the rate of growth and rate of change in growth of expressed negative affect. In addition, the analyses indicated that an adolescent's enmeshment in reciprocal negativity in the family of origin carried over into early adult social relationships. The findings demonstrate the reciprocal nature of negative affect in interactions between parents and adolescents and suggest that family experience with this interactional style may have an adverse influence on the development of early adult social relationships.     

Higher cortisol is associated with poorer executive functioning in preschool children: The role of parenting stress,parent coping and quality of daycare

Child executive functions (cognitive flexibility, inhibitory control, working memory) are key to success in school. Cortisol, the primary stress hormone, is known to affect cognition; however, there is limited information about how child cortisol levels, parenting factors and child care context relate to executive functions in young children. The aim of this study was to examine relationships between child cortisol, parenting stress, parent coping, and daycare quality in relation to executive functions in children aged 3–5 years. We hypothesized that (1) poorer executive functioning would be related to higher child cortisol and higher parenting stress, and (2) positive daycare quality and positive parent coping style would buffer the effects of child cortisol and parenting stress on executive functions. A total of 101 children (53 girls, 48 boys, mean age 4.24 years ±0.74) with complete data on all measures were included. Three saliva samples to measure cortisol were collected at the child’s daycare/preschool in one morning. Parents completed the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P), Parenting Stress Index (PSI), and Ways of Coping Questionnaire (WCQ). The Early Childhood Environment Rating Scale – Revised (ECERS-R) was used to measure the quality of daycare. It was found that children with poorer executive functioning had higher levels of salivary cortisol, and their parents reported higher parenting stress. However, parent coping style and quality of daycare did not modulate these relationships. Identifying ways to promote child executive functioning is an important direction for improving school readiness.     

Expressed emotion and familial interaction: a study with agoraphobic and obsessive-compulsive patients and their relatives

Patients with panic disorder with agoraphobia (n = 40) or obsessive- compulsive disorder (n = 61) participated in a 10-min problem-solving interaction with their primary relative. Relatives were categorized as hostile or nonhostile toward the patient on the basis of a measure of expressed emotion (EE). Observed interactions between patients and their hostile relatives, relative to those of dyads with a nonhostile relative, were marked by higher rates of relatives' criticism and of patients' negativity but not by higher rates of negative reciprocity. Analyses of sequences indicated that the dyads with a hostile relative had a higher rate of sequences in which the relative was first critical and the patient then negative than was the case for dyads with nonhostile relatives. Moreover, hostile relatives were more frequently critical than nonhostile relatives whether patients' preceding behavior was positive, negative, or neutral. The findings are consistent with the stress-vulnerability model of the effect of EE on mental health, in that patients living with a high EE relative appear to be exposed to higher levels of interpersonal stress.     

Consistency and inconsistency in infant emotional and social interactive behavior across contexts and caregivers

This study examined consistency in infant emotional and social interactive behavior in stressful and nonstressful situations with mothers and fathers. Infants were seen at 12 and 13 months, once with each parent. Emotion was assessed during free play and the Strange Situation. Strange Situation social interactive behaviors were also examined. Results demonstrated that (a) proximity seeking and contact maintaining are consistent cross-parent, (b) emotion is more consistent from free play to the Strange Situation with the father than with the mother, and (c) emotion is primarily consistent cross-parent within the Strange Situation, not in free play. These results suggest both infant- and relationship-based determinants of behavior within the Strange Situation. The greater cross-context consistency in infant emotion with the father is interpreted as supportive of the view that infant—father interactions reflect primarily affiliative, rather than attachment, relationships.     

Caregivers's Stress Secondary to Raising Young Children with HIV Infection: A Preliminary Investigation

This study examined the impact of caring for a child with HIV infection on biological mothers (also infected with HIV), familial caregivers, and foster mothers. Levels of reported parenting stress, emotional functioning, the impact of the child's illness, and coping strategies utilized were compared. Participants were 35 female caregivers of young children (birth to 5 years) with HIV infection. Demographic variables reflected group differences: biological mothers were younger, foster mothers had greater monthly income, and children who were living with relatives were older. Group differences were noted with regards to parent related stress, anxiety, and depression with foster mothers reporting lower levels. The types of coping strategies utilized were generally similar across groups. Results suggest that young, biological caregivers of children with HIV infection may benefit from careful assessment with regard to their need for psychological intervention.     

Race, family interactions, and patient stabilization in schizophrenia

This study examined family interactions associated with a failure to stabilize in schizophrenia. Fifty-eight patient and parent dyads completed a problem-solving task soon after an acute episode. Stabilization was assessed over the following 6 months. African American patients' self-initiated discussions of substance use and increased anxiety during the interaction were associated with a failure to stabilize. Nonstabilization in White patients was associated with high levels of both the patients' odd thinking and the parents' criticism. White patients who were depressed during the interaction were also less likely to stabilize. Findings suggest that family relationships may play in important role in determining whether patients stabilize after an acute episode. Results also point to the importance of cultural factors in predicting patient stabilization.     

Parent Socialization of Coping and Child Emotion Regulation Abilities: A Longitudinal Examination

This study examined the hypothesis that parent socialization of coping (SOC) would have a longitudinal relation with child emotion regulation abilities. Participants included a sample of 256 parents of 5- to 12-year-old children (child M age = 8.36, SD = 2.03, 54.7% male; parent M age = 34.49, SD = 6.20, 59% female). Data on demographic information, parenting behaviors, and child emotion regulation abilities were collected via online questionnaires at baseline and 12 months. Results from longitudinal structural equation modeling (SEM) analyses suggested that parent SOC, measured at baseline, predicted child adaptive and maladaptive emotion regulation, measured 12 months later. More specifically, parental engagement coping suggestions predicted child's adaptive emotion regulation, whereas parental disengagement coping suggestions predicted child's maladaptive emotion regulation. Further, child gender emerged as a moderator in the longitudinal association between socialization of engagement coping and child adaptive emotion regulation: Whereas this association was small and marginally significant for girls, it was large and statistically significant for boys. Results highlight the importance of parent SOC as potentially contributing to emotion regulation abilities of 5- to 12-year-olds.     

Expressed emotion and causal attributions in relatives of post-traumatic stress disorder patients

This study investigates the relationship between expressed emotion (EE) and causal attributions in relatives of post-traumatic stress disorder (PTSD) patients, and examines the contributions of EE and attributions to patient outcomes. Thirty-eight relatives of patients with PTSD participating in a treatment trial were assessed on EE, causal attributions for patient problems and nature of attributions. Patients' PTSD symptoms at 6 and 12 months were assessed. Criticism and hostility in relatives were associated with attributing problems to factors controllable by patients. Relatives with marked emotional over-involvement (EOI) had an attributional profile similar to low EE relatives. Deficits in normal behaviour ("negative symptoms") were perceived as more controllable, internal and stable than were more obvious signs of an illness or mental health problem such as hypervigilance and intrusive thoughts and nightmares ("positive symptoms"). Irritability or anger was perceived as more controllable and personal than any other problem. Hostility was associated with less psychological understanding. EE (hostility) but not attributions was found to predict clinical outcome. The results are consistent with previous studies of relatives of schizophrenia patients. The study suggests a need for interventions, which focus on helping relatives to reappraise the impact of PTSD.     

The Relation of Weight Stigmatization to Psychological Adjustment1

This study investigated weight stigmatization as a predictor of adjustment in samples of 100 undergraduates and 99 bariatric patients. Coping strategies (emotion‐focused coping, problem‐focused coping, disengagement coping) were tested as moderators of this relation. Weight stigmatization predicted depression, anxiety, and antisocial behavior when controlling for the effects of stressful life events. Problem‐focused coping weakened the association between weight stigmatization and depression. Emotion‐focused coping augmented the relation between weight stigmatization and antisocial behavior. The results support weight stigmatization as a meaningful predictor of adjustment difficulties. Engendering a problem‐focused coping style over an emotion‐focused coping style might benefit patients reporting weight stigmatization. Further work is necessary to understand what specific elements of these coping styles impact adjustment.     

Parent Stress and Coping: Waiting for a Child to Receive a Kidney Transplant

The current study examined the degree of parent stress and depression among mothers and fathers of children with end-stage renal disease (ESRD) listed for a kidney transplant, to determine whether demographic factors, stress, and coping would predict parent depression. Eighty-six mothers and 58 fathers of children with ESRD preparing for a kidney transplant completed standardized measures of parent stress related to the child’s chronic illness (PIP), coping style (Brief Cope), and depression (BDI-II). Information about the disease was obtained from the medical record. Maternal depression was predicted by having a lower family income, higher degree of parent stress associated with the child’s illness, and the use of avoidant coping strategies. Paternal depression was only predicted by higher parent stress. Illness related variables did not contribute significantly to the understanding of parent outcomes. Pre-transplant evaluations should screen for elevated levels of stress and depression, and develop interventions to help parents cope with their child’s renal disease.     

Authenticity: a mediator in the relationship between attachment style and affective functioning

Attachment has been show to exhibit a strong effect on emotional well-being throughout an individual’s lifetime. This study examined individuals’ authenticity as a potential mediating variable in the relationship between insecure attachment and affective functioning. Authenticity was examined from multiple perspectives to better define its role as a mediating variable. Results showed that avoidant attachment is a predictor of affective functioning, and that authenticity acts as a mediating variable in this relationship. Anxious attachment showed no direct relationship with affective functioning, yet evidence was found for an indirect pathway from anxious attachment through authenticity on affective functioning. The differing results by attachment style support Mikulincer, Shaver, and Pereg’s theory suggesting a two-part model of emotional response style, wherein individuals with avoidant attachment deactivate emotion and individuals with anxious attachment show hyper-activation when coping with emotion. The study examines the construct of authenticity and its importance in affective functioning. Implications for therapists working with clients are made that highlight the importance of authentic relationships in therapy and life.     

Family Functioning and Coping Behaviors in Parents of Children with Autism

We analyzed family dynamics and coping behaviors of parents with a child with an autistic spectrum disorder. Previous research suggests that moderate levels of cohesion and adaptability are associated with higher levels of positive coping, and that the more coping strategies a family implements, the greater their satisfaction with family functioning. Using a family systems approach, the relationships among the familial variables of cohesion, adaptability, and social support were evaluated for their contributions to coping in the family unit. We also compared the responses of mothers and fathers. Surprisingly, for these parents of children with autism, those who rated their family as enmeshed implemented more positive coping strategies than did those from other cohesion styles. This finding suggests that the enmeshed style may be more adaptive for a family that encounters extreme challenges. Notably, mothers and fathers agreed on all variables except for perception of social support from family and friends. Mothers perceived more social support from family and friends. The results lead to several interesting suggestions for future research.     

Coping Style of Psychiatric Patients with Somatic Complaints

To investigate the impression that personality traits found to be characteristic of somatizing patients are related to the more basic personality dimension of “passive-coping style,” 17 matched pairs (one patient who presented himself with somatic complaints, and the other with psychological complaints), were administered the Rorschach Test during the process of intake. Rorschach variables found to correspond with coping style in prior studies, were used for evaluating the Rorschach records of the Ss. Statistical comparisons between the total coping scores of the somatizing and non-somatizing patients supported the initial hypothesis that the somatizers scored significantly lower on the variables of active coping. Tentative explanations for these findings were presented in the discussion.