Expressed emotion and attributions in the relatives of bipolar patients: an analysis of problem-solving interactions

Among the relatives of schizophrenic and depressed patients, high expressed emotion (EE) attitudes are associated with "controllability attributions" about the causes of patients' symptoms and problem behaviors. However, previous studies have judged EE attitudes and causal attributions from the same assessment measure, the Camberwell Family Interview (CFI; C. E. Vaughn & J. P. Leff, 1976). The authors examined causal attributions among relatives of 47 bipolar patients, as spontaneously expressed to patients in family problem-solving interactions during a postillness period. Relatives rated high EE during the patients' acute episode (based on the CFI) were more likely than relatives rated low EE to spontaneously attribute patients' symptoms and negative behaviors to personal and controllable factors during the postillness interactional assessment. Thus, the EE-attribution linkage extends to the relatives of bipolar patients evaluated during a family interaction task.     

Attribution and expressed emotion in the relatives of patients with schizophrenia.

Indexes of expressed emotion (EE) in 58 relatives of patients with schizophrenia were related to those relatives' spontaneously expressed causal beliefs about the illness and about related symptoms and behaviors. Relatives made attributions predominantly to factors external, universal, and uncontrollable from their own perspective, and to factors internal, universal, and uncontrollable from the patient's perspective. Low-EE relatives were similar in their attributions to emotionally overinvolved relatives. Compared with these two groups, critical and/or hostile relatives made more attributions to factors personal to and controllable by the patient. Subsequent analyses suggested that hostile relatives were further characterized by making more attributions to factors internal to the patient and by making attributions with fewer causal elements.     

Testing a conceptual model of patient and family predictors of obsessive compulsive disorder (OCD) symptoms

Path analysis was used to test a model linking family member's attributions, criticism, hostility, emotional overinvolvement (EOI) that focused on intrusiveness, and family accommodation to severity of obsessive compulsive symptoms. This study draws upon previous expressed emotion (EE) research by including separate components of EE assessed in relatives and patients, as well as family accommodation measures to build a model of family influences on OCD symptoms. Measures of patient- and relative-perceived criticism, family accommodation, EOI intrusiveness and OCD symptom severity were collected on a single occasion from 50 patients and 50 relatives whom the patient had daily contact with. Novel self-report scales for the three EE components of criticism, hostility and EOI derived from existing instruments showed good to excellent internal consistency. Confirmatory path analyses were used to demonstrate that the data provided an adequate fit to the hypothesized path model. The patient-rated data suggested that patients who perceived their relatives as either critical or hostile were likely to have more severe OCD symptoms. For relative-rated EE, hostility proved to be a better determinant than criticism in the path model. Implications of this model for interventions and for future research are discussed. The measures employed may prove to be a cost-effective alternative to the labor intensive Camberwell Family Interview.     

Causal attributions about schizophrenia in families in China: expressed emotion and patient relapse

Previous studies have indicated a robust link between relatives' causal attributions and levels of expressed emotion (EE). However, these studies have primarily been conducted in Western cultures. The current study, conducted in China, examined the spontaneous causal attributions made by 54 relatives of schizophrenia patients during the Camberwell Family Interview. Chinese relatives made few controllable and personal attributions overall. Yet as predicted, highly critical and/or hostile EE relatives attributed patients' negative behaviors to more controllable and personal factors. High EE and controllable attributions positively predicted relapse, whereas personal attributions unexpectedly protected against relapse. EE mediated the effect of controllable, but not personal, attributions on relapse. Relatives' use of a particular Chinese characteristic (narrow-mindedness) was integral to the personal dimension's protective effect.     

Expressed emotion and attributions in the carers of patients with Alzheimer's disease: the effect on carer burden

Burden of care, expressed emotion (EE), causal attributions, and salivary cortisol were assessed in 100 carers of patients with Alzheimer's disease. Forty-one carers were rated high EE, which was associated with higher scores of carer distress and strain, and greater reports of noncognitive features in the patient, but not with cortisol levels. High EE carers made more attributions personal to, and controllable by, the patient for negative events. Critical carers made more attributions of the patient's behavior that was idiosyncratic. Warmth toward the patient was associated with the opposite of this pattern. Overinvolved carers made attributions of the patient's behavior to causes external to the patient and internal to themselves. Cortisol levels were associated with self-reports of strain and distress.     

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.     

Controllability perceptions and reactions to symptoms of schizophrenia: a within-family comparison of relatives with high and low expressed emotion

In a sample of 35 family members of patients with recent-onset schizophrenia, attributions of control and the content of critical comments were compared for 2 relatives of the same household who held discrepant expressed emotion (EE) attitudes (1 high and 1 low) toward their mentally ill family member. Attributions and the content of critical comments were also compared for low-EE relatives from low-EE homes versus low-EE relatives from high-EE homes. Our results indicate that high-EE relatives tend to attribute more control over behavior to patients than do low-EE relatives of the same patient. In addition, low-EE relatives from high-EE homes attribute more behavioral control to patients than do low-EE relatives from low-EE homes. These findings suggest that EE status is linked to attributions of control over behaviors, but additional patient factors or influences among family members may also affect EE attitudes.     

Attributions for recovery and adherence to rehabilitation following anterior cruciate ligament reconstruction: A prospective analysis

Abstract

The relationship between causal attributions for recovery and adherence was examined in a sample of 80 individuals (25 females and 55 males) undergoing rehabilitation following anterior cruciate ligament reconstruction. Participants estimated their speed of recovery and then rated their open-ended attributions for recovery on the Revised Causal Dimension Scale (McAuley, Duncan and Russell, 1992). Adherence was assessed in terms of attendance at rehabilitation sessions and practitioner ratings for the remainder of the rehabilitation period. Participants who perceived themselves as recovering rapidly attributed their recovery to more stable and personally controllable factors than participants who perceived themselves as recovering slowly. Causal dimension ratings predicted attendance at rehabilitation sessions, but not practitioner ratings of adherence. The results, which further demonstrate the relevance of causal attributions to health behavior, are compared with previous cross-sectional findings.     

Relationships among Dispositional Attributional Style,Trauma-Specific Attributions,and PTSD Symptoms

The learned helplessness model and its various revisions suggest that causal attributions influence responses to events. This study examined relationships among the 3-factor symptom clusters of posttraumatic stress disorder (PTSD) represented in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV; American Psychiatric Association, 1994) and the individual dimensions of dispositional attributional style and trauma-specific attributions (i.e., internal–external, stable–unstable, global–specific). Relationships among attributions and clusters of PTSD symptoms represented by the 4-factor dysphoria model were also examined. Trauma-specific attributions were most predictive of PTSD symptoms, with higher associations for avoidance and numbing symptoms compared to arousal symptoms in the three-factor model and higher associations for dysphoria symptoms compared to arousal and avoidance symptoms in the four-factor dysphoria model. Results suggest that cognitive vulnerabilities could underlie the comorbidity between PTSD and depression and might represent a high-impact target for treatment.     

Causal Attributions, Depression, and Post-Traumatic Stress Disorder in Victims of Crime

The major purpose of this study was to investigate relationships between causal attributions and symptomatology in victims of crime. Fifty-one subjects who had not been crime victims and 120 subjects who had been crime victims participated in the study and were assessed for symptoms of post-traumatic stress disorder (PTSD) and depression. Subjects also completed two attributional questionnaires. The potential differences in symptomatology among victims of a single crime, multiple crimes, and nonvictims were investigated. Results did not indicate differences in depression and PTSD based on single vs. multiple victimization, although differences between victims and nonvictims were found. Results using the Causal Dimension Scale (CDS; Peterson et al., 1982) indicated significant differences in the causal attributions of victims and nonvictims. On the Attributional Style Questionnaire (ASQ; Russell, 1982), group comparisons among nonvictims, PTSD victims, depression victims, both depression and PTSD victims, and victims with low symptoms did not yield significant results. However, regression analyses indicated that several subscales of both the CDS and ASQ were found to be moderate predictors of symptomatology. Implications for future research are discussed.     

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.     

Understanding Intentions to Exercise Following a Structured Exercise Program: An Attributional Perspective1

The present study examined the relationships among perceived outcome, causal attributions, affect, expected success, and intentions to exercise following a structured exercise program. Participants were 105 volunteers who had just completed a 12-week exercise program. Results indicated that perceived outcome over objective outcome (% attendance) was significantly more important for understanding the attribution process. Interesting interactions indicated that (a) individuals who made personally controllable attributions reported higher positive affect following perceived success, but lower positive affect following perceived failure than those who made personally uncontrollable attributions, and (b) individuals who made external attributions following perceived failure reported higher expected success than those who made internal attributions. Finally, both positive affect and expected success showed positive relationships with intention to exercise following the program. It was suggested that attribution theory may be beneficial to understanding continued exercise following structured exercise programs.     

Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia

This study examined significant others' expressed emotion (EE) and a closely related construct, perceived criticism, as predictors of cognitive-behavioral therapy outcome in a sample of 40 patients with social phobia (social anxiety disorder). Patients enrolled in group therapy for social phobia completed pre- and post-treatment questionnaire measures of perceived criticism and anxious and depressive symptoms. Designated significant others were assessed for the components of high EE (criticism, hostility and emotional overinvolvement) using the Camberwell Family Interview. It was hypothesized that these high-EE components and patients' perceived criticism would be associated with poorer treatment outcome, and results ran counter to these expectations. Controlling for initial social phobia severity, lower levels of perceived criticism predicted treatment dropout. There was also a nonsignificant trend for participants with a significant other rated as high in emotional overinvolvement to show less change on a composite symptom measure. Findings from this study suggest that close relationships impact the outcome of cognitive-behavioral interventions for social phobia.     

Children's Trait and Emotion Attributions in Socially Ambiguous and Unambiguous Situations

Children's attributions about story characters in ambiguous and unambiguous social situations were assessed. One hundred and forty-four 6–7-year-olds and 10–11-year-olds heard about actors who slighted a recipient intentionally or for an undetermined reason and then made causal attributions about the events, an emotion attribution about the recipient, and global personality attributions about the actors and recipient. Relations between perceived self-competence and attribution style were also assessed. Participants were more likely to make negative causal attributions in the unambiguous condition and with increasing age. Older girls and younger boys were more likely than other groups to attribute negative emotions to the recipient. Overall, participants perceived recipients positively and actors negatively. Perceived self-competence was positively correlated with actor attributions, although these differed by age and gender. Implications for children's psychosocial adjustment are discussed.     

Racial Differences in Attributions,Perceived Criticism,and Upset: A Study With Black and White Community Participants

The primary aims of the current investigation were (a) to examine the relationships among attributions, perceived constructive and destructive criticism, and upset due to criticism and (b) to explore racial differences in mean levels of attributions, perceived criticism, upset due to criticism, and warmth in a community sample of Blacks and Whites (N = 272). The Attributions of Criticism Scale (ACS) was used to measure participants’ attributions regarding criticism from their relatives. No racial differences were found in mean levels of attributions or type of perceived criticism. However, Blacks were significantly less upset by perceived criticism from their relatives than Whites. When the relationships between attributions, perceived criticism, and upset were explored, results showed that positive attributions were associated with greater perceived constructive criticism and less upset due to criticism, whereas negative attributions were associated with greater perceived destructive criticism and more upset. Perceptions of relatives’ warmth were also associated with greater perceived constructive criticism and less perceived destructive criticism, but warmth was only related to less upset for Blacks and not Whites. Findings suggest that attributions and warmth play an important role in the perception of criticism and the extent to which individuals become upset in response to criticism from loved ones. Results also point to potential racial differences in mean levels of these variables and the associations among them.     

Gender, Female Traditionality, Achievement Level, and Cognitions of Success and Failure

Differences in ratings of initial expectancy of success, perceived scholastic ability, and causal attributions were assessed for male and female high school students for a simulated academic test. Subjects were also differentiated on their achievement level (i.e., under- and overachievement) and the traditionality of their career aspirations. As predicted, higher expectancies were found for high performance achievers and nontraditional females. Males generally made more attributions to lack of effort for failure, as did low performance achievers. Females and high performance achievers attributed success more to effort. Hypotheses concerning differential usage of luck and ability attributions were not supported. Although there was an overall trend for females to be more external, traditionality also mediated causal attributions for females.     

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).     

Nurses' Evaluations of Patient Attributions for the Cause and Future of Their Illness1

It was hypothesized that evaluations of patients' attributions for the cause and future of their illnesses would be seen as more realistic when these attributions coincided with subjects' views on the cause and future of the patients' illness. It was also thought that of the two, i.e., cause and future attributions, future attributions would be more pertinent for the observer when evaluating the adjustment of the patient. One hundred and twenty-eight female nurses assessed the health interviews of four patients through the use of questionnaires. The first hypothesis was supported in the case of causal attributions, but it was found that patients who accepted responsibility, regardless of nurses' views, were seen as more realistic. The second hypothesis was fully supported with future attributions indicating level of coping and causal attributions indicating level of emotional support needed. These findings have implications for caretakers' perceptions of the adaptiveness, for patients of serious illness, of control attributions.     

Appraisal antecedents of shame and guilt: support for a theoretical model

Four studies used experimental and correlational methods to test predictions about the antecedents of shame and guilt derived from an appraisal-based model of self-conscious emotions (Tracy & Robins, 2004). Results were consistent with the predicted relations between appraisals (i.e., causal attributions) and emotions. Specifically, (a) internal attributions were positively related to both shame and guilt; (b) the chronic tendency to make external attributions was positively related to the tendency to experience shame; and (c) internal, stable, uncontrollable attributions for failure were positively related to shame, whereas internal, unstable, controllable attributions for failure were positively related to guilt. Emotions and attributions were assessed using a variety of methods, so converging results across studies indicate the robustness of the findings and provide support for the theoretical model.     

The Relationship of Informational Attributions to Affective Response to Success and Failure

Abstract

This study assessed the relationship of informational attributions—perceived characteristics of the self and the task situation—to postperformance affect. College students performed an anagram task and rated causal and informational attributions for their outcomes, the causal dimensions for the perceived causes of their outcomes, and their affective response to their outcomes. The valence of the outcome—success or failure—was the best predictor of affect, and both causal attributions and causal dimensions accounted for substantial portions of the affect variance. Informational attributions accounted for a significant proportion of the affect variance beyond that attributable to the other factors. Implications of these results for the attributional theory of emotion are discussed.