Changes in maternal expressed emotion toward clinically anxious children following cognitive behavioral therapy

The aim of this study was to determine whether maternal expressed emotion (criticism and emotional overinvolvement) decreased across treatment for childhood anxiety. Mothers of 48 clinically anxious children (aged 6-14 years) were rated on levels of criticism (CRIT) and emotional overinvolvement (EOI), as measured by a Five Minute Speech Sample (FMSS) from mothers, prior to and following cognitive behavioral therapy (CBT) for their children’s anxiety. Results showed a significant decrease in the proportion of mothers who expressed high levels of criticism and emotional overinvolvement from pretreatment to posttreatment. This finding suggests that interventions aimed at reducing symptoms of child anxiety can also result in a decrease of maternal expressed emotion (criticism and emotional overinvolvement).     

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.     

Teachers' emotional expression about disruptive boys

Objectives. To assess teachers' emotional expression about pupils using the Five Minute Speech Sample (FMSS) and coding procedures for parental expressed emotion (EE). To compare EE for disruptive and non‐disruptive pupils. Method. Twenty‐one teachers provided speech samples for both a disruptive and a non‐disruptive pupil in their class selected using standard behaviour rating scales. Results. Teachers' emotional expression was reliably measured using EE codings. Teachers displayed no emotional overinvolvement (EOI) and made few critical comments. High EE, characterized by criticism and a lack of positive comments, was associated with children's behavioural difficulties. Multiple regression suggested that conduct problems rather than hyperactivity were associated with high EE. Discussion. Results support the application of certain elements of the EE construct to teachers' emotional expression about pupils. However, there was an absence of EOI and a lack of association between relationship and other EE categories. The absence of this association suggests that EE might be most usefully considered as a measure of teachers' emotional response to pupils, rather than the emotional quality of the teacher–pupil relationship.     

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.     

Alternative measures of expressed emotion: a methodological and cautionary note

Undergraduate raters listened to Camberwell Family Interviews that had been conducted with the spouses of depressed patients and then rated each relative with a rating-scale assessment of expressed emotion (EE). Students' ratings of relatives' criticism, hostility, emotional overinvolvement, and warmth were significantly correlated with trained raters' EE assessments obtained in the conventional manner. Despite this correspondence, further analyses revealed that undergraduates' assessments of relatives did not predict 9-month relapse rates in patients. These results highlight the importance of establishing both the concurrent and predictive validity of any alternative measure of EE. They also emphasize the dangers of assuming that significant correlates of EE are necessarily significant predictors of relapse.     

青少年多维自我控制量表的编制及信效度检验

编制与多维自我控制理论相适应的,用于测量中国青少年多维自我控制的量表并检验其信、效度。通过查阅文献、专家评估等方式形成初测问卷; 以初中生和高中生为被试,选取1424名被试进行初测,681名被试正式施测。主动性自我控制量表包含情绪调节、目标维持和自我控制策略3个维度,抑制性自我控制量表包含注意力控制、冲动控制和情绪控制3个维度。两个量表均具有良好的结构效度、效标关联效度和信度。综上所述,青少年多维自我控制量表中的主动性、抑制性自我控制量表均符合测量学标准,可用于评估中国青少年的自我控制能力。     

Expression and processing of emotions: Relationships with cd4+ levels in 42 hiv-positive asymptomatic individuals

Abstract

Background: The study investigated the relationship between CD4+ levels and two emotion-related measures, one of expressed emotion (Hostility directed Inwards, Hdl) and one of capacity for emotional processing (Referential Activity, RA).

Method42 HIV-1 positive asymptomatic subjects, under AZT treatment, underwent CD4+ assessment immediately after a brief interview. Interviews were recorded, transcribed and analyzed using the Gottschalk-Gleser and Referential Activity scales. Of the Gottschalk-Gleser scales, only Hdl was considered.

ResultsAs hypothesized, the regression of emotion-related scores on CD4 + levels showed a curvilinearrelationship with Hdl scores, and a linearrelationship with RA scores. Subjects with the best immune status therefore showed intermediate levels of expressed emotion and a high capacity for emotional processing.

ConclusionThe findings support the usefulness of working through, rather than releasing emotion. Previous negative findings in the field might be explained by the unjustified assumption of linear relationships between expressed emotion and health.     

Expressed emotion and sociocultural moderation in the course of schizophrenia

This study examined whether the sociocultural context moderates the relationship between families' expressed emotion (EE) and clinical outcomes in schizophrenia. In a sample of 60 Mexican American caregivers and their ill relatives, we first assessed whether EE and its indices (criticism, emotional overinvolvement [EOI], and warmth) related to relapse. Second, we extended the analysis of EE and its indices to a longitudinal assessment of symptomatology. Last, we tested whether bidimensional acculturation moderated the relationship between EE (and its indices) and both relapse and symptom trajectory over time. Results indicated that EOI was associated with increased relapse and that criticism was associated with increased symptomatology. Additionally, as patients' Mexican enculturation (Spanish language and media involvement) decreased, EE was increasingly related to relapse. For symptomatology, as patients' U.S. acculturation (English language and media involvement) increased, EE was associated with increased symptoms longitudinally. Our results replicate and extend past research on how culture might shape the way family factors relate to the course of schizophrenia.     

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.     

Sex differences in judgement of facial affect: a multivariate analysis of recognition errors

The present paper investigated recognition errors in affective judgement of facial emotional expressions. Twenty-eight females and sixteen males participated in the study. The results showed that in both males and females emotional displays could be correctly classified, but females had a higher rate of correct classification; males were more likely to have difficulty distinguishing one emotion from another. Females rated emotions identically regardless of whether the emotion was displayed by a male or female face. Furthermore, the two-factor structure of emotion, based on a valence and an arousal dimension, was only present for female subjects. These results further extend our knowledge about gender differences in affective information processing.     

Observed emotional involvement and overinvolvement in families of patients with bipolar disorder

Many studies have examined the construct validity of the criticism component of expressed emotion, but little work has been done on clarifying the emotional overinvolvement (EOI) construct. In a sample of 115 recently episodic patients with bipolar disorder, the authors of the present study examined the construct validity of an observational coding system for both appropriate and inappropriate emotional involvement that permitted separate ratings for relatives' intrusiveness, self-sacrificing behaviors, and distress related to the patient's well-being. Findings support the measure's reliability and convergent validity and are moderately supportive of the measure's discriminant validity. Results also suggest that Camberwell Family Interview (C. E. Vaughn & J. P. Leff, 1976) EOI ratings do not discriminate among the different dimensions of the emotional involvement construct (or their appropriateness or inappropriateness) as revealed in laboratory-based interactions. The findings suggest that clinicians working with such families might consider differentiating among the various ways in which family members are involved with the patient and helping them learn to judge under what circumstances such involvement is appropriate and inappropriate.     

Psychoeducation and expressed emotion by parents of children with learning disorders

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program (n=46) or to a regular treatment group (n=35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.     

Maternal Expressed Emotion in Relation to Child Behavior Problems: Differential and Mediating Effects

Maternal expressed emotion (EE), including maternal criticism and emotional over-involvement, is considered an index of family emotional climate that is critical for children’s psychological well-being. Limited research investigates how each element of EE differentially contributes to child behavior problems, or explores the mechanisms, such as child emotion dysregulation, through which parental EE influences child psychosocial outcomes. This study examined maternal EE, child emotion dysregulation, and child behavior problems among 60 mother–child dyads from a community sample, utilizing multi-method and multi-reporter assessment. Findings indicated that maternal expressed criticism toward the child was positively associated with child externalizing symptoms through its relation to increased child emotion dysregulation, whereas maternal emotional over-involvement was negatively associated with child externalizing symptoms through its negative relation to child emotion dysregulation. These results provided increased support for a model in which maternal criticism remains negatively associated with child psychosocial outcomes, but the construct of emotional over-involvement is not necessarily associated with youth psychosocial problems. This study also illustrated one pathway through which maternal EE influence child psychosocial functioning, thus placing EE research in the broader context of research on family emotion socialization.     

6～11年级学生情绪自我调节发展研究

本研究以六年级到高二学生为被试进行问卷研究,着重探讨与情绪表达有关的自我意向和具体情境下的情绪反应。问卷设置了事件的正-负性、事件的大-小、情绪反应的人际-单独场合等多种情境因素。结果显示,稳重和开朗自我意向影响着情绪表达。开朗意向一般表现人际场合的情绪增强表达,稳重意向对单独场合的强表达和人际场合的弱表达有预测效果。进一步探讨日常活动与情绪表达状态及心理健康的关系,结果表明,日常活动的丰富性可以形成对个体情绪表达的有益补充。     

Adult attachment and emotional control

The connection between attachment style and affect regulation, proposed by attachment theorists, was explored in the context of long-term dating relationships. Seventy-two couples completed questionnaire measures of attachment (using a four-group forced-choice item, together with scales tapping Comfort with closeness, and Anxiety over relationships) and emotional control (in which subjects rated own and partner's control of anger, sadness, and anxiety, and the extent to which partners wanted them to control these emotions). Couples in which both partners endorsed insecure attachment styles (using the forced-choice measure) reported greater emotional control than did couples with two secure partners. Data from the attachment scales also supported the link between insecure attachment and emotional control: Comfort with closeness was negatively related both to one's own emotional control and to perceptions that partners wanted subjects to control their sadness; Anxiety over relationships was associated with perceptions that partners controlled sadness and wanted subjects to control their anger and sadness. The link between insecure attachment and the control of negative emotion remained significant when the frequency of experiencing such emotion was controlled. The association between attachment dimensions and other responses to negative emotions was also explored, and was consistent with attachment theory.     

Parental expressed emotion toward children: prediction from early family functioning

Expressed emotion (EE), an index of family member criticism and emotional overinvolvement, predicts outcome among adults and children with mental disorders. However, limited research exists on factors contributing to EE. Aims of the current study were to (a) examine EE in mothers of young children; (b) assess relationships between demographic factors and EE in a diverse sample; and (c) investigate whether family stress and functioning, including quality of marital relationship, life events, maternal stress, and family environment, predict EE. In the current study, 276 mothers completed questionnaires when their children were between 1 and 3 years of age and a measure of EE when their children were in kindergarten. Results indicated that family expressiveness was the most consistent predictor of EE. Further research seems warranted to better delineate associations between family functioning and EE.     

How do Hostile and Emotionally Overinvolved Relatives View Relationships?: What Relatives' Pronoun Use Tells Us

Expressed emotion (EE) has been linked to negative outcomes for a variety of psychiatric illnesses. Despite development of effective interventions to reduce EE, relatively little is known about EE's antecedents or maintaining factors. The present study uses a novel methodology (measurement of pronouns used by relatives during the Camberwell Family Interview [CFI] or a problem-solving interaction with the patient) to explore possible cognitive correlates of EE. Participants were 98 outpatients with obsessive-compulsive disorder or panic disorder with agoraphobia and their primary relative. Results showed that relatives' pronoun use was stable across situations. Relatives' hostility and criticism, as measured by objective coding of relatives' behavior during the CFI and interactions, respectively, were related to relatives' decreased we-focus and increased me-focus in the 2 situations. In contrast to expectations, relatives' emotional overinvolvement was related to their decreased we-focus during CFIs and interactions. Results support the value of using pronouns as a means to explore important aspects of relationship functioning.     

Global Assessment of Relational Functioning Scale (GARF): II. Reliability and Validity in a Sample of Families of Bipolar Patients

The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73 ) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.     

Two scales for measuring patients' perceptions for coercion during mental hospital admission

Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.     

先前情绪和过度自信对灾难事件后继风险决策的影响

研究考察了先前情绪和过度自信对灾难事件后继风险决策的影响。结果发现：(1)先前情绪的主效应显著, 积极情绪比消极情绪的个体在灾后风险决策时更加倾向于风险寻求;过度自信的主效应显著, 高过度自信比低过度自信个体在灾后风险决策时更加倾向于风险寻求。(2)先前情绪和过度自信水平交互影响灾难事件后继风险决策。高过度自信者在积极情绪状态下比在消极情绪状态下更倾向于风险寻求; 消极情绪状态下过度自信水平不同的个体之间没有显著差异。