Decrease of Relatives' High Levels of Expressed Emotion in Schizophrenic Disorders

Abstract

The family emotional atmosphere, Expressed Emotion, was assessed with the Swedish version of the Camberwell Family Interview, before and after a six-session multifamily education programme. The intervention provided illness-related knowledge and emotional support to relatives of patients with schizophrenic disorders. Relatives' high level of EE decreased significantly. Mainly responsible for the decrease was a reduction in the number of critical remarks, while emotional overinvolvement decreased non-significantly. The findings indicate that high levels of Expressed Emotion in relatives of patients suffering from long-standing schizophrenic disorders may decrease over a relatively short span of time.     

Measuring Emotion Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder: Revisiting the Factor Structure of the Emotion Regulation Checklist

Emotion dysregulation (ED) is prevalent among youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and significantly impacts functioning. Nuanced measurement of ED is central to understanding its role in this disorder and informing treatment approaches. The present study examined the factor structure of the Emotion Regulation Checklist (ERC) among children with ADHD with and without Oppositional Defiant Disorder (ODD). Exploratory factor analysis (EFA) conducted in a sample of 328 youth (mean age = 6.08) with ADHD indicated a four-factor solution, comprised of the following factors: Negative Emotion Lability, Positive Emotion Lability, Socially Appropriate Affect, and Socially Incongruent Affect. The Negative and Positive Emotion Lability subscales assess the reactivity of negatively and positively valenced emotions, respectively. The Socially Appropriate and Socially Incongruent Affect subscales provide an assessment of social-emotional functioning. All subscales discriminated between children with ADHD only and ADHD with co-morbid ODD, such that children with ODD had greater emotional lability and social-emotional difficulties. This revised factor structure of the ERC facilitates a uniquely brief, yet multifaceted and specific, assessment of emotional difficulties in children with ADHD that can inform treatment planning and operationalize emotional reactivity and social-emotional functioning in future research efforts.     

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).     

The construction and preliminary validation of a scale for measuring emotional control

This study reports on the construction and preliminary validation of a scale for measuring emotional control, which has been developed in the context of research on stress. Factor analysis of the initial item pool uncovered a 40-item, four-factor structure which was replicated in an independent sample of subjects. The four factors, entitled Rehearsal, Emotional Inhibition, Aggression Control and Benign Control, were all internally consistent and stable over time. Preliminary concurrent validation of the final form of the scale, entitled the Emotion Control Questionnaire (ECQ), showed that the factors were related in meaningful ways to other relevant indices of personality. The study concludes with suggestions for research applications using the ECQ.     

How to tell a happy person: Accuracy of subjective well-being perception from texts

Motivation and Emotion - Although perceptions of subjective well-being (SWB) in unacquainted others have been shown to play a major role in impression formation, little is known about how accurate...     

The internalization of and defiance against rules within prison: The role of correctional officers’ autonomy-supportive and controlling communication style as perceived by prisoners

Motivation and Emotion - While incarcerated, prisoners are subject to a vast number of rules. Drawing upon self-determination theory, the present study examined whether prisoners’ perceptions...     

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.     

Empirically derived personality subtypes of public psychiatric patients: effect on self-reported symptoms, coping inclinations, and evaluation of expressed emotion in caregivers.

Personality scales on the Millon Clinical Multiaxial Inventory-II (MCMI-II) for 195 psychiatric inpatients (93 men and 102 women) in a public facility were cluster analyzed to develop an empirical subtyping according to personality traits. Subjects also completed the Brief Symptom Inventory (BSI), Methods of Coping Scale (MOC), and the Level of Expressed Emotion Scale (LEE). The five personality subtypes that emerged were consistent across two clustering methods (K-means and complete linkage). Subtypes members differed on subscales of the BSI, MOC, and LEE. Results support the relevance of personality traits and disorders in assessing psychopathology in psychiatric patients. Results also support the relevance of subtyping these patients according to MCMI-II results.     

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.     

Development of the Parent Emotion Regulation Scale (PERS): Factor Structure and Psychometric Qualities

This study aims to develop a self-report measure based on a multidimensional conceptualization of the regulation of negative emotions in the context of parenting. We examined the factor structure, factorial invariance, internal consistency and construct validity of the newly developed measure, the Parent Emotion Regulation Scale (PERS). The sample was composed of 254 mothers of children aged 3 to 15 years old (M?=?8.54, SD?=?3.53) who participated in an online study. Exploratory factor analysis of the PERS yielded a four-factor structure with the following factors: parents’ orientation to the child’s emotions, parents’ avoidance of the child’s emotions, parents’ lack of emotional control and parents’ acceptance of the child’s and their own emotions. Confirmatory factorial analysis supported the four-factor model, showing an adequate fit for this structure. Additionally, the model displayed configural, metric, scalar and residual invariance across the children’s sex groups. Cronbach’s alpha values and mean inter-item correlations indicated an adequate internal consistency. Correlations between the PERS scale and the Coping with Children’s Negative Emotions Scale (CCNES) indicated that the different dimensions of parents’ emotion regulation were significantly associated with both positive and negative reactions to the children’s negative emotions. Furthermore, the emotion regulation dimensions showed incremental validity in the prediction of the child’s adjustment. This study provides preliminary support for the adequacy of this newly developed measure, although further studies are needed to establish its psychometric qualities in more diverse populations.     

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.     

Transexuals' Recognition of Emotions as Measured by the FEEL-Test

ABSTRACT

The study investigates the ability of transsexuals (TS) to recognize facially expressed basic emotions. It was hypothesized that, due to their discomfort in their gender role, this ability might be diminished in TS. In addition it was expected that emotion recognition improves during the course of transgendering, e.g., after having started the Real-life Experience (RLE) which regularly reduces stress levels. Finally it was hypothesized that TS do better in recognizing facial emotions when the person showing them has their desired sex and gender. To test these hypotheses the FEEL-test (Facially Expressed Emotion Labelling) was used. Forty-seven TS and 55 non-transsexual controls matched for age and sex were included in the study. The first hypothesis was confirmed. As regards the second hypothesis, no differences could be found between the groups at different stages in the transition between the two genders. The third hypothesis was also rejected: TS recognized facially expressed basic emotions from male and female stimuli independently of their desired sex.     

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.     

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.     

Is Expressed Emotion a Specific Risk Factor for Depression or a Nonspecific Correlate of Psychopathology?

Five Minute Speech Sample Expressed Emotion (FMSS-EE) was examined in families of youth with depressive disorders, nondepressed youth with attention deficit/hyperactivity disorder (ADHD), and community controls screened for the absence of depression and ADHD. Consistent with the hypothesis that FMSS-EE shows some specificity as a risk factor for depression, rates of critical EE were significantly higher among mothers of youth with depression as compared to mothers of nondepressed youth with ADHD, or mothers of controls. When both mothers' and fathers' scores were used to generate family EE ratings, rates of overall EE and critical EE were significantly higher for the depressed group than the control group, but the nondepressed ADHD group did not differ significantly from the other groups. Results support the hypothesis that critical EE in mothers shows some specificity as a risk factor or correlate of depression in youth.     

Racial and gender differences in expressed emotion and interpersonal control in families of persons with schizophrenia

Expressed Emotion (EE) has been shown to be predictive of course or severity in many illnesses, but the studies have been largely of white middle-class patients. This study examined gender and racial differences in parental EE level and communication patterns between the parent and patient with schizophrenia, using data from the NIMH Treatment Strategies in Schizophrenia study. Dialogues (n = 140) from 54 patient-parent dyads were coded into the Relational Control Coding System. Resultant data (n = 13,605 sequences) were analyzed with log-linear models. Results show that the relationship between control and EE level was stronger in African American families compared to Caucasians. Gender differences were as expected, with daughters less competitive and more deferential to their parents. Although the total number of high-EE parents with daughters was small, patterns in these families showed parents who responded submissively in contrast to the competitive symmetry in families with male patients.     

The Family Environment Scale: comparison with the construct of Expressed Emotion

The Family Environment Scale (FES) was completed by parents of 30 children with conduct disorders (CD), 30 children with emotional disorders (ED), and 30 well-functioning controls. Parents were also interviewed and rated for Expressed Emotion (EE), and mothers completed the Child Behaviour Checklist (CBCL). Clinical families had significantly lower ratings of Cohesion, Expressiveness, Intellectual-Cultural and Active-Recreational Orientation. These differences were not specific to either diagnostic group. Maternal Criticism was associated with reported conflict in the CD group. The EE scales of Criticism and Warmth (absence of warmth) were correlated with child behaviour ratings in the CD group, in contrast with FES sub-scales. Maternal scores of Cohesion were significantly associated with social competence in the ED and the control group. Maternal ratings of Conflict predicted dropping-out of treatment (CD group), and ratings of Cohesion and Control had some value in predicting clinical outcome. The implications for the future use of the Family Environment Scale and other self-rated measures of family functioning are discussed.     

Internal States Language in the Childhood Recollections of Adolescents with and without Abuse Histories

This study examined the representation of internal states in childhood recollections of male and female adolescents with and without abuse histories. Participants' (N = 71) exposure to spousal violence, physical abuse, and sexual abuse was documented when they were 6 to 12 years old and 6 years later when they were 12 to 18 years old. At the Year 6 assessment, teens recollected childhood experiences related to positive, negative, and neutral cues. Recollections were coded for references to emotions, cognitions, perceptions, and physiological states. Emotion terms varied according to childhood abuse history, whereas other internal states language did not. Teens with childhood abuse histories used fewer emotion terms than other teens but only for memories related to conflict and punishment. Emotion terms were unrelated to depression measured at the second assessment, regardless of abuse history. Explanations for abuse-related patterns of emotional language and possible links to coping and emotion regulation are discussed.     

Disruption and reconstruction: narrative insights into the experience of family members caring for a relative diagnosed with serious mental illness.

The findings of a study investigating carers' accounts about serious mental illness occurring in their family are presented. The narrative form is a primary means of ordering, structuring, and communicating illness experiences, reflecting some of the processes that carers intend to master and understand. Psychotic episodes entail a frightening disruption that forces carers to face fundamental existential, moral, and psychological issues because they call into question the continuity of lives and life-projects. This study has explored how carers articulate the consequences of a devastating experience and turn it into a meaningful event that can in some way be incorporated into the course of their life. Two types of narrative structure were identified. In stories of restitution or reparation, the experience of the event is transformed into phenomena having meaning, occupying a place in carers' lives. In chaotic and frozen narratives, the illness remains a series of random events. The effects on coping of these two narrative types were explored, as well as gender-related themes and beliefs about mastery and control. Therapeutic implications are discussed and also possible connections to other research constructs (for example, Expressed Emotion). It is argued that the concept of illness must be approached from a systemic, multidetermined perspective that includes our narrative constructions.