Family interventions in schizophrenia: evidence for efficacy and proposed mechanisms of change

Family intervention for psychosis developed from empirical work on the role of emotion in families of those caring for someone with schizophrenia. The level of expressed emotion (EE) has been shown to be a robust predictor of subsequent outcome for service users returning to live in family settings. There is also evidence that staff have similar attitudes. This has led to the development of specific family interventions for schizophrenia. NICE Guidelines for Schizophrenia (2003) confirm that family intervention is effective at reducing service user relapse rates and recommends it for those in contact with carers. Exactly how family intervention improves outcome is less clear. A recent model of psychosis proposes a primarily emotional rather than cognitive route for family factors, and some evidence is presented which supports this. Implications for family interventions are discussed.