A Trial of Family Therapy v. a Relatives Group for Schizophrenia

Abstract

Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.

Family criticism and self‐starvation: a study of expressed emotion

“…been recorded in studies of depression (Vaughn and Leff, 1976a), schizophrenia in Denmark and rural communities in India (Leff et al, 1989); these could offer a likely explanation for the low levels of EE recorded in the study presented here. Dare (1992) has shown that levels of EE in families with a conduct disordered or bulimic child are quite high when compared with relatives of anorexic children (see later), and we can look at the question of levels of EE in the light of our clinical knowledge of the families.…”

“…Kuipers and Bebbington (1988) therefore suggest that EE represents an aspect of ongoing family interaction, and similarly, Vaughn ( 1989) describes the EE index as an indicator of the emotional temperature of the family. A related question is that in some family intervention studies (Berkowitz et al, 1984;Leff et al, 1989) it has been shown that levels of EE can be altered in order to improve symptomatic outcome. I n these family intervention studies changes in levels of criticism but not Emotional Over-Involvement were achieved.…”

Meta-análise de ensaios clínicos de intervenção familiar na condição esquizofrenia

“…Em relação à intervenção testada, cinco ensaios foram classificados como de linha pragmáti-ca 49,50,51,56,57,58,61,62 . Quatro ensaios 52,53,54,59,60,65 foram classificados como comportamentais e dois 55,63,64 , como cognitivo-comportamentais.…”

Aproximaciones psicológicas al tratamiento de las esquizofrenias

“…(2) Los beneficios obtenidos tras la intervención se mantienen en dos años de seguimiento, con un incremento de las recaídas si la intervención no es continuada (Fallón, 1985). (3) El rango menor de recaídas se asociaba a un mayor descenso en el nivel de EE (Hogarty, McEvoy, Munezt, DiBarry, Bartone, Cather, Cooley, Ulhrich, Cárter y Madonia, 1988;Tarrier et al , 1988;Leff et al , 1989). (4) Las intervenciones que incorporan programas educacionales y medidas profilácticas favorecen la reducción del estrés o tensión dentro del ámbito familiar (Tarrier, 1991).…”