Expressed emotion and causal attributions in the spouses of depressed patients.

Hooley, Jill M.; Licht, Deborah M.

doi:10.1037/0021-843x.106.2.298

Cited by 104 publications

(88 citation statements)

References 24 publications

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“…Indeed, a number of authors have noted that the correlates of these variables are different (e.g. Miklowitz et al, 1984;Harrison and Dadds, 1992;Hooley and Licht, 1997), and our analysis of posttest data indicated they have differing predictive relationships with immediate outcome. These findings suggest that EE variables should be treated as separate constructs until combining them has been empirically justified.…”

Section: G Steketee and D L Chamblessmentioning

confidence: 69%

Does expressed emotion predict behaviour therapy outcome at follow‐up for obsessive‐compulsive disorder and agoraphobia?

Steketee

Chambless

2001

Clin Psychology and Psychoth

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The relationship of expressed emotion (EE) to outcome of behaviour therapy at 1-year follow-up was examined in a sample of patients with obsessive-compulsive disorder (OCD) or panic disorder with agoraphobia (PDA). Included were 54 subjects who were reliably changed after outpatient treatment via in vivo exposure (plus response prevention for OCD). Perhaps because few clients relapsed (11%), EE variables assessed by the Camberwell Family Interview and perceived criticism ratings, although successful in predicting drop-out and posttest outcome in this sample, were not significantly related to regression during the follow-up period. The sole exception, critical comments from the CFI, predicted worsened social adjustment at follow-up, but only for PDA patients. The experience of stressful life events did not interact with EE variables to predict outcome.

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Section: G Steketee and D L Chamblessmentioning

confidence: 69%

Does expressed emotion predict behaviour therapy outcome at follow‐up for obsessive‐compulsive disorder and agoraphobia?

Steketee

Chambless

2001

Clin Psychology and Psychoth

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“…Several studies of schizophrenia and depression have shown that high EE is related to personal, internal, and controllable attributions (Barrowclough et al, 1994;Brewin, MacCarthy, Duda, & Vaughn, 1991;Hooley & Licht, 1997;Wendel, Miklowitz, Richards, & George, 2000). Wendel et al (2000) found that high EE relatives made more personal and controllable attributions than low EE relatives, whereas stability and internality of attributions were not related to EE.…”

mentioning

confidence: 98%

“…Because high EE relatives believe the patient is in control of his or her behavior, they believe the patient must also be capable of modifying this behavior. Thus, relatives struggle to normalize the patient's behavior through negative feedback and controlling behavior of their own (Hooley & Campbell, 2002 Several studies of schizophrenia and depression have shown that high EE is related to personal, internal, and controllable attributions (Barrowclough et al, 1994;Brewin, MacCarthy, Duda, & Vaughn, 1991;Hooley & Licht, 1997;Wendel, Miklowitz, Richards, & George, 2000). Wendel et al (2000) found that high EE relatives made more personal and controllable attributions than low EE relatives, whereas stability and internality of attributions were not related to EE.…”

mentioning

confidence: 99%

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

Eisner

Johnson

2008

Behavior Therapy

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Expressed emotion (EE) is a robust predictor of outcome in bipolar disorder. Despite decades of research, interventions to reduce EE levels have had only modest effects. This study used an expanded model of EE to develop an intervention. Research has demonstrated a strong link between attributions and EE in families of patients with psychiatric disorders. There is also substantial research to suggest that anger can drive blaming attributions. Combining these ideas, this study built on previous psychoeducation interventions through the addition of an acceptance component designed to decrease anger and blaming attributions among family members of those with bipolar disorder. Twenty-eight family members attended a 1-day or 2-evening multifamily group workshop and completed a followup assessment 1 week later. At follow-up, participants demonstrated more knowledge about bipolar disorder. Anger, blaming attributions, and number of criticisms remained unchanged. Results of this study are consistent with others in that it is difficult to change EE. Implications for future clinical research in this area are addressed.The construct of expressed emotion (EE) is defined as critical, hostile, or emotionally overinvolved (EOI) attitudes toward a relative with a psychiatric disorder (Hooley, Rosen, & Richters, 1995). EE has been linked with poor patient outcome for several psychiatric disorders (Barrowclough & Hooley, 2003;Butzlaff & Hooley, 1998). Butzlaff and Hooley (1998) found a meta-analytic effect size of r=.39 across six studies that examined the relationship between EE and relapse within mood disorders. More recent research suggests that, although EE was unrelated to manic relapse, high EE was related to a five-fold increase in the odds of a depressive recurrence, even after controlling for symptom severity (Yan, Hammen, Cohen, Daley, & Henry, 2004). Criticism has been found to be the most important element of EE for understanding the course of mood disorders (Hooley et al., 1995) and for bipolar depression (Kim & Miklowitz, 2004). Thus, EE has an influence on bipolar relapse, more specifically for depression.What drives high levels of criticism? According to Weiner's (1995) attribution-affect model, attributions influence the way people experience emotion. In particular, when an individual perceives that another person is in control of his or her behavior, this leads to a judgment that the other person is responsible for his or her behavior. A judgment that the other person is responsible elicits anger and criticism. High EE relatives who are critical have a tendency to view symptoms of mental illness as behaviors that are within the patient's control (Barrowclough, Johnston, & Tarrier, 1994). Because high EE relatives believe the patient is in control of his or her behavior, they believe the patient must also be capable of modifying this behavior. Thus, relatives struggle to normalize the patient's behavior through negative feedback and controlling behavior of their own (Hooley & Campbell, 2002 Several studie...

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“…It provides information about the patient's symptomatology. It also provides a spontaneous sample of the relative's speech that can be used for other research purposes, such as coding attributions (see Barrowclough, Johnston, & Tarrier, 1994;Hooley & Licht, 1997) or controlling behaviors (Hooley & Campbell, 2002). The CFI may also be flexible enough in its probes to allow it to be successfully modified for use in crosscultural research.…”

Section: Summary and Recommendationsmentioning

confidence: 99%

Measuring expressed emotion: An evaluation of the shortcuts.

Hooley¹,

Parker²

2006

Journal of Family Psychology

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184

171

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The construct of expressed emotion (EE) is a highly reliable and valid predictor of poor clinical outcomes in patients with major psychopathology. Patients are at early risk for relapse if they live with family members who are classified as high in EE. Conventionally, EE is assessed with the Camberwell Family Interview (CFI), a semistructured interview that is conducted with the patient's key relatives. Unfortunately, training in the CFI is difficult to obtain. The CFI is also time-consuming to administer and labor intensive to rate. In this article, the authors discuss alternative ways of assessing EE. They also evaluate the predictive validity of these measures and make recommendations for researchers and clinicians interested in using these assessments.

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Expressed emotion and causal attributions in the spouses of depressed patients.

Cited by 104 publications

References 24 publications

Does expressed emotion predict behaviour therapy outcome at follow‐up for obsessive‐compulsive disorder and agoraphobia?

Does expressed emotion predict behaviour therapy outcome at follow‐up for obsessive‐compulsive disorder and agoraphobia?

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

Measuring expressed emotion: An evaluation of the shortcuts.

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