Expressed Emotion and Psychiatric Relapse

Butzlaff, Ronald L.; Hooley, Jill M.

doi:10.1001/archpsyc.55.6.547

Cited by 1,177 publications

(820 citation statements)

References 49 publications

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“…The EE measure has been used extensively in studies of adult psychopathology, and is a fairly robust predictor of relapse for schizophrenia, depression, and other psychiatric problems in adults (Butzlaff & Hooley, 1998). Although it has been extended to use with, children, little data on its validity with juvenile populations exists.…”

Section: Discussionmentioning

confidence: 99%

“…Expressed emotion (EE) is one measure that has been used to assess the parent-child relationship among adults, and more recently children, with psychological disorders. Having a caregiver score high on the EE measure has been associated with poorer outcome for adults with mood, anxiety, and schizophrenic disorders, and with the presence of internalizing and externalizing disorders for children (Asarnow, Tompson, Woo, & Cantwell, 2001;Butzlaff & Hooley. 1998; Stubbe, Zahner, Goldstein, & Leckman, 1993;Vostanis, Nicholls, & Harrington, 1994).…”

Section: Abstract Expressed Emotion; Parent-child Interaction; Criticmentioning

confidence: 99%

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Parent-Child Interactions in Relation to Critical and Emotionally Overinvolved Expressed Emotion (EE): Is EE a Proxy for Behavior?

McCarty

Lau

Valeri

et al. 2004

J Abnorm Child Psychol

105

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Expressed emotion measures, encompassing dimensions of criticism (CRIT), and emotional overinvolvement (EOI) are increasingly being used to assess the parent-child relationship in child clinical populations, despite the lack of studies assessing their validity. We examined the correspondence between CRIT, EOI, and parent-child interactions as observed by neutral coders in a sample of 252 clinic-referred children and adolescents, ages 7-17 years. We found support for the validity of the CRIT code, with high critical parents showing more antagonism, negativity, disgust, harshness, and less responsiveness, compared to parents who scored in the low or borderline ranges. In contrast, none of the observed behaviors were found to correspond with parental EOI, suggesting either that this construct lacks validity with juvenile samples or that behaviors that correspond to EOI are difficult to observe. We conclude that high parental CRIT can be used as an index of problematic parent-child interactions. Keywords expressed emotion; parent-child interaction; criticism; emotional overinvolvementEvidence is accumulating that some childhood disorders, such as depression, are associated with low levels of family support (Barrera & Garrison-Jones, 1992;Feldman, Rubenstein, & Rubin, 1988), high family conflict Wierson, Forehand, & McCombs, 1988), or poor family relations (Puig-Antich et al., 1993). Expressed emotion (EE) is one measure that has been used to assess the parent-child relationship among adults, and more recently children, with psychological disorders. Having a caregiver score high on the EE measure has been associated with poorer outcome for adults with mood, anxiety, and schizophrenic disorders, and with the presence of internalizing and externalizing disorders for children (Asarnow, Tompson, Woo, & Cantwell, 2001;Butzlaff & Hooley. 1998; Stubbe, Zahner, Goldstein, & Leckman, 1993;Vostanis, Nicholls, & Harrington, 1994). The assumption underlying EE is that the way parents talk about a child is indicative of the way they treat the child on a day-to-day basis (Chambless, Bryan, Aiken, 6 Address all correspondence to Carolyn A. McCarty, PhD, Child Health Institute, University of Washington, Box 354920, Seattle, Washington, 98195-4920; e-mail:cmccarty@u.washington.edu.. Steketee, & Hooley, 1999). Given the suggested association between parent-child interactions and these disorders and given the increasing use of EE as an index of dyadic relationship problems within the family, it is important to know whether the expressed emotion measure actually corresponds to such interactions. NIH Public AccessEE is assessed via interview or an open-ended query posed to the parent or caregiver. Commonly, EE is measured using the Five-Minute Speech Sample (Magana et al., 1986) wherein caregivers are asked to describe their child and their relationship with him/her and responses are coded for two different components of EE-criticism (CRIT) and emotional overinvolvement (EOI), with a high score on either indicating a "High EE...

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Section: Discussionmentioning

confidence: 99%

Section: Abstract Expressed Emotion; Parent-child Interaction; Criticmentioning

confidence: 99%

Parent-Child Interactions in Relation to Critical and Emotionally Overinvolved Expressed Emotion (EE): Is EE a Proxy for Behavior?

McCarty

Lau

Valeri

et al. 2004

J Abnorm Child Psychol

105

View full text Add to dashboard Cite

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“…Interpersonal events, interpersonal dependency, and the interaction of the two have been found to predict higher symptom severity scores (Hammen, Ellicott, & Gitlin, 1992) and faster relapse (Fingerhut, 2000). In keeping with the importance of interpersonal stressors, Expressed Emotion, or family criticism regarding a patient's illness, has been shown to predict poorer outcomes for patients with bipolar disorder in a series of studies (Butzlaff & Hooley, 1998). Personality traits and interpersonal stressors, then, may be important predictors.…”

Section: Studies That Do Not Distinguish Polarity Of Symptomsmentioning

confidence: 95%

Life events in bipolar disorder: Towards more specific models

Johnson

2005

Clinical Psychology Review

182

167

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This article reviews the evidence concerning life events as a predictor of symptoms within bipolar disorder. First, key methodological issues in this area are described, and criteria used for including studies in this review are defined. Then findings that negative life events predict worse outcomes within bipolar disorder are reviewed. Beyond general studies on relapse, it is important to differentiate predictors of depression from predictors of mania. When severe negative life events occur, they appear to trigger increases in bipolar depression. Nonetheless, many depressions are unrelated to negative life events and appear to be triggered by other variables. The strongest evidence suggests that negative life events do not trigger mania, except perhaps in certain contexts. Retrospective findings for schedule-disrupting life events as a trigger for manic symptoms await further assessment within a longitudinal study. Life events involving goal attainment do appear to trigger manic symptoms. Overall, it is time to differentiate among specific types of life events, as these different forms of events point towards mechanisms linking stressors with symptom expression. These mechanisms provide clues into ways to integrate the social environment with biological vulnerability (see Bipolar disorder is clearly a biological disorder. Nonetheless, over the past 15 years, a wealth of research has made it abundantly clear that psychosocial variables shape outcomes of this disorder. Much of this psychosocial research has focused on whether life events predict the timing and severity of symptoms within this disorder. This paper reviews the evidence that life events are related to symptom expression within bipolar disorder. This basic question has challenged researchers for over 20 years. Given the growing literature, this paper focus on addressing two more specific questions. Which types of symptoms are related to life events? What types of life events influence symptoms? Given the growing number of studies available on these issues, this review will focus on those studies with the most rigorous methodologies. To set the stage for this endeavor, it is important to first review the major methodological issues in research on life events and bipolar disorder, including issues related to design, measurement, and sampling.

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“…Wellreplicated research findings indicate that being in family environments where at least one member is assessed as high-EE can negatively impact on patients' psychotic 5 experiences (Hooley, 2010). Face-to-face contact with high-EE relatives has been consistently associated with increased risk of psychotic relapse (Butzlaff and Hooley, 1998). Similarly, psychophysiological research demonstrates that the presence of high-EE relatives is more autonomically arousing for individuals than the presence of low-EE relatives (Tarrier and Tupin, 1992).…”

Section: Introductionmentioning

confidence: 99%

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

Wearden

Hartley

et al. 2016

Psychiatry Research

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2 Highlights• Patients' self-reports of their relatives being behaviourally controlling in the course of everyday life, namely taking control of them or helping them, were associated with higher levels of negative mood and symptoms.• Relatives' self-reports of behaviourally controlling interactions such as nagging, keeping an eye on the patient or taking control of the patient were significantly linked with fluctuations in relatives' mood, but not with patients' symptoms.• Contact with high-EE relatives (critical and overinvolved), had no association with patients' affect or symptoms in the course of daily life.3 Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis While research using Experience Sampling Methodology (ESM) suggests that, in general, contact with relatives or friends may be protective for psychotic experiences, contact with high-Expressed Emotion (high-EE) relatives can have adverse consequences for patients. This study investigated whether contact with high-EE relatives, and relatives' behaviourally controlling interactions (BCI) are related to patients' symptoms and to both patients' and relatives' affect when measured using structured diary assessments in the course of everyday life. Twenty-one patients experiencing psychosis and their closest relatives provided synchronized self-reports of symptoms (patients only), affect, dyadic contact and BCI over a 6-day period.Relatives' EE was obtained from Camberwell Family Interviews. Multi-level modeling showed that patients' reports of relatives taking control of them and helping them were associated with increased patient negative affect and symptoms. Relatives' self-reports of nagging, taking control and keeping an eye on the patient were related to fluctuations in relatives' affect. No evidence was found for the moderating effect of EE status on the association between dyadic contact and affect or, in the case of patients, symptoms. When measured using an ecologically valid methodology, momentary behaviourally controlling interactions within dyads experiencing psychosis can impact on patients' affect and symptoms.

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Expressed Emotion and Psychiatric Relapse

Cited by 1,177 publications

References 49 publications

Parent-Child Interactions in Relation to Critical and Emotionally Overinvolved Expressed Emotion (EE): Is EE a Proxy for Behavior?

Parent-Child Interactions in Relation to Critical and Emotionally Overinvolved Expressed Emotion (EE): Is EE a Proxy for Behavior?

Life events in bipolar disorder: Towards more specific models

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

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