Interactional Correlates of Expressed Emotion in the Families of Schizophrenics

Miklowitz, David J.; Goldstein, Michael J.; Falloon, Ian R. H.; Doane, Jeri A.

doi:10.1192/bjp.144.5.482

Cited by 195 publications

(153 citation statements)

References 14 publications

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“…The adolescents and caregivers were asked to discuss the adolescents' ideas and opinions concerning educational or professional plans for 10 min. This procedure is similar to other interaction assessments used in family studies of patients with schizophrenia and has been found to differentiate between families with high EE and low EE [26,27,28]. The interactions were videotaped for later head position coding.…”

Section: Methodsmentioning

confidence: 99%

Head Position and Expressed Emotion of Adolescents with Schizophrenia and Their Caregivers Compared to Non-Patient Controls

et al. 2012

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Background: Family interactions with schizophrenia patients and caregivers rated as high expressed emotion (EE) are characterized by increased negative non-verbal behaviour. Head position is one important component of non-verbal behaviour and has not been examined in relation to EE before. The aim of this pilot study was to investigate the influence of caregivers' EE on the head position of adolescents with schizophrenia and their caregivers. Sampling and Methods: 15 adolescent schizophrenia patients and 17 non-patient adolescents were videotaped during a 10-min problem-solving task with their caregiver. The head position was coded by the Berner System of Non-Verbal Behaviour. The caregivers' EE level (high EE vs. low EE) was measured by the Five-Minute Speech Sample. Results: Adolescent patients and non-patients showed a higher frequency of averted head positions towards high EE caregivers compared to low EE caregivers (β = 47.85, t = 2.41, p = 0.023). They displayed longer mean times of averting towards high EE caregivers compared to low EE caregivers (β = -1.78, t = -2.51, p = 0.018). An indirect approach was shown more frequently by adolescent patients towards low EE compared to high EE caregivers (β = 39.99, t = 2.31, p = 0.028). In contrast, non-patient adolescents showed a more indirect approach towards high EE caregivers compared to low EE caregivers. Caregivers of schizophrenia patients had head positions with a straight ahead lowered approach for a longer time compared to caregivers of non-patients (β = -29.75, t = -2.51, p = 0.018). Within the patient and non-patient groups, low EE caregivers showed longer total times of positions with a straight ahead lowered approach than high EE caregivers. Conclusions: High EE communication may be characterized by a higher ratio of averting head position in adolescents, which is especially pronounced in adolescents with schizophrenia. Low EE communication seems to be better adjusted by a more indirect approach being shown by the adolescent and straight ahead lowered head positions by the caregiver, especially when the adolescent suffers from schizophrenia.

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Section: Methodsmentioning

confidence: 99%

Head Position and Expressed Emotion of Adolescents with Schizophrenia and Their Caregivers Compared to Non-Patient Controls

et al. 2012

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“…Parental CRIT has also correlated positively with "belittling and blaming" statements made by parents, and negatively with "disclosing and expressing" and "trusting and relying" (Hubschmid & Zemp, 1989). The way that EOI relates to interactions between parents/ relatives and patients has generally been less consistent across the literature compared to CRIT (Miklowitz et al, 1984;Mueser et al, 1993). Some studies have found that high EOI parents make more intrusive statements (Strachan et al, 1986) or more ambiguous and unclear statements (Hubschmid & Zemp, 1989); others have found that they do not differ in behavioral interactions compared to low EOI parents .…”

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confidence: 96%

“…The measure also has not demonstrated cohesiveness as a measure, in terms of its internal consistency and the way that the individual criteria relate to child psychopathology (McCarty & Weisz, 2002). To increase our understanding of the appropriateness of applying EOI to child clinical samples, investigation of its concurrent validity with behavioral data is warranted.Thus far, the research relating observed interactions to EE has mostly focused on families of adults with or at risk, for schizophrenia-spectrum disorders (Miklowitz, Goldstein, Falloon, & Doane, 1984;Strachan, Goldstein, & Miklowitz, 1986;Valone, Norton, Goldstein, & Doane, 1983;) bipolar disorder (Simoneau, Miklowitz, & Saleem, 1998), or depression (Mundt, Fiedler, Ernst, & Backenstrab, 1996 and has assessed interactions between relatives as a function of overall EE in general, not differentiating CRIT from EOI The studies that have assessed the two EE components separately suggest that relatives high on the CRIT dimension express a significantly greater number of criticisms during interactions than relatives who score low on this dimension, and show extreme negative escalation patterns . Parental CRIT has also correlated positively with "belittling and blaming" statements made by parents, and negatively with "disclosing and expressing" and "trusting and relying" (Hubschmid & Zemp, 1989).…”

mentioning

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

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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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“…Birchwood (1983) found that the coping strategies employed to deal with behavioural disturbance commonly found in schizophrenia appeared to be associated with the subsequent course of the condition. Miklowitz et al (1984) showed that the critical and over-involved attitudes expressed in the Camberwell Family Interview were, indeed, markers of critical and intrusive behaviours in actual family problem solving discussions. It has been noted that the EE levels, especially criticism, peak during the patient's florid episode and decline once the florid symptoms and associated behaviour disturbance remit.…”

Section: Factors Provoking High Ee Responsesmentioning

confidence: 99%