The impact of significant other expressed emotion on patient outcomes in chronic fatigue syndrome.

Abstract

Objective: Previous literature has identified the importance of interpersonal processes for patient outcomes in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), particularly in the context of significant other relationships. The current study investigated expressed emotion (EE), examining the independent effects of critical comments and emotional overinvolvement (EOI) in association with patient outcomes. Method: Fifty-five patients with CFS/ME and their significant others were recruited from specialist CFS/ME services. Significant other EE status was coded from a modified Camberwell Family Interview. Patient outcomes (fatigue severity, disability, and depression) were derived from questionnaire measures. Forty-four patients (80%) completed follow-up questionnaires 6-months after recruitment. Results: Significant other high-EE categorized by both high levels of critical comments and high EOI was predictive of worse fatigue severity at follow-up. High-critical EE was associated with higher levels of patient depressive symptoms longitudinally; depressive symptoms were observed to mediate the relationship between high critical comments and fatigue severity reported at follow-up. There were higher rates of high-EE in parents than in partners, and this was because of higher rates of EOI in parents. Conclusions: Patients with high-EE significant others demonstrated poorer outcomes at follow-up compared with patients in low-EE dyads. One mechanism for this appears to be as a result of increased patient depression. Future research should seek to further clarify whether the role of interpersonal processes in CFS/ME differs across different patient-significant other relationships. The development of significant other-focused treatment interventions may be particularly beneficial for both patients and significant others.

Social support and treatment adherence in patients with end‐stage renal disease: A systematic review

“…There is growing evidence from studies with other chronic illnesses that significant others support and/or distress, may have important associations with several health outcomes . Patients with ESRD and their significant others may establish a joint narrative and understanding of the condition or, alternatively, may experience some level of disagreement about the meaning of certain symptoms and its management . Therefore, literature on other chronic conditions also suggested that illness beliefs from significant others could be incorporated into new intervention models to improve clinical outcomes, such as treatment adherence …”

“…45 Patients with ESRD and their significant others may establish a joint narrative and understanding of the condition or, alternatively, may experience some level of disagreement about the meaning of certain symptoms and its management. 46,47 Therefore, literature on other chronic conditions also suggested that illness beliefs from significant others could be incorporated into new intervention models to improve clinical outcomes, such as treatment adherence. 48 Research focusing on the role of perceived social support from health professionals and its benefits for treatment adherence is scarce.…”

Significant other behavioural responses and patient chronic fatigue syndrome symptom fluctuations in the context of daily life: An experience sampling study

“…In turn, patient depression has been associated with poorer long-term patient illness outcomes and responses to treatment (Bentall, Powell, Nye, & Edwards, 2002;Wearden, Dunn, Dowrick, & Morriss, 2012). The review proposed that elevated levels of patient depression may mediate an association between negative significant other responses and increased fatigue (Band et al, 2015), and this association has indeed been observed longitudinally (Band et al, 2014). The second type of response proposed in the review was solicitous significant other responses, such as encouraging patients to rest or doing tasks on their behalf (Cordingley, Wearden, Appleby, & Fisher, 2001;Kerns & Rosenberg, 1995).…”

“…Current explanatory models suggest that patients’ cognitive, behavioural, and affective responses to symptoms are important for symptom perpetuation (Deary, Chalder, & Sharpe, ; Surawy, Hackmann, Hawton, & Sharpe, ). Interpersonal relationships may influence these maintaining factors (e.g., by reinforcing thinking patterns or illness management behaviour, or by providing a source of support or stress for the patient; Band, Barrowclough, & Wearden, ; Deary et al ., ), and interactions with significant others have been highlighted as important in the patient illness experience (Dickson, Knussen, & Flowers, ). Cognitive behaviour therapy and graded exercise therapy, both of which encourage gradual increases in daily activity levels, are effective treatments for CFS/ME (Castell, Kazantzis, & Moss‐Morris, ; White et al ., ).…”

Distress in significant others of patients with chronic fatigue syndrome: A systematic review of the literature

“…Further exploration of significant others' beliefs about the illness, as has been done in other conditions, using framework of the Common-Sense Model (Karademas, 2014), may prove worthwhile and again might result in interventions that addressed misperceptions about the illness. Finally, a recent study with significant others of adult patients with CFS/ME has shown that Expressed Emotion (Leff & Vaughan, 1985) may be an important determinant of patients' response to treatment (Band et al, 2014). Given the associations between Expressed Emotion and carer distress seen in many other physical health conditions (Wearden, Tarrier, Barrowclough, Zastowny, & Rahill, 2000), the relationship between Expressed Emotion and distress in significant others may be fruitful topic for further research.…”