An attributional analysis of expressed emotion in Mexican-American families with schizophrenia.

In this study we tested an attributional model of expressed emotion (EE) among Mexican-American families. A sample of 46 key family members of schizophrenic patients was measured on 3 dimensions: affect toward patient, controllability attributions, and level of EE. Consistent with an attributional model, it was found that high EE families (defined on the basis of critical comments) viewed the illness and associated symptoms as residing within the patient's personal control, more so than did low EE families. Also, attributions held by family members were to be related to their affective reactions. Specifically, family members who perceived the patient as having control over the symptoms of schizophrenia tended to express greater negative emotions such as anger and annoyance toward the patient than did family members who viewed the symptoms as beyond the patient's personal control. An examination of the types of affects found and their relationship to EE status is discussed, along with implications for this research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution and expressed emotion in the relatives of patients with schizophrenia.

[Correction Notice: An erratum for this article was reported in Vol 101(2) of Journal of Abnormal Psychology (see record 2008-10481-001). An incorrect sentence was published. The sentence that ends the fourth paragraph on p. 547 ought to read: A more recent onset of illness would be expected to produce more unstable attributions, and more disturbed behavior (particularly involving violence toward the relative) would be expected to produce attributions that were more internal and personal to the patient but more external and uncontrollable as regards the relative.] Indexes of expressed emotion (EE) in 58 relatives of patients with schizophrenia were related to those relatives' spontaneously expressed causal beliefs about the illness and about related symptoms and behaviors. Relatives made attributions predominantly to factors external, universal, and uncontrollable from their own perspective, and to factors internal, universal, and uncontrollable from the patient's perspective. Low-EE relatives were similar in their attributions to emotionally overinvolved relatives. Compared with these 2 groups, critical and/or hostile relatives made more attributions to factors personal to and controllable by the patient. Subsequent analyses suggested that hostile relatives were further characterized by making more attributions to factors internal to the patient and by making attributions with fewer causal elements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Attribution and expressed emotion in the relatives of patients with schizophrenia": Correction to Brewin, MacCarthy, Duda, and Vaughn (1991).

Reports an error in "Attribution and expressed emotion in the relatives of patients with schizophrenia" by Chris R. Brewin, Brigid MacCarthy, Karin Duda and Christine E. Vaughn (Journal of Abnormal Psychology, 1991[Nov], Vol 100[4], 546-554). An incorrect sentence was published. The sentence that ends the fourth paragraph on p. 547 ought to read: A more recent onset of illness would be expected to produce more unstable attributions, and more disturbed behavior (particularly involving violence toward the relative) would be expected to produce attributions that were more internal and personal to the patient but more external and uncontrollable as regards the relative. (The following abstract of the original article appeared in record 1992-12907-001.) Indexes of expressed emotion (EE) in 58 relatives of patients with schizophrenia were related to those relatives' spontaneously expressed causal beliefs about the illness and about related symptoms and behaviors. Relatives made attributions predominantly to factors external, universal, and uncontrollable from their own perspective, and to factors internal, universal, and uncontrollable from the patient's perspective. Low-EE relatives were similar in their attributions to emotionally overinvolved relatives. Compared with these 2 groups, critical and/or hostile relatives made more attributions to factors personal to and controllable by the patient. Subsequent analyses suggested that hostile relatives were further characterized by making more attributions to factors internal to the patient and by making attributions with fewer causal elements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causal Attributions About Schizophrenia in Families in China: Expressed Emotion and Patient Relapse.

Previous studies have indicated a robust link between relatives' causal attributions and levels of expressed emotion (EE). However, these studies have primarily been conducted in Western cultures. The current study, conducted in China, examined the spontaneous causal attributions made by 54 relatives of schizophrenia patients during the Camberwell Family Interview. Chinese relatives made few controllable and personal attributions overall. Yet as predicted, highly critical and/or hostile EE relatives attributed patients' negative behaviors to more controllable and personal factors. High EE and controllable attributions positively predicted relapse, whereas personal attributions unexpectedly protected against relapse. EE mediated the effect of controllable, but not personal, attributions on relapse. Relatives' use of a particular Chinese characteristic (narrow-mindedness) was integral to the personal dimension's protective effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

High levels of expressed emotion are thought to be related to the attributions relatives make about the causes of a patient's illness and problem behaviors. Causal attributions occurring during spontaneous speech in 43 spouses of depressed patients were examined. Consistent with theoretical prediction and with previous research in schizophrenia high critical spouses were more likely than low critical spouses to attribute patients symptoms and negative behaviors to factors that were controllable by and personal to the patients. High critical spouses also made more attributions that implied that they held patients responsible for their difficulties. Although predictive of spouses criticism these attribution dimensions did not predict patient relapse. The results suggest that causal attributions are important for understanding spouses criticism but are of limited predictive validity with respect to depressive relapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of relapse in unipolar depressives: Expressed emotion, marital distress, and perceived criticism.

The predictive validity of expressed emotion (EE) and two conceptually related but more easily measured alternatives—marital distress, and patients' perceptions of criticism from spouses—were examined in a sample of hospitalized unipolar depressives. All three psychosocial variables were significantly associated with 9-month relapse rates. Expressed emotion and marital distress predicted the same proportion of variance in patients' outcomes. The single best predictor of relapse, however, was a patient's response to the question "How critical is your spouse of you?" Patients who relapsed rated their spouses as significantly more critical than did patients who remained well. Alone, the perceived criticism variable accounted for more of the variance in relapse rates than that explained by EE and marital distress combined. The results suggest that asking depressed patients how critical they believe their relatives are may facilitate the identification of individuals at high risk for relapse subsequent to hospital discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fibroblast growth factor-2 and -9 regulate proliferation and production of matrix metalloproteinases in human gliomas

BACKGROUND: Although high expressed emotion (EE) has been found to be an important predictor of poor prognosis in a wide range of conditions such as schizophrenia, anorexia and depression no complete explanation exists for individual differences in EE responses. The aim of this paper is to investigate the role of intimacy in determining the level of EE in carers of people with dementia. METHODS: Ninety-nine carers of people with dementia who presented to Old Age Psychiatry Services in South and Central Manchester completed questionnaires to ascertain past and current levels of intimacy. Camberwell Family Interviews (CFIs) were carried out to ascertain levels of EE. RESULTS: Current intimacy was found to be strongly related to EE such that low current intimacy was associated with high EE and there was a significant difference between high and low intimacy groups on measures of criticism and hostility, though not warmth. CONCLUSIONS: The association found between intimacy and EE indicates that high EE may be a characteristic of low intimacy relationships between the carer and the cared-for-person. Since the assessment of EE is time intensive, perhaps a measure of intimacy will provide a short-hand screen for identifying critical and hostile caring environments.     

Controllability perceptions and reactions to symptoms of schizophrenia: A within-family comparison of relatives with high and low expressed emotion.

In a sample of 35 family members of patients with recent-onset schizophrenia, attributions of control and the content of critical comments were compared for 2 relatives of the same household who held discrepant expressed emotion (EE) attitudes (1 high and 1 low) toward their mentally ill family member. Attributions and the content of critical comments were also compared for low-EE relatives from low-EE homes versus low-EE relatives from high-EE homes. Our results indicate that high-EE relatives tend to attribute more control over behavior to patients than do low-EE relatives of the same patient. In addition, low-EE relatives from high-EE homes attribute more behavioral control to patients than do low-EE relatives from low-EE homes. These findings suggest that EE status is linked to attributions of control over behaviors, but additional patient factors or influences among family members may also affect EE attitudes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressed emotion and attributions in the relatives of bipolar patients: An analysis of problem-solving interactions.

Among the relatives of schizophrenic and depressed patients, high expressed emotion (EE) attitudes are associated with "controllability attributions" about the causes of patients' symptoms and problem behaviors. However, previous studies have judged EE attitudes and causal attributions from the same assessment measure, the Camberwell Family Interview (CFI; C. E. Vaughn and J. P. Leff, 1976). The authors examined causal attributions among relatives of 47 bipolar patients, as spontaneously expressed to patients in family problem-solving interactions during a postillness period. Relatives rated high EE during the patients' acute episode (based on the CFI) were more likely than relatives rated low EE to spontaneously attribute patients' symptoms and negative behaviors to personal and controllable factors during the postillness interactional assessment. Thus, the EE-attribution linkage extends to the relatives of bipolar patients evaluated during a family interaction task. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Models to evaluate the role of stress in periodontal disease

We evaluated the association of stress,distress, and coping behaviors with periodontal disease in 1,426 subjects, aged 25 to 74, in Erie County, NY, Demographic characteristics, medical and dental history, and tobacco and alcohol consumption, as well as clinical assessments of supragingival plaque, subgingival flora, gingival bleeding, calculus, probing depth, clinical attachment level (CAL), and radiographic alveolar bone loss (ABL) were obtained for each subject. Subjects also completed a set of 5 psychosocial instruments that measured life events, daily strains, hassles and uplifts, distress, and coping behaviors. Internal consistencies of all subscales on the instruments were high, with Cronbach's alpha ranging from 0.88 to 0.99. Logistic regression indicated that financial strain was significantly associated with greater attachment and alveolar bone loss (OR 1.70; 95% CI, 1.09-2.65; and 1.68; 95% CI, 1.20-2.37, respectively) after adjusting for age, gender, and smoking. When those with financial strain were stratified with respect to coping behaviors, it was found that those who exhibited high emotion-focused coping (inadequate coping) had and even higher risk of having more severe attachment loss (OR 2.24; 95% CI, 1.15-4.38) and alveolar bone loss (OR 1.91; 95% CI, 1.15-3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. After further adjusting for number of visits to the dentist, those with financial strain who were high emotion-focused copers still had higher levels of periodontal disease based on CAL (OR 2.12; 95% CI, 1.07-4.18). In contrast, subjects with high levels of financial strain who reported high levels of problem-based coping (good coping) had no more periodontal disease than those with low levels of financial strain. Salivary cortisol levels were higher in a test group exhibiting severe periodontitis, a high level of financial strain, and high emotion-focused coping, as compared to a control group consisting of those with little or no periodontal disease, low financial strain, and low levels of emotion-focused coping (11.04 +/-4.4 vs/ 8.6 +/- 4.1 nmol/L salivary cortisol, respectively). These findings suggest that psychosocial measures of stress associated with financial strain are significant risk indicators for periodontal disease in adults. Further prospective studies are needed to help establish the time course of stress, distress, and inadequate coping on the onset and progression of periodontal disease, as well as to evaluate the mechanisms by which stress exerts its effects on periodontal infections.     

Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning

BACKGROUND: There is evidence that high expressed emotion (EE) in relatives of patients with schizophrenia is associated with higher levels of burden of care, and with worse perception of patient's social functioning. However, it is not clear whether changes in EE levels over time are associated with changes in relatives' burden of care and their perception of patients' social functioning. METHODS: Fifty patients with a diagnosis of schizophrenia and 50 relatives were included in the study soon after patients' admission to hospital. Thirty-six relatives and 31 patients were re-assessed 9 months after patients' discharge. Both assessments included patients' symptomatology and relatives' EE levels, burden of care, and perception of patients' social functioning. RESULTS: Twenty-three relatives (64%) had the same EE level in both assessments, nine (25%) had changed from high to low EE, and four (11%) from low to high EE. Improvement in burden and perception of patients' social role performance were significantly more accentuated among relatives who changed from high to low EE than among relatives who had a stable EE level. Variables that best predicted changes in EE levels were changes in burden scores and number of hours of contact between patients and relatives at follow-up. CONCLUSIONS: Change in EE is associated with change in circumstances and burden. Findings support the idea that EE is better understood in an integrative model.     

Effects of prognostic information on global ratings of psychotherapy outcome.

30 graduate students in clinical psychology (raters) viewed a videotape recording of an interview with a patient after having read 1 of 3 types of posttherapy information about the patient. One group of raters was presented information associated with a good prognosis, one group was presented information associated with a poor prognosis, and the last group received neutral information about the patient. Half of the members of each group were told that the interview was made at the termination of therapy, the other half were told that it was a 1-yr follow-up interview. All raters then completed scales regarding patient's level of adjustment, psychic distress, amount of change, and success of patient's therapy. Only ratings of pre- to posttherapy patient change varied as a function of prognostic information. Results suggest that although poor prognosis patients are perceived as exhibiting more change than good prognosis patients, only final level of functioning determines global judgments of psychotherapy outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions and behavior in functional and dysfunctional marriages

The study examined whether spouses' attributions for partner behavior are related to their own behavior by assessing their attributions and observing the problem-solving discussions of couples in which (a) neither spouse was depressed or maritally distressed, (b) the wife was depressed and both spouses were maritally distressed, and (c) the wife was not depressed and both spouses were maritally distressed. To the extent they made maladaptive attributions, wives displayed less positive behavior and more negative behavior. Husbands' attributions and behavior were unrelated, and associations between attributions and behavior were not moderated by marital distress and depression. These results highlight the need to clarify how partner behavior contributes to the attributions spouses make and to reexamine interventions designed to modify attributions in marital therapy.     

The role of awakening cortisol and psychological distress in diurnal variations in affect: A day reconstruction study.

People often feel unhappy in the morning but better later in the day, and this pattern may be amplified in the distressed. Past work suggests that one function of cortisol is to energize people in the morning. In a study of 174 students, we tested to see whether daily affect patterns, psychological distress, and awakening cortisol levels were interlinked. Affect levels were assessed using the Day Reconstruction Method and psychological distress was measured using the Depression Anxiety Stress Scales. On average, positive affect increased markedly in a linear pattern across the day, whereas negative affect decreased linearly. For the highly distressed, this pattern was stronger for positive affect. Lower than average morning cortisol, as assessed by two saliva samples at waking and two samples 30 min after waking, predicted a clear increasing pattern of positive affect throughout the day. When we examined the interlinkages between affect patterns, distress, and cortisol, our results showed that a pronounced linear increase in positive affect from morning through to evening occurred chiefly among distressed people with below average cortisol levels upon awakening. Psychological distress, although not strongly associated with morning cortisol levels, does appear to interact with cortisol levels to profoundly influence affect. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Expressed emotion and relapse in alcoholic patients

Although family members' expressed emotion (EE) predicts patients' elevated relapse rates in schizophrenia and mood disorders, little is known about the relationship between EE and relapse in alcoholism. For 86 alcoholic patients (78 men, 8 women), the association between the spouse's EE and the alcoholic patient's subsequent relapse status in the 12 months after the couple began an outpatient behavioral marital therapy (BMT) program for alcoholism was examined. Alcoholic patients with high EE spouses, when compared with their counterparts with low EE spouses, were more likely to relapse, had a shorter time to relapse, and drank on a greater percentage of days in the 12 months after starting BMT. EE continued to be associated with relapse after patients' age, education, and alcohol problem severity were taken into account. Greater use of Antabuse and more sessions of BMT were associated with reduced relapse for alcoholic patients with high EE spouses.     

Acute and chronic distress and posstraumatic stress disorder as a function of responsibility for serious motor vehicle accidents.

In this study on the effects of attributions of responsibility for traumatic events, stress, coping, and symptoms of posttraumatic stress disorder (PTSD) were measured, including intrusive thoughts among 130 victims of serious motor vehicle accidents (MVAs) 14-21 days and 3, 6, and 12 months after their accident. MVA victims and 43 control participants were categorized by accident and attribution of responsibility for their accidents (self-responsible, other-responsible, and control). Although initially all MVA victims reported higher levels of intrusive thoughts and were more likely to meet criteria for PTSD diagnoses, only other-responsible participants continued to demonstrate increased distress 6 and 12 months postaccident. Self-responsible participants used more self-blame coping than other-responsible participants, although within the self-responsible group, use of self-blame was associated with more distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Les corrélats des attributions de causalité et de responsabilité des couples qui consultent en thérapie conjugale.

This exploratory study aimed to identify the clinical correlates of partner's attributions in 165 couples beginning couple therapy. Results revealed that marital satisfaction, the interpersonal problem of dominance, and psychological distress were significatively linked to men's attributions. Marital satisfaction, the interpersonal problem of the tendency to self-sacrifice, and women's age were significatively associated with women's attributions. At a dyadic level, only men's marital satisfaction was linked to women's causality attributions. The importance of studying both dyadic and individual correlates of attributions is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroendocrine reactivity, internalizing behavior problems, and control-related cognitions in clinic-referred children and adolescents.

Literature on neuroendocrine-behavior relations suggests that cortisol reactivity to social challenge may be associated with children's internalizing problem behavior. To explore this possibility, and the role of control-related beliefs, 102 7–17 yr-old clinic-referred children were studied. Measures of problem behavior, depression and anxiety, and control-related beliefs were collected, and Ss' saliva was sampled before and after a parent–child conflict task. Neuroendocrine activation (i.e., cortisol increase) in response to the interaction task was associated with Ss' (1) social withdrawal, social anxiety, and social problems; (2) socially inhibited behavior during the task; and (3) low levels of perceived social contingency and high levels of external attributions for personal successes and failures. Our findings are among the first to link children's behavioral response to social challenge, neuroendocrine activation, cognitions, and psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual differences in repressive-defensiveness predict basal salivary cortisol levels.

Prior studies assessing the relation between negative affective traits and cortisol have yielded inconsistent results. Two studies assessed the relation between individual differences in repressive-defensiveness and basal salivary cortisol levels. Experiment I assessed midafternoon salivary cortisol levels in men classified as repressors, high-anxious, or low-anxious. In Experiment 2, more rigorous controls were applied as salivary cortisol levels in women and men were assessed at 3 times of day on 3 separate days. In both studies, as hypothesized, repressors and high-anxious participants demonstrated higher basal cortisol levels than low-anxious participants. These findings suggest that both heightened distress and the inhibition of distress may be independently linked to relative elevations in cortisol. Also discussed is the possible mediational role of individual differences in responsivity to, or mobilization for, uncertainty or change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathy and the self: Cognitive and emotional influences on the evaluation of negative affect in others.

Used E. T. Higgins's (see record 1987-34444-001) self-discrepancy model to examine the relation of the self to empathy. In Study 1, Ss read about a target displaying either dejection or agitation because of a self-discrepancy. Ss who possessed the self-discrepancy associated with the target's distress showed greater empathic concern, made more situational attributions, and rated the target's reaction as more appropriate. In Study 2, Ss matched the target on affective and cognitive components of the self. Similarity between observer and target on emotional vulnerability was associated with both affective and cognitive empathic effects. Although similarity on attribute accessibility was associated with cognitive empathic effects, it was associated with affective effects only when the attribute produced a self-discrepancy for an observer. Then only feelings of personal distress showed differences. Results establish a link between the self and empathy and show that a number of effects grouped under empathy respond differently to different similarities between observers and targets. (PsycINFO Database Record (c) 2010 APA, all rights reserved)