Expressed emotion and anorexia nervosa: The validation of the five‐minute speech sample in reference to the Camberwell family interview

Rein, Zoé; Perdereau, Fabienne; Curt, Florence; Jeammet, Philippe; Fermanian, Jacques; Godart, Nathalie

doi:10.1002/eat.20245

Cited by 22 publications

(17 citation statements)

References 17 publications

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“…For nonpsychiatric populations, the mean state anger score for females age 30 and over is 17.50 (SD=4.52) and for males is 18.43 (SD=5.63) (Spielberger, 1988). The majority of families expressed no criticisms at baseline, which is consistent with other studies (Rein et al, 2006). The number of criticisms was not related to the number of hours spent with the relative (r=.32, p>.10).…”

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confidence: 87%

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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confidence: 87%

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

Eisner

Johnson

2008

Behavior Therapy

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“…Respondents are classifi ed as high EE if they are rated as being high in criticism and/or EOI, and family EE is rated on the basis of the highest score from both parents. Overall FMSS-EE ratings have shown signifi cant agreement with the CFI in adult samples (Halford, 1991;Leeb et al, 1991;Maga ñ a et al, 1986;Moore & Kuipers, 1999), as well as in studies with children (Calam & Peters, 2006) and adolescents (Rein et al, 2006). …”

Section: Expressed Emotion: Defi Nition and Measurementmentioning

confidence: 94%

Family environment, expressed emotion and adolescent self-harm: A review of conceptual, empirical, cross-cultural and clinical perspectives

Michelson

Bhugra

2012

International Review of Psychiatry

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Self-harm in young people is a complex and pervasive problem with a number of co-existing risk factors. Although research has implicated a range of family variables in understanding the onset, maintenance and prevention of adolescent self-harm, relatively little attention has been given to the expressed emotion (EE) construct. Based on a narrative review and synthesis of peer-reviewed literature up to and including 2011, this paper considers the conceptual background and empirical evidence for the role of family environment in the expression of adolescent self-harm, with a particular focus on EE. The clinical implications of this literature for working with young people and families from different cultures are also addressed. In summary, the surveyed research provides insuffi cient evidence for a direct causal link between family environment and adolescent self-harm, with questions raised about the temporal sequencing of measured variables, specifi city of implicated family risk factors, and the nature and role of protective factors in families. Emerging evidence for an association between high EE and adolescent self-harm requires replication in well-controlled, prospective studies. There is also a lack of empirically-supported, family-based treatment modalities for adolescents who self-harm. Intervention strategies should be guided by personalised formulation, taking into account individual vulnerabilities, strengths and social contexts, as well as cultural norms for family environment.

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“…Dropout is however problematic, since a higher EE level is associated with greater probability of dropout (see Results; [31,[34][35][36][37] [27] used the same cohort as Le Grange et al [37] and Le Grange et al [38]; Hodes et al [39] the same as Eisler et al [40] and Eisler et al [41]; Hoste et al [25] the same as Le Grange et al [35] and Duclos et al 1 the same as Rein et al [42] and Rein et al [43]. In BN, Perkins et al [36] used the same cohort as Winn et al [44] and in ED, Van Furth et al [32] the same as Van Furth et al [45]; Kyariacou et al [46] and Sepulveda et al [47] used the same baseline.…”

Section: Inclusion Criteria (Table 1 Column 4)mentioning

confidence: 99%

Expressed Emotion in Families of Patients with Eating Disorders: A Review of the Literature

Duclos

Vibert²,

Mattar³

et al. 2012

CPSR

Self Cite

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Expressed emotion and anorexia nervosa: The validation of the five‐minute speech sample in reference to the Camberwell family interview

Abstract: The FMSS can reliably measure EE in reference to the CFI in terms of Final EE and EOI EE. For the Critical EE subgroup, further investigation is needed with a bigger sample size.

Cited by 22 publications

References 17 publications

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

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

Family environment, expressed emotion and adolescent self-harm: A review of conceptual, empirical, cross-cultural and clinical perspectives

Expressed Emotion in Families of Patients with Eating Disorders: A Review of the Literature

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