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

Abstract

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.

Possible Application of Ecological Momentary Assessment to Older Adults’ Daily Depressive Mood: Integrative Literature Review

“…All 38 studies applied a longitudinal design to observe depressive mood throughout EMA from several days to months to emphasize the benefit of multiple-timescale aspects of the study design. Most of the analyzed studies (18/38, 47%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design [ 6 , 9 , 10 , 15 , 18 - 20 , 22 , 24 , 25 , 28 , 32 , 33 , 36 , 39 - 42 ]. Approximately half of the studies used EMA primarily to assess depressive mood over time.…”

“…The sample size of surveyed studies ranged from 12 to 404, which varied according to study purpose, data collection method, and analysis plans. Some studies specifically aimed to enroll study participants with depressive mood and relevant mental health problems (7/38, 18%) [ 7 , 9 , 13 , 17 , 23 , 24 , 34 ], other physical health problems or diseases (8/38, 21%) [ 6 , 29 , 31 , 36 , 40 , 43 - 45 ], or chronic pain (2/38, 5%) [ 16 , 25 ], which may be related to depressive mood. Some studies aimed to enroll study participants who had an alcohol or smoking habit (4/38, 11%) [ 22 , 28 , 33 , 46 ] or obesity (2/38, 5%) [ 19 , 20 ].…”

“…Most studies (22/38, 58%) examined depressive mood at baseline using a diverse array of clinically valid screening instruments or established diagnostic criteria. Several screening or diagnostic instruments were used: the Mini International Neuropsychiatric Interview [ 13 , 22 , 50 ]; Hamilton Rating Scale for Depression [ 13 , 29 , 51 ]; Beck Depression Inventory [ 7 , 13 , 48 , 52 , 53 ]; Patient Health Questionnaire (PHQ) [ 39 , 54 ]; Composite International Diagnostic Interview [ 40 , 55 ]; Montgomery-Asberg Depression Rating Scale [ 9 , 56 ]; Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) [ 7 , 17 , 23 , 34 , 57 , 58 ]; Structured Clinical Interview for the DSM-IV-Text Revision [ 10 , 25 , 59 ]; Patient-Reported Outcomes Measurement Information System (PROMIS) [ 34 , 60 ]; Center for Epidemiologic Studies Depression Scale (CES-D) [ 15 , 30 , 36 , 47 , 61 ]; Positive and Negative Affect Schedule (PANAS) [ 49 , 62 ]; Positive and Negative Syndrome Scale [ 24 , 63 ]; Hospital Anxiety and Depression Scale [ 16 , 43 , 64 , 65 ]; and Hamilton Depression Inventory [ 31 , 66 ]. The researchers of each study used this information to describe sample characteristics at baseline or included the data as a controlled variable in their analyses.…”

“…Most studies included variables relating to momentary experiences, activities, or behaviors occurring before or at the time of report [ 6 , 9 , 13 , 16 , 17 , 21 , 23 - 32 , 39 - 44 , 47 , 48 ]. Some studies also included concurrent symptoms of depression such as fatigue [ 6 , 29 , 36 , 42 , 45 ], pain [ 6 , 16 , 25 , 31 , 36 , 40 , 43 , 45 , 48 , 49 ], stress [ 9 , 10 , 18 - 22 , 26 , 28 , 29 , 32 , 33 , 41 , 42 , 44 , 46 ], anxiety [ 7 , 9 , 10 , 13 , 14 , 16 , 17 , 21 , 24 - 26 , 34 , 39 - 43 , 45 , 47 ], loneliness [ 14 , 20 , 23 , 24 , 27 , 31 , 42 , 46 , 47 ], or cognitive impairment [ 7 ...…”

“…When employing EMA, most studies did not clearly define “momentary mood of depression,” and there was no consistency of operational definition across the 38 selected studies. Moreover, the depressive score was defined in diverse terms, such as depressive or negative mood and affect [ 6 , 7 , 9 , 10 , 13 - 29 , 31 - 34 , 36 , 39 - 48 ], sadness [ 9 , 15 , 17 - 22 , 24 - 30 , 32 , 33 , 36 , 39 , 42 , 44 , 46 , 48 , 49 ], feeling down [ 13 , 14 , 23 , 47 ], or relevant symptoms of depression [ 6 , 29 , 31 , 34 , 45 ]. In some studies, depression was included as a set of subitems of global affect or mood [ 7 , 9 , 10 , 13 , 16 , 21 , 26 , 36 , 39 - 44 ], whereas other studies treated depressive scores separately from other measurements that might have been taken [ 6 , 30 , 31 , 34 , 45 ].…”