Expressed emotion as an adaptation to loss

Patterson, Paul; Birchwood, Max; Cochrane, Raymond

doi:10.1192/bjp.187.48.s59

Cited by 86 publications

(35 citation statements)

References 43 publications

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“…The failure to identify significant reductions in levels of EOI may, in part, reflect the complexity of the concept (and measurement) of EOI and difficulties identified within the literature of distinguishing from behaviors and attitudes that can be understood as being caring (van Os et al, 2001; Singh et al, 2013). Early psychosis is characterized by high levels of carer and patient distress and fluctuating symptoms, which may contribute to EE being particularly unstable, changing over time or in relation to stressors rather than intervention (Patterson et al, 2005). Symptom severity or duration were not typically controlled for across the studies, thus limiting the conclusions that can be made in this regard.…”

Section: Discussionmentioning

confidence: 99%

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

2017

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Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.

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Section: Discussionmentioning

confidence: 99%

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

2017

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“…Investigations into the experience of caring for a relative have revealed that throughout the early stages of psychosis, family members have a significant involvement in a young person’s life; 80–90% of young FEP service consumers reside in the family home [9]. The commencement of acute-phase treatment for psychosis is often overwhelming for families and has been compared to bereavement [10]. During this period family members face the risk of exposure to traumas, such as violence perpetrated by the young person [11, 12], and families worry frequently about behavioural changes [13].…”

Section: Introductionmentioning

confidence: 99%

Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial

Gleeson

Lederman

Herrman

et al. 2017

Trials

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BackgroundFirst-episode psychosis most often has its onset during late adolescence. In caring for the young person, families endure high levels of stress and depression. Meanwhile, the social networks of families often erode. Our group has previously shown that family cognitive behaviour therapy (CBT) leads to significantly improved perceived stress compared with specialist first-episode treatment as usual; however, there are well-known barriers to the dissemination of effective family interventions. To address this, we have developed a novel online intervention entitled ‘Altitudes’ that fully integrates purpose-built online social networking, expert and peer moderation, and evidence-based psychoeducation within a single application. The primary aim of this trial is to evaluate the effectiveness of Altitudes in reducing stress in carers over a 6-month period.Methods/designWe describe here a single-blinded cluster randomised controlled trial (cRCT) with permutated blocks. The clusters comprise individual families. The two treatment conditions include Altitudes plus Specialist Treatment as Usual (STAU) and STAU alone. Altitudes involves participation in our novel online programme whereas STAU comprises specialist family work at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. We aim to recruit 160 family members of young, 15–27 year-old, patients registered for treatment for first-episode psychosis (FEP) at EPPIC. The design includes two assessment time points, namely, baseline and 6-month follow-up. The study is due for completion within 2 years including an 18-month recruitment period and a 6-month treatment phase. The primary outcome is carers’ perceived stress at 6 months. Secondary outcome measures include a biomarker of stress, depressive symptoms, worry, substance use, loneliness, social support, satisfaction with life, and a range of measures that tap into coping resources. We seek to gain a dynamic picture of carer stress through our Smartphone Ecological Momentary Assessment (SEMA) tool.DiscussionThis is the first randomised controlled trial designed to evaluate an online intervention for carers of young people recovering from FEP. It has the potential to produce evidence in support of a highly novel, accessible, and cost-effective intervention to reduce stress in carers who are providing support to young people at a critical phase in their recovery from psychosis.Trial registrationAustralian New Zealand Clinical Trial Registry, identifier: ACTRN12616000968471. Retrospectively registered on 22 July 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1775-5) contains supplementary material, which is available to authorized users.

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“…Unfortunately, many carers are negatively affected by their roles, and often report experiencing high levels of ‘burden’ and distress . This is particularly the case in the first episode of psychosis .…”

Section: Introductionmentioning

confidence: 99%

Distress and negative experiences of the caregiving relationship in early psychosis: does social cognition play a role?

Tomlinson

Onwumere

Kuipers

2013

Early Intervention Psych

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Even in the early stages of psychosis, both patients and carers were reporting negative experiences of the caregiving relationship. These were related to higher levels of anxiety and depression. Social cognition difficulties were found in both early psychosis patients and first-degree relatives, but did not relate to caregiving relationships. The findings underscore the importance of providing targeted family interventions to individuals with early psychosis and their carers that address appraisals of the relationship and low mood.

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Expressed emotion as an adaptation to loss

Abstract: The results are consistent with Bowlby's attachment theory, where EOI and coercive criticism may be understood as adaptive reactions to perceived loss. Implications for family intervention in first-episode psychosis and the prevention of high EE are discussed.

Cited by 86 publications

References 43 publications

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial

Distress and negative experiences of the caregiving relationship in early psychosis: does social cognition play a role?

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