Psychological explanations; Expressed Emotion Flashcards
History
- In the 1970s theories of the role of the family in schizophrenia were largely rejected
- However it still appeared that some patients did better than others in relation to how their family treated them
- Relapse rats seemed higher in certain types of families
Brown (1972)
- Brown identified 3 factors that were god predictors of relapse called expressed emotion (EE)
- High EE = more likely to relapse
The three elements of EE:
- Hostility
- Critical comments
- Emotional over-involvement
Measurement of EE
- EE can be measured using an interview of observation
- The Camberwell Family Interview is the main measurement tool used to assess EE
Models of EE
- EE can be seen as a stressor in the diathesis-stress model, e.i. those at genetic risk will be affected
- EE can be seen as one possible contributors to dopamine dysfunction within the ‘final common pathway’ version of the dopamine hypothesis
Introduction of EE
- EE is a qualitative measure of the ‘amount’ of emotion displayed within the family dynamic
- It is thought that a high level of EE in the home can worsen the prognosis or act as a potential risk factor for the development of S.
Hostility
-Is is negative attitude directed at the patient because the family feels that the disorder is controllable; blamed on patient.
Critical comments
-The relative feels that the patient is wholly or at least partly responsible for their disorder.
Emotional over-involvement
-When a family member blames themselves for the disorder; the pity from the relative causes too much stress and then relapse.
The Camberwell family interview
- Conducted with the key carers of the patient; the interviewer tries to create a picture of the events and attitude in the household in the months leading up to the onset schizophrenia.
- Objective info: events and circumstances
- Subjective info: relatives feelings + attitudes
Why might the three factors lead to relapse being more likely?
-Because the patient may begin to believe the comments and so become extremely upset and distressed. Also the frequency of the comments and attitudes may cause the patient to become very stressed.
Difficulties in measuring EE
- Very objective thing to measure; each family may interpret questions and situations differently
- Social desirability; family members are unlikely to admit to being cruel to a person with schizophrenia
Types of research
- Survey studies
- Treatment studies (study of therapy)
- Prospective studies
Survey studies
- This has been supported by two meta-analyses, which found a close relationship between levels of EE and relapse rates in those returned to the family home.
- It has showed that relapse rates are twice as high in homes where EE is high than those where EE is low.
Weakness with survey study
-A key problem with Survey studies is that it is correlational data and therefore lacks a causal relationship between EE and schizophrenia.