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Expressed emotion, types of behavioural control and controllability attributions in relatives of people with recent-onset psychosis

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Abstract

Purpose

High expressed emotion (high-EE), as compared with low-EE, relatives of patients with long-term psychosis may behave in a more controlling manner towards patients. Furthermore, higher levels of behavioural control have been associated with higher relapse rates. We investigated in a recent-onset sample, the extent to which high-EE relatives engage in controlling behaviours and attribute the patient’s illness to factors within patient’s control. Furthermore, we examined whether criticism/hostility and emotional overinvolvement (EOI) were, respectively, associated with two types of behavioural control (termed ‘direct influencing’ and ‘buffering’). We also investigated if controlling behaviours or attributions were better relapse predictors than EE.

Method

Measures of EE, controllability attributions and behavioural control and its subtypes (‘direct influencing’ and ‘buffering’) were derived from Camberwell Family Interviews with 80 relatives of recent-onset psychosis patients. ‘Direct influencing’ attempts denote any behaviour intending to coerce the patient; while ‘buffering’ attempts refer to any behaviour aiming to take control or do things for the patient.

Results

High-EE relatives perceived patients as having more control over their illness and were more inclined to attempt to control patients’ behaviour than low-EE relatives. Furthermore, high-EE-critical relatives used more direct influencing attempts, and high-EE–EOI relatives used more buffering attempts, but behavioural control was not associated with relapse in this recent-onset sample.

Conclusions

These findings may help us to understand the development of EE in recent-onset psychosis families. Acknowledging and integrating relatives’ attributional and behavioural patterns in designing and delivering clinical and familial early interventions should prove beneficial in meeting the needs of this specific population.

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Acknowledgments

We wish to thank Prof. Hooley for kindly providing the supporting materials from the Hooley and Campbell [13] study, including the guidelines for rating behavioural control; as well as Dr. Weisman for making available the attributions manual. In addition we would like to thank Katie Chow for rating controllability attributions, Amy Degnan for acting as an interrater for behavioural control and Dr. Katherine Berry for her input during this process. We also would like to acknowledge the RAP research team, particularly Dr. Gary Lee for providing the EE and relapse data and Sophie Jeffery. We are very grateful for the statistical advice provided by Julie Morris. The present study was funded and supported by a doctoral grant from the Fundação para a Ciência e Tecnologia (FCT), Portugal (SFRH/BD/37569/2007). The RAP research work was financed with a UK grant from Merseyside Mental Health NHS Trust. None of the above mentioned funding sources had any further contribution to the collection, analysis and interpretation of the data; in the writing of the manuscript and the submission for publication.

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All authors have declared that they have no conflicts of interest.

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Correspondence to Debora Vasconcelos e Sa.

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Vasconcelos e Sa, D., Wearden, A. & Barrowclough, C. Expressed emotion, types of behavioural control and controllability attributions in relatives of people with recent-onset psychosis. Soc Psychiatry Psychiatr Epidemiol 48, 1377–1388 (2013). https://doi.org/10.1007/s00127-013-0659-1

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