Psychological explanations; Expressed Emotion

Question 1

History

Answer 1

• 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

Question 2

Brown (1972)

Answer 2

• Brown identified 3 factors that were god predictors of relapse called expressed emotion (EE)
• High EE = more likely to relapse

Question 3

The three elements of EE:

Answer 3

• Hostility
• Critical comments
• Emotional over-involvement

Question 4

Measurement of EE

Answer 4

• EE can be measured using an interview of observation

- The Camberwell Family Interview is the main measurement tool used to assess EE

Question 5

Models of EE

Answer 5

• 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

Question 6

Introduction of EE

Answer 6

• 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.

Question 7

Hostility

Answer 7

-Is is negative attitude directed at the patient because the family feels that the disorder is controllable; blamed on patient.

Question 8

Critical comments

Answer 8

-The relative feels that the patient is wholly or at least partly responsible for their disorder.

Question 9

Emotional over-involvement

Answer 9

-When a family member blames themselves for the disorder; the pity from the relative causes too much stress and then relapse.

Question 10

The Camberwell family interview

Answer 10

• 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

Question 11

Why might the three factors lead to relapse being more likely?

Answer 11

-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.

Question 12

Difficulties in measuring EE

Answer 12

• 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

Question 13

Types of research

Answer 13

• Survey studies
• Treatment studies (study of therapy)
• Prospective studies

Question 14

Survey studies

Answer 14

• 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.

Question 15

Weakness with survey study

Answer 15

-A key problem with Survey studies is that it is correlational data and therefore lacks a causal relationship between EE and schizophrenia.

Question 16

Study of therapy + prospective

Answer 16

The findings of these two types of studies contrast with each other, as they give opposite causal relationships for EE and schizophrenia.

Question 17

Study of therapy (Vaughn & Leff)

Answer 17

-Supported by Vaughn & Leff as they found a 51% relapse rate with households with high EE, and a 16% relapse rate with households with low EE. Supports the theory that high EE within a family dynamic can worsen schizophrenia and subsequently increase the risk of relapse

Question 18

Study of therapy (Meta-analysis, Butzlaff et al.)

Answer 18

• Examined the results of 27 relapse studies.

- They found that EE is a significant and robust predictor of causing relapse in schizophrenia

Question 19

Butzlaff weakness

Answer 19

• The results were primarily showing EE causing relapse with over mental disorders such as eating disorders and mood disorders.
• This could mean that there was a very low portion of schizophrenic participants in the study.
• Additionally the study was retrospective meaning that it lacks validity, as the psychologists are not able to determine the order of events and subsequently the causality of EE and the onset of schizophrenia.

Question 20

Prospective (King)

Answer 20

• The results of the study showed that the more severe and hostile the patients were, the more critical the mothers became over time, suggesting that schizophrenia can cause the onset of EE within a family dynamic.
• Although one issue with this study is that is only involved 28 participants and therefore could lack generalisability.

Question 21

Study of therapies + Prospective =

Answer 21

These findings of the studies seem to contradict each other with the causal relationship between schizophrenia and EE. This can therefore lead the psychologists to say that perhaps each conclusion is valid and therefore this is a bi-directional relationship.

Question 22

Issues with studies of the therapies

Answer 22

• Pharoah et al’s Cochrane review, found than family interventions had lower relapse rates, reduce hospital admissions and increased compliance with medication
• Evidence from therapies is only indirect; might work without the theory behind it being true
• Methodological issues with original trials; lack of random allocation, could lead to bias correlations, e.g. less severe symptoms in therapy groups and high in non-therapy groups.