George Brown in 1956 introduced the concept of expressed emotions, wherein he observed that the patients of schizophrenia after being successfully treated and discharged, in certain cases showed relapse.
Expressed emotion (EE), is a qualitative measure of the 'amount' of emotion displayed towards a psychiatric patient, typically in the family setting, usually by a family member or caretakers. It refers to affective attitudes & behavior of relatives towards a family member with psychiatric illness.
Brown proposed 5 components of expressed emotions:
1. Critical comments: As observed the patients who had caregivers who passed critical/angry comments towards them consisted of almost 70% on negative symptoms of schizophrenia and further led to physical violence which caused high expressed emotions leading to relapse in patients under such circumstances.
2. Hostility: It refers to a negative attitude directed at the patient because the family feels that the disorder is controllable and that the patient is choosing not to get better. Problems in the family are often blamed on the patient and the patient has trouble problem-solving in the family. The family believes that the cause of many of the family’s problems is the patient’s mental illness, whether they are or not
3. Emotional Over-involvement: It is said to occur when the family members blame themselves for the mental illness. These family members feel that any negative occurrence is their fault and not the disorders and hence shows a lot of concern for the patient and the disorder. This is the opposite of a hostile attitude and a show that the family member is open-minded about the illness, but still has the same negative effect on the patient. The pity from the relative causes too much stress and the patient relapses to cope with the pity.
4. Positive remarks: Positive regard comprises statements that express appreciation or support for the patient's behavior and verbal/nonverbal reinforcement by the caregiver and hence seen to have a positive impact on the recovery of the schizophrenic patient.
5. Warmth: It is assessed based on kindness, concern, and empathy expressed by the caregiver while talking about the patient. It depends greatly on vocal qualities with smiling being a common accompaniment, which often conveys an empathetic attitude by the relative. Warmth is a significant characteristic of the low expressed emotion family and hence having better recovery for the patients.
There are many psychometric assessments to measure EE one of them is CFI. Camberwell Family Interview (CFI) was developed by Rutter & Brown in 1966. It is a semi-structured interview to measure family characteristics. The CFI scale consists of 5 scales to measure. Critical comments, hostility & emotional over-involvement have been found to predict relapse, whereas warmth & positive are known to protect relapse.
Criticism
Over involvement
Warmth
Positive remark
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