Prediction of Schizophrenic Relapse Using the Parental Bonding Instrument

After admission, 57 schizophrenic patients completed two versions of the Parental Bonding Instrument (PBI) to assess perceived recent and earlier parenting attributes. The parents were also assessed using the Camberwell Family Interview to generate Expressed Emotion (EE) scores. The schizophrenic patients, compared to matched non-clinical controls, reported a significantly greater chance (50% vs 26%) of exposure to “affectionless control” from their father. Nine months later, the subjects were re-Interviewed and their relapse status determined. The PBI measure assessing parenting over the first 16 years had greater utility than the recent parenting version of the PBI. When re-calibrated, only the father's scores on the early parenting PBI scale discriminated “relapsers” and “non-relapsers”. A multivariate analysis suggested that pre-established illness criteria and other family factors were the clearest predictors, and that PBI-defined constructs (as for EE measures) failed to add significantly to the discriminant function. The extent to which EE and PBI scales might measure similar constructs was examined, with only weak links being suggested.

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Attributions of Symptomatology: An Exploration of Family Factors Associated with Expressed Emotion

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679209072063 ◽

1992 ◽

Vol 26 (3) ◽

pp. 408-416 ◽

Cited By ~ 23

Author(s):

Christine A. Harrison ◽

Mark R. Dadds

Keyword(s):

Negative Symptoms ◽

Expressed Emotion ◽

Causal Attributions ◽

Family Factors ◽

Factors Associated ◽

Schizophrenic Patients ◽

Attributional Model

This study explored family factors associated with Expressed Emotion (EE) in families with a member diagnosed with schizophrenia. Drawing on an attributional model of expressed emotion it was predicted that high EE relatives would have less knowledge of the illness and would attribute negative symptoms to the personality, rather than the illness, of the sufferer. Thirty-one caregivers of schizophrenic patients were interviewed. Results indicated that EE status was related to knowledge, coping and causal attributions of negative symptoms. Low EEs, as compared with High EEs, tended to have more knowledge of the illness and to cope better with the patient, and were less likely to attribute the cause of negative symptoms to the sufferer's personality. Support was therefore obtained for the utility of an attributional model in attempting to understand the determinants of levels of EE.

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Inter-rater reliability of expressed emotion ratings based on the Camberwell Family Interview

Psychological Medicine ◽

10.1017/s0033291700037843 ◽

1996 ◽

Vol 26 (4) ◽

pp. 821-828 ◽

Cited By ~ 8

Author(s):

H. Bentsen ◽

B. Boye ◽

O. G. Munkvold ◽

G. Uren ◽

A. B. Lersbryggen ◽

...

Keyword(s):

Predictive Power ◽

Expressed Emotion ◽

Rater Reliability ◽

Group Of Seven ◽

Schizophrenic Patients ◽

Family Interview ◽

Good For ◽

Level Scale

SynopsisHigh expressed emotion in relatives has been shown to predict a poorer outcome in a range of disorders and cultures. However, variation in predictive power is considerable, and this could partly be due to low inter-rater reliability. Sixty-nine relatives of 47 acutely admitted schizophrenic patients were interviewed using the Camberwell Family Interview. Audiotapes were assessed by pairs of raters drawn from a group of seven approved raters. Inter-rater reliability was good for criticism, hostility, emotional over-involvement (as a six level scale) and expressed emotion index (EOI cut-off score 2–3); and it was fair, but unsatisfactory, for emotional over-involvement (binary scales), warmth, positive remarks and expressed emotion (EOI cut-off score 3–4). These findings suggest that the warmth scale and the dichotomized versions of the EOI scale should be used with caution. The influence of warmth on the outcome in schizophrenia may have been underestimated because of low reliability.

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Further results on the reliability of the Parental Bonding Instrument (PBI) in an Italian sample of schizophrenic patients and their parents

Journal of Clinical Psychology ◽

10.1002/1097-4679(200101)57:1<119::aid-jclp12>3.0.co;2-2 ◽

2000 ◽

Vol 57 (1) ◽

pp. 119-129 ◽

Cited By ~ 14

Author(s):

Ettore Favaretto ◽

Stefano Torresani ◽

Christa Zimmermann

Keyword(s):

Parental Bonding ◽

Parental Bonding Instrument ◽

Schizophrenic Patients ◽

Italian Sample

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Psychiatrists' Ratings of Expressed Emotion

The Canadian Journal of Psychiatry ◽

10.1177/070674379403900802 ◽

1994 ◽

Vol 39 (8) ◽

pp. 358-360 ◽

Cited By ~ 5

Author(s):

Suzanne King ◽

Alain D. Lesage ◽

Pierre Lalonde

Keyword(s):

Expressed Emotion ◽

Formal Training ◽

Agreement Rate ◽

Schizophrenic Patients ◽

Family Interview ◽

Better Than

The purpose of this study was to determine the extent to which psychiatrists are familiar with the concept of expressed emotion and to determine the extent of its use in their day-to-day practices. We also wished to test the ability of psychiatrists to estimate the expressed emotion status of the relatives of their patients. Following the assessment of expressed emotion in 96 relatives using the Camberwell Family Interview, the psychiatrists treating the schizophrenic patients were surveyed about their knowledge of expressed emotion and were asked to estimate the expressed emotion of their relatives. Thirty-five percent of the respondents use the expressed emotion concept daily in their practice. When the Camberwell Family Interview ratings of expressed emotion were compared with those from the psychiatrists, the agreement rate was no better than chance (45.7%). Without formal training in the use of the Camberwell Family Interview, practitioners are cautioned against ascribing an expressed emotion status to the relatives of their patients.

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Longitudinal Study of the Stability of Expressed Emotion in Families of Schizophrenic Patients: A 9-Month Follow-Up

The Spanish Journal of Psychology ◽

10.1017/s1138741600005667 ◽

2001 ◽

Vol 4 (1) ◽

pp. 65-71 ◽

Cited By ~ 8

Author(s):

Asunción Santos ◽

Alberto Espina ◽

Begoña Pumar ◽

Pilar González ◽

Ana Ayerbe ◽

...

Keyword(s):

Longitudinal Study ◽

Expressed Emotion ◽

The Other ◽

Family Interventions ◽

Attitude Stability ◽

Other Hand ◽

Schizophrenic Patients ◽

Family Interview ◽

The Stability

The goal of this paper is to study attitude stability in schizophrenics' relatives, as reflected in the expressed emotion (EE) construct. For this purpose, the EE of 32 families of schizophrenic patients was assessed by means of the Camberwell Family Interview (CFI, Brown, Birley, & Wing, 1972; Vaughn & Leff, 1976b), both initially and at a 9-month follow-up. The results obtained indicate that EE is stable in fathers, whereas in mothers, high EE seems to be influenced by stressful situations, because, when assessed in crisis, EE was not stable, but in-between crises, it was. These results are discussed, as well as their relevance in family interventions aimed at reducing EE, where clinicians should take into account that mothers' EE may drop because of its instability, and not because of the intervention. On the other hand, clinicians should focus especially on fathers, because their high EE is constant, which is stressful to the patient during the follow-up.

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Incarcerated Adolescents' Distress and Suicidality in Relation to Parental Bonding Styles

Crisis ◽

10.1027//0227-5910.20.4.164 ◽

1999 ◽

Vol 20 (4) ◽

pp. 164-170 ◽

Cited By ~ 12

Author(s):

Elizabeth L McGarvey ◽

Ludmila A Kryzhanovskaya ◽

Cheryl Koopman ◽

Dennis Waite ◽

Randolph J Canterbury

Keyword(s):

At Risk ◽

Attachment Theory ◽

Suicidal Behavior ◽

Parental Bonding ◽

Psychosocial Problems ◽

Self Esteem ◽

Suicidal Thoughts ◽

Parental Bonding Instrument ◽

Significant Relationships ◽

Incarcerated Adolescents

This study examines the relationships between the bonding style of an incarcerated adolescent with parents and his/her current feelings of self-esteem, hopelessness, and suicidal thoughts and attempts. It also investigates differences between bonding to mother and bonding to father. Some 296 incarcerated adolescents were interviewed using the Parental Bonding Instrument. Significant relationships were found between youths' self-esteem, hopelessness, and suicidal behavior and their bonding style. Youths whose parent(s) had a parental bonding style of affectionless control reported the greatest distress, and youths whose parent(s) had an optimal bonding style reported the least distress. Differences were found between bonding styles with the mother and with the father. Attachment theory may be useful in targeting incarcerated youths who have affectionless control bonding with parent(s) for special interventions since these youths are most at risk for psychosocial problems.

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Expressed Emotion in the Client-Professional Dyad

European Journal of Psychological Assessment ◽

10.1027/1015-5759.20.4.237 ◽

2004 ◽

Vol 20 (4) ◽

pp. 237-246 ◽

Cited By ~ 7

Author(s):

G. Van Humbeeck ◽

Ch. Van Audenhove ◽

G. Storms ◽

M. De Hert ◽

G. Pieters ◽

...

Keyword(s):

Therapeutic Relationship ◽

Correlation Matrix ◽

Concurrent Validity ◽

Positive Relationship ◽

Expressed Emotion ◽

Family Interview ◽

Insufficient Time ◽

Perceived Criticism

Summary: Background: This article reports on a study of the concurrent validity between the standard expressed emotion instrument, the Camberwell Family Interview (CFI), and two alternative EE measures, the Level of Expressed Emotion (LEE) and the Perceived Criticism Scale (PCS). Methods: The research sample consisted of 56 schizophrenic clients, who were residing in sheltered residences, and 56 professionals. Results: Based on the results of the correlation matrix between all the subscales of the instruments, a significantly positive relationship was found between the criticism scale of the CFI, the total score of the LEE, and the client version of the PCS. These correlations, however, were rather weak, which implies that the three instruments have little in common with each other. The professionals' version of the PCS does not appear to be an EE instrument. Conclusions: The results suggest that the CFI still remains the best instrument for assessing EE in a therapeutic relationship (between a professional and a client). If there is insufficient time to administer the CFI, then the client version of the PCS and the LEE can be used with the qualification that the PCS and LEE also measure other aspects and thus cannot completely replace the CFI. Nevertheless, the research indicates that asking the clients would seem to provide a better indication of the level of the professionals' criticism rather than asking the professionals themselves directly.

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Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.171.1.26 ◽

1997 ◽

Vol 171 (1) ◽

pp. 26-30 ◽

Cited By ~ 92

Author(s):

Christine Barrowclough ◽

Michael Parle

Keyword(s):

Expressed Emotion ◽

Symptom Control ◽

Well Being ◽

Primary Appraisal ◽

Coping Theory ◽

Secondary Appraisal ◽

Multivariate Relationships ◽

Schizophrenic Patients ◽

A Prospective Study ◽

Appraisal Processes

BackgroundIt is argued that coping theory may be useful in attempting to understand how relatives adapt to the demands of living with a schizophrenia sufferer.MethodIn a prospective study, univariate and multivariate relationships were explored between appraisal variables (appraisal of symptom threat (primary appraisal) and perceived symptom control (secondary appraisal)) and (a) expressed emotion, and (b) psychological distress in relatives of schizophrenic patients. The profile of relatives who showed sustained distress over time was also examined.ResultsThe appraisal variables were found to be related to both the concurrent distress (GHQ scores), EE ratings of relatives at the time of the patients relapse and hospitalisation, as well as the subsequent GHQ scores of relatives when the patient was discharged back home. Relatives who showed sustained distress were likely to show high EE and have a longer caring history.ConclusionsThe study gives some support to the theory that appraisal processes underlie how relatives react to having a family member with schizophrenia, and may have implications both for identifying those at risk of poor adaptation, and for understanding strategies that improve well-being.

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