Criticism in the Parkinson’s Caregiving Relationship: A Key Target for Intervention

Introduction: Caregiver distress is prevalent in Parkinson’s disease (PD) and predictive of negative health outcomes for both people with PD and caregivers. To identify future intervention targets, it is important to better elucidate the specific processes, such as criticism, that perpetuate burden. Objective: Evaluate the frequency and impact of criticism and reactivity to criticism in PD caregiving dyads. Methods: Eighty-three people with PD and their caregivers independently completed measures of criticism and physical and emotional health. Results: Criticism in the caregiving relationship was reported by 71.1% (n = 59) of people with PD and 80.7% (n = 67) of caregivers. Both perceived criticism and emotional reactivity to criticism were significant predictors of caregiver distress, adjusting for PD motor and non-motor symptom severity. In contrast, criticism was not related to PD depression. Conclusion: Criticism in the PD caregiving relationship is a clear target for psychotherapeutic intervention and may improve caregiver health and quality of life.

Exposure to Criticism Modulates Left but Not Right Amygdala Functional Connectivity in Healthy Adolescents: Individual Influences of Perceived and Self-Criticism

Background: Frequent exposure to criticism is a known risk factor for various adult psychiatric disorders. Adolescents may be even more vulnerable to (parental) criticism, as their imbalanced brain maturation makes them prone to stronger mood changes and less effective emotional regulation. Identifying which adolescent subgroups are more vulnerable than others could be of great clinical relevance. Perceived criticism (PC) and self-criticism (SC), two related but distinct traits, could well be crucial vulnerability factors.Hypotheses: After exposure to criticism during fMRI scanning, rapid changes in amygdalar functional connectivity (FC) with other brain areas involved in emotion regulation and social cognitive processing will occur. These changes will depend on trait moderators, such as the adolescents' proneness to (a) perceive others as critical of them (PC) or (b) perceive themselves positively or negatively (SC).Methods: Sixty-four healthy 14–17-year-olds were exposed to a series of auditory comments. Changes in mood states were assessed based on the Profile of Mood States (POMS) prior to and after exposure to these segments. Pre- and post-experiment FC of the left and right amygdalae with other brain areas were also measured. Correlates between FC changes and psychometric measures—including the perceived criticism measure (PCM) and self-perception profile for adolescents (SPPA)—were assessed.Results: First, after being criticized, FC increases of the left amygdala seed region with brain areas related to sustained emotional processing were found, but no right amygdalar FC changes. Second, there was a significant positive partial correlation between individual PCM scores and FC changes between the left amygdala seed region and the left precuneus and left superior parietal cortex, both part of the default mode network.Conclusion: Exposure to criticism resulted in a rapid negative mood change accompanied by an increase in FC between the left amygdala and regions known to be involved in sustained emotional processing, but no right amygdalar FC changes. Furthermore, higher PC but not SC was correlated with stronger left amygdalar FC increases with these regions, suggesting an elevated vulnerability for disturbed emotional processing, as observed in mood disorders, in healthy adolescents with higher PCM scores.

The relationship between DBT network training and perceived criticism: a pre-post study

Background: Emotional and behavioural dysregulation in patients with Borderline Personality Disorder (BPD), such as repeated non-suicidal self-injury, are strongly affecting patients’ family members or partners. In addition, critical disapproval of this emotional and behavioural phenomena by family members and reconciling understanding, affects the patients’ sensitivity for rejection. As a result, scientific findings endorse that individuals with BPD appear to experience less satisfying social support and a stronger feeling of loneliness. This negative spiral possibly elicits further challenging behaviour. Therapy programs for BPD might therefore benefit from the inclusion of family members or partners in the treatment. One of the programs that includes family members is the network training of Dialectical Behavior Therapy (DBT). This study examines the impact of the DBT network training on the perceived criticism of both patients and network members.Method: This study follows a pre-post design where a DBT network training is given to 33 patients (mean age 25 years) and 61 relatives during 8 group sessions. The degree of perceived criticism is measured by using a self-report questionnaire.Results: Results show that the overall scores of the perceived criticism scale decrease significantly for both patients and relatives after following the DBT network training. More specific, item scores of both patients and relatives concerning how critical they looked towards the other and how critical they thought the other looked at them also decreased significantly after following the DBT network training. Conclusion: Findings suggest that a DBT network training may be instrumental in decreasing levels of perceived criticism. Further research may focus on the putative mechanisms of behaviour such as improved perspective taking, behavioural change, and the evaluation of social cues.

Correlates of expressed emotions as perceived by patients with bipolar disorder

Aim: To evaluate expressed emotions (EEs) as perceived by the patients and its correlates among patients with bipolar disorder (BD). Methodology: One hundred patients diagnosed with BD were assessed on the Perceived Criticism Measure (PCM), Family emotional involvement and criticism scale (FEICS), Brief dyadic scale for expressed emotions (BDSEE) and Vulnerability for abuse screening scale (VASS) to assess EE and possible abuse by the caregivers. Caregivers were evaluated on family burden interview schedule and family coping questionnaire. Results: Longer duration of illness (Pearson’s correlation coefficient: −0.335; p = .001***) and longer duration of treatment (Pearson’s correlation coefficient: −0.317; p = .001***) were associated with significantly lower perceived criticism as assessed by FEICS. Higher use of coping mechanisms such as coercion, avoidance and resignation by caregivers were associated with the higher perception of EE, whereas the use of coping mechanisms such as information seeking, communication, and social involvement by the caregivers was associated with the perception of lower EE among the patients. Higher caregiver burden was associated with a higher perception of the EE by the patients. Higher perception of abuse by the patients was associated with higher EE. Conclusions: Present study suggests that higher use of maladaptive coping, caregiver burden, and abuse has a significant impact on the EE. Accordingly, psychosocial interventions need to focus on caregivers to reduce EE.

Self-compassion and Perceived Criticism in Adults with Attention Deficit Hyperactivity Disorder (ADHD)

Objectives Attention deficit hyperactivity disorder (ADHD) is associated with increased criticism from others. To date, there is little research considering the consequences of how others respond to people with ADHD. Self-compassion is a positive way of relating to oneself during difficulty. Here, we investigate whether levels of self-compassion differ between people with and without ADHD, and whether perceived criticism mediates any differences in self-compassion between people with and without ADHD. Methods A cross-sectional design was used to conduct natural group comparisons. A sample of 1203 adults (46% with a self-reported ADHD diagnosis) recruited via social media, online forums and posters completed online self-report measures of diagnostic status, ADHD traits, self-compassion and perceived criticism. Between-group comparisons of self-compassion and perceived criticism were conducted on participants grouped by diagnosis, then grouped by ADHD trait severity. Perceived criticism was tested as a mediator variable between ADHD diagnosis and self-compassion. Results Adults with an ADHD diagnosis showed significantly lower self-compassion and higher perceived criticism than the participants without ADHD. Participants high in ADHD traits but without a diagnosis had significantly similar levels of self-compassion to the diagnosed group. Mediation analysis found that higher perceived criticism partially explained the relationship between ADHD diagnosis and self-compassion, even after accounting for co-occurring mood disorder diagnosis. Conclusions Adults with ADHD are less self-compassionate than adults without ADHD. This is partially explained by the higher level of criticism they perceive from others.

The relationship between DBT family training and perceived criticism: a pre-post study

Background: Dysregulating emotional and behavioural phenomena of patients with Borderline Personality Disorder (BPD), such as repeated non-suicidal self-injury, are strongly affecting patients’ family members or partners. In addition, critical disapproval of this emotional and behavioural phenomena by family members and reconciling understanding, affects the patients’ sensitivity for rejection. As a result, individuals with BPD appear to have less satisfying social support. This negative spiral possibly elicits further challenging behaviour. Therapy programs for BPD might therefore benefit from the inclusion of family members or partners in the treatment. One of the programs that includes family members is the network training of Dialectical Behaviour Therapy (DBT). This study examines the impact of the DBT network training on the perceived criticism of both patients and network members. Method: This study follows a pre-post design where a DBT network training is given to 33 patients (mean age 25 years) and 61 relatives during 8 group sessions. The degree of perceived criticism is measured by using a self-report questionnaire. Results: Results show that the overall scores of the perceived criticism scale decrease significantly for both patients and relatives after following the DBT network training. More specific, item scores of both patients and relatives concerning how critical they looked towards the other and how critical they thought the other looked at them also decreased significantly after following the DBT network training. Conclusion: Findings suggest that a DBT network training may be instrumental in decreasing levels of perceived criticism. Further research may focus on the putative mechanisms of behaviour such as improved perspective taking, behavioural change, and the evaluation of social cues.

A study of expressed emotion, perceived stress and socio-demographic profile in patients of dissociative disorder

Background: Dissociation is understood as one of coping mechanism to deal with intense stressors. Individuals vary widely in their subjective response to a similar stressful event depending on number of factors including their family and social support system. So, authors tried to study the expressed emotion in patients of dissociative disorder along with other socio-demographic factors and its relation with perceived stress.Methods: This cross-sectional descriptive study was done on 100 patients with primary diagnosis of dissociative disorder. Hamilton depression rating scale (HAM-D) was used to assess comorbid Depressive symptoms and Hamilton anxiety rating scale (HAM-A) was used to asses comorbid anxiety symptoms. Perceived stress scale (PSS) was used to assess the perception of stress. Family emotional involvement and criticism scale (FEICS) was used to measure perceived criticism (PC) and intensity of emotional involvement (EI).Results: Mean perceived stress in this study was 25.8. Mean score for perceived criticism (PC) was 16.5 and emotional involvement (EI) was 15.7. Both measures of expressed emotions were significantly higher in females and subjects belonging to joint families and rural area. In this study perceived stress by subjects was significantly (p=0.001) correlated to perceived criticism (Pearson r = 0.78) and emotional involvement (Pearson r = 0.77).Conclusions: High perceived criticism and emotion over involvement of family member was associated with perceived stress in dissociation patients.

Disapproval from romantic partners, friends and parents: source of criticism regulates prefrontal cortex activity

The prevalence of criticism in everyday social situations, and its empirically demonstrated association with psychopathology, highlight the importance of understanding neural mechanisms underlying the perception and response of individuals to criticism. However, neuroimaging studies to date have been limited largely to maternal criticism. The present study aims to investigate neural responses to criticism originating from three different relationship types: romantic partners, friends, and parents. Perceived criticism ratings for these relationships from 49 participants were collected. Functional near-infrared spectroscopy was used to measure changes in oxygenated haemoglobin levels in the prefrontal cortex when participants read vignettes describing three different scenarios of criticism. Participants were randomly assigned to 3 groups where the given description of the relationship of the protagonist to the source of criticism for each vignette was randomised. A significant interaction between relationship type and perceived criticism ratings for mothers was found in the dorsolateral prefrontal cortex. Compared to low perceived criticism, high perceived criticism individuals showed increased activation reading vignettes describing criticism from romantic partners and parents but decreased activation for those from friends. Findings contribute to understanding neural responses to criticism as observed from a third-party perspective. Future studies can look into differentiating neural responses of personalised experiences of criticism and third-party observations.

The path from schizotypy to depression and aggression and the role of family stress

Background. Schizotypy is a multidimensional construct that is linked to the vulnerability for psychosis. Positive schizotypy includes having paranormal beliefs. Negative schizotypy includes social anhedonia. Disorganized schizotypy includes social anxiety and communication disorder. Schizotypy relates to depression and aggression. Family stress from high expressed emotion (EE; a rating of criticism, hostility, and emotional overinvolvement in a close relative toward a person showing signs of mental disorder) may mediate the link between schizotypy, depression and aggression. This study tested, using path analyses, the hypotheses that schizotypy predicts depression and aggression through high perceived EE as criticism and irritability (hypothesis 1) and praise and intrusiveness in a close relative (hypothesis 2). Methods. One hundred and four healthy participants listened to and rated the self-relevance of standard criticism and standard praise that denote EE. Participants rated their level of schizotypy, depression, aggression, and perceived EE in self-report questionnaires. Two path models tested the hypotheses. Results. Disorganized schizotypy, more than positive schizotypy, predicted the path to depression and aggression when perceived criticism and perceived EE-irritability were mediators. Disorganised schizotypy, more than negative schizotypy, predicted the path to depression and aggression when perceived praise and perceived EE-intrusiveness were mediators. Conclusions. Greater perceived criticism and less perceived praise in family communication explain the path from disorganized schizotypy (more so than positive or negative schizotypy) to depression and aggression. These findings indicate a need to consider the thought disorder-EE link as a potential contributor to depression and aggression in people with schizophrenia.