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Expressed Emotion Research

 

The robust results of the "expressed emotion" (EE) research, conducted in several countries in the developed and developing worlds, reveal that people with schizophrenia living with relatives (by birth or marriage) who are critical or over-involved (referred to in the research as high EE) have a much higher relapse rate than those living with relatives who are less critical or intru­sive (low EE). High EE relatives, it emerges, have a higher sense of burden from care-giving and less well developed coping strategies. In conducting this research, the family member’s level of expressed emotion is measured by recording an interview with a family member in which he or she discusses the person with schizophrenia, and by having a researcher count the number of remarks which indicate criticism, hostility, over-involvement, warmth or positive attributions.

 

A meta-analysis of expressed emotion studies of schizophrenia conducted in 11 countries indicates that the relapse rate over a two-year follow-up period was more than twice as high, at 66 percent, for patients in families which included a high EE relative than in low EE households (29 percent). Other studies have shown that relatives who are less critical and over-involved exert a posi­tive therapeutic effect on the person with schizo­phrenia, their presence leading to a reduc­tion in the patient's level of arous­al.

 

There is no indication that the more critical and over-involved relatives are abnormal by everyday standards. It is more likely, in fact, that the families in which people with schizophrenia do well have adapted to having a person with a psychotic illness in the house­hold by becoming unusually low-key and permissive.