Hooley Jill M, Campbell Christine
Department of Psychology, Harvard University, Cambridge, MA 02138, USA.
Psychol Med. 2002 Aug;32(6):1091-9. doi: 10.1017/s0033291702005779.
Expressed emotion (EE) is a measure of the family environment that is a well replicated psychosocial predictor of psychiatric relapse. Theoretical models of EE place heavy emphasis on the notion of control. We explored the extent to which high and low EE relatives made both attributions of control about patients and engaged in controlling behaviours.
Trained raters who were blind to information about EE coded interviews with 35 relatives of patients with schizophrenia and 42 relatives of patients with unipolar depression. Relatives were rated on two reliable scales that assessed relatives' tendencies to make illness controllability attributions and relatives' efforts to exert direct behavioural control over patients.
In both the schizophrenia and depressed groups, high-EE relatives attributed more control to their ill family members than did low EE relatives. They also behaved in a more controlling manner. Examination of patients' clinical outcomes during a 9-month follow-up period revealed that high levels of behavioural control on the part of relatives significantly predicted relapse in patients with schizophrenia but not in patients with depression.
These findings support the attribution-based model of EE. They further suggest that controlling behaviours on the part of relatives may mediate the EE-relapse link in schizophrenia. Such behaviours may be important targets for modification in family-based interventions for schizophrenia.
情感表达（EE）是衡量家庭环境的一种方式，是精神病复发的一个得到充分验证的社会心理预测指标。EE的理论模型非常强调控制的概念。我们探讨了高EE和低EE亲属在对患者进行控制归因以及采取控制行为方面的程度。
对35名精神分裂症患者的亲属和42名单相抑郁症患者的亲属进行访谈，访谈由对EE信息不知情的经过培训的评估人员进行编码。亲属在两个可靠的量表上进行评分，这两个量表评估亲属对疾病可控性的归因倾向以及亲属对患者施加直接行为控制的努力程度。
在精神分裂症组和抑郁症组中，高EE亲属比低EE亲属更多地将控制权归因于他们患病的家庭成员。他们的行为控制方式也更强硬。对患者9个月随访期临床结果的检查发现，亲属的高水平行为控制显著预测了精神分裂症患者的复发，但对抑郁症患者则不然。
这些发现支持基于归因的EE模型。它们进一步表明，亲属的控制行为可能在精神分裂症的EE-复发关联中起中介作用。此类行为可能是精神分裂症家庭干预中需要改变的重要目标。
