Barrowclough, Christine; (1991) Attributions and expressed emotion in the relatives of schizophrenic patients. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This study examines the concept of Expressed Emotion (EE) and tests the utility of an attributional model in understanding why individual relatives differ in their responses and attitudes to schizophrenia sufferers, and how causal beliefs of family members might mediate relapse in patients. The model proposes that relatives look for causes to explain the patient's symptoms and other negative events associated with the illness; that illness variables and the perceptions of the relatives about the illness will influence the amount of causal search and the type of attributions which the relatives make; and that certain kinds of attributions may be predictive of patient relapse. The spontaneous attributions of relatives about negative events associated with the patient and the illness were assessed from audiotaped Camberwell Family Interviews using a modified form of the Leeds Attributional Coding System after developments to the method of extracting attributional statements. 60 relatives were included in the study. The results of the study supported the attributional model: high EE relatives made more attributions about illness than did low EE; and within the high EE group there were differences in the sort of beliefs that the relatives held. The attributions of relatives with marked EOI were similar to the low EE group with problems attributed to factors more external to and uncontrollable by the patient. On the other hand, relatives with high criticism gave more causes internal to the patient whilst the hostile relatives also tended to perceive the causes to be controllable by and personal to the schizophrenia sufferer. Illness chronicity and severity was associated with more causal search, but the relatives' subjective experience of the problems was a better predictor of the direction of their beliefs. The study found that attribution variables were better predictors of patient relapse at nine months follow up than were EE measures. Finally, although relatives made very few attributions which invoked their own causal role in illness events, it was found that such beliefs were reliable predictors of emotional problems in the relatives themselves.

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