The importance of the emotional environment in psychosis development
A research that involves Universidad Internacional de La Rioja (UNIR) gives us important information about the psychological process that affects the caregivers of schizophrenia patients. Results outlines that helping families to a better understanding of the situation and the progressive acceptance of it take them to handle negative appraisals.
Madrid, November 15th, 2017.- Eva Ferreras
Adapting to life with a relative affected by a mental disorder is often a stressful experience that creates a sense of subjective burden and distress in family members. Even when we are progressively normalizing this problems, a lot of tabu keep present when someone has to face a mental illness or has a family member with a psychotic disorder. Desinformation often leads to develope negative thoughts towards the patients. Several studies have shown that, in the absence of adequate information about the disorder, caregivers are likely to make attributions that psychotic symtons are under the patient control or are their responsibility.
There is substantial evidence in the literature demonstrating that the responsibility of caring for a family member with a psychotic disorder can lead to show elevated levels of distress, anxiety, and depression in caregivers. In the early stages of psychosis, caregivers face a number of issues, sush as shock, grief, poor understanding of illness and the psychiatric system. In fact, caregivers present higher levels of distress in relatives of early psychosis patients than those of individuals who have a more chronic course of illness.
In relation to family caring role, one of the most influential concepts in psychosocial research on psychosis has been Expressed Emotion (EE), a measure of the family emotional environment comprised of stances expressed by relatives towards an ill family member. Given that high-EE, defined by the presence of elevated levels of criticism, hostility and Emotional Over-Involvement (EOI), has consistenly shown to be an important predictor of relapse in schizophrenia, much research has focused on trying to understand the psychological factors that underlie this construct. Most EE and related factors studies in the field of psychosis have been carried out with patients with chronic psychosis or schizophrenia, although the recent focus of research on early stages of the psychotic continuum has led to an increasing interest in the study of EE, in order to prevent the entrenchment of high-EE and relapses.
The research, “Relatives’ expressed emotion, distress and attributions in clinical high-risk and recent onset of psychosis”, in which have participated Dra. Cristina Medina-Pradas, neuropsychology at Universidad Internacional de La Rioja (UNIR) among other experts from Spain, Mexico and United States, describes and compares the levels of EE (criticism and EOI), distress (levels of anxiety and depression), and several illness attributions in relatives of ARMS (At Risk Mental State) and FEP (First Episode Patients) patients. The study, published at Psychiatry Research, shows that criticism and EOI are strongly associated with anxiety and depression levels. Anxiety was more strongly related to criticism in ARMS-relatives than in FEP-relatives, and it was associated with EOI in ARMS but not in the FEP group, probably because ARMS-relatives were more concerned, distressed and had more uncertainty about the patient’s problems than FEP-relatives.
Findings highlight the need to focus on early family interventions that provide proper information and psychological support in accordance with the illness stage, to help relatives improve their understanding of the disorder, handle difficult thoughts and emotions, reduce negative appraisals, and prevent high-EE over the psychotic process.
Tercelli Domínguez-Martínez, Cristina Medina-Pradas, Thomas R. Kwapila, Neus Barrantes-Vidal. Relatives’ expressed emotion, distress and attributions in clinical high-risk and recent onset of psychosis, en Psychiatry Research 247 (2017) 323-329. DOI: http://dx.doi.org(10.1016/j.psychres.2016.11.048