Disturbed attachment and negative affective style. An intergenerational spiral.

The relationship between the quality of parents' attachment to their own parents and the quality of affective style was examined with a sample of 49 severely disturbed young adults and adolescents and their families receiving long-term in-patient treatment. Measures reflecting disturbances in attachment of parents to their own parents, derived from a five-minute speech sample task, were strongly associated with measures of negative affective style (e.g., criticism, intrusiveness and guilt induction) in face-to-face interactions with the disturbed offspring, as assessed through videotaped discussions of conflictual family issues after three months of treatment. The most significant findings involved the linkages between disturbances in the mother's attachment to her own mother and the degree of negative affect directed at the child patient. The association between disturbed intergenerational parental attachments and negative affective style supports the hypothesis that the parent's own internal burdens, stemming from disturbed attachment representations, particularly of the same-sex parent, may be a driving force behind the negative affect they display in interactions with their disturbed offspring.

Effects of emotion on perceptual asymmetry in adolescent inpatients with attention-deficit hyperactivity disorder.

OBJECTIVE: The authors studied the hemispheric functioning of adolescents with attention-deficit hyperactivity disorder (ADHD) in relation to this group's response to positively toned emotional stimuli. METHOD: Dichotic word tests were used to measure perceptual asymmetry in 21 adolescent inpatients and 24 control subjects. Ten patients had ADHD; 11 did not. Subjects were tested under four emotional conditions by using combinations of neutral, positive, and negative words. RESULTS: the ADHD group had lower right ear advantage (REA) scores when presented with stimulus pairs containing positive words than when presented with pairs not containing positive words. By comparison, the non-ADHD patient group and the control group had higher REA scores under positive emotional conditions than under non-positive conditions. CONCLUSIONS: The abnormal response to positive emotional tone supports the reward system dysfunction hypothesis of ADHD and may also have implications for learning problems, behavioral difficulties, and disturbed interpersonal relationships in this population.

A developmental view of therapeutic bonding in the family: treatment of the disconnected family.

Data from an ongoing research study have been used to identify a subgroup of families of severely ill, young adults who present formidable treatment challenges to the family therapist. The disconnected family is characterized by disturbances in attachment between one or both parents and the patient. In many cases, disturbances in attachment and caretaking in the family of origin are reported for the parents in these families. Disconnected families that also have intense emotional styles of relating are particularly difficult to treat. A treatment model that focuses on intergenerational attachment issues is described.

Communication deviance in families of schizophrenic and manic patients.

Levels of communication deviance (CD) distinguish parents of schizophrenic patients from parents of nonpsychotic patients, but the prevalence of intrafamilial CD in other psychotic disorders has not been examined. Levels of CD were compared across biological parents of schizophrenic (n = 39) and bipolar manic (n = 16) patients and across patients themselves. CD ratings were based on Thematic Apperception Test protocols (parents only) and family interactions (parents and patients). Total levels of CD did not distinguish between groups of parents or patients. However, instances of odd word usage were more frequent among parents of manic patients than among parents of schizophrenic patients on both CD measures. Also, during the interaction task, odd word usage was more frequent among manic patients, whereas schizophrenic patients made more ambiguous references. Results suggest that high levels of intrafamilial CD are not unique to schizophrenia.

Parental communication deviance and schizophrenia: a cross-cultural comparison of Mexican- and Anglo-Americans.

Levels of parental communication deviance (CD), as measured on the Thematic Apperception Test (TAT), were compared among families of schizophrenic patients in two culturally distinct groups. Spanish-speaking Mexican-American parents of schizophrenics completed the TAT in their native language, and CD was coded from their stories by a Spanish-speaking rater. Mexican-American parents had levels of CD that were nearly identical to those of a carefully matched sample of English-speaking Anglo-American parents. Factor scores that measure distinct subtypes of CD also did not differ across groups. The data suggest that levels of CD, despite discriminating between parents of schizophrenics and nonschizophrenics, do not vary across different languages and cultures.

Is expressed emotion an index of a transactional process? I. Parents' affective style.

The degree to which expressed emotion (EE) attitudes in key relatives reflect ongoing transactional processes in families is a topic of controversy. The associations between EE attitudes, as measured during an acute hospitalization (using the Camberwell Family Interview) and during the aftercare period (using 5-minute speech samples), and interactional behavior in parents of recent-onset schizophrenics (this article) and in patients themselves (second article), were investigated. In the first study, EE attitudes manifested by parents during the aftercare period were stronger correlates of their interactional behaviors during the aftercare period than were EE attitudes measured during the inpatient period, despite the frequent correspondence between the two EE measures. The pattern of attitudes shown between the inpatient and outpatient periods also predicted transactional styles in parents during the outpatient period, findings not accounted for by clinical attributes of patients. When high-EE attitudes persist during the aftercare period and are reflected in transactional behaviors, the risk for subsequent patient relapse may be enhanced.

Expressed emotion and patient-relative interaction in families of recent onset schizophrenics.

This article examines the interaction patterns of relatives of young, recent onset schizophrenic patients classified as displaying either high or low expressed emotion (EE) by two measures, the original Camberwell interview method and a recently developed brief method. The former was administered during the hospitalization period and the latter was administered approximately 2 months later when the patient was in the community. Family interactions were coded with an observational coding system that permitted sequential patterns to be analyzed as a function of the EE status of the family. No relation between the Camberwell EE rating and interactional behavior was found. However, high EE-critical relatives, defined by the brief EE method, were more negative in direct interactions than low EE relatives or high EE relatives classified as emotionally overinvolved. Sequential analyses indicated that high EE-critical relatives showed extreme negative escalation patterns. Patients' reactions to high EE-critical relatives were characterized by self-justification and negative nonverbal behavior.

Family system functioning: behavior in the laboratory and the family treatment setting.

The Family System Functioning (FSF) scale is a new instrument for measuring dimensions of the intrafamilial environment thought to be important in recovery from major psychiatric illness. Modest statistical correlations were obtained when FSF ratings of laboratory-based family interactions were compared with researcher-guided therapist ratings of FSF based upon the family's behavior in family therapy sessions during the subsequent month. The data from these two settings provide support for the validity of some of the scales. Because of the modest size of the correlations, however, behavior in the laboratory setting may not always be an accurate indicator of how the family will behave in the early weeks of family therapy.

Communication deviance in adolescence and adulthood: a longitudinal study.

Measures of communication deviance (CD) on the TAT were obtained for a sample of nonpsychotically disturbed adolescents and repeated 15 years later. For both males and females, total amount of CD significantly increased from adolescence to adulthood. The proportion of certain types of CD in an individual's speech was relatively stable across time, but further analysis indicated that the phenomenon was significant only for the females. Low amounts of CD in adulthood were associated with absence of any psychiatric disturbance throughout the 15-year follow-up period.

Emotional attitudes and direct communication in the families of schizophrenics: a cross-national replication.

To examine how the measure of expressed emotion relates to family life, 30 relatives of schizophrenic patients were assessed for EE and then observed in ten-minute discussions with the patients. It was found that high-EE relatives express more negative emotional statements than low-EE relatives when face-to-face with the patient; they also talk more rapidly, and this speech rate is correlated with the patient speech rate. Whereas low-EE relatives expressed few criticisms or intrusive statements, high-EE over-involved relatives were more intrusive, and high-EE critical relatives were more critical as well as more intrusive in direct interaction. These findings emphasise the importance of understanding divergent EE sub-styles and the complementary behaviour of patients. The findings of an earlier Los Angeles study were replicated.

Social competence and family environment: 15-year follow-up of disturbed adolescents.

Measures of familial emotional climate and communication deviance, obtained when subjects were adolescents, were used to predict social adjustment 15 years later. The results showed that disturbed family functioning predicted poor quality of later intimate relationships, but did not predict other dimensions of adult social functioning.

The impact of individual and family treatment on the affective climate of families of schizophrenics.

Measures of parental affective style were compared for families of schizophrenics participating in a controlled treatment study which contrasted individual and family-based therapeutic programmes. The total number of critical statements and non-critical, intrusive remarks was significantly lower after three months for parents of schizophrenics participating in family therapy, compared to those whose offspring received only individual therapy. An increased risk for relapse was associated with an increase in the number of critical and/or intrusive remarks for patients in individual treatment. A significant increase in non-emotional, problem-solving statements was observed in parents who received family therapy, compared with those who did not. The results suggest that a behaviourally-oriented, problem-solving family approach may have reduced the risk of relapse in the first nine months after discharge from hospital by teaching families concrete ways of solving problems and concomitantly reducing the amount of negative emotional relating between family members.

Parental affective style and the treatment of schizophrenia. Predicting course of illness and social functioning.

In a randomized controlled study, the affective style (AS) of parents of schizophrenics in clinic-based individual treatment groups and home-based family treatment groups was compared prior to treatment and again three months after treatment had begun. Affective style is an index reflecting the quality of the family emotional climate, measured from face-to-face discussion. Pretherapy and posttherapy measures of negative AS were significantly predictive of relapse within the nine-month treatment period for patients in individual treatment. In addition, for both treatment groups, a negative AS pattern at the posttherapy reassessment was significantly associated with decreased patient social functioning, reduced ability of the family to absorb the family intervention, and lower capacity of the family to cope with everyday family stresses. The results suggest that AS is an important intrafamilial attribute, with implications for treatment strategy and planning.

Interactional correlates of expressed emotion in the families of schizophrenics.

Measures of intrafamilial expressed emotion (EE) predict relapse in schizophrenic patients, but previous research has not investigated whether EE scores are representative of ongoing family transactions. Parents of 42 hospitalized schizophrenic patients were rated for level and type of EE. Following the patient's discharge, families participated in two 10-minute direct interaction tasks. Transcripts from these interactions were coded on dimensions of affective communication. High-EE parents exhibited more negatively charged emotional verbal behaviour in direct transaction with their schizophrenic offspring than did low-EE parents. Some parents rated high-EE were distinguished by their frequent usage of critical comments during the interactions, whereas high-EE overinvolved parents used more intrusive, invasive statements. These findings support the construct validity of expressed emotion.

Family factors in the onset, course, and treatment of schizophrenic spectrum disorders: an update on current research.

Recent findings from several research projects on the role of family factors in the onset, course, and treatment of schizophrenia are discussed. The report emphasizes several key issues facing researches in this field such as how family characteristics associated with onset are related to the course of schizophrenia, replicability of findings on expressed emotion and relapse rates, and the construct validity of measures of familial characteristics. Ongoing studies employing neuroleptic treatment and family therapy are outlined, and the implications of these preliminary findings are discussed.