Altered functional connectivity subserving expressed emotion environments in schizophrenia: An fNIRS study.

Living in high-expressed emotion (EE) environments, characterized by critical, hostile, or over-involved family attitudes, has been linked to increased relapse rates among individuals with schizophrenia (SZ). In our previous work (Wang et al., 2023), we conducted the first feasibility study of using functional near-infrared spectroscopy (fNIRS) with our developed EE stimuli to examine cortical hemodynamics in SZ. To better understand the neural mechanisms underlying EE environmental factors in SZ, we extended our investigation by employing functional connectivity (FC) analysis with a graph theory approach to fNIRS signals. Relative to healthy controls (N=40), individuals with SZ (N=37) exhibited altered connectivity across the medial prefrontal cortex (mPFC), left ventrolateral prefrontal cortex (vlPFC), and left superior temporal gyrus (STG) while exposed to EE environments. Notably, while individuals with SZ were exposed to high-EE environments, (i) reduced connectivity was observed in these brain regions and (ii) the left vlPFC-STG coupling was found to be associated with the negative symptom severity. Taken together, our FC findings suggest individuals with SZ experience a more extensive disruption in neural functioning and coordination, particularly indicating an increased susceptibility to high-EE environments. This further supports the potential utility of integrating fNIRS with the created EE stimuli for assessing EE environmental influences, paving the way for more targeted therapeutic interventions.

Automatic detection of expressed emotion from Five-Minute Speech Samples: Challenges and opportunities.

Research into clinical applications of speech-based emotion recognition (SER) technologies has been steadily increasing over the past few years. One such potential application is the automatic recognition of expressed emotion (EE) components within family environments. The identification of EE is highly important as they have been linked with a range of adverse life events. Manual coding of these events requires time-consuming specialist training, amplifying the need for automated approaches. Herein we describe an automated machine learning approach for determining the degree of warmth, a key component of EE, from acoustic and text natural language features. Our dataset of 52 recorded interviews is taken from recordings, collected over 20 years ago, from a nationally representative birth cohort of British twin children, and was manually coded for EE by two researchers (inter-rater reliability 0.84-0.90). We demonstrate that the degree of warmth can be predicted with an F1-score of 64.7% despite working with audio recordings of highly variable quality. Our highly promising results suggest that machine learning may be able to assist in the coding of EE in the near future.

The Effect of a Mindful Self-Compassion Intervention on Burden, Express Emotion and Mental Well-Being in Family Caregivers of Patients with Schizophrenia: A Randomized Controlled Trial.

The objective of this randomized controlled trial was to examine the impact of a mindful self-compassion intervention on burden, express emotion, and mental well-being in family caregivers of patients with schizophrenia. Standardized measures, including the ZARIT Caregiving Burden Scale, Expressed Emotion Scale and Warwick-Edinburgh Mental Well-Being Scale, were administered at baseline, post-intervention. Statistical analysis was conducted to assess differences between the two groups. Significant reductions in caregiver burden, expressed emotion, and enhanced mental well-being in the intervention group compared to the control group at post-intervention. The results of this randomized controlled trial indicate that the mindful self-compassion intervention significantly reduces caregiver burden, expressed emotion, and improves mental well-being in family caregivers of patients with schizophrenia. These findings underscore the potential utility of mindful self-compassion interventions as effective support for this population, highlighting the importance of integrating such interventions into caregiver support programs.

Emotion coaching skills as an augmentation to family-based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion.

OBJECTIVE: To examine the feasibility and acceptability of augmenting family-based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion. METHOD: In this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation). RESULTS: Forty-one adolescents with AN or AAN were recruited (88% female, Mage = 14.9 ± 1.6 years, 95% White: Non-Hispanic, 1% White: Hispanic, 1% Bi-racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was "beneficial"-"very beneficial." The FBT + EC group demonstrated higher parental warmth scores at post-treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3-month follow-up. Finally, at post-treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3-month follow-up. DISCUSSION: Augmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness. PUBLIC SIGNIFICANCE: Family based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well-liked by families.

Expressed Emotion in Families of People With Dementia: A Review of Scale-Based Measures.

PURPOSE: Research on the concept of expressed emotion (EE) has expanded in recent years but its role in dementia still requires elucidation. Understanding the role of EE in the dementia context could help in the development of appropriate interventions. METHOD: The current review synthesized relevant literature to investigate the prevalence and correlates of EE status in families of people with dementia. A comprehensive search of four databases from inception to 2022 produced 2,683 papers; 18 studies met inclusion criteria. RESULTS: The use of EE criteria differed not only across cultural contexts, but even within the same cultural context. Overall, the prevalence of EE in families with dementia compared with other psychiatric conditions was not high. CONCLUSION: Specific changes in EE over time remain to be explored, and findings emphasize the need to carefully discriminate High EE status based on the cultural background of family members with dementia. [Journal of Gerontological Nursing, 50(2), 17-25.].

Leveraging natural language processing to study emotional coherence in psychotherapy.

The association between emotional experience and expression, known as emotional coherence, is considered important for individual functioning. Recent advances in natural language processing (NLP) make it possible to automatically recognize verbally expressed emotions in psychotherapy dialogues and to explore emotional coherence with larger samples and finer granularity than previously. The present study used state-of-the-art emotion recognition models to automatically label clients' emotions at the utterance level, employed these labeled data to examine the coherence between verbally expressed emotions and self-reported emotions, and examined the associations between emotional coherence and clients' improvement in functioning throughout treatment. The data comprised 872 transcribed sessions from 68 clients. Clients self-reported their functioning before each session and their emotions after each. A subsample of 196 sessions were manually coded. A transformer-based approach was used to automatically label the remaining data for a total of 139,061 utterances. Multilevel modeling was used to assess emotional coherence and determine whether it was associated with changes in clients' functioning throughout treatment. The emotion recognition model demonstrated moderate performance. The findings indicated a significant association between verbally expressed emotions and self-reported emotions. Coherence in clients' negative emotions was associated with improvement in functioning. The results suggest an association between clients' subjective experience and their verbal expression of emotions and underscore the importance of this coherence to functioning. NLP may uncover crucial emotional processes in psychotherapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotionally expressive interdependence in Latin America: Triangulating through a comparison of three cultural zones.

Evidence suggests that Latin Americans display elevated levels of emotional expressivity and positivity. Here, we tested whether Latin Americans possess a unique form of interdependence called expressive interdependence, characterized by the open expression of positive emotions related to social engagement (e.g., feelings of closeness to others). In Study 1, we compared Latin Americans from Chile and Mexico with European Americans in the United States, a group known to be highly independent. Latin Americans expressed positive socially engaging emotions, particularly in response to negative events affecting others, whereas European Americans favored positive socially disengaging emotions, such as pride, especially in response to personally favorable circumstances. Study 2 replicated these findings with another group of Latin Americans from Colombia and European Americans in the United States. Study 2 also included Japanese in Japan, who expressed positive emotions less than Latin and European Americans. However, Japanese displayed a higher tendency to express negative socially engaging emotions, such as guilt and shame, compared to both groups. Our data demonstrate that emotional expression patterns align with overarching ethos of interdependence in Latin America and Japan and independence among European Americans. However, Latin Americans and Japanese exhibited different styles of interdependence. Latin Americans were expressive of positive socially engaging emotions, whereas Japanese were less expressive overall. Moreover, when Japanese expressed emotions, they emphasized negative socially engaging emotions. Implications for theories of culture and emotion are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Expressed emotion and early treatment response in family-based treatment for adolescent anorexia nervosa.

This study examined the effect of pre-treatment levels of parental expressed emotion (EE) on early treatment response for adolescent anorexia nervosa (AN). Data were collected from 121 adolescents, ages 12-18, who met DSM-IV criteria for AN excluding the amenorrhea criterion, and their parents. Participants were randomized to family-based treatment (FBT) or adolescent-focused therapy (AFT). To examine the effects of different thresholds of EE, we used two different levels of EE in analyses. Results demonstrated that adolescents who had at least one parent with elevated EE indicated by a lower threshold (i.e. even mild levels) at baseline were less likely to achieve an early treatment response, suggesting that EE might interfere with treatment success from the start of treatment. When high EE was defined by a higher threshold, these effects were no longer significant, regardless of treatment type (FBT or AFT). These findings suggest that adolescents with AN may be more sensitive to EE than other mental illnesses, such that lower thresholds of EE impact the speed with which they are able to reduce symptoms and gain weight in treatment. It may be necessary to target parental EE prior to or early in treatment or pivot to parent-focused treatment to change the trajectory of treatment response. Future research is needed to explore ways parental EE can be reduced.

Conhecimento e sentimentos de pessoas pré-procedimento de cateterismo cardíaco / Knowledge and feelings of people before cardiac catheterization procedure / Conocimientos y sentimientos de las personas antes del procedimiento de cateterismo cardíaco

Objetivo: identificar o conhecimento e sentimentos de pessoas sobre o cateterismo cardíaco. Método: estudo descritivo, abordagem qualitativa, realizado com 12 pacientes em hospital referência em cardiologia, no município de João Pessoa, no período de novembro a dezembro de 2021. Os dados foram coletados através de entrevista gravada e semiestruturada, os dados analisados pela Análise de Conteúdo de Bardin. Resultados: a partir das entrevistas foram construídas três categorias temáticas: C1 - Conhecimento do procedimento de cateterismo cardíaco, C2 - Falta de orientação dos cuidados que envolvem o cateterismo cardíaco e C3 - Sentimentos à realização do cateterismo cardíaco. Os dados evidenciam um conhecimento insuficiente e limitado que podem se relacionar com o surgimento de sentimentos negativos. Considerações finais: Percebe-se a necessidade de orientações e informações, bem como o planejamento e construção de tecnologias educativas para as pessoas que irão realizar o cateterismo cardíaco, com a finalidade de promover um pré, intra e pós-exame seguro

Objective: to identify people's knowledge and feelings about cardiac catheterization. Method: descriptive study, qualitative approach, carried out with 12 patients in a cardiology reference hospital, in the city of João Pessoa, from November to December 2021. Data were collected through recorded and semi-structured interviews, the data analyzed by Analysis of Bardin content. Results: three thematic categories were constructed from the interviews: C1 - Knowledge of the cardiac catheterization procedure, C2 - Lack of guidance on care involving cardiac catheterization and C3 - Feelings regarding cardiac catheterization. The data highlights insufficient and limited knowledge that may be related to the emergence of negative feelings. Final considerations: There is a perceived need for guidance and information, as well as the planning and construction of educational technologies for people who will undergo cardiac catheterization, with the purpose of promoting a safe pre, intra and post-exam

Objetivos: identificar los conocimientos y sentimientos de las personas sobre el cateterismo cardíaco. Método: estudio descriptivo, de enfoque cualitativo, realizado con 12 pacientes en un hospital de referencia en cardiología, en la ciudad de João Pessoa, de noviembre a diciembre de 2021. Los datos fueron recolectados a través de entrevistas grabadas y semiestructuradas, los datos analizados por Análisis de Bardin contenido. Resultados: a partir de las entrevistas se construyeron tres categorías temáticas: C1 - Conocimiento sobre el procedimiento de cateterismo cardíaco, C2 - Falta de orientación sobre los cuidados relacionados con el cateterismo cardíaco y C3 - Sentimientos respecto al cateterismo cardíaco. Los datos destacan conocimientos insuficientes y limitados que pueden estar relacionados con la aparición de sentimientos negativos. Consideraciones finales: Se percibe la necesidad de orientación e información, así como la planificación y construcción de tecnologías educativas para las personas que serán sometidas a cateterismo cardíaco, con el propósito de promover un pre, intra y post examen seguro

Avaliação e ensino de emoções com crianças e jovens adultos com autismo ou síndrome de down mediado pela família / Assessment and teaching of emotions with children and young adults with autism or down syndrome mediated by family / Evaluación y enseñanza de las emociones con niños y jóvenes con autismo o síndrome de down mediadas por la familia

Este estudo avaliou o reconhecimento (imitação, identidade e identificação) e a nomeação de estímulos emocionais de valência negativa (raiva e tristeza) e positiva (alegria e surpresa) em conjunto com a influência dos tipos de estímulos utilizados (social-feminino, social-masculino, familiar e emoji) em crianças e jovens adultos com autismo ou síndrome de Down, por meio de tarefas aplicadas pela família e mediadas por recursos tecnológicos durante a pandemia de covid-19. Participaram cinco crianças e dois jovens adultos com autismo e uma criança e dois jovens adultos com síndrome de Down. Foram implementadas tarefas de identidade, reconhecimento, nomeação e imitação, com estímulos faciais de função avaliativa (sem consequência diferencial) e de ensino (com consequência diferencial, uso de dicas e critério de aprendizagem), visando a emergência da nomeação emocional por meio do ensino das tarefas de reconhecimento. Os resultados da linha de base identificaram que, para os participantes que apresentaram menor tempo de resposta para o mesmo gênero, a diferença de tempo de resposta foi em média 57,28% menor. Em relação à valência emocional, 50% dos participantes apresentaram diferenças nos acertos, a depender da valência positiva e negativa, sendo que 66,66% apresentaram diferenças para o tempo de resposta a depender da valência emocional. Após o procedimento de ensino, os participantes mostraram maior número de acertos nas tarefas, independentemente do gênero de estímulo e valência emocional, criando ocasião para generalização da aprendizagem de reconhecimento e nomeação de emoções, além de consolidar a viabilidade de estratégias de ensino mediadas por recursos tecnológicos e aplicadas por familiares.(AU)

This study evaluated the recognition (imitation, identity, and identification) and naming of negative (anger and sadness) and positive (joy and surprise) emotional stimuli alongside the influence of the types of stimuli (social-female, social-male, family, and emoji) in children and young adults with autism and Down syndrome, via tasks applied by the family and mediated by technological resources, during the COVID-19 pandemic. Five children and two young adults with autism and one child and two young adults with Down syndrome participated. Identity, recognition, naming, and imitation tasks were planned and implemented using facial stimuli with evaluative (without differential consequence) and teaching (with differential consequence, tips, and learning criteria) functions, aiming at the emergence of emotional naming from the recognition teaching tasks. The baseline results showed that, for participants who had a shorter response time for the same gender, the response time difference was on average 57.28% lower. Regarding the emotional valence, 50% of the participants showed differences in the correct answers, depending on the positive and negative valence, and 66.66% showed differences in the response time depending on the emotional valence. After the teaching procedure, the participants showed a greater number of correct answers in the tasks, regardless of the stimulus type and emotional valence, creating an opportunity for generalizing learning of emotion recognition and naming, in addition to consolidating the feasibility of teaching strategies mediated by technological resources and applied by family members.(AU)

Este estudio evaluó el reconocimiento (imitación, identidad e identificación) y la denominación de estímulos emocionales negativos (enfado y tristeza) y positivos (alegría y sorpresa) y la influencia de los tipos de estímulos utilizados (social-femenino, social-masculino, familiar y emoji ) de niños y jóvenes con autismo o síndrome de Down, a través de tareas aplicadas por la familia, mediadas por recursos tecnológicos durante la pandemia de la covid-19. Participaron cinco niños y dos adultos jóvenes con autismo, y un niño y dos adultos jóvenes con síndrome de Down. Se planificaron e implementaron tareas de identidad, reconocimiento, nombramiento e imitación con estímulos faciales con función evaluativa (sin consecuencia diferencial) y enseñanza (con consecuencia diferencial, uso de ayudas y criterios de aprendizaje), buscando la emergencia del nombramiento emocional después de la enseñanza de tareas de reconocimiento. Los resultados de la línea de base identificaron que para los participantes que tenían un tiempo de respuesta más corto para el mismo género, la diferencia en el tiempo de respuesta fue un 57,28% menor. En cuanto a la valencia emocional, el 50% de los participantes mostraron diferencias en las respuestas correctas, en función de la valencia positiva y negativa, y el 66,66% tuvieron diferencias en el tiempo de respuesta, en función de la valencia emocional. Después del procedimiento de enseñanza, los participantes mostraron mayor número de aciertos en las tareas evaluadas, independientemente del tipo de estímulo o valencia emocional, lo que genera una oportunidad para la generalización del aprendizaje de reconocimiento y denominación de emociones, además de consolidar la viabilidad de estrategias de enseñanza mediadas por recursos tecnológicos y aplicadas por la familia.(AU)

Expressed emotion in the South Asian diaspora living in the UK: A qualitative study.

BACKGROUND: 'Expressed Emotion (EE)' captures ways in which emotions are expressed within a family environment. Research has found that EE in families has an impact on psychiatric illness, in particular psychosis, such that it increases risk of relapse. EE was conceptualised by research conducted in the UK. Thus, behaviours defined as pathological were largely based on white samples adhering to UK norms. Cross-cultural variations have been found in EE and its relationship with clinical outcomes. A more culturally appropriate understanding of norms surrounding the EE across cultures is required. AIMS: This study aims to use a bottom-up approach to provide a culturally specific understanding of family relationships and EE across 'non-clinical' UK-based South Asian families. METHODS: Semi-structured interviews were conducted with 18 South Asian participants to explore their relationships with a significant other. Interviews were analysed using thematic analysis. RESULTS: Four main themes were generated: expression of love, setting boundaries, inter-generational differences and acceptance. CONCLUSION: The findings indicate considerable cultural variability within EE and highlight the need to interpret EE in the context of socio-cultural norms. Whilst certain domains of EE that are considered pathological in Western contexts are present in the UK-based South Asian diaspora, these are perceived as less problematic, indicative of varying cultural norms.

Qualitative and Artificial Intelligence-Based Sentiment Analysis of Turkish Tweets Related to Schizophrenia. / Sizofreniye Yönelik Türkçe Twitter Iletilerin Nitel ve Yapay Zekâ Temelli Duygu Çözümlemesi.

OBJECTIVE: The aim of this study was to qualitatively examine Turkish tweets about schizophrenia in respect of stigmatization and discrimination within a one-month period and to conduct emotional analysis using artificial intelligence applications. METHOD: Using the keyword 'schizophrenia,' Turkish tweets were gathered from the Python Tweepy application between December 19, 2020 and January 18, 2021. Features were extracted using the Bidirectional Encoder Representations from Transformers (BERT) method and artificial neural networks and tweets were classified as positive, neutral, or negative. Approximately 5% of the tweets were qualitatively analyzed, constituting those most frequently liked and retweeted. RESULTS: The study found that, of the total of 3406 schizophreniarelated messages shared in Turkey over a period of one-month, 2996 were original, and were then retweeted a total of 1823 times, and liked by 25,413 people. It was determined that 63.4% of the tweets shared about schizophrenia contained negative emotions, 28.7% were neutral, and 7.71% expressed positive emotions. Within the scope of the qualitative analysis, 145 tweets were examined and classified under four main themes and two sub-themes; namely, news about violent patients, insult (insulting people in interpersonal relationships, insulting people in the news), mockery, and information. CONCLUSION: The results of this study showed that the Turkish tweets about schizophrenia, which were emotionally analyzed using artificial intelligence were found often to contain negative emotions. It was also seen that Twitter users used the term schizophrenia, not in a medical sense but to insult and make fun of individuals, frequently shared the news that patients were victims or perpetrators of violence, and the messages shared by professional branch organizations or mental health professionals were primarily for conveying information to the public.

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Actividades para tener una semana de bienestar.

An fNIRS investigation of novel expressed emotion stimulations in schizophrenia.

Living in high expressed emotion (EE) environments tends to increase the relapse rate in schizophrenia (SZ). At present, the neural substrates responsible for high EE in SZ remain poorly understood. Functional near-infrared spectroscopy (fNIRS) may be of great use to quantitatively assess cortical hemodynamics and elucidate the pathophysiology of psychiatric disorders. In this study, we designed novel low- (positivity and warmth) and high-EE (criticism, negative emotion, and hostility) stimulations, in the form of audio, to investigate cortical hemodynamics. We used fNIRS to measure hemodynamic signals while participants listened to the recorded audio. Healthy controls (HCs, [Formula: see text]) showed increased hemodynamic activation in the major language centers across EE stimulations, with stronger activation in Wernicke's area during the processing of negative emotional language. Compared to HCs, people with SZ ([Formula: see text]) exhibited smaller hemodynamic activation in the major language centers across EE stimulations. In addition, people with SZ showed weaker or insignificant hemodynamic deactivation in the medial prefrontal cortex. Notably, hemodynamic activation in SZ was found to be negatively correlated with the negative syndrome scale score at high EE. Our findings suggest that the neural mechanisms in SZ are altered and disrupted, especially during negative emotional language processing. This supports the feasibility of using the designed EE stimulations to assess people who are vulnerable to high-EE environments, such as SZ. Furthermore, our findings provide preliminary evidence for future research on functional neuroimaging biomarkers for people with psychiatric disorders.

The relationships between expressed emotion, cortisol, and EEG alpha asymmetry.

Families can express high criticism, hostility and emotional over-involvement towards a person with or at risk of mental health problems. Perceiving such high expressed emotion (EE) can be a major psychological stressor for individuals, especially those at risk of mental health problems. To reveal the biological mechanisms underlying the effect of EE on health, this study investigated physiological response (salivary cortisol, frontal alpha asymmetry (FAA)) to verbal criticism and their relationship to anxiety and perceived EE. Using a repeated-measures design, healthy participants attended three testing sessions on non-consecutive days. On each day, participants listened to one of three types of auditory stimuli, namely criticism, neutral or praise, and Electroencephalography (EEG) and salivary cortisol were measured. Results showed a reduction in cortisol following criticism but there was no significant change in FAA. Post-criticism cortisol concentration negatively correlated with perceived EE after controlling for baseline mood. Our findings suggest that salivary cortisol change responds to criticism in non-clinical populations and this response might be largely driven by individual differences in the perception of criticism (e.g., arousal and relevance). Criticisms expressed by audio comments may not be explicitly perceived as an acute emotional stressor, and thus, physiological response to criticisms could be minimum.

Variações culturais na socialização das emoções pelos pais: uma revisão integrativa da literatura / Cultural variations in socialization of emotions by parents: An integrative literature review

Resumen. Objetivo. Este estudo teve como objetivo identificar as características teóricas e metodológicas, assim como os resultados de estudos empíricos, que abordaram a socialização parental da emoção em diversos grupos culturais não ocidentais. Método. Para isso, foi realizada uma revisão integrativa da literatura com um enfoque qualitativo. Resultados. Os resultados mostraram que as principais abordagens teóricas foram os enfoques ecológicos e o modelo heurístico da socialização das emoções. Quanto à metodologia, prevaleceram os estudos quantitativos com maior presença de mães. Os principais resultados salientam que existem variações na socialização da emoção em diversos aspectos, como no funcionamento das crianças, expressão emocional, reação às emoções das crianças, etnoteorias parentais, narrativa emocional e outros. São discutidas as implicações dessas descobertas para futuras pesquisas.

Abstract. Objective. This study aimed to identify the theoretical and methodological characteristics, as well as the results of empirical studies that addressed the parental socialization of emotions in different non-western cultural groups. Method. This required an integrative literature review with a qualitative focus. Results. The results showed that the main theoretical approaches were the ecological approaches and the heuristic model of the socialization of emotions. Regarding employed methodologies, quantitative studies with a greater presence of mothers prevailed. The main results point out that there are variations in the socializing emotions in several aspects such as the functioning of children, emotional expression, reaction to children's emotions, parental ethnotheories, emotional talk and others. Discussion focuses on the implications of these findings for future research.

Concurrent and Prospective Associations Between Communicated Emotional Arousal and Adjustment Among Couples Coping With Cancer.

BACKGROUND: The experience of cancer can create considerable emotional distress for patients and their committed partners. How couples communicate about cancer-related concerns can have important implications for adjustment. However, past research has primarily utilized cross-sectional designs and retrospective self-reports of couple communication. While informative, little is known about how patients and partners express emotion during conversations about cancer, and how these emotional patterns predict individual and relational adjustment. PURPOSE: The current investigation examined how patterns of emotional arousal within couples' communication about cancer was associated with concurrent and prospective individual psychological and relational adjustment. METHODS: At baseline, 133 patients with stage II- breast, lung, or colorectal cancer and their partners completed a conversation about a cancer-related concern. Vocally expressed emotional arousal (f0) was extracted from recorded conversations. Couples completed self-report measures of individual psychological and relational adjustment at baseline and at 4, 8, and 12 months later. RESULTS: Couples who started the conversation higher in f0 (i.e., greater emotional arousal) reported better individual and relational adjustment at baseline. If the non-cancer partner had lower f0 relative to patients, this predicted worse individual adjustment across follow-up. Additionally, couples who maintained their level of f0 rather than decreasing later in the conversation reported improvements in individual adjustment across follow-up. CONCLUSIONS: Elevated emotional arousal within a cancer-related conversation may be adaptive for adjustment, as it may reflect greater emotional engagement and processing of an important topic. These results may suggest ways for therapists to guide emotional engagement to enhance resilience in couples experiencing cancer.

Cancer is a stressful experience for patients and their partners. We know that how couples communicate about cancer is important, but we do not know much about how couples express emotion during cancer conversations and how those emotional expressions affect well-being. Our study looked at how couples' emotional arousal within cancer conversations relate to individual and relationship well-being. At the beginning of the study, cancer patients and their partners had a conversation about cancer. Within these conversations, we tracked the emotional arousal expressed in their voices. Couples also completed surveys about their well-being at the beginning of the study and later in time (4, 8, and 12 months later). We found that couples who started the conversation with higher emotional arousal had better initial well-being. Couples who remained higher in arousal later in the conversation improved in their individual well-being over time. We also found that if the non-cancer partner was low in arousal compared with patients, this predicted worse well-being over time. More research is needed, but these findings suggest that being emotionally aroused during conversations about important topics like cancer might be helpful for well-being, potentially because couples are discussing concerns and not backing off when it feels challenging.

[The determinants of emotional climate in families of patients with schizophrenia: a cross-sectional study of 50 families]. / Les déterminants du climat émotionnel dans les familles de patients avec schizophrénie: étude transversale sur 50 familles.

Introduction: expressed emotion (EE) is a concept which dates back to the sixties and refers to the attitude that relatives have toward a family member with schizophrenia. It comprises three behavioral patterns: criticism, hostility, and emotional overinvolvement. An important body of literature has shown that high expressed emotion (EE) is a factor of relapse in schizophrenia. The purpose of our study was to measure expressed emotion in the families of a Moroccan sample of patients and then to investigate factors associated with high EE. Methods: fifty (50) patients with stable schizophrenia, each with a relative involved in their care, were recruited during outpatients visits. Sociodemographic data were collected and the FAS scale was used by relatives. Data were also collected from the mental representations of relatives about the patient and disease. Statistical analysis was carried out using the SPSS software and was based on the Chi 2 tests as well as T tests for independent samples. Results: forty-eight percent (48%) of relatives had a high EE. High EE was associated with a feeling of shame toward the patient. It was also associated with cannabis addiction. Low EE was associated with the fact that the patient financially took care of his family. Conclusion: the knowledge of the determinants of high EE in our socio-cultural context is essential in order to direct any psycho-educational intervention aimed at reducing EE.

A randomized controlled trial of moderated online social therapy for family carers of first-episode psychosis patients in a specialist treatment setting.

BACKGROUND: Family members, who provide the majority of informal care during the recovery period from first-episode psychosis (FEP), experience high levels of psychological distress. However, there is a lack of effective and accessible interventions for FEP carers. OBJECTIVE: To determine the effectiveness of an online intervention ("Altitudes") in relation to the primary outcome of FEP-carer stress at 6 months follow-up. METHODS: We conducted a cluster randomized controlled trial in which FEP carers were randomized to Altitudes combined with specialized treatment as usual (STAU) or STAU alone. In addition to questionnaires, we included multiple waves of intensive ecological momentary assessment (EMA) to measure carer stress and family outcomes in 164 carers of young (15-27 years) FEP patients. RESULTS: Both groups improved over time on stress and a range of secondary outcomes, including mental health symptoms, self-efficacy, and expressed emotion with no group by time interactions. At 12 months there were significantly fewer visits to emergency departments by FEP patients in the Altitudes group (p = 0.022). Modelling of multiple EMA waves revealed that more time spent by carers with FEP patients predicted greater worry, expressed emotion, and adaptive coping. CONCLUSIONS: Engagement and usability findings for Altitudes were positive. Further refinements to our online carer interventions may be needed to engage carers in purposeful skill development for improved management of stress and communication with the young person compared with existing specialist family interventions. TRIAL REGISTRATION: ACTRN12616000968471.