Expressed emotion, types of behavioural control and controllability attributions in relatives of people with recent-onset psychosis

High expressed emotion (high-EE), as compared with low-EE, relatives of patients with long-term psychosis may behave in a more controlling manner towards patients. Furthermore, higher levels of behavioural control have been associated with higher relapse rates. We investigated in a recent-onset sample, the extent to which high-EE relatives engage in controlling behaviours and attribute the patient's illness to factors within patient's control. Furthermore, we examined whether criticism/hostility and emotional overinvolvement (EOI) were, respectively, associated with two types of behavioural control (termed 'direct influencing' and 'buffering'). We also investigated if controlling behaviours or attributions were better relapse predictors than EE. Measures of EE, controllability attributions and behavioural control and its subtypes ('direct influencing' and 'buffering') were derived from Camberwell Family Interviews with 80 relatives of recent-onset psychosis patients. 'Direct influencing' attempts denote any behaviour intending to coerce the patient; while 'buffering' attempts refer to any behaviour aiming to take control or do things for the patient. High-EE relatives perceived patients as having more control over their illness and were more inclined to attempt to control patients' behaviour than low-EE relatives. Furthermore, high-EE-critical relatives used more direct influencing attempts, and high-EE-EOI relatives used more buffering attempts, but behavioural control was not associated with relapse in this recent-onset sample. These findings may help us to understand the development of EE in recent-onset psychosis families. Acknowledging and integrating relatives' attributional and behavioural patterns in designing and delivering clinical and familial early interventions should prove beneficial in meeting the needs of this specific population.