Fam Proc 28:153-167, 1989 Is Expressed Emotion an Index of a Transactional Process? I. Parents' Affective Style DAVID J. MIKLOWITZ, Ph.D. a MICHAEL J. GOLDSTEIN, Ph.D. a JERI A. DOANE, Ph.D. b KEITH H. NUECHTERLEIN, Ph.D. c ANGUS M. STRACHAN, Ph.D. a KAREN S. SNYDER, M.A. c ANA MAGAÑA-AMATO, M.A. a a Dr. Miklowitz was a NIMH Postdoctoral Fellow; Dr. Goldstein is a Professor, Dr. Strachan an Adjunct Assistant Professor, and Ana Magaña-Amato a Research Associate at the UCLA Department of Psychology. Dr. Strachan is also affiliated with The Southern California Family Institute. Send reprint requests to the first author, currently an Assistant Professor, Department of Psychology, Muenzinger Bldg., Campus Box 345, University of Colorado, Boulder CO 80309-0345. b Assistant Professor, Yale Psychiatric Institute, Yale University School of Medicine, New Haven CT. c Dr. Nuechterlein is an Associate Professor and Karen Snyder a Research Associate at the Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles. 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. THERE ARE NOW seven independent replications of the finding that high expressed emotion (EE) attitudescriticism and emotional overinvolvementin relatives of hospitalized schizophrenics are associated with a three-to-fourfold greater risk of patient relapse in the 9 or 12 months following hospital discharge than are low-EE attitudes (2, 15, 18, 25, 28, 34, 36). Further, the association between EE and symptomatic relapse has been documented in samples of depressed (14, 34), bipolar affective (24), and obese patients (7). Three failures of replication have also been reported in samples of schizophrenic patients (5, 21, 29). Expressed emotion is assessed from the semistructured Camberwell Family Interview (CFI; 35) administered to a key relative shortly after the patient's hospital admission. There are a number of unresolved questions in the EE research. First, do these emotional attitudes in relatives persist after the patient has resolved the acute episode, entered remission, and returned to the community? Second, is this persistence in attitudes predictive of the everyday transactions between relative and patient during the aftercare period? Third, are these affective attitudes and interactional behaviors in relatives independent of the patient's clinical state during the acute episode and after he or she returns home? Fourth, are variations in EE attitudes or in the affective quality of family transactions during the aftercare period linked to certain interactional response styles in the patient? For example, a notable degree of criticism from relatives may be associated with a negativistic stance by the patient, whereas a supportive interactional style may be associated with active engagement of the patient in social relationships. However, the manner in which these response styles in patients influence the interactional behavior of relatives has received scant attention. We address the above issues in two articles. This article will deal with the first three issues in a sample of recent-onset schizophrenic patients and their parents. The second article (31) will address the connections between parent and patient response styles as a function of the family's EE status as assessed during both the acute and remitted stages of the patient's current episode of schizophrenia. Prior Research ______________________________________________________________________________________________________________ 1