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  • 1
    Electronic Resource
    Electronic Resource
    Psychological Treatment and Medication for the Mood and Anxiety Disorders: Moderators, Mediators, and Domains of Outcome (2005)
    Oxford, UK : Blackwell Publishing Ltd
    Clinical psychology 12 (2005), S. 0 
    Details
    ISSN: 1468-2850
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: Studies that combine pharmacotherapy with psychological treatment for the mood and anxiety disorders must consider the role of moderators (pretreatment variables that specify the conditions under which treatments are effective) and mediators (change mechanisms in the causal pathways between treatments and outcomes) in explaining the impact of experimental treatments. This article gives examples of the kinds of moderators and mediators—both psychosocial and biological—that are important to examine in combination treatment studies. It conceptualizes outcome as involving multiple domains, including mood and anxiety symptoms, life functioning, and illness costs. Research should also examine the appropriate sequencing of pharmacological and psycho-social interventions and how this sequencing may vary from disorder to disorder.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1093/clipsy.bpi012
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Expressed Emotion Attitudes and Individual Psychopathology Among the Relatives of Bipolar Patients (2002)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 41 (2002), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: This study investigated the relationships between expressed emotion (EE) and individual psychopathology among 82 biological and non-biological relatives of 66 patients with bipolar I disorder. Relatives' psychopathology was assessed via the Structured Clinical Interview for DSM-III-R, Patient Version (SCID-P) and the General Behavior Inventory (GBI), a self-report measure of lifetime subsyndromal mood disturbances. We hypothesized that relatives who held high-EE critical, hostile, and/or overinvolved attitudes toward their bipolar family member, as measured via the Camberwell Family Interview, would be more likely to have DSM-III-R Axis I diagnoses on the SCID, as well as more mood and temperamental disturbances on the GBI, than those who held low-EE attitudes. The findings did not support a significant relationship between overall EE status and psychopathology in family members. However, relatives without significant Axis I pathology scored significantly higher than those with Axis I pathology on one measure of EE, emotional overinuolvement. The findings are discussed with reference to explanations for the genesis of high-EE attitudes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.2002.00645.x
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  • 3
    Electronic Resource
    Electronic Resource
    Family Transactions and Relapse in Bipolar Disorder (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 40 (2001), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: This study examined whether patient symptoms and relatives' affective behavior, when expressed during directly observed family interactions, are associated with the short-term course of bipolar disorder. Twenty-seven bipolar patients and their relatives participated in two 10-minute family interactions when patients were discharged after a manic episode. Results indicated that patients who showed high levels of odd and grandiose thinking during the interactions were more likely to relapse during a 9-month followup period than patients who did not show these symptoms during the family discussions. Relapse was also associated with high rates of harshly critical and directly supportive statements by relatives. Patients' odd thinking and relatives' harsh criticism were significantly more likely to be correlated when patients relapsed (r = .53) than when they did not relapse (r = .12). Results suggest that bipolar patients who show increased signs of residual symptomatology during family transactions during the post-hospital period are at increased relapse risk. The data also suggest that relatives of relapsing patients cope with these symptoms by increasing both positive and negative affective behaviors. Moreover, a bidirectional, interactional relationship between patients' symptoms and relatives' coping style seems to capture best the role of the family in predicting relapse in bipolar disorder.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.2001.4010100005.x
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  • 4
    Electronic Resource
    Electronic Resource
    Clinicians' Fidelity to a Manual-Based Family Treatment as a Predictor of the One-Year Course of Bipolar Disorder (2002)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 41 (2002), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: This study assessed whether therapist adherence to the family focused treatment model1 for patients with bipolar disorder and their relatives was associated with patient outcomes at one year after treatment entry. A total of 78 videotaped sessions of FFT consisting of 26 families with a member with bipolar disorder (3 sessions/family) were rated on fidelity using the Therapist Competence/Adherence Scale (TCAS; see Endnote 1, p. 130). Patients' outcomes (relapse status) were assessed using the Brief Psychiatric Rating Scale (BPRS) and selected items from the Schedule of Affective Disorders and the Schizophrenia-Change (SADS-C) scale (measured at 3-month intervals for 12 months). Contrary to expectations, therapist fidelity was not related to overall outcome as assessed by the BPRS and the SADS-C. Among patients who did relapse, higher levels of cooperation among therapists predicted a later date for relapse than did lower levels of cooperation. Surprisingly, and in opposition to the study's hypotheses, patients who were hospitalized because of relapses had therapists who were rated as more competent in their ability to conduct the problem-solving module of FFT. Study implications are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.2002.40102000123.x
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  • 5
    Electronic Resource
    Electronic Resource
    Difficulty in Implementing a Family Intervention for Bipolar Disorder: The Predictive Role of Patient and Family Attributes (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 39 (2000), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: Family affect was examined as a predictor of difficulty implementing a 9-month, manual-based, psychoeducational family therapy for recently manic bipolar patients. Prior to therapy, family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task. Following family treatment, both therapists and independent observers rated the overall difficulty of treating the family, and therapists also rated each participant's problem behaviors during treatment, in the areas of affect, communication, and resistance. Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family. Relatives' critical behavior toward patients during the pretreatment interaction task predicted both independent observers' ratings of overall treatment difficulty and therapists' perceptions of relatives' affective problems during treatment. Moreover, patients' residual symptoms predicted independent observers' ratings of overall difficulty and therapists' perceptions of patients' resistance to the family intervention. Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic, pretreatment family and clinical assessment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.2000.39110.x
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  • 6
    Electronic Resource
    Electronic Resource
    Global Assessment of Relational Functioning Scale (GARF): II. Reliability and Validity in a Sample of Families of Bipolar Patients (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 35 (1996), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.1996.00175.x
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  • 7
    Electronic Resource
    Electronic Resource
    Is Expressed Emotion an Index of a Transactional Process? II. Patient's Coping Style (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 28 (1989), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: This article examines the extent to which expressed emotion (EE) indexes not only relatives' behavior toward schizophrenic patients but also patients' behavior toward their relatives. The coping styles (CS) of schizophrenic patients were assessed during interactions with their parents and were compared with parental EE attitudes assessed during an acute hospitalization and during the aftercare period. It was found that parental EE attitudes measured during the inpatient period strongly predicted patients' outpatient transactional behavior: patients interacting with low-EE relatives showed significantly fewer critical and more autonomous statements than patients interacting with high-EE relatives. Further, the dominant patient coping style (autonomous, neutral, externalizing, or internalizing) was strongly related to the relatives' interactional affective style (AS) and to their pattern of EE attitudes. Patient coping style was not related to clinical attributes of these patients themselves. This article and its preceding companion (17) together suggest that EE indexes a transactional process so that the quality of both parents' and patients' transactional behaviors may predict subsequent patient functioning.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.1989.00169.x
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  • 8
    Electronic Resource
    Electronic Resource
    Can Communication Deviance Be Measured in a Family Problem-Solving Interaction? (1990)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 29 (1990), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: Communication deviance (CD) refers to confusing and fragmented communication that prevents family members from attaining a shared focus of attention and meaning. Levels of communication deviance based on individual parental projective test protocols — Thematic Apperception Test (TAT) and Rorschach — have repeatedly been found to be higher in parents of schizophrenic offspring than in parents of normal or nonpsychotic offspring. CD has also been measured in family transactions in which parents and their offspring interact with one another around a projective test stimulus, the Consensus Rorschach. There have been relatively few attempts to measure specific CD codes in familial interaction that is not initiated around an ambiguous visual stimulus. The present article examines the reliability and construct validity of an interactional measure (ICD) obtained from family transactions in which parents and patients are working toward the solution of a salient family problem. ICD from this family problem-solving task was compared to more traditional measures of CD from parental TAT protocols in a sample of 59 parents of 37 recent-onset schizophrenic patients. Results indicated that CD could be reliably measured in an interactive setting not initiated around a projective test stimulus, and provided evidence for the construct validity of ICD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.1990.00213.x
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  • 9
    Electronic Resource
    Electronic Resource
    Nonverbal Interactional Behavior in the Families of Persons with Schizophrenic and Bipolar Disorders (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 35 (1996), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: Whereas verbal interactional behaviors have been repeatedly found to distinguish the families of persons with and without major psychiatric disorders, there has been comparatively little examination of the discriminative value of nonverbal interactional behaviors. We developed the Nonverbal Interactional Coding System to measure “affiliative” and “distancing” nonverbal behaviors in 18 schizophrenic and 18 bipolar patients and their parents during 10-minute interactions conducted during a posthospital period. Bipolar patients and their parents displayed affiliative nonverbal behaviors (“illustrator gestures” or “prosocial behaviors”) for longer durations than schizophrenic patients and their parents. In contrast, parents of schizophrenic patients displayed distancing nonverbal behaviors (looking away) for longer durations than those of bipolar patients. The nonverbal interactional data added to the statistical strength of patients’ and parents’ verbal interactional data in distinguishing between these diagnostic groups. Nonverbal interactional behaviors are important variables to consider in interventions aimed at improving the communication skills of families coping with psychiatric disorders.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.1996.00083.x
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  • 10
    Electronic Resource
    Electronic Resource
    Expressed Emotion and Reciprocal Affective Relationships in Families of Disturbed Adolescents (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Family process 28 (1989), S. 0 
    Details
    ISSN: 1545-5300
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Psychology
    Notes: Relatives expressed emotion (EE) is a known risk factor for relapse among recovering psychiatric patients. Recent research has focused on the behavioral correlates of EE, seeking better understanding of the family processes associated with this important variable. The present study used sequence analysis to explore interactions of high-EE and low-EE parent-child dyads in a sample of disturbed adolescents. High-EE mother-child interactions were characterized by bidirectional influence, and, in contrast to adolescents in low-EE dyads, adolescents in high-EE dyads had an oppositional style of responding. In Low-EE mother-child interactions, the adolescents showed more temporal consistency (stability) of affect than their high-EE counterparts. Overall, the results suggest that high-EE mother-child dyads constitute more tightly joined emotional systems than low-EE dyads. Consequently, interventions designed to reduce this connectedness might also reduce the risk of adolescent psychiatric problems.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1545-5300.1989.00337.x
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