Investigating Expressed Emotion (EE) in individuals at-risk of developing psychosis and their families over 12-months

Emma Izon, Katherine Berry, Alison Wearden, Lesley-Anne Carter, Heather Law, Paul French

Research output: Contribution to journalArticlepeer-review


High levels of Expressed Emotion (EE) are present in families of individuals with an At-Risk Mental State (ARMS) of psychosis and can negatively impact on service users’ functioning and symptoms, as well as relatives’ psychological wellbeing.
Objectives This is the first longitudinal study to assess EE from the family/carers’ perspective, as well as the service users’ perceptions of the family/carers’ EE. We explored the effects of EE on transition risk and outcomes of depression, worry and anxiety.
Methods Questionnaires were completed by 70 ARMS individuals and 70 family/carers at three time points: baseline, 6-months, and 12-months. All participants completed measures of anxiety, depression and worry, plus a version of the Family Questionnaire to assess EE.
Results EE scores reduced over time for both service users and family/carers. High-EE perceived by service users at 6-months was associated with higher transition to psychosis at 12-months. High-EE levels at baseline was associated with higher levels of service user depression and family/carer anxiety at 12-months. Higher family/carer total EE scores were associated with less contact with the service user and higher levels of worry.
Conclusions Novel implications suggest that interventions to reduce high-EE in families of people with ARMS would benefit service users by protecting them from higher levels of depression and transition to psychosis. Reducing high-EE attitudes would also benefit the family/carers by reducing levels of anxiety and worry. Family interventions focussing on multiple perceptions of the home environment could help to direct services and prevent negative psychological outcomes for all family
Original languageEnglish
JournalClinical Psychology & Psychotherapy
Early online date19 Feb 2021
Publication statusPublished - 19 Feb 2021


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