The impact of warmth, positive remarks, and criticism on paranoia and psychosis

Abstract

‘Expressed emotion’ (EE), the affective attitudes and behaviours within the family environment, has been widely researched in psychosis. However, positive aspects of EE, such as warmth, have received far less attention than negative aspects, such as criticism. This thesis aimed to address this with a systematic review of positive EE and an experimental investigation of the impact of critical and warm comments on paranoia. Paper One reports a systematic review, which attempted to synthesise and evaluate research to date looking at relationships between positive EE in families and outcomes in psychosis. Twenty-seven eligible studies were identified, reporting outcome measures including relapse, psychotic and affective symptomatology, social functioning, and life satisfaction. Study samples varied cross-culturally and in stage of psychosis. Stronger evidence emerged for the predictive validity of warmth than positive remarks, and for significant effects to be found earlier in psychosis and at earlier follow-up points. A limitation of the literature was the predominance of correlational designs. Paper Two aimed to address the relative neglect of potential protective factors through an experimental study focusing on paranoia in non-clinical participants. The study assessed, firstly, whether criticism and warm comments elicited changes in state paranoia, and secondly, whether warm comments provided protective effects when participants faced a subsequent social exclusion manipulation. As predicted, paranoia levels increased following exposure to criticism. Paranoia did not decrease significantly following exposure to warm comments. Furthermore, warm comments did not provide protection against the effects of subsequent social exclusion. Contrary to expectation, the warm comments condition was the only condition in which significant increases in paranoia were seen following social exclusion. Clinical implications and areas for future work are discussed. Paper Three provides a critical reflection on the previous two papers, encompassing the planning, implementation, and interpretation of the research presented and consideration of clinical implications and areas for future research.

Date of Award	31 Dec 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Katherine Berry (Supervisor) & Sandra Bucci (Supervisor)