Actualización en torno a la Emoción Expresada: Consideraciones teóricas, metodológicas y prácticas
DOI:
https://doi.org/10.33898/rdp.v27i103.60Palabras clave:
Familia, Psicopatología, Estrés, Calidez, Estudio TeóricoResumen
En el presente trabajo teórico se revisan cuestiones de diferente índole relacionadas con la Emoción Expresada (EE), un campo de trabajo que desde sus inicios a finales de los años sesenta ha llegado a ser muy fructífero para el entendimiento de los factores familiares implicados en los trastornos mentales graves y enfermedades de curso crónico, aunque al que no se le ha dedicado demasiada reflexión crítica. En varios aspectos se hace necesaria una actualización desde una mirada comprehensiva de la literatura que permita avanzar cualitativamente en su estudio, y que repercute en sus aplicaciones clínicas. Primero, se aboga por la consideración de la baja EE y la inclusión de los aspectos positivos, fundamentalmente la calidez, como factores de protección, redirigiendo el tema hacia la psicología positiva. Segundo, se subraya la naturaleza bidireccional y diádica de las relaciones entre pacientes y sus familias en torno a la EE, con las consecuentes implicaciones metodológicas y prácticas a nivel de medida, diseño de estudios y trabajo clínico.
Descargas
Citas
Amaresha, A.C. y Venkatasubramanian, G. (2012). Expressed Emotion in Schizophrenia: An Overview. Indian Journal of Psychological Medicine, 34, 12-20.
Anastasiadou, D., Medina-Pradas, C., Sepulveda, A.R. y Treasure, J. (2014). A systematic review of family caregiving in eating disorders. Eating Behaviours, 15(3), 464-477.
Bachmann, S., Bottmer, C., Jacob, S. y Schröder, J. (2006). Perceived criticism in schizophrenia: A comparison of instruments for the assessment of the patient’s perspective and its relation to relatives’ EE. Psychiatry Research, 142, 167-175.
Ballús-Creus, C., Rangel, M.V., Peñarroya, A., Pérez, J. y Leff, J. (2014). Expressed emotion among relatives of chronic pain patients, the interaction between relatives’ behaviours and patients’ pain experience. International Journal of Social Psychiatry, 60(2), 197-205.
Bebbington, P. y Kuipers, L. (1994). The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychological Medicine, 21, 707-718.
Becerra, J.A. (2011). Descripción y limitaciones de los instrumentos de evaluación de la emoción expresada. Papeles del Psicólogo, 32, 152-158.
Bhugra, D. y McKenzie, K. (2003). Expressed Emotion across cultures. Advances in Psychiatric Treatment, 9, 342- 348.
Brown, G.W. y Rutter, M. (1966). The measurement of family activities and relationships: a methodological study. Human Relations, 19, 241-263.
Brown, G.W., Birley, J.L.T. y Wing, J.K. (1972). Influence of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry, 121, 241-258.
Burbach, F.R. (2013). Towards a systemic understanding of family emotional atmosphere and outcome after psychosis. En A. Gumley, A. Gillham, K. Taylor y M. Schwannauer (eds.), Psychosis and Emotion (pp. 116- 235). USA y Canada: Routledge.
Butzlaff, R.L. y Hooley, J.M. (1998). Expressed emotion and psychiatric relapse. Archives of General Psychiatry, 55, 547- 552.
Cole, J.D. y Kazarian, S.S. (1988). The level of expressed emotion scale: a new measure of expressed emotion. Journal of Clinical Psychology, 44, 392-397.
Cruise, R.C., Sheeber, L.B. y Tompson, M.C. (2011). Behavioural correlates of maternal expressed emotion in interaction tasks. Journal of Family Psychology, 25(5): 781-784.
Cutting, L.P., Aakre, J.M. y Docherty, N.M. (2006). Schizophrenic Patients’ Perceptions of Stress, Expressed Emotion, and Sensitivity to Criticism. Schizophrenia Bulletin, 32(4), 743-750.
Dean, N. y Lin, N. (1977). The stress-buffering role of social support. Journal of Nervous and Mental Disease, 165, 403-416.
Di Paola, F., Faravelli, C. y Ricca, V. (2010). Perceived expressed emotion in anorexia nervosa, bulimia nervosa, and binge-eating disorder. Comprehensive Psychiatry, 51, 401-405.
Docherty, N.M., St-Hilaire, A., Aakre, J.M., Seghers, J.P., McCleery, M. y Divilbiss, M. (2011). Anxiety Interacts With Expressed Emotion Criticism in the Prediction of Psychotic Symptom Exacerbation. Schizophrenia Bulletin, 37(3), 611-618.
Duclos, J., Vibert, S., Mattar, L. y Godart, N. (2012). Expressed Emotion in Families of Patients with Eating Disorders: A Review of the Literature. Current Psychiatry Reviews, 8.
Ellis, A.J., Portnoff, L.C., Axelson, D.A., Kowatch, R.A., Walshaw, P. y Miklowitz, D.J. (2014). Parental expressed emotion and suicidal ideation in adolescents with bipolar disorder. Psychiatry Research, 216(2): 213-16.
Feixas, G. (1998). Los constructos personales en la práctica sistémica. En: R.A. Neimeyer, M.J. Mahoney (eds.), Constructivismo en psicoterapia (pp. 273-309). Barcelona, España: Paidós.
Fernandez-Rios, L. y Novo, M. (2012). Positive Pychology: Zeigeist (or spirit of the times) or ignorance (or disinformation) of history? International Journal of Clinical and Health Psychology, 12(2), 333-344.
Finnegan, D., Onwumere, J., Green, C., Freeman, D., Garety, P. y Kuipers, E. (2014). Negative communication in psychosis: understanding pathways to poorer patient outcomes. Journal of Nervous and Mental Disorders, 202, 829-832.
Fredickson, B.L. (2001). The role of positive emotions in positive psychology. The Broaden-and-Build Theory of positive emotions. American Psychologist, 56, 218-226.
Gonzalez-Pinto, A., Ruiz de Azua, S., Ibanez, B., Otero-Cuesta, S., Castro-Fornieles, J., Graell-Berna, M., … Arango, C. (2011) Can positive family factors be protective against the development of psychosis? Psychiatry Research, 186, 28-33.
Gonzalo, N. y Amor, B. (2003). Intervención familiar en la esquizofrenia. En E. Doménech-Llaberia, J.E. Obiols, M.C. Janè y S. Subirà (eds.), Actualizaciones en psicopatología clínica 2003 (pp. 295-332). Barcelona, España: Masters Psicopatología UAB.
Gutierrez, E. Sepulveda, A.R., Anastasiadou, D. y Medina-Pradas, C. (2014). Programa de psicoeducación familiar para los trastornos del comportamiento alimentario. Behavioral Psychology/ Psicologia Conductual, 22(1), 133-149.
Hahlweg, W.K., Goldstein, M.J. y Nuechterlein, K.H. (1989). Expressed emotion and patient relative interaction in families of recent onset schizophrenics. Journal of Consulting and Clinical Psychology, 57, 11-18.
Halford, K.W. (1992). Assessment of family interaction with a schizophrenic member. In D.J. Kavanagh (ed.), Schizophrenia: An overview and practical handbook (pp. 254-274). London: Chapman & Hall.
Hirsch, S.R. y Leff, J. (1975). Abnormalities in patients of schizophrenics. Maudsley Monograph nº 22. Londres: Oxford University Press.
Hooley, J.M. (2007). Expressed Emotion and Relapse of Psychopathology. Annual Review of Clinical Psychology, 3, 329-352.
Hooley, J.M. y Gotlib, I.H. (2000). A diathesis-stress conceptualization of expressed emotion and clinical outcome. Applied and Preventive Psychology, 9, 135-151.
Hooley, J.M. y Parker, H.A. (2006). Measuring expressed emotion: an evaluation of the shortcuts. Journal of Family Psychology, 20, 386-396.
Kazarian, S.S., Malla, A.K., Cole, J.D. y Baker, B. (1990).Comparisons of two expressed emotion scales with the Camberwell Family Interview. Journal of Clinical Psychology, 46, 306-309.
Koujalgi, S.R., Nayak, R.B., Patil, N.M. y Chate, S.S. (2014). Expressed emotions in patients with obsessive compulsive disorder: a case control study. Indian Journal of Psychological Medicine, 36(2), 138-141.
Kuipers, E., Leff, J. y Lam, D. (2002). Family Work for Schizophrenia. London: Gaskell.
Lazarus, R.S. (1993). From psychological stress to the emotions: a history of changing outlooks. Annual Review of Psychology, 44, 1-21.
Lazarus, R. y Folkman, S. (1984). Stress, appraisal and coping. Nueva York: Springer.
Lee, G., Barrowclough, C. y Lobban, F. (2014). Positive affect in the family environment protects against relapse in first-episode psychosis. Social Psychiatry and Psychiatric Epidemiology, 49, 367-376.
Leff, J., Kuipers, L., Berkovitz, R., Vaughn, C. y Sturgeon, D. (1983). Life events, relatives expressed emotion and maintenance neuroleptics in schizophrenic relapse. Psychological Medicine, 13, 799-806.
Li, C.Y. y Murray, M. (2015). A review of conceptualisation of expressed emotion in caregivers of older adults with dementia. Journal of Clinical Nursing, 24(3-4): 332-343.
López, S.R., Hipke, K.N., Polo, A.J., Jenkins, J.H., Karno, M., Vaughn, C. y Snyder, K.S. (2004). Ethnicity, expressed emotion, attributions, and course of schizophrenia: Family warmth matters. Journal of Abnormal Psychology, 113, 428-439.
Magana, A.B., Goldstein, M.J., Karno, M., Miklovitz, D.J., Jenkins, J. y Fallon, I.R.H. (1986). A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatric Research, 17, 203-212.
Medina-Pradas, C., Domínguez-Martínez, T., Kwapil, T.E., Barrantes-Vidal, N., López, S.R. (2016, en prensa). The Brief Dyadic Scale of Expressed Emotion (BDSEE) – Relatives Version.
Medina-Pradas, C., Navarro, J.B., López, S.R., Grau, A. y Obiols, J.E. (2011a). Dyadic view of expressed emotion, stress, and eating disorder psychopathology. Appetite, 57(3), 743-748.
Medina-Pradas, C., Navarro, J.B., López, S.R., Grau, A. y Obiols, J.E. (2011b). Further development of a scale of perceived expressed emotion and its evaluation in a sample of patients with eating disorders. Psychiatry research, 190(2-3), 291-296.
Medina-Pradas, C., Navarro, J.B., Pousa, E., Montero, M.I. y Obiols, J.E. (2013). Expressed and perceived criticism, family warmth, and symptoms in schizophrenia. Spanish Journal of Psychology, 16(45), 1-8.
Miklovitz, D.J. (2004). The role of family systems in severe and recurrent psychiatric disorders: a developmental psychopathology view. Development and Psychopathology, 16, 667-688.
Miklowitz, D.J., Wisniewski, S.R., Miyahara, S., Otto, M.W. y Sachs, G.S. (2005). Perceived criticism from family members as a predictor of the one-year course of bipolar disorder. Psychiatry Research, 136, 101-111.
Montero, I. y León, O.G. (2007). A guide for naming research studies in Psychology. International Journal of Clinical and Health Psychology, 7, 847-862.
Moulds, M.L., Touyz, W., Schotte, D., Beumont, P.J.V., Griffiths, R., Russell, J. y Charles, M. (2000). Perceived expressed emotion in the siblings and parents of hospitalized patients with anorexia nervosa. International Journal of Eating Disorders, 27, 288-296.
Muela, J.A. y Godoy, J.F. (1997). El estrés crónico en la esquizofrenia: la emoción expresada. Revista electrónica de Motivación y Emoción, 4, 7.
Nuechterlein, K.H., Snyder, K.S. y Minz, J. (1992). Paths to relapse: possible transactional processes connecting patient illness onset, expressed emotion, and psychotic relapse. The British Journal of Psychiatry, Supp. 18, 88-96.
Parker, G. y Johnston, P. (1988). Examining for links between expressed emotion and EPI personality variables: Can low EE be faked? Acta Psychiatrica Scandinavica, 78, 599-602.
Perez-Pareja, B., Quiles, Y., Romero, C., Pamies-Aubalat, L. y Quiles, M.J. (2014). Malestar psicológicoy emoción expresada en cuidadores de pacientes con un trastorno de la conducta alimentaria. Anales de Psicología, 30, 1, 37-45.
Perkins, S., Schmidt, U., Eisler, I., Treasure, J., Yi, I., Winn, S., … Berelowitz, M. (2005). Why do adolescents with bulimia nervosa choose not to involve their parents in treatment? European Child and Adolescent Psychiatry, 14, 376-385.
Pharoah, F., Mari, J.J., Rathbone, J., Wong, W. (2010). Family intervention for schizophrenia. Chochrane Database of Systematic Reviews, 12: Art. Nº CD000088.
Procter, H. (1981). Family construct psychology: An approach to understanding and treating families. En: S. Walrond-Skinner (ed.), Developments in family therapy: Theories and applications since 1948. Londres: Routledge y Kegan Paul.
Procter, H. (1985). A personal construct approach to family therapy and systems intervention. En E. Button (ed.), Person construct theory and mental health. Londres: Croom Helm.
Renshaw, K.D. (2008). The predictive, convergent, and discriminant validity of perceived criticism: A review. Clinical Psychology Review, 28, 521-534.
Scazufca, M., Kuipers, E. y Menezes, P.R. (2001). Perception of negative emotions in close relatives by patients with schizophrenia. British Journal of Clinical Psychology, 40, 167-175.
Schlosser, D.A., Zinberg, J.L., Loewy, R.L., Casey-Cannon, S., O’Brien, M.P., Bearden, C.E., … Cannon, T.D. (2010). Predicting the longitudinal effects of the family environment on prodromal symptoms and functioning in patients at-risk for psychosis. Schizophrenia Research, 118, 69-75.
Subotnik, K.L., Schell, A.M., Chilingar, M.S., Dawson, M.E., Ventura, J., Kelly, K.A., ... Nuechterlein, K.H. (2012). The interaction of electrodermal activity and expressed emotion in predicting symptoms in recent- onset schizophrenia. Psychophysiology, 49(8): 1035-1038.
Tarrier, N. y Turpin, G. (1992). Psychosocial factors, arousal and schizophrenic relapse: a review of the psychophysiological data. British Journal of Psychiatry, 161, 3-11.
Tompson, M.C., Goldstein, M.J., Lebell, M.B., Mintz, L.I., Marder, S.R. y Mintz, J. (1995). Schizophrenic patients’ perceptions of their relatives’ attitudes. Psychiatry Research, 57, 155-167.
Treanor, L., Lobban, F. y Barrowclough, C. (2011). Relatives’ responses to psychosis: An exploratory investigation of low expressed emotion relatives. Psychology and Psychotherapy, 86(2), 197-211.
Treanor, L., Lobban, F. y Barrowclough, C. (2013). Relatives’ responses to psychosis: An exploratory investigation of low expressed emotion relatives. Psychology and Psychotherapy: Theory, Research and Practice, 86, 197-211.
Treasure, J. y Schmidt, U. (2013). The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders, 1, 13.
Van Humbeeck, G., Van Audenhove, Ch., De Hert, M., Pieters, G. y Storms, G. (2002). Expressed emotion: a review of assessment instruments. Clinical Psychological Review, 22, 323-343.
Vaughn, C.E. y Leff, J. (1976a). The influence of family and social factors on the course of psychiatric illness.
British Journal of Psychiatry, 129, 125-137.
Vaughn, C.E. y Leff, J. (1976b). The measurement of expressed emotion of families of psychiatric patients. British Journal of Social and Clinical Psychology, 15, 157-165.
Wearden, A.J., Tarrier, N., Barrowclough, C., Zastowny, T.R. y Armstrong, A. (2000). A review of expressed emotion research in health care. Clinical Psychology Review, 20, 5, 633-666.
Weisman, A.G., Rosales, G.A., Kymalainen, J.A. y Armesto, J.C. (2006). Ethnicity, expressed emotion, and schizophrenia patients’ perceptions of their family members’ criticism. The Journal of Nervous and Mental Diseases, 194, 644-649.
Zubin, J. y Spring, B. (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology, 86, 103-126.