Communication Deviance, Expressed Emotion, and Family Cohesion in Schizophrenia

Although schizophrenia is a biologically-based disorder, environmental stress (including stress within familial relationships) plays a major role in the onset and maintenance of symptoms. This study examined family variables that have implications for psychotherapeutic treatment of schizophrenia. Previous research has found Communication Deviance (CD), Expressed Emotion (EE), and family cohesion (FC) to be related to symptom severity. However, the exact nature of the relationship between these constructs is unclear. The current study tested a model whereby the tone and content of family member’s communication (EE) and the sense of family unity (FC) are hypothesized to mediate the relationship between CD and psychiatric symptoms. This model stems from the theory that high CD is likely to be experienced as frustrating because it hinders relatives’ communication goals. Thus, relatives may resort to more critical and hostile methods of expressing their thoughts (High EE). Simultaneously, inability to share experiences in a clear manner may lead patients and family members to feel more disconnected (low FC). High EE and low FC in turn were hypothesized to lead to increased symptoms. This study did not find support for the above model. Communication Deviance was not related to severity of psychiatric symptoms, and Expressed Emotion and family cohesion were also unrelated to communication deviance and psychiatric symptoms in the larger model. Higher family cohesion was related to fewer psychiatric symptoms when looking at individual correlations, but this relationship disappeared once other variables were included in analyses. The largely null study findings may be due to limited variance in many of our primary study variables (e.g., CD, family cohesion). Other explanations are also entertained