What is expressed emotion?
Expressed emotion (EE) describes how critical, hostile or emotionally overinvolved family members are when they talk about a relative with a mental health condition. It is not meant to blame families. Instead, it shows that the emotional climate at home can affect recovery.
- Origins
- British social psychiatry research (George Brown and colleagues)
- Measurement
- The Camberwell Family Interview (CFI), rating what relatives say and how they say it
- Components
- Critical comments, hostility, emotional overinvolvement (plus warmth and positive remarks)
- Key finding
- High-EE households are linked to higher relapse risk
How the research began
In the 1950s, British researchers following patients discharged after treatment for schizophrenia noticed that those who returned to live with parents or spouses relapsed more often than those who lived alone or with siblings. Brown, Birley and Wing (1972) measured EE through family interviews and found a nine-month relapse rate of 58% in high-EE homes versus 16% in low-EE homes. Vaughn and Leff (1976) replicated the finding and showed that a critical climate was also linked to relapse in depression.
Components of expressed emotion
| Component | Example |
|---|---|
| Critical comments | "He just lies in bed all day. He’s lazy." |
| Hostility | "She has ruined this family." (rejecting the person as a whole) |
| Emotional overinvolvement | "He can’t do anything without me. I’ve given up all my friends for him." |
| Warmth and positive remarks | "She’s been trying hard to get up on her own in the mornings." (protective) |
The meta-analysis and what it means
A family’s words can matter almost as much as medication. Repeated criticism like "Why are you doing this again?" becomes a daily stressor, and that stress can trigger a return of symptoms.
Butzlaff and Hooley (1998) combined 27 studies and found that EE significantly predicts relapse in schizophrenia, with even stronger links for mood and eating disorders. This fits the stress–vulnerability idea in stress theory. Importantly, high EE is often an understandable reaction from exhausted caregivers, not a sign of bad families.
Family psychoeducation and practical tips
EE research led to family psychoeducation, which teaches relatives about the illness, communication and problem solving, and has been shown to reduce relapse. In the US, NAMI offers free Family-to-Family classes, and the 988 Suicide & Crisis Lifeline provides 24/7 crisis support.
- Separate the person from the symptoms. Low motivation can be part of the illness, not laziness.
- Make specific requests instead of criticizing. Swap "You’re lazy" for "Let’s take a 10-minute walk together today."
- Notice small efforts. Warmth and praise are protective factors.
- Look after yourself. Doing everything for your relative wears out both of you.
Frequently asked questions
- What is expressed emotion in psychology?
- It is a measure of the critical, hostile and emotionally overinvolved attitudes family members show toward a relative with a mental illness.
- Why does high expressed emotion increase relapse?
- Ongoing criticism and tension create chronic stress for the patient, which is thought to raise the risk of symptoms returning.
- How can families lower expressed emotion?
- Family psychoeducation, replacing criticism with specific requests and praise, and caregivers taking care of their own wellbeing all help.
References
- Brown, G. W., Birley, J. L. T., & Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorders: A replication. British Journal of Psychiatry, 121(562), 241–258.
- Vaughn, C. E., & Leff, J. P. (1976). The influence of family and social factors on the course of psychiatric illness: A comparison of schizophrenic and depressed neurotic patients. British Journal of Psychiatry, 129(2), 125–137.
- Butzlaff, R. L., & Hooley, J. M. (1998). Expressed emotion and psychiatric relapse: A meta-analysis. Archives of General Psychiatry, 55(6), 547–552.