Development of exposure-based treatments has marked a breakthrough in psychosocial treatment of anxiety disorders: 60-75% of agoraphobics and obsessive-compulsives show good improvement. However, residual disability generally remains, and these figures ignore the problems of treatment refusal, drop-out, and relapse. Attempts to explain the highly variable outcome have yielded few cross-validated findings. The one exception is marital dissatisfaction, which often shows substantial correlations with poor status at follow-up for agoraphobics. Preliminary data indicate that relatives' perceptions of, and responses to obsessive-compulsives contribute strongly to prediction of relapse. Such findings warrant a more careful exploration of the effects of the family environment on exposure outcome. Expressed Emotion (EE), defined as relatives' criticism of, and/or emotional over-involvement with the patient, has consistently predicted relapse for schizophrenics and depressed patients when patients returned to high EE homes after treatment. The purpose of the proposed studies is twofold: (a) to extend the prediction research on EE to severe anxiety disorders, and (b) to explore the construct of EE, as assessed by the Camberwell Family Interview, with this population. Fifty patients with panic disorder with agoraphobia and 50 with obsessive-compulsive disorder and their closest relative(s) will form the study sample. All patients will be behaviorally treated via exposure methods. Pretreatment EE will be examined as a predictor of relapse and change with treatment at 6-months and 1-year follow-up and of treatment drop-out and failure, controlling for likely confounding variables. Possible contributors to EE or to its effects on patients' symptoms will be explored through correlational analyses of EE with variables such as relatives' verbal and nonverbal behavior during interactions with the patients as scored by the Kategoriensystem fuer partnerschaftliche Interaktion (KPI); relatives' attributions concerning the patient's disorder; patients' perceptions of relatives' criticalness; and patients' and relatives' psychopathology. This information will provide findings which may guide the development of family treatment interventions to be added to exposure treatment for severe anxiety disorders.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH044190-03
Application #
3383661
Study Section
Treatment Development and Assessment Research Review Committee (TDA)
Project Start
1989-09-01
Project End
1994-08-31
Budget Start
1991-09-30
Budget End
1992-08-31
Support Year
3
Fiscal Year
1991
Total Cost
Indirect Cost
Name
Boston University
Department
Type
Schools of Social Work
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Renshaw, Keith D; Chambless, Dianne L; Thorgusen, Sommer (2017) Expressed Emotion and Attributions in Relatives of Patients With Obsessive-Compulsive Disorder and Panic Disorder. J Nerv Ment Dis 205:294-299
Chambless, Dianne L; Blake, Kimberly D; Simmons, Rachel A (2010) Attributions for relatives' behavior and perceived criticism: studies with community participants and patients with anxiety disorders. Behav Ther 41:388-400
Chambless, Dianne L; Blake, Kimberly D (2009) Construct validity of the Perceived Criticism Measure. Behav Ther 40:155-63
Simmons, Rachel A; Chambless, Dianne L; Gordon, Peter C (2008) How do hostile and emotionally overinvolved relatives view relationships? What relatives'pronoun use tells us. Fam Process 47:405-19
Chambless, Dianne L; Floyd, Frank J; Rodebaugh, Thomas L et al. (2007) Expressed emotion and familial interaction: a study with agoraphobic and obsessive-compulsive patients and their relatives. J Abnorm Psychol 116:754-61
Renshaw, Keith D; Chambless, Dianne L; Steketee, Gail (2006) The relationship of relatives' attributions to their expressed emotion and to patients' improvement in treatment for anxiety disorders. Behav Ther 37:159-69
Rodebaugh, Thomas L; Chambless, Dianne L; Renneberg, Babette et al. (2005) The factor structure of the DSM-III-R personality disorders: an evaluation of competing models. Int J Methods Psychiatr Res 14:43-55
Fredman, Steffany J; Chambless, Dianne L; Steketee, Gail (2004) Development and validation of an observational coding system for emotional overinvolvement. J Fam Psychol 18:339-47
Renshaw, Keith D; Chambless, Dianne L; Steketee, Gail (2003) Perceived criticism predicts severity of anxiety symptoms after behavioral treatment in patients with obsessive-compulsive disorder and panic disorder with agoraphobia. J Clin Psychol 59:411-21
Chambless, Dianne L; Fauerbach, James A; Floyd, Frank J et al. (2002) Marital interaction of agoraphobic women: a controlled, behavioral observation study. J Abnorm Psychol 111:502-12

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