Background: Family interactions with schizophrenia patients and caregivers rated as high expressed emotion (EE) are characterized by increased negative non-verbal behaviour. Head position is one important component of non-verbal behaviour and has not been examined in relation to EE before. The aim of this pilot study was to investigate the influence of caregivers' EE on the head position of adolescents with schizophrenia and their caregivers. Sampling and Methods: 15 adolescent schizophrenia patients and 17 non-patient adolescents were videotaped during a 10-min problem-solving task with their caregiver. The head position was coded by the Berner System of Non-Verbal Behaviour. The caregivers' EE level (high EE vs. low EE) was measured by the Five-Minute Speech Sample. Results: Adolescent patients and non-patients showed a higher frequency of averted head positions towards high EE caregivers compared to low EE caregivers (β = 47.85, t = 2.41, p = 0.023). They displayed longer mean times of averting towards high EE caregivers compared to low EE caregivers (β = -1.78, t = -2.51, p = 0.018). An indirect approach was shown more frequently by adolescent patients towards low EE compared to high EE caregivers (β = 39.99, t = 2.31, p = 0.028). In contrast, non-patient adolescents showed a more indirect approach towards high EE caregivers compared to low EE caregivers. Caregivers of schizophrenia patients had head positions with a straight ahead lowered approach for a longer time compared to caregivers of non-patients (β = -29.75, t = -2.51, p = 0.018). Within the patient and non-patient groups, low EE caregivers showed longer total times of positions with a straight ahead lowered approach than high EE caregivers. Conclusions: High EE communication may be characterized by a higher ratio of averting head position in adolescents, which is especially pronounced in adolescents with schizophrenia. Low EE communication seems to be better adjusted by a more indirect approach being shown by the adolescent and straight ahead lowered head positions by the caregiver, especially when the adolescent suffers from schizophrenia.

Butzlaff RL, Hooley JM: Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 1998;55:547-552.
Marom S, Munitz H, Jones PB, Weizman A, Hermesh H: Expressed emotion: relevance to rehospitalization in schizophrenia over 7 years. Schizophr Bull 2005;31:751-758.
Wearden AJ, Tarrier N, Barrowclough C, Zastowny TR, Rahill AA: A review of expressed emotion research in health care. Clin Psychol Rev 2000;20:633-666.
Vaughn C, Leff J: The measurement of expressed emotion in the families of psychiatric patients. Br J Soc Clin Psychol 1976;15:157-165.
Magana AB, Goldstein JM, Karno M, Miklowitz DJ, Jenkins J, Falloon IR: A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatry Res 1986;17:203-212.
Vaughn CE, Leff JP: The influence of family and social factors on the course of psychiatric illness. A comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry 1976;129:125-137.
Kavanagh DJ: Recent developments in expressed emotion and schizophrenia. Br J Psychiatry 1992;160:601-620.
Bebbington P, Kuipers L: The predictive utility of expressed emotion in schizophrenia: an aggregate analysis. Psychol Med 1994;24:707-718.
Hooley JM: Social factors in schizophrenia. Curr Dir Psychol Sci 2010;19:238-242.
Hahlweg K, Goldstein MJ, Nuechterlein KH, Magana AB, Mintz J, Doane JA, Miklowitz DJ, Snyder KS: Expressed emotion and patient-relative interaction in families of recent onset schizophrenics. J Consult Clin Psychol 1989;57:11-18.
Kuipers L, Sturgeon D, Berkowitz R, Leff J: Characteristics of expressed emotion: its relationship to speech and looking in schizophrenic patients and their relatives. Br J Clin Psychol 1983;22:257-264.
Woo SM, Goldstein MJ, Nuechterlein KH: Relatives' expressed emotion and non-verbal signs of subclinical psychopathology in schizophrenic patients. Br J Psychiatry 1997;170:58-61.
Altorfer A, Jossen S, Wurmle O, Kasermann ML, Foppa K, Zimmermann H: Measurement and meaning of head movements in everyday face-to-face communicative interaction. Behav Res Methods Instrum Comput 2000;32:17-32.
Hadar U, Steiner T, Clifford Rose F: The relationship between head movements and speech dysfluencies. Lang Speech 1984;27:333-342.
Hadar U: Gestural modulation of speech production: the role of head movement. Lang Commun 1989;9:245-257.
Hadar U: Body movement during speech: period analysis of upper arms and head movement. Hum Mov Sci 1991;10:419-446.
McClave EZ: Linguistic functions of head movements in the context of speech. J Pragmatics 2000;32:855-878.
Cranach M, Ellgring JH: Problems in the recognition of gaze direction; in v. Cranach M (ed): Social Communication and Movement. London, Academic Press, 1973, pp 419-443.
Ekman P, Friesen WV: Head and body cues in the judgment of emotion: a reformulation. Percept Mot Skills 1967;24:711-724.
Frijda NH, Kuipers P, ter Schure E: Relations among emotion, appraisal, and emotional action readiness. J Pers Soc Psychol 1989;57:212-228.
Kendon A: The role of visible behavior in the organization of social interaction; in v. Cranach M (ed): Social Communication and Movement. New York, Academic Press, 1973, pp 29-74.
Mehrabian A: Nonverbal Communication. Oxford, Aldine-Atherton, 1972.
Leeb B: Manual zur Kodierung der ‘Expressed Emotion' aus der Fünf-Minuten-Sprechstichprobe (FMSS). Heidelberg, unpubl data, 1997.
World Health Organization: Tenth Revision of the International Classification of Diseases, Chapter V (F): Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, World Health Organization, Division of Mental Health, 1991.
Döpfner M, Berner W, Lehmkuhl G: Fragebogen für Jugendliche. Forschungsergebnisse zur deutschen Fassung des Youth Self-Reports (YSR) der Child Behaviour Checklist. Köln, KJFD, Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik, 1994.
Miklowitz DJ, Goldstein MJ, Falloon IR, Doane JA: Interactional correlates of expressed emotion in the families of schizophrenics. Br J Psychiatry 1984;144:482-487.
Strachan AM, Leff JP, Goldstein MJ, Doane JA, Burtt C: Emotional attitudes and direct communication in the families of schizophrenics: a cross-national replication. Br J Psychiatry 1986;149:279-287.
Blanchard JJ, Sayers SL, Collins LM, Bellack AS: Affectivity in the problem-solving interactions of schizophrenia patients and their family members. Schizophr Res 2004;69:105-117.
Frey S, Cranach M: A method for the assessment of body movement variability; in v. Cranach M (ed): Social Communication and Movement. New York, Academic Press, 1973, pp 389-418.
Frey S, Jorns U, Daw W: A systematic description and analysis of nonverbal interaction between doctors and patients in a psychiatric interview; in Corson SA (ed): Ethology and Nonverbal Communication in Mental Health: An Interdisciplinary Biopsychosocial Exploration. Oxford, Pergamon Press, 1980, pp 231-258.
StataCorp: Stata Statistical Software. College Station, StataCorp LP, 2009.
Berk R: A primer on robust regression; in Fox J, Long JS (eds): Modern Methods of Data Analysis. Newbury Park, Sage Publications, 1990.
Nugter M, Dingemans P, Linszen D, Van der Does A, Gersons B: The relationships between expressed emotion, affective style and communication deviance in recent-onset schizophrenia. Acta Psychiatr Scand 1997;96:445-451.
Müller U, Hahlweg K, Feinstein E, Hank G, Wiedemann G, Dose M: Family atmosphere (expressed emotion) and interactional processes in families with a schizophrenic member. Z Klin Psychol 1992;21:332-351.
Dimic S, Wildgrube C, McCabe R, Hassan I, Barnes TR, Priebe S: Non-verbal behaviour of patients with schizophrenia in medical consultations - a comparison with depressed patients and association with symptom levels. Psychopathology 2010;43:216-222.
Altorfer A, Goldstein MJ, Miklowitz DJ, Nuechterlein KH: Stress-indicative patterns of non-verbal behaviour. Their role in family interaction. Br J Psychiatry 1992;161:103-113.
King S: Is expressed emotion cause or effect? A longitudinal study. Int Clin Psychopharmacol 1998;13:107-108.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.