Providing information to relatives and patients about expressed emotion and schizophrenia in a community support setting : a randomized controlled trial

The present study aimed to enhance family members’ knowledge about schizophrenia and expressed emotion (EE), and awareness of their current coping strategies by conducting a brief educational intervention (Moxon & Ronan, 1999) and evaluation designed to overcome methodological shortcomings of past studies. People diagnosed with schizophrenia were recruited into the study along with family members. Relatives and clients were randomly allocated to a treatment group or a wait-list control group. The intervention itself was a two session format designed to increase knowledge and provide coping strategies. The intervention was also delivered in a manner designed to elicit active involvement as well as provide social reinforcement. Findings showed that knowledge increased significantly after the intervention condition. This knowledge was maintained at a three-month follow-up. The control condition reflected no changes in knowledge. Other results showed that both relatives’ and clients’ EE ratings significantly decreased from pre- to post-test. Changes in total EE scores improved after treatment by over twice the magnitude compared to the control condition. All gains were maintained at the three-month follow-up, with continuing improvement seen in family members’ negative attitudes. The analyses overall suggested that although knowledge increased as a result of education, the decreases in EE appeared to be due to education perhaps combined with non-specific factors such as social and community-based support. These issues are considered in terms of implementation in community settings and in terms of future research.