Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-01-07T18:20:21.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychosocial family intervention in schizophrenia: a review of empirical studies

Published online by Cambridge University Press:  09 July 2009

Dominic H. Lam
Dominic H. Lam*
Affiliation:
MRC Social and Community Psychiatry Unit, Institute of Psychiatry, London
*
1Address for correspondence: Mr Dominic H. Lam, MRC Social and Community Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF.
Get access Rights & Permissions [Opens in a new window]

Synopsis

This paper reviews the recent empirical studies on psychosocial family intervention in schizophrenia. Six family educational intervention studies and five more intensive family work studies with 2-year follow-up have been included. A series of questions is asked relating to the effects of such interventions, the efficacy of the different educational models, the active ingredients of these multi-component treatment packages, and the contribution of this new generation of studies to our understanding of the mechanisms through which these interventions work. Suggestions for further research are made. Finally, from the published manuals, the common components of these diverse, multi-component treatment packages of different family-intervention studies are identified.

Type
Original Articles
Information
Psychological Medicine , Volume 21 , Issue 2 , May 1991 , pp. 423 - 441
Copyright
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, I. A. & Coursey, R. D. (1989). Impact of an educational support group of family participants who take care of their schizophrenic relatives. Journal of Consulting and Clinical Psychology 57, 232–236.CrossRefGoogle ScholarPubMed
Anderson, C. M., Reiss, D. J. & Hogarty, G. E. (1986). Schizophrenia in the Family: A Practitioner's Guide to Psychoeducation and Management. Guildford Press: New York.Google Scholar
Barrowclough, C. & Tarrier, N. (1984). ‘Psychosocial‘ intervention with families and their effects on the course of schizophrenia: a review. Psychological Medicine 14, 629–642.CrossRefGoogle ScholarPubMed
Barrowclough, C & Tarrier, N. (1987). A behavioural intervention with a schizophrenic patient. Behavioural Psychotherapy 15, 252–271.CrossRefGoogle Scholar
Barrowclough, C & Tarrier, N. (1990). Social functioning in schizophrenic patients. 1. The effects of expressed emotion and family intervention. Social Psychiatry and Psychiatric Epidemiology 25, 125–130.CrossRefGoogle Scholar
Barrowclough, C., Tarrier, N., Watts, S., Vaughn, C., Bamrah, J. S. & Freeman, H. L. (1987). Assessing the functional value of relatives' knowledge about schizophrenia: a preliminary report. British Journal of Psychiatry 151, 1–8.CrossRefGoogle ScholarPubMed
Barter, J. T. (1984). Psychoeducation. In The Chronic Mental Patient: Five Years Later (ed. Talbot, J. A.), pp. 183–191. Guildford Press: New York.Google Scholar
Beck, A. T. (1976). Cognitive Therapy and Emotional Disorders. Internal Universities Press: New York.Google Scholar
Beck, A. T., Rush, D., Shaw, B. & Emery, G. (1979). Cognitive Therapy and Depression. Guildford Press: New York.Google Scholar
Berkowitz, R., Eberlein-Friess, R., Kuipers, L. & Leff, J. (1984). Educating relatives about schizophrenia. Schizophrenia Bulletin 10, 418–429.CrossRefGoogle ScholarPubMed
Berkowitz, R., Kuipers, L., Eberlein-Friess, R. & Leff, J. (1981). Lowering expressed emotion in relatives of schizophrenics. In New Developments in Interventions with Families of Schizophrenics (ed. Goldstein, M.), pp. 27–48.Google Scholar
Berkowitz, R., Shavit, N. & Leff, J. (1990). Psychosocial interventions with schizophrenic patients and their families. (Submitted for publication).Google Scholar
Birchwood, M. & Smith, J. (1987). Schizophrenia. In Coping with Disorders in the Family (ed. Orford, J.), pp. 7–38. Croom Helm: London.Google Scholar
Birchwood, M., Smith, J., Cochrane, R., Wetton, S. & Copestake, S. (1990). The social functioning scale: the development and validation of social adjustment for use in family intervention programmes with schizophrenic patients (Submitted for publication.)CrossRefGoogle Scholar
Bloch, S., Reibstein, J., Crouch, E., Holroyd, P. & Themen, J. (1979). A method for the study of therapeutic factors in group therapy. British Journal of Psychiatry 134, 257–263.CrossRefGoogle Scholar
Bowen, M. (1978). Family Therapy in Clinical Practice. Jason Aronson: New York.Google Scholar
Brewin, C. R. (1988). Cognitive Foundations of Clinical Psychology. Lawrence Erlbaum: London.Google Scholar
Brewin, C. R., MacCarthy, B., Duda, K. & Vaughn, C. E. (1990). Attribution and expressed emotion in the relatives of patients with schizophrenia. (Submitted for publication).Google Scholar
Brown, G. W., Birley, J. L. T. & Wing, J. K. (1972). Influence of family life on the course of schizophrenia disorders: replication. British Journal of Psychiatry 121, 241–258.CrossRefGoogle ScholarPubMed
Cardin, V. A., McGill, C. W. & Falloon, I. R. H. (1986). An economic analysis: costs, benefits, and effectiveness. In Family Management of Schizophrenia (ed. Falloon, I. R. H.), pp. 115–123. Johns Hopkins University Press: Baltimore.Google Scholar
Carver, C. S., Scheier, M. F. & Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology 56, 267–283.CrossRefGoogle ScholarPubMed
Cozolino, L. J., Goldstein, M. J., Nuechterlein, K. H., West, K. L. & Synder, K. S. (1988). The impact of education about schizophrenia on relatives varying in expressed emotion. Schizophrenia Bulletin 14, 675–687.CrossRefGoogle ScholarPubMed
Doane, J. A., Goldstein, M. J., Miklowitz, D. J. & Falloon, I. R. H. (1986). The impact of individual and family treatment on the affective climate of families of schizophrenics. British Journal of Psychiatry 148, 279–287.CrossRefGoogle ScholarPubMed
Elliott, R. (1985). Helpful and nonhelpful events in brief counseling interviews: an empirical taxonomy. Journal of Counselling Psychology 32, 307–322.CrossRefGoogle Scholar
Falloon, I. R. H. (1984). Family Management of Mental Illness: A Study of Clinical Social and Family Benefits. Johns Hopkins University Press: Baltimore.Google Scholar
Falloon, I. R. H. & Pederson, J. (1985). Family management in the prevention of morbidity of schizophrenia: the adjustment of family unit. British Journal of Psychiatry 147, 156–163.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L., McGill, C. W., Ranzani, J., Moss, H. B. & Gilderman, A. M. (1982). Family management in the prevention of exacerbation of schizophrenia. A controlled study. New England Journal of Medicine 306, 1437–1440.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L., McGill, C. W., Williamson, M., Ranzani, J., Moss, H. B., Gilderman, A. M. & Simpson, G. M. (1985). Family management in the prevention of morbidity of schizophrenia. Clinical outcome of a two-year longitudinal study. Archives of General Psychiatry 42, 887–896.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., McGill, C. W., Boyd, J. L. & Pederson, J. (1987). Family management in the prevention of morbidity of schizophrenia: a social outcome of a two-year longitudinal study. Psychological Medicine 17, 59–66.CrossRefGoogle ScholarPubMed
Fishermann-Havstad, L. & Marston, A. R. (1984). Weight loss maintenance as an aspect of family emotion and process. British Journal of Clinical Psychology 23, 265–271.CrossRefGoogle Scholar
Folkman, S. (1984). Personal control and stress and coping processes: a theoretical analysis. Journal of Personality and Social Psychology 46, 839–852.CrossRefGoogle ScholarPubMed
Goldstein, M. J., Rodnick, E. H., Evans, J. R., May, P. R. A. & Steinberg, M. R. (1978). Drug and family therapy in the aftercare of acute schizophrenics. Archives of General Psychiatry 35, 1169–1177.CrossRefGoogle ScholarPubMed
Greene, J. E. (1982). Measuring behavioural disturbance of elderly demented patients in the community and its effects on relatives: a factor analytic study. Age and Aging 11, 121–126.CrossRefGoogle ScholarPubMed
Hogarty, G. E. & Anderson, C. M. (1986). Medication, family psycho-education, and social skills training: first-year relapse of a controlled study. Psychopharmacology Bulletin 22, 860–861.Google Scholar
Hogarty, G. E., Goldberg, S. C., Schooler, N. R. & Ulrich, R. F. (1974). Drug and sociotherapy in the aftercare of schizophrenic patients, two-year relapse rate. Archives of General Psychiatry 31, 603–608.CrossRefGoogle Scholar
Hogarty, G. E., Schooler, N. R., Ulrich, R., Mussare, F., Ferro, P. & Herron, E. (1979). Fluphenazine and social therapy in the after care of schizophrenic patients. Archives of General Psychiatry 36, 1283–1294.CrossRefGoogle ScholarPubMed
Hogarty, G. E., Anderson, C. M., Reiss, D. J., Kornblith, S. J., Greebwald, D. P.Javana, C. D. & Madonia, M. J. (1986). Family psycho-education, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia. I One-year effects of a controlled study on relapse and expressed emotion. Archives of General Psychiatry 43, 633–642.CrossRefGoogle Scholar
Hogarty, G. E., Anderson, C. M. & Reiss, D. J. (1987). Family psychoeducation, social skill training and medication in schizophrenia: the long and short of it. Psychopharmacology Bulletin 23, 12–13.Google Scholar
Hooley, J. M., Orley, J. & Teasdale, J. D. (1986). Level of expressed emotion and relapse in depressed patients. British Journal of Psychiatry 148, 642–647.CrossRefGoogle ScholarPubMed
Hoult, J., Reynolds, I., Charbonneau-Powis, M., Weekes, P., Briggs, J., Cass, Y., Lapsley, H. & Rosen, R. (1983). Psychiatric Hospital versus Community Treatment: A Controlled Study. Department of Health: NSW, Australia.Google Scholar
Johnson, J. A. W, (1976). The duration of maintenance therapy in chronic schizophrenia. Acta Psychiatrica Scandinavica 53, 298–301.CrossRefGoogle ScholarPubMed
Kahn, R. (1964). Conflict and Ambiguity: Studies in Organisational Roles and Personal Stress. Wiley: New York.Google Scholar
Katschnig, H. & Konieczna, T. (1989). What works in work with the relatives? – A hypothesis. British Journal of Psychiatry 155 (suppl. 5), 144–150.CrossRefGoogle Scholar
Kazdin, A. E. (1980). Research Design in Clinical Psychology. Harper & Row: New York.Google Scholar
Kazdin, A. E. & Wilson, G. T. (1978). Evaluation of Behaviour Therapy: Issues. Evidence and Research Strategies. Ballinger: Cambridge, Mass.Google Scholar
Kellner, R. & Sheffield, B. (1973). A self-rating scale of distress. Psychological Medicine 3, 88–100.CrossRefGoogle ScholarPubMed
Kottgen, C., Sonnichsen, I., Mollenhauser, K. & Jurth, R. (1984). Group therapy with families of schizophrenia patients: results of the Hamburg Camberwell Family Interview Study. III. International Journal of Family Psychiatry 5, 84–94.Google Scholar
Kuipers, L. & Bebbington, P. (1988). Expressed emotion research in schizophrenia: theoretical and clinical implications. Psychological Medicine 18, 893–909.CrossRefGoogle ScholarPubMed
Laporta, M., Falloon, I. R. H., Shanahan, W. & Hole, V. (1989). The NIMH Behaviour Family Therapy Skills Measure (BFTSM) * Reliability and validity.Paper presented to the World Congress of Psychiatry,Athens, Greece.Google Scholar
Lazarus, R.. (1966). Psychological Stress and the Coping Process. McGraw-Hill: New York.Google Scholar
Leff, J. P. (1981). Clinical and methodological problems in interactive studies. In Epidemiological Impact of Psychotropic Drugs (ed. Tognoni, G., Bellantuono, C. and Lader, M.), pp. 256–376. Elsevier: Amsterdam.Google Scholar
Leff, J. P. & Vaughn, C. (1985). Expressed Emotion in Families. Guildford Press: New York.Google Scholar
Leff, J. P. & Wing, J. K. (1971). Trial of maintenance therapy in schizophrenia. British Medical Journal iii, 599–604.CrossRefGoogle Scholar
Leff, J. P., Kuipers, L., Berkowitz, R., Eberlein-Fries, R. & Sturgeon, D. (1982). A controlled trial of social intervention in schizophrenia families. British Journal of Psychiatry 141, 121–134.CrossRefGoogle Scholar
Leff, J. P., Kuipers, L., Berkowitz, R. & Sturgeon, D. (1985). A controlled trial of social intervention in the families of schizophrenia patients: two-year follow-up. British Journal of Psychiatry 146, 594–600.CrossRefGoogle ScholarPubMed
Leff, J. P., Berkowitz, R., Shavit, N., Strachan, A., Glass, I. & Vaughn, C. (1988). A trial of family therapy v. a relatives' group for schizophrenia. British Journal of Psychiatry 153, 58–66.Google Scholar
Leff, J. P., Berkowitz, R., Shavit, N., Strachan, A., Glass, I. & Vaughn, C. (1990). A trial of family therapy versus a relatives' group for schizophrenia. Two-year follow-up. British Journal of Psychiatry 157, 571–577.CrossRefGoogle Scholar
Liberman, R. P., Lillie, F., Falloon, I. R. H., Vaughn, C. E., Harpin, E., Leff, J. P., Hutchinson, W., Ryan, P. & Stoute, M. (1978). Social skill training for schizophrenic patients and their families. (Unpublished manuscript cited by Barrowclough & Tarrier, 1984).Google Scholar
Lipman, R. B., Covi, L., Rickels, K., Uhlenhuth, E. H. & Lazar, B. A. (1968). Selected measures of change in outpatient drug evaluation. In Psychopharmacology: A Review of Progress. Public Health Service Publication 1836, 249–254.Google Scholar
MacCarthy, B. (1988). The role of relatives. In Community Care in Practice (ed. Lavender, A. and Holloway, F.), pp. 207–277. Wiley: Chichester.Google Scholar
McGill, C. W., Falloon, I. R. H., Boyd, J. L. & Wood-Siverio, C. (1983). Family educational intervention in the treatment of schizophrenia. Hospital and Community Psychiatry 34, 934–938.Google ScholarPubMed
O'Leary, K. D. & Borkovec, T. D. (1978). Conceptual methodological and ethical problems of placebo groups in psychotherapy research. American Psychologist 33, 821–830.CrossRefGoogle ScholarPubMed
Palazolli, M. S., Boscolo, L., Cecchin, G. & Prata, G. (1978). Paradox and Counterparadox. Jason Aronson: New York.Google Scholar
Pasamanick, B., Scarpitti, F. & Dinitz, S. (1967). Schizophrenics in the Community. Appleton-Century-Crofts: New York.Google Scholar
Platt, S., Weyman, A., Hirsch, S. & Hewett, S. (1980). The Social Behaviour Assessment Schedule (SABS): rationale, contents, scoring and reliability of a new interview schedule. Social Psychiatry 15, 43–55.CrossRefGoogle Scholar
Sarason, I. G. (1972). Experimental approaches to tests of anxiety: attention and the uses of information. In Current Trends in Theory and Research vol. 2 (ed. Speilburger, C. D.), pp. 383–403. Academic Press: New York.Google Scholar
Smith, J. & Birchwood, M. J. (1987). Specific and non-specific effects of educational intervention with families living with schizophrenic relatives. British Journal of Psychiatry 150, 645–652.CrossRefGoogle Scholar
Speilberger, C. D., Gorsuch, R. L. & Lushene, R. E. (1970). The State–Trait Anxiety Inventory. Consulting Psychologist Press: Palo Alto, CA.Google Scholar
Spitzer, R. D., Endicott, J. & Ronin, E. (1978). Research diagnostic criteria. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Strachan, A. M. (1986). Family intervention for the rehabilitation of schizophrenia: towards protection and coping. Schizophrenia Bulletin 12, 678–698.CrossRefGoogle Scholar
Szmuckler, G. I., Eisler, I., Russel, G. F. M. & Dare, C. (1985). Anorexia Nervosa, parental ‘expressed emotion’ and dropping out of treatment. British Journal of Psychiatry 147, 265–271.CrossRefGoogle Scholar
Tarrier, N. (1989). Effect of treating the family to reduce relapse in schizophrenia: a review. Journal of the Royal Society of Medicine 82, 423–424.CrossRefGoogle ScholarPubMed
Tarrier, N. & Barrowclough, C. (1986). Providing information to relatives about schizophrenia: some comments. British Journal of Psychiatry 149, 458–463.CrossRefGoogle ScholarPubMed
Tarrier, N. & Barrowclough, C. (1990). Family Intervention. Special Issue: Behavioural Treatment of Chronic Psychiatric Illness. Behaviour Modification.Google Scholar
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J. S., Porceddu, K., Watts, S. & Freeman, H. L. (1988). The community management of schizophrenia: a controlled trial of a behavioural intervention with families to reduce relapse. British Journal of Psychiatry 153, 532–542.CrossRefGoogle ScholarPubMed
Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J. S., Porceddu, K., Watts, S. & Freeman, H. L. (1989). Community management of schizophrenia: a two-year follow-up of a behavioural intervention with families. British Journal of Psychiatry 154, 625–628.CrossRefGoogle ScholarPubMed
Test, M. A. (1990). The training in community living model: delivering treatment and rehabilitation services through a continuous treatment team. In Rehabilitation of the Seriously III (ed. Liberman, R. P.). Plenum: New York.Google Scholar
Tipton, R. M. & Worthington, E. L. (1984). The measurement of generalized self-efficacy: a study of construct validity. Journal of Personality Assessment 48, 545–548.Google ScholarPubMed
Vaughn, C. (1986). Comments on Ch. 5. In Treatment of Schizophrenia: Family Assessment and Intervention (ed. Goldstein, M., Hand, I. & Halweg, K.), pp. 76–77. Springer-Verlag: New York.Google Scholar
Vaughn, C. E. & Leff, J. P. (1976). The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenia and depressed neurotic patients. British Journal of Psychiatry 15, 157–165.Google Scholar
Weakland, J. H., Fisch, R., Watzlawick, P. & Brodin, A. M. (1974). Brief therapy: focused problem resolution. Family Process 13, 141–168.CrossRefGoogle Scholar
Weiner, B. (1986). An Attributional Theory of Motivation and Emotion. Springer-Verlag: New York.CrossRefGoogle Scholar
Weissman, M. M., Prusoff, B. A., Thompson, W. D., Harding, P. S. & Myers, J. K. (1978). Social adjustment by self-report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disorder 166, 317–326.CrossRefGoogle Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar