Expressed Emotion in Families with Mild Cognitive Impairment
Pasymowski, Stefan G.
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Mild cognitive impairment (MCI) is a medical diagnosis that is conceptualized as existing on a continuum between normal cognitive aging and dementia. While a growing body of research has established the impact of this condition on family members' emotional well-being, as well as the quality of family relationships, the reciprocal impact of family dynamics and the family environment on illness course has received much less attention. Expressed emotion (EE) is a measure of the family emotional climate that has been established as being highly predictive of relapse and symptom exacerbation for a variety of mental health disorders. The recent integration of attribution theory with EE has offered new insights into the underlying attitudes and beliefs that give rise to it. This mixed methods study applied the attribution model of EE to test the validity of EE in predicting the illness course of MCI, and to identify family members' attributions regarding MCI-related behaviors and symptoms that underlie their EE status. The study sample included 57 family dyads consisting of a person with MCI and a family member providing primary care or assistance. The results of the ANCOVA did not support the hypothesis that EE status would predict changes in the non-cognitive features of MCI over time. However, methods of thematic analysis revealed four major themes, or care partner attributional stances: (a) non-blaming, (b) blaming, (c) variable, and (d) no identified. The analysis also revealed three subthemes, or attributional styles, within the variable stance: (a) ambivalent, (b) mixed, and (c) complex. These attributional stances and styles intersected with family EE status in notable ways and form the basis for future research in this area, as well as clinical interventions with these families that promote adaptation to the illness.
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