Targeting dysfunctional family interactions and high expressed emotion in the psychosocial treatment of bipolar disorder

Expressed emotion (EE) is discussed in relation to bipolar affective disorder, a major psychiatric illness involving fluctuating periods of mania and depression. High levels of EE among relatives of bipolar clients are conceptualized as reactions to the stress of adjusting to the acute illness period and the post-episode aftercare period. EE has an associated cognitive component involving certain styles of attribution about illness in the client, and a behavioral component involving aversive interaction patterns between the bipolar client and his or her relatives. Family-focused psychoeducational treatment—consisting of psychoeducation about bipolar disorder, communication enhancement training, and problem-solving skills training—addresses high EE on the cognitive, affective, and behavioral levels. A case study illustrates the approach. © 1998 John Wiley & Sons, Inc.