The Effect of a Culturally-Informed Therapy for Schizophrenia on Caregiver Burden, Perceptions of Interdependence and Self-Conscious Emotions

Research has demonstrated that taking care of a patient with schizophrenia has serious mental health costs to caregivers that include high levels of burden and poorer overall mental health. Thus, it is necessary to pinpoint predictors of caregiver distress and develop strategies to reduce it. We have developed a family focused, culturally-informed treatment for schizophrenia (CIT-S). We examined this intervention and its ability to decrease the maladaptive behaviors, beliefs, and values that we believe contribute to caregiver distress. CIT-S was compared against a three-session psychoeducation condition in a sample of 113 caregivers of patients with schizophrenia. Specifically, we hypothesized that schizophrenia caregivers who completed CIT-S would demonstrate lower levels of caregiver burden, shame and guilt/self-blame, as well as increased perceived interdependence when compared to participants who completed psychoeducation. Additionally, we hypothesized that shame, guilt/self-blame and interdependence would mediate the relationship expected between treatment type and caregiver burden. In line with hypotheses, CIT-S was found to decrease caregivers’ burden and guilt/self-blame when compared to the psychoeducation condition. Also consistent with hypotheses, reductions in guilt/self-blame were found to mediate the changes in caregiver burden associated with treatment type. Treatment type did not appear to influence shame nor interdependence. Study implications are discussed and a case vignette is provided.</p

Ethnic/Racial Differences in the Experience of Burden and Psychological Outcomes for Caregivers of Patients with Schizophrenia: the Influence of Family Cohesion and Interdependence

Research has demonstrated that taking care of a patient with schizophrenia has serious mental health costs to caregivers including high levels of burden and poorer overall mental health. Research also indicates that caregivers from certain ethnic/racial groups may fare better in this process. Specifically, prior research indicates that African American and Hispanic caregivers often exhibit better mental health than their Caucasian counterparts. Using a sample of 176 caregivers of patients with schizophrenia, the present study was specifically aimed at examining whether three variables (caregiver burden, family cohesion and interdependence) may account for part of the formerly observed ethnic/racial differences in psychological outcomes. Study hypotheses pertaining to ethnicity/race and family cohesion were not supported. For the most part, minorities in this study did not demonstrate better mental health outcomes than Caucasians and family cohesion did not predict mental health outcomes. However, in line with study hypotheses, we did find that subjective burden mediated the relationship between objective burden and mental health. In other words, subjective appraisals of caregiving appear to partially underlie the association between concrete costs of caregiving and psychological outcomes in schizophrenia caregivers. Also as expected, we found that interdependence moderated the relationship between objective burden and subjective burden. This finding suggests that helping caregivers to value harmony and connection with others over individual self-interests may reduce the likelihood that objective stressors (which are often inevitable in schizophrenia) will result in subjective distress

The effect of a culturally informed therapy on self-conscious emotions and burden in caregivers of patients with schizophrenia: A randomized clinical trial.

OBJECTIVE: Caring for a family member with schizophrenia often results in high degrees of self-conscious emotions (shame and guilt/self -blame), burden, and other serious mental health consequences. Research suggests that ethnic and cultural factors strongly influence the manner in which family members respond to mental illness. Research further indicates that certain cultural practices and values (spirituality, collectivism) may assist family members in coping with the self-conscious emotions and burden associated with caregiving. With this in mind, we have developed a family focused, culturally-informed treatment for schizophrenia (CIT-S). METHOD: Using a sample of 113 caregivers of patients with schizophrenia (60% Hispanic, 28.2% Caucasian, 8% African American and 3.8% “Other”), we assessed the ability of CIT-S to reduce self-conscious emotions and caregiver burden above and beyond a three-session psychoeducation (PSY-ED) control condition. We further examined whether self-conscious emotions mediated the relationship between treatment type and caregiver burden. RESULTS: In line with expectations, CIT-S was found to outperform PSY-ED in reducing guilt/self-blame and caregiver burden. Furthermore, consistent with hypotheses, reductions in guilt/self-blame were found to mediate the changes observed between treatment type and caregiver burden. While caregivers in both treatment groups demonstrated significant post treatment reductions in shame, CIT-S was not found to outperform PSY-ED in reducing levels of this construct. CONCLUSIONS: Results suggest that caregivers of patients with schizophrenia may respond well to a treatment that specifically taps in to their cultural beliefs, values, and behaviors in helping them cope with schizophrenia in a loved one. Study implications and future directions are discussed

Nonreligious coping and religious coping as predictors of expressed emotion in relatives of patients with schizophrenia

Expressed emotion (EE) is a measure of the amount of criticism and emotional over involvement expressed by a key relative towards a relative with a disorder or illness. Research has established that living in a high EE environment, which is characterised by increased levels of critical and emotionally exaggerated communication, leads to a poorer prognosis for patients with a mental illness when compared to low EE environments. Despite evidence that EE is a strong predictor of the course of the illness, there continue to be questions concerning why some family members express excessive levels of high EE attitudes about their mentally ill relatives while others do not. Based on indirect evidence from previous research, the current study tested whether religious and nonreligious coping serve as predictors of EE. A sample of 72 family members of patients with schizophrenia completed an EE interview, along with questionnaires assessing situational nonreligious coping and religious coping. In line with the hypotheses, results indicated that nonreligious coping predicted EE. Specifically, less use of adaptive emotion-focused coping predicted high EE. Also consistent with predictions, maladaptive religious coping predicted high EE above and beyond nonreligious coping

Shame and guilt/self-blame as predictors of expressed emotion in family members of patients with schizophrenia

Expressed emotion (EE) is a measure of the family environment reflecting the amount of criticism and emotional over-involvement expressed by a key relative towards a family member with a disorder or impairment. Patients from high EE homes have a poorer illness prognosis than do patients from low EE homes. Despite EE's well-established predictive validity, questions remain regarding why some family members express high levels of EE attitudes while others do not. Based on indirect evidence from previous research, the current study tested whether shame and guilt/self-blame about having a relative with schizophrenia serve as predictors of EE. A sample of 72 family members of patients with schizophrenia completed the Five Minute Speech Sample to measure EE, along with questionnaires assessing self-directed emotions. In line with the hypotheses, higher levels of both shame and guilt/self-blame about having a relative with schizophrenia predicted high EE. Results of the current study elucidate the EE construct and have implications for working with families of patients with schizophrenia