Research over about 30 years demonstrates a strong relationship between Expressed Emotion [EE] and relapse in many disorders, such as schizophrenia, anxiety disorders, substance use disorders, childhood psychiatric disorders, and depression.
EE seems to be a major factor in relapse and recurrence. While EE affects the onset of these disorders and is high in families of children at risk of depression, it is not as robust a factor in the initial onset of these disorders as it is in relapse after remission.
High EE corresponds to a poorer prognosis. The relapse rate for those living in a high EE environment is about 56%, 1.5 to 5x the rate for those in a low EE environment.
Professionals are high EE people. Finally, professionals show a surprising degree of high EE. We are sometimes a cause of relapse! But with experience professionals learn to show lower EE and to be more successful with clients.
Three factors in high EE. High EE does not mean all emotion, certainly not positive, supportive, encouraging, hopeful emotions. But rather, high EE refers to three factors, Criticism, Hostility, and Over-involvement.