Family Cohesion and Flexibility in Early Episode Psychosis

Abstract

Our understanding of treatment for psychotic disorders has improved considerably over the last 20 years. One area that has received international attention is the importance of early intervention for psychosis. Research suggests that family support promotes recovery and is a key component of any successful early intervention program. However, very little is known about familial interaction patterns in families that are coping with the unexpected onset of a psychotic illness and the factors that help to foster adaptive family functioning during this challenging time. The purpose of this study was to understand the individual, caregiver, and family factors that are associated with healthy and adaptive family functioning in early episode psychosis and to explore differences in family interaction patterns between families with an individual with psychosis and healthy control families. This study employed two methodologies: (1) an online caregiver survey that examined relationships among various caregiver and family system variables such as caregiver appraisals, coping strategies, quality of life, perceived helpfulness of support systems, and family functioning and (2) an experimental laboratory-based study that examined the real time affective states and dynamic flexibility of family interactions in families with an individual with early psychosis and healthy control families. The results of this project indicate that cognitive appraisals about the illness, its consequences, and one’s caregiving role are important predictors of family functioning. Specifically, greater positive caregiver appraisals were associated with better family functioning. Family members of an individual with psychosis reported more family difficulties across dimensions of cohesion and flexibility; however in the laboratory-based observation study, families with an individual with psychosis were equally flexible and diverse in their expression of affect, and had more predictable interactions compared to healthy control families. This is the first study to use state space grids to visually depict family interactions in real time, demonstrating its unique applications both for research and clinical intervention. The findings from this study have important implications for the field of early intervention in psychosis and could inform relevant treatment targets for family-based interventions.