Research indicates that certain family environments can impact negatively on psychosis. Expressed Emotion (EE) in relatives is a reliable measure of the individual’s interpersonal family environment that has been shown to predict relapse. However, the factors contributing to the development of EE in this condition and the mechanisms by which EE leads to relapse are still poorly understood. Relatives’ control attributions and behaviours have been linked to EE, and controlling behaviours have been found to be predictive of relapse. This thesis investigated the role of behavioural control, controllability and self-blame attributions in high- and low-EE relatives of individuals with psychosis, and explored the impact of these cognitions and behavioural responses on patient’s symptom outcomes and on relative’s distress. The first empirical study (Study 1) utilised a cross-sectional design to compare types of behavioural control attempts (direct influencing vs. buffering) in high-EE-critical/hostile and high-EE-overinvolved relatives of patients with recent-onset psychosis; and examined whether behavioural control attempts and controllability attributions differed for the high- and low-EE relatives. The links between relatives’ behavioural control and patient relapse were also explored. Results confirmed that types of behaviours (direct influencing and buffering) were associated with different sets of beliefs (about controllability) and with different types of EE (criticism and EOI). However, EE, controllability attributions, nor behavioural control predicted patient relapse. Study 2 used a cross-sectional design to explore the links between self-blame attributions and distress, and self-blame attributions and behavioural control in recent-onset relatives. Results showed that self-blame attributions predicted relatives’ controlling behaviours towards the patient. Relatives who blame themselves did so for not overseeing their family member’s mental health problems properly or for perceiving themselves generally as poor carers. However, self-blame was not predictive of distress. The final empirical study (Study 3) examined temporal associations between contact with high/low EE relatives, behavioural control, affect and symptom experiences in the daily life of patient-relative dyads experiencing psychosis, using experience sampling methodology. Findings revealed that contact with high/low-EE relatives per se did not impact on patient’s symptom experiences or affect, but behaviourally controlling interactions did, suggesting that the measure of behavioural interactions rather than the EE status of the relative may be more sensitive to momentary fluctuations in patients’ symptoms. Momentary self-reports of relatives’ behavioural responses were also linked with their negative affect. This thesis evidenced that relatives’ controllability and self-blame attributions and behavioural control are associated in significant and meaningful ways with psychosis experiences and can impact both patient and relative outcomes, shedding some light into the EE mechanisms that relate to relapse and to the development of EE responses in relatives. However, more work is needed to further understand how these mechanisms operate, particularly in high-EE-overinvolved or low-EE relatives, in order to increase our knowledge about relapse prevention. The findings highlighted that the concept of behavioural control should be considered in future clinical work with families experiencing psychosis.

Att avsiktligt skära, bränna eller på annat sätt skada sig själv illa är förenat med ett stort lidande och väcker ofta starka reaktioner hos de anhöriga. Problematiken är omfattande och självskadebeteende förefaller vara en stark prediktor för självmordsförsök och fullbordade självmord. Globalt är självmord den näst vanligaste dödsorsaken bland ungdomar. Efterfrågan på effektiva behandlingsmodeller för denna målgrupp är stor. I Sverige, närmare bestämt i Uppsala har behandlingsmodellen IKB – Intensiv Kontextuell Behandling utvecklats för ungdomar med självskadebeteende och/eller suicidala beteenden och deras familjer. Modellen är en integrerad individ- och familjeterapeutisk behandlingsmodell. Föreliggande studie syftade till att undersöka behandlingsmodellen IKB:s effektivitet i förhållande till minskat självskadebeteende hos ungdomarna och minskade nivåer av Expressed emotion hos föräldrarna. Sammanlagt har 34 familjer deltagit i studien och de har samtliga genomgått behandling inom ramen för IKB-modellen. Resultatet visade på en effektivitet i behandlingsmodellen IKB avseende att minska självskadebeteende hos ungdomarna samt att minska nivåerna av Expressed emotion hos föräldrarna. Utfallet av studien diskuteras utifrån tidigare forskning och metodologiska frågor. / To intentionally cut, burn or hurt oneself severely is associated with great suffering and often arouse strong reactions within the family context. The problem is extensive and self-harm appears to be a strong predictor of suicide attempts and completed suicides. Globally, suicide is the second leading cause of death among young people. Effective treatment models for this group is urgent. In Sweden, (Uppsala) the model IKB - Intensive Contextual Treatment was developed for adolescents with self-harm and / or suicidal behavior, and their families in order to provide support. IKB is an integrated individual and family therapeutic model. The aim of the study were to evaluate the effectiveness of IKB in relation to frequency of self-harm and levels of Expressed emotion. A total of 34 families participated in the study and they all received treatment in the context of the IKB-model. The families completed the self-assessment forms for data collection before treatment, after treatment and follow-up. Results showed efficiency to reduce self-harm among adolescents and to decrease levels of Expressed emotion. The outcome of the study are discussed based on previous research and methodological issues. / <p>27</p>