psychological explanations and therapies

Question 1

psychological explanations

Answer 1

1. family dysfunction
2. cognitive explanations

Question 2

family dysfunction

Answer 2

abnormal processes within a family
- poor communication, cold parenting and high levels of expressed emotion
- risk factors for the development and maintenance of SZ

Question 3

types of family dysfunction

Answer 3

1. schizophrenogenic mother
2. double-bind theory
3. expressed emotion

Question 4

what is a schizophrenogenic mother

Answer 4

the schizophrenogenic mother is cold, rejecting and controlling towards her family/ children
- proposed by Fromm-Reichman
- psychodynamic explanation based on client reviews of childhood

Question 5

how does the schizophrenogenic mother cause SZ

Answer 5

• creates a family climate of tension and secrecy
• leads to distrust that later develops into paranoid delusions and ultimately SZ

Question 6

what is double-bind theory

Answer 6

a situation where the child always receives mixed signals and are unable to comment on the unfairness or seek clarification
- emphasises the role of familial communication
- proposed by Bateson

Question 7

how does double-bind theory lead to schizophrenia

Answer 7

• when they get smth wrong, they are punished by withdrawal of love
• leaves them w an understanding that the world is confusing and dangerous
• reflected by symptoms like disorganised thinking and paranoid delusions
  > clear that this is not the only factor, just a risk factor

Question 8

what is expressed emotion

Answer 8

the level of emotion, particularly negative, expressed towards someone w SZ by their carers

Question 9

elements of expressed emotion

Answer 9

1. verbal criticism of them, occasional accompany of violence
2. hostility towards them, anger and rejection
3. emotional over-involvement, needless self-sacrifice

Question 10

how does expressed emotion cause schizophrenia

Answer 10

high levels of expressed emotion are a serious source of stress
- explanation for relapse in ppl w SZ
- suggested that the source of the stress can trigger the onset of SZ in someone who is already vulnerable, maybe bc of genetic makeup

Question 11

research investigating family dysfunction

Answer 11

Sojit
- observed parents of SZC’s interact w them and compared to control
- support double-bind, parents of SZCs were more likely to send mixed messages

Question 12

supporting evaluation of family dysfunction

Answer 12

P - there is support for family dysfunction as a risk factor
E - Read et al found 69% of women and 59% of men w SZ reported childhood physical/ sexual abuse
- Berry et al, adults who had insecure attachment to PCG more likely to have SZ
E - traumatic childhood may disrupt brain development, impair emotional regulation
CA - most use retrospective recall (Tienari), SZ symptoms could distort memories, reduces validity
L - family dysfunction is associated w SZ but more rigorous research needed

Question 13

limiting evaluation for family dysfunction

Answer 13

P - weak evidence for family based explanations
E - no support for the importance of SZC mother or double-bind theory, just based on clinical observations, lacks scientific rigour
E - theories emerged from psychoanalytic approaches but fail to account for biological/ genetic factors
CA - family dysfunction does correlate w SZ, but theories over-simplify causation
L - modern psychiatry emphasises multifactorial models, interactionist, over out-dated theories

Question 14

issues and debate link for family dysfunction

Answer 14

schizophrenogenic mother shows acute gender bias (alpha bias)
- suggests mothers play a key destructive role in onset of SZ in a child

Question 15

cognitive explanations

Answer 15

dysfunctional thought processing

Question 16

what is dysfunctional thought processing

Answer 16

refers to the way in which a person w SZ understands, perceives and interprets the world and others

Question 17

how does dysfunctional thought processing cause schizophrenia

Answer 17

SZC may be unable to distinguish between the inner voice and what they perceive to be a voice actually speaking to them
- suggested by Frith

Question 18

types of dysfunctional thought processing

Answer 18

1. metarepresentation
2. central control

Question 19

metarepresentation

Answer 19

the cognitive ability to reflect on thoughts and behaviour
- allows insight into our own intentions and goals
- dysfunction would disrupt the ability to know our actions are carried out by ourself and not others
- explains delusions and hallucinations

Question 20

central control

Answer 20

SZCs lack cognitive ability to suppress automatic responses
- disorganised speech and thought disorder could be a result of this
- SZC experience delayed speech bc words trigger associations and they can’t suppress this automatic responses

Question 21

supporting evaluation of cognitive explanations

Answer 21

P - strong evidence for dysfunctional thought processing
E - Stirling et al, compared 30 SZCs to 18 control in the time it took them to read a list of colour written in another colour (eg. green but in red font, answer is red)
- SZC group took twice as long as control
E - aligns w Friths theory of central control that SZCs have difficulty in suppressing automatic processes
CA - does not tell us about origins of SZ
- explains proximal causes but not distal
L - still provides understanding, may need more depth of research

Question 22

psychological therapies

Answer 22

1. CBT
2. Family therapy
3. Token economies

Question 23

Cognitive Behaviour Therapy

Answer 23

method for treating mental disorders using cognitive and behavioural techniques
- eg. cognitive = challenging negative thoughts

Question 24

CBT in schizophrenia

Answer 24

takes 5-20 sessions
- aim involves identifying irrational thoughts and trying to change them
- will not get rid of symptoms, only helps ppl cope better

Question 25

how CBT helps

Answer 25

- make sense of how delusions and hallucinations impact feelings and behaviour - understanding where the symptoms come from can be helpful - delusions can be challenged so person can learn that their beliefs are not based on reality

Question 26

case example of CBT

Answer 26

Turkington et al, example of how to challenge P - The Mafia are observing me to decide how to kill me T - you are obviously frightened... there must be a good reason for this P - Do you think it's the mafia? T - it's a possibility, but there may be another explanation, why do you think it's the mafia?

Question 27

Family therapy

Answer 27

takes place w families rather than individual patients - aims to improve the quality of communication and interaction between family members

Question 28

family therapy in schizophrenia

Answer 28

some therapists see the family as the root cause of SZ, SZC mother and double-bind - most therapists are more concerned w reducing stress within the family to reduce risk of relapse - in particular, they tries to reduce expressed emotion

Question 29

how family therapy works

Answer 29

Pharoah et al - identify a range of strategies used to improve the functioning of the family 1. form a therapeutic alliance w all members 2. reduce stress for member w SZ 3. reduce anger and guilt in members - work by reducing EE whilst increasing the chances of ppl complying w meds - less likelihood of relapse and re-admission

Question 30

token economies

Answer 30

behavioural therapy where desirable behaviours are encouraged by selective reinforcement - relies on operant conditioning

Question 31

token economies in schizophrenia

Answer 31

used particularly on those who developed maladaptive behaviours from spending time in psychiatric hospitals (institutionalised) - common for ppl to develop bad hygiene - modifying these habits doesn't cure SZ but improves quality of life

Question 32

tokens

Answer 32

given to patients immediately when they carry out desirable behaviours - immediate response important bc prevents delay discounting

Question 33

delay discounting

Answer 33

the reduced effect of a reward bc it is delayed

Question 34

rewards

Answer 34

tokens have no value themselves, but can later be swapped in for more tangible rewards - eg. 10 tokens = 1 hour of TV - tokens are secondary reinforcers, only have value once patient learns they can be used to get rewards

Question 35

Turkington et al

Answer 35

found CBT combined w family therapy can treat pos and neg symptoms and can generally improve outcomes for the person

Question 36

supporting evaluation for psychological therapies

Answer 36

P - show promising benefits in managing symptoms E - CBT - Juahar et al, reviewed 34 studies, found effect on pos + neg symptoms > FT - Pharoah et al, shows that it reduces relapse and improves quality of life E - provide practical support, CBT helps patients reframe delusions, FT reduces stress, TE encourages adaptive behvaiours L - valuable support for SZ, larger, rigorous studies could strengthen credibility

Question 37

limiting evaluation for psychological therapies

Answer 37

1. treatments help manage symptoms and improve quality of life but don't cure 2. ethical issues in token economies

Question 38

treatments help manage symptoms and improve quality of life but don't cure

Answer 38

E - CBT helps patient challenge symptoms like delusion FT reduces familial stress and improves dynamic TE promote socially acceptable behaviours E - addresses symptom management and makes daily life more tolerable, but doesn't target underlying causes CA - biological treatments also fail to cure, but more effective in reducing symptoms L - valuable for quality of life, should be paired w biological therapies for comprehensive care

Question 39

ethical issues in token economies

Answer 39

E - discriminate against severely ill patients who can't comply w desired behaviours E - creates inequities, risks harming vulnerable patients CA - but motivates positive behaviours L - ethical guidelines must balance therapeutic goals w patient rights, TE needs reform