Schizophrenia Flashcards

Question

Psychological explanations- Family dysfunction: Double Bind communication

Answer 1

Bateson et al (1956) argues that schizophrenia is due to the faulty communication patterns that exist within families. This communication type is double bind communication; this occurs when the parent communicates a verbal message which is not matched with their non-verbal message, so the child receives mixed messages. For example, a father may be verbally loving but emotionally rejecting, for example, becoming rigid when the child tries to show affection. These conflicting, confusing forms of communication can contribute or cause schizophrenia. The child feels they cannot do the right thing and becomes increasingly anxious, leading to them withdrawing and avoiding social contact – signs of avolition (negative symptoms) and the mixed messages result in disorganised thinking and paranoid delusions

Answer 2

:) Research to support the schizophrenogenic mother theory comes from Mednick et al (1984). They researched 207 children (high risk for developing SZ) who were raised in dysfunctional families where the mothers were cold, rejecting and emotionally unresponsive to their children’s needs. It was found that 10 years later, 17 children of this high-risk group were diagnosed with schizophrenia, this is 8%, compared to 1% of the general population and thus supporting the theory that family dysfunction can lead to schizophrenia. :) Research to support double bind communication was conducted by Berger (1965). When asked about the interactions with their parents in childhood, it was found that schizophrenics could remember more instances of double bind communication from their mother than non-schizophrenics. This provides clear support for mixed communication in schizophrenics’ childhood and therefore supports family dysfunction as an explanation of schizophrenia. Discussion: However, this research is based on retrospective data as the patient has to think back to childhood. Therefore, this could mean that there are inaccuracies in recall as a long period of time has passed. This reduces the internal validity of the research to support the family dysfunction as an explanation of schizophrenia.

Answer 3

Cognitive explanations of schizophrenia focus on the role of internal mental processes. Schizophrenia is characterised by disruption to normal thought processing. There are two kinds of dysfunctional thought processing that could trigger some symptoms.

Answer 4

Metarepresentation is the cognitive ability to reflect on thoughts and behaviour. This allows us to understand our actions and the actions of others. Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves or others. This could explain Auditory hallucinations (positive symptom) as an individual may not understand that a voice in their head is their own voice and not somebody else’s. Therefore, causing distress in the individual.

Answer 5

Central control is the cognitive ability to suppress automatic responses whilst performing a deliberate action instead. Dysfunction in central control could explain Speech poverty and thought disorder as the individual is not able to suppress automatic thoughts and speech triggered by other thoughts/words spoken. Therefore, sufferers with schizophrenia can experience disrupted spoken sentences, known as derailment. This is where the individual’s speech is disrupted as the spoken words trigger other associations and the person cannot suppress the action.

Answer 6

:) Research to support dysfunctional thought processing (central control) was conducted by Stirling et al (2006). They compared 30 patients with schizophrenia with 18 non-patient controls on a range of cognitive tasks such as the Stroop Test. Participants had to accurately name the ink colour of the colour word printed. Schizophrenia patients took over twice as long to complete the task as the control group, as they could not supress their automatic response of saying the word rather than the colour. Thus, supporting Frith’s theory of central control dysfunction as an explanation of schizophrenia. :( An alternative explanation for schizophrenia is the biological explanation or Family Dsyfunction. This would suggest that schizophrenia is due to hyperdopaminergia, where high levels of dopamine in central areas of the brain are associated with auditory hallucinations rather than a dysfunction in thought processing, such as a lack of metarepresentation. Therefore, weakening the cognitive explanation for schizophrenia as it is not the only explanation of schizophrenia that should be considered. :)A strength of the cognitive explanation of schizophrenia has practical applications. This is because the principles of the theory, that schizophrenia is caused by delusional thoughts has led to the treatment of cognitive behavioural therapy. This is effective in treating schizophrenia as, patients are helped to identify and challenge their delusional thoughts. This can reduce positive symptoms of schizophrenia such as delusions of control, therefore the cognitive explanation of schizophrenia is an important part of applied psychology as it helps to treat people in the real world.

Answer 7

Aim: The aim of CBT is to help patients identify irrational/delusional thoughts and change them into more rational ones via disputing (making them less threatening) Once the irrational thoughts have been identified, for example a paranoid delusion that aliens were trying to abduct them, the psychiatrist would challenge the patient’s irrational thoughts in order to encourage patients to come up with a more plausible explanation: 1) The therapist could use empirical disputing, in which the therapist would ask the patient where is the evidence of their delusion/hallucination? This disputing helps patients to understand the delusions/hallucinations are not real and the therapist could explain that it is just a symptom of their schizophrenia. Offering more plausible explanations for these symptoms can reduce anxiety and helps the patient realise their beliefs (e.g. delusions) are not based in reality and that their thoughts are less threatening. 2) Positive self-talk can also be used, for example, if an individual hears negative voices, they can say positive statements that challenge the auditory hallucinations. 3) The therapist could also teach the patient self-distraction strategies, for example listening to music to drown out voices when they occur.

Answer 8

Research into the effectiveness of CBT was carried out by Jauhar et al. They reviewed the results of 34 studies of CBT as a treatment for schizophrenia. They concluded that CBT has a significant but small effect on both positive and negative symptoms. Demonstrating that CBT is fairly effective in treating schizophrenia and that by challenging patients irrational thoughts it can reduce symptoms of depression. However, it is worth noting that out of the 34 studies, CBT only had a small impact on SZ symptoms. Therefore placing doubt on the effectiveness of cognitive behavioural therapy as a treatment for schizophrenia. :( A limitation of CBT as a treatment for schizophrenia is that it requires motivation and commitment from patients to attend sessions, this is something that individuals suffering from negative symptoms of schizophrenia, such as avolition, often lack. THINK FURTHER… CBT also requires a patient to engage with the therapy, however, somebody with positive symptoms of schizophrenia (delusions) may have a lack of awareness and an inaccurate perception of reality. Therefore, in some cases of schizophrenia, CBT is only effective when combined with antipsychotics. This is because the drugs help the patient to motivate themselves to attend the sessions/increase the patients awareness. Therefore, CBT alone may not be an effective treatment for all cases of schizophrenia. :) Some may prefer this therapy as it avoids the chemical dependence. This is because CBT encourages individuals to identify and challenge their irrational/delusional thoughts independently, giving them control over their own behaviour. This is unlike drug therapy, which imposes the chemical straitjacket as the drug controls activity of neurotransmitters in the brain such as dopamine to reduce the symptoms of schizophrenia, which could cause dependence. Due to this, some may prefer CBT as a more appropriate treatment for schizophrenia.

Answer 9

based on the idea that as family dysfunction can play a role in the development of schizophrenia, altering relationship and communication patterns within dysfunctional families should help schizophrenics to recover. It also works by reducing Expressed emotion and stress levels within the family which may contribute to a patient’s risk of relapse. The main aim of family therapy is to reduce levels of expressed emotions/stress by: 1) Improving families’ beliefs about and behaviour towards schizophrenia 2) Reducing the stress of caring for a relative with schizophrenia 3) Decreasing feelings of guilt and anger in family members. 4) Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives. Therapists meet regularly with patients and family members, over the course of around 9 months to a year and are encouraged to be open and talk about the patient's symptoms, behaviour and progress.

Answer 10

:) Research to support family therapy as a treatment for schizophrenia was conducted by Leff et al (1985). They compared family therapy with routine outpatient care for schizophrenics and found that in the first 9 months of treatment 50% of those receiving routine care relapsed, compared with only 8% of those receiving family therapy. This suggests that family therapy is an effective therapy for treating schizophrenics. :( A limitation of family therapy as a treatment of schizophrenia is that it does not get to the root cause (aetiology) of schizophrenia. It works by helping to reduce the stress of living with schizophrenia in a family, for both the patient and family members, this does not eliminate the symptoms completely. This questions the appropriateness and effectiveness of the therapy as when the therapy stops patients could relapse, which is what Hogarty et al (1986) found in a follow up study of patients who had received family therapy. :( Due to these weaknesses, an alternative therapy that may be useful in treating schizophrenia is art therapy. This is less well known and less likely to be available to patients. However art therapy takes place with a specially trained art teacher who has worked with patients with schizophrenia and allows patients to interpret their emotions and feelings, and express them without necessarily using words, in a safe environment. It also acts as a healthy form of distraction from various symptoms, such as disturbing thoughts, hearing voices, etc. Therefore art therapy may be more appropriate treatment than family therapy for schizophrenia.

Answer 11

Token economies are a behaviourist approach to manage the behaviour of patients with schizophrenia. It is mainly used with patients who have spent a long time in hospital and therefore who have developed maladaptive behaviour such as bad hygiene or lack of communication with others. Aim: The aim of token economies is to change a patient's behaviour so that they are easier to manage, will have a better quality of life and thus enabling them to live outside of a hospital setting. How it works: The technique uses Skinner's operant conditioning principles, whereby patients receive reinforcements (rewards) in the form of tokens, such as coloured discs, immediately after producing a desired behaviour such as self-care or social interaction. The tokens can then be later exchanged for goods or privileges such as hours watching tv

Answer 12

:) Research to support the use of token economy as a management technique for SZ was conducted by Dickerson et al (2005). A meta-analysis reviewing 13 studies of token economies found the technique was useful in increasing the adaptive behaviour of patients, such as self-hygiene. This suggest that token economies is an effective management technique and it increases the credibility of the use of token economies in the management of schizophrenia. :( Moreover, the use of token economies can raise ethical issues. The major issue is that privileges become more available to patients with mild symptoms and less available to those with more severe symptoms of schizophrenia that prevent them from complying with desirable behaviours. Token economies suggests that symptoms of schizophrenia can easily be bypassed if they seek the reward. However, this leads to the most severely ill patients suffer discrimination, as the severity of their symptoms prevents them from accessing this programme. Therefore, this has reduced the use of token economies in the psychiatric system to manage schizophrenia as they may not be appropriate for all patients. :( Another issue with token economies is that they do not get to the root cause of schizophrenia. The aim is to make schizophrenia more manageable and improve patients' quality of life; it helps by making patients' behaviour more socially acceptable so that they can better integrate into society. Whilst this is important, the therapy does not treat schizophrenia. Further to this, Token economies is mainly effective in an institutionalised setting and when patients are sent back home, they lose the structure they had to help manage their behaviour i.e., they don’t have someone to give them a token for completing the desired behaviour. This questions the appropriateness and effectiveness of the therapy in managing schizophrenia, as there is high chance of relapse when patients are given independence.

Answer 13

suggests that schizophrenia is developed due to a combination of biological, psychological and social factors. This is known as the diathesis-stress model Diathesis = Vulnerability (at risk) Stress = A negative psychological experience

Answer 14

In Meehl’s original diathesis stress model, diathesis was entirely genetic. It was down to a single ‘schizo-gene’, which made somebody sensitive to stress. Meehl suggested that if a person does not have this schizo-gene then no amount of stress would lead to schizophrenia. However, if you have the gene, stress through childhood, such as having a schizophrenogenic mother could lead to schizophrenia. However, it is now believed that there is no single schizo-gene, but that it is many genes that increase generic vulnerability to schizophrenia (polygenic). It is also believed that factors other than genes can be a diathesis such as psychological trauma. Early and severe enough trauma, such as child abuse can seriously affect aspects of brain development and can make a person more vulnerable to later stress. Moreover, a modern definition of stress (trigger) includes anything that risks triggering schizophrenia, not just parenting. Much of the recent research has concerned cannabis use. In terms of the diathesis-stress model cannabis is the stressor because it increases the risk of schizophrenia by up to seven times according to the dose. Probably due to its interference with the dopamine system. However, not everyone develops schizophrenia after smoking cannabis suggesting there must also be one or more vulnerability factors.

Answer 15

As the interactionist model considers both biological and psychological factors in the development of schizophrenia, it is therefore compatible with both biological and psychological treatments for schizophrenia. In particular, the combination of antipsychotic medication and psychological therapies, most commonly CBT. Turkington et al (2006) argue that it is possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms. However, this requires adopting an interactionist model. It is not possible to adopt a purely biological approach and tell the patient their condition is purely biological and that there is no psychological significance to symptoms, and then to treat them with CBT.

Answer 16

:) Research to support the interactionist approach in explaining schizophrenia comes from Tienari et al (2004). They followed up 19,000 adopted children in Finland whose mothers had schizophrenia and compared them to a control group of adopted children without any genetic risk. The child rearing styles of the adoptive parents were observed. Those children who were brought up in families with a lot of conflict and low empathy (family dysfunction) were much more likely to develop schizophrenia but only in the children who had a genetic vulnerability, not the control group. This suggests that both genetic vulnerability and family related stress are important in the development of schizophrenia. :( However, one limitation of the interactionist approach to explaining schizophrenia is that there are individual differences, for example two people may have the same vulnerability and stressor but one may not develop schizophrenia. This means that we do not have a full understanding of the interactionist approach to explaining schizophrenia and more research may need to be conducted. :) Research to support the interactionist approach in treating schziphrenia was conducted by Tarrier et al (2004). 315 patients were randomly allocated to treatment conditions. They found that patients given a combined therapy of medication and CBT/counselling had lower symptom levels than a control group with just one treatment (medication). This therefore suggests by adopting an interactionist approach and using both biological and psychological therapies, patient’s schizophrenic symptoms will be treated more effectively.

Schizophrenia Flashcards

(40 cards)