4.8. Interactionist Approach to Sz

Question 1

What does the diathesis stress model link?

Answer 1

Links biological vulnerability to environmental stressors

Question 2

What does the diathesis stress model explain?

Answer 2

Individuals will develop sz if they have a biological predisposition and if they are exposed to stressful situations

Question 3

What is diathesis?

Answer 3

Predisposition to develop a medical conditions

Question 4

What is stress?

Answer 4

Any environmental factor that could trigger the disorder

Question 5

What is the interactionist approach also known as?

Answer 5

the biosocial approach

Question 6

What was the original explanation?

Answer 6

• gene + stress = sz
• Meehl’s model was entirely genetic due to a single schizogene
• Meehl argued that someone without schizogene should never develop sz, no matter how much stress they were exposed to
• But a person who does have the gene is vulnerable to the effects of chronic stress (schizophrenogenic mother)

Question 7

What is the modern understanding of diathesis?

Answer 7

• Sz has a genetic component -> mz twins of schizophrenic parents are at a greater risk of developing it than siblings or dzs, however concordance rate is 48% so there’s some environmental influence.
• It’s now believed many genes increase vulnerability
• Diathesis doesn’t have to be genetic, can be early psychological trauma ( affects brain development) -> child abuse affects HPA system (hypothalamic-pituitary-adrenal) -> makes child vulnerable to stress

Question 8

What is the modern understanding of stress?

Answer 8

• Anything that risks triggering sz, including psychological stress
• A lot of research looks at cannabis usage, cannabis a stressor as it increases risk of sz by up to 7x
• Due to fact that cannabis interferes with dopamine system
• However, not everyone that uses cannabis develops sz, so it seems there must be more vulnerability factors
• Further findings suggest living in densely populated urban areas increase the risk of developing sz -> Vassors: risk of sz in densely populated urban areas were 2.37x higher than rural

Question 9

How does the UK differ from the US in terms of treatment?

Answer 9

In the UK, it’s standard practice to treat patients with a combinations of drug therapy and CBT whereas in the US, there’s more conflict between biological and psychological approaches -> slower adoption of the interactionist approach as a result

Question 10

What did Turkington find?

Answer 10

It’s not possible to adopt an entirely biological approach, tell patients their condition is entirely biological, then treat them with CBT.

We cannot adopt a purely biological approach and say the cause is due to chemical imbalances then treat with CBT, the two must interact.

Question 11

Treatment: the idea of combining 2

Answer 11

The idea of combining 2 treatments can highly improve the effectiveness of the treatments in reducing symptoms of sz

• Antipsychotics + antidepressants = to treat -ve symptoms
• Antipsychotics + assertive community therapy =gets patients back to work in the community
• Antipsychotics + CBT = to treat +ve and -ve symptoms
• Antipsychotics + family therapy = cures dysfunctional family problems
• Antipsychotics + mindfulness = treats +ve symptoms

Drugs are used to stabilise the patient and other methods are useful in order to try to treat the disorder.

Question 12

What was the key research that Tienari carried out?

Answer 12

• Carried out a prospective study of 19,000 Finnish children adopted away from the biological family who had mothers diagnosed with sz
• Also assessed the rearing style of the adoptive family
• They compared this group with a group of children with no parent diagnosed with sz.
• After 21 yrs, they found that in adoptees at high genetic risk of sz, but not in those at low genetic risk, an adoptive family with a high level of criticism and conflict was a significant predictor of sz.

Question 13

Strength: Tienari et al

Answer 13

• Show that combination of genetic vulnerability and family stress leads to an increased risk of sz
• Also show there is a clear practical advantage to adoption in the interactionist approach in the form of superior treatment outcomes

Question 14

Weakness: Multiple genes

Answer 14

• Multiple genes increase vulnerability, each with a small effect on its own, there is no schizogene.
• Stress comes in many forms, Houston found childhood sexual trauma was a diathesis and cannabis use was a trigger.
• This demonstrates the original diathesis- stress model is too simplistic

Question 15

Strength: Hogarty

Answer 15

• Looked at relapse rates of sz patients- drug therapy alone had a relapse rate of 41% but combined with family therapy, relapse rates decreased to 19% and with social support therapy 20%
• Cheaper in the long run as it reduces hospitalisation

Question 16

Weakness: Treatment Causation Fallacy

Answer 16

• Turkington argues that combined biological and psychological therapies are more effective than either on their own but this doesn’t mean the interactionist approach to sz is correct.
• It means that the superior outcomes of combined therapies should not be over interpreted in terms of evidence in spirit of the interactionist approach

Question 17

Strength: Tarrier

Answer 17

• Randomly allocated 315 patients to (1) medication and CBT group or (2) a medication and supporting counselling group or (3) a control group.
• Patients in 2 combination groups showed lower symptom levels than those in the control group -> but no difference in hospital readmission.
• Studies like this show that there is a clear practical advantage to adopting an interactionist approach in the form of superior treatment outcomes.