6.6: The interactionist approach

Question 1

The interactionist approach

Answer 1

The interactionist approach is a broad approach to explaining schizophrenia, which acknowledges that there are a range of factors (biological, psychological and societal factors) involved in the development of schizophrenia

Question 2

What is the interactionist approach also sometimes called?

Answer 2

The interactionist approach is also sometimes called the ‘biosocial approach’

Question 3

The interactionist approach is a broad approach to explaining schizophrenia, which acknowledges that there are a range of factors (biological, psychological and societal factors) involved in the development of schizophrenia.
What do biological factors include?

Answer 3

Biological factors include genetic vulnerability and neurochemical and neurological abnormality

Question 4

The interactionist approach is a broad approach to explaining schizophrenia, which acknowledges that there are a range of factors (biological, psychological and societal factors) involved in the development of schizophrenia.
Biological factors include genetic vulnerability and neurochemical and neurological abnormality.
What do psychological factors include?

Answer 4

Psychological factors include stress, for example resulting from life events and daily hassles, including poor quality interactions in the family

Question 5

What does diathesis mean?

Answer 5

Diathesis means vulnerability

Question 6

Diathesis means vulnerability.

In the context of schizophrenia, what does stress simply mean?

Answer 6

In the context of schizophrenia, stress simply means a negative psychological experience

Question 7

Diathesis means vulnerability.
In the context of schizophrenia, stress simply means a negative psychological experience.
The diathesis-stress model says that both what are necessary in order to develop the condition?

Answer 7

The diathesis-stress model says that both a vulnerability to schizophrenia and a stress-trigger are necessary in order to develop the condition

Question 8

Diathesis means vulnerability.
In the context of schizophrenia, stress simply means a negative psychological experience.
The diathesis-stress model says that both a vulnerability to schizophrenia and a stress-trigger are necessary in order to develop the condition.
One or more underlying factors make a person particularly vulnerable to developing schizophrenia, but

Answer 8

One or more underlying factors make a person particularly vulnerable to developing schizophrenia, but the onset of the condition is triggered by stress

Question 9

The diathesis-stress model

Answer 9

The diathesis-stress model is an interactionist approach to explaining behaviour

Question 10

The diathesis-stress model is an interactionist approach to explaining behaviour.
Example

Answer 10

For example, schizophrenia is explained as the result of both an underlying vulnerability (diathesis) and a trigger, both of which are necessary for the onset of schizophrenia

Question 11

The diathesis-stress model is an interactionist approach to explaining behaviour.
For example, schizophrenia is explained as the result of both an underlying vulnerability (diathesis) and a trigger, both of which are necessary for the onset of schizophrenia.
In early versions of the diathesis-stress model, vulnerability was genetic and triggers were psychological.
Nowadays,

Answer 11

Nowadays, both genes and trauma are seen as diatheses and stress can be psychological or biological in nature

Question 12

In the original diathesis-stress model (who, when)

Answer 12

In the original diathesis-stress model (Meehl, 1962)

Question 13

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was

Answer 13

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic

Question 14

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic, the result of what?

Answer 14

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic, the result of a single ‘schizogene’

Question 15

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic, the result of a single ‘schizogene.’
What did this lead to?

Answer 15

This led to the development of a biologically based schizotypic personality

Question 16

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic, the result of a single ‘schizogene.’
This led to the development of a biologically based schizotypic personality, one characteristic of which is what?

Answer 16

This led to the development of a biologically based schizotypic personality, one characteristic of which is sensitivity to stress

Question 17

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic, the result of a single ‘schizogene.’
This led to the development of a biologically based schizotypic personality, one characteristic of which is sensitivity to stress.
According to Paul Meehl, if a person does not have the schizogene, then

Answer 17

According to Paul Meehl, if a person does not have the schizogene, then no amount of stress would lead to schizophrenia

Question 18

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic, the result of a single ‘schizogene.’
This led to the development of a biologically based schizotypic personality, one characteristic of which is sensitivity to stress.
According to Paul Meehl, if a person does not have the schizogene, then no amount of stress would lead to schizophrenia.
However, in carriers of the gene,

Answer 18

However, in carriers of the gene, chronic stress through childhood and adolescence, in particular the presence of a schizophrenogenic mother, could result in the development of the condition

Question 19

The modern understanding of diathesis:

One way in which our understanding of diathesis has changed

Answer 19

One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly

Question 20

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no

Answer 20

One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014)

Question 21

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
What do modern views of diathesis also include?

Answer 21

Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005)

Question 22

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so what?

Answer 22

Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor

Question 23

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001)

Answer 23

Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain

Question 24

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
Early and

Answer 24

Early and severe enough trauma

Question 25

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
What can early and severe enough trauma, such as child abuse, do?

Answer 25

Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development

Question 26

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development.
Example

Answer 26

For example, the hypothalamic-pituitary-adrenal (HPA) system can become over-active

Question 27

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development.
For example, the hypothalamic-pituitary-adrenal (HPA) system can become over-active, doing what?

Answer 27

For example, the hypothalamic-pituitary-adrenal (HPA) system can become over-active, making the person much more vulnerable to later stress

Question 28

The modern understanding of stress:

In the original diathesis-stress model of schizophrenia, how was stress seen?

Answer 28

In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature

Question 29

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to what?

Answer 29

In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting

Question 30

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.
Although psychological stress, including that resulting from parenting, may still be considered important, what does a modern definition of stress in relation to the diathesis-stress model include?

Answer 30

Although psychological stress, including that resulting from parenting, may still be considered important, a modern definition of stress in relation to the diathesis-stress model includes anything that risks triggering schizophrenia (Houston et al, 2008)

Question 31

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.
Although psychological stress, including that resulting from parenting, may still be considered important, a modern definition of stress in relation to the diathesis-stress model includes anything that risks triggering schizophrenia (Houston et al, 2008).
What has much of the recent research into factors triggering an episode of schizophrenia concerned?

Answer 31

Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use

Question 32

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.
Although psychological stress, including that resulting from parenting, may still be considered important, a modern definition of stress in relation to the diathesis-stress model includes anything that risks triggering schizophrenia (Houston et al, 2008).
Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use.
In terms of the diathesis-stress model, what is cannabis?

Answer 32

In terms of the diathesis-stress model, cannabis is a stressor

Question 33

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.
Although psychological stress, including that resulting from parenting, may still be considered important, a modern definition of stress in relation to the diathesis-stress model includes anything that risks triggering schizophrenia (Houston et al, 2008).
Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use.
In terms of the diathesis-stress model, why is cannabis a stressor?

Answer 33

In terms of the diathesis-stress model, cannabis is a stressor, because it increases the risk of schizophrenia by up to 7 times according to dose

Question 34

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.
Although psychological stress, including that resulting from parenting, may still be considered important, a modern definition of stress in relation to the diathesis-stress model includes anything that risks triggering schizophrenia (Houston et al, 2008).
Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use.
In terms of the diathesis-stress model, cannabis is a stressor, because it increases the risk of schizophrenia by up to 7 times according to dose.
Why is this probably because?

Answer 34

This is probably because cannabis interferes with the dopamine system

Question 35

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.
Although psychological stress, including that resulting from parenting, may still be considered important, a modern definition of stress in relation to the diathesis-stress model includes anything that risks triggering schizophrenia (Houston et al, 2008).
Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use.
In terms of the diathesis-stress model, cannabis is a stressor, because it increases the risk of schizophrenia by up to 7 times according to dose.
This is probably because cannabis interferes with the dopamine system.
However,

Answer 35

However, most people do not develop schizophrenia after smoking cannabis, so it seems there must also be one or more vulnerability factors

Question 36

The modern understanding of stress:
In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.
Although psychological stress, including that resulting from parenting, may still be considered important, a modern definition of stress in relation to the diathesis-stress model includes anything that risks triggering schizophrenia (Houston et al, 2008).
Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use.
In terms of the diathesis-stress model, cannabis is a stressor, because it increases the risk of schizophrenia by up to 7 times according to dose.
This is probably because cannabis interferes with the dopamine system.
However, most people do not develop schizophrenia after smoking cannabis, so it seems there must also be one or more vulnerability factors.
Therefore, high doses of cannabis can trigger schizophrenia in people with

Answer 36

Therefore, high doses of cannabis can trigger schizophrenia in people with a pre-existing vulnerability

Question 37

Treatment according to the interactionist model:
The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and is therefore compatible with

Answer 37

The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and is therefore compatible with both biological and psychological treatments

Question 38

Treatment according to the interactionist model:
The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and is therefore compatible with both biological and psychological treatments.
In particular, what is the interactionist model of schizophrenia associated with?

Answer 38

In particular, the interactionist model of schizophrenia is associated with combining antipsychotic medication and psychological therapies, most commonly CBT

Question 39

Treatment according to the interactionist model:
The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and is therefore compatible with both biological and psychological treatments.
In particular, the interactionist model of schizophrenia is associated with combining antipsychotic medication and psychological therapies, most commonly CBT.
Douglas Turkington et al. (2006)

Answer 39

Douglas Turkington et al. (2006) point out that it is perfectly possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms

Question 40

Treatment according to the interactionist model:
The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and is therefore compatible with both biological and psychological treatments.
In particular, the interactionist model of schizophrenia is associated with combining antipsychotic medication and psychological therapies, most commonly CBT.
Douglas Turkington et al. (2006) point out that it is perfectly possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms.
However,

Answer 40

However, this requires adopting an interactionist model - it is not possible to:

1. Adopt a purely biological approach
2. Tell patients that their condition is purely biological and that there is no psychological significance to their symptoms
3. Simultaneously treat them with CBT

Question 41

Treatment according to the interactionist model:

In Britain, how is it increasingly standard practice to treat patients?

Answer 41

In Britain, it is increasingly standard practice to treat patients with a combination of antipsychotic drugs and CBT

Question 42

Treatment according to the interactionist model:
In Britain, it is increasingly standard practice to treat patients with a combination of antipsychotic drugs and CBT.
In the USA,

Answer 42

In the USA, there is more of a history of conflict between adoption of an interactionist approach

Question 43

Treatment according to the interactionist model:
In Britain, it is increasingly standard practice to treat patients with a combination of antipsychotic drugs and CBT.
In the USA, there is more of a history of conflict between adoption of an interactionist approach.
Thus,

Answer 43

Thus, medication without an accompanying psychological treatment is more common in the USA than in the UK

Question 44

Treatment according to the interactionist model:

It is unusual to treat schizophrenia using what alone?

Answer 44

It is unusual to treat schizophrenia using psychological therapies alone

Question 45

Treatment according to the interactionist model:
It is unusual to treat schizophrenia using psychological therapies alone.
CBT, family therapy and the use of token economies with sufferers of schizophrenia are usually carried out with patients who?

Answer 45

CBT, family therapy and the use of token economies with sufferers of schizophrenia are usually carried out with patients who take antipsychotics

Question 46

A combination of genetic vulnerability and growing up in a dysfunctional family increases the risk of schizophrenia.
Each on their own may not be problematic, but

Answer 46

Each on their own may not be problematic, but they interact in such a way to produce mental health problems

Question 47

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development.
For example, the hypothalamic-pituitary-adrenal (HPA) system can become over-active, making the person much more vulnerable to later stress.

What is an example of early trauma?

Answer 47

An example of early trauma is seeing both your parents die at an early age

Question 48

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development.
For example, the hypothalamic-pituitary-adrenal (HPA) system can become over-active, making the person much more vulnerable to later stress.

There is lots of research that cortisol does what?

Answer 48

There is lots of research that cortisol inhibits growth

Question 49

The modern understanding of diathesis:
One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability sightly - there is no single ‘schizogene’ (Ripke et al, 2014).
Modern views of diathesis also include a range of factors beyond genetics, including psychological trauma (Ingram and Luxton, 2005) - so trauma becomes the diathesis, rather than the stressor.
Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development.
For example, the hypothalamic-pituitary-adrenal (HPA) system can become over-active, making the person much more vulnerable to later stress.

There is lots of research that cortisol inhibits growth.
This explains why children who are neglected are often short - not because of not eating (although that may ofcourse be a factor), but because they’ve been what?

Answer 49

This explains why children who are neglected are often short - not because of not eating (although that may ofcourse be a factor), but because they’ve been unhappy/stressed

Question 50

You’re 7 times more likely to develop schizophrenia if you smoke cannabis.
When you smoke cigarettes, what does your brain do?

Answer 50

When you smoke cigarettes, your brain grows receptors that want nicotine

Question 51

You’re 7 times more likely to develop schizophrenia if you smoke cannabis.
When you smoke cigarettes, your brain grows receptors that want nicotine.
When you smoke cannabis, what does your brain do?

Answer 51

When you smoke cannabis, your brain grows receptors that want endocannabinoids

Question 52

You’re 7 times more likely to develop schizophrenia if you smoke cannabis.
When you smoke cigarettes, your brain grows receptors that want nicotine.
When you smoke cannabis, your brain grows receptors that want endocannabinoids.
What does an overgrowth mean?

Answer 52

An overgrowth means that there is more dopamine in the brain

Question 53

You’re 7 times more likely to develop schizophrenia if you smoke cannabis.
When you smoke cigarettes, your brain grows receptors that want nicotine.
When you smoke cannabis, your brain grows receptors that want endocannabinoids.
An overgrowth means that there is more dopamine in the brain.
Therefore, smoking changes your brain’s what?

Answer 53

Therefore, smoking changes your brain’s structure

Question 54

In the original diathesis-stress model (Meehl, 1962), diathesis (vulnerability) was entirely genetic, the result of a single ‘schizogene.’

However,

Answer 54

However, Ripke et al. found that 108 different genetic variations were associated with increased risk of schizophrenia

Question 55

Overall, it is unusual to treat schizophrenia using psychological therapies alone.
What with sufferers of schizophrenia are usually carried out with patients taking antipsychotics?

Answer 55

1. CBT
2. Family therapy
3. Token economies
   with sufferers of schizophrenia are usually carried out with patients taking antipsychotics