interactionist approach Flashcards
What is the diathesis stress model in relation to schizophrenia
According to this model, the symptoms of schizophrenia are triggered or made worse when significant stressors (the ‘stress’) in the person’s life are combined with a biological vulnerability (the ‘diathesis’) to the disorder. Both the vulnerability to schizophrenia and a stressful trigger are necessary in order to develop the disorder. This model might, therefore, explain why not all people who have genetic vulnerability to schizophrenia go on to develop the disorder.
Diathesis component evidence
Gottesman found children from two parents who had schizophrenia has a concordance rate of 46%, compared with 13% from one parent and only 6% where a sibling had schizophrenia
How else has schizophrenia been proposed to develop other than genetic
A modern view of diathesis (vulnerability) include a range of factors beyond genetic, including psychological trauma. Read et al (2001) proposed how early trauma alters the developing brain. For example, the hypothalamic-pituitary-adrenal (HPA) system can become overactive making a person more vulnerable to stress later.
Stress component of model
Childhood trauma:
Varese found children who experience severe trauma before 16 years were 3 times as likely to develop schizophrenia in later life compared to controls. The more severe the trauma, the greater risk of developing schizophrenia.
Urbanised environments:
Vassos found that the risk for schizophrenia is the most urban environments was 2.37 times higher than in the most rural environments. This may be due to more adverse living conditions of densely populated urban environments. However, this may be due to the fact that people who live in in urban environments are more likely to be from a lower income group and therefore the stress from that may trigger schizophrenia.
Cannabis use:
Cannabis increases the risk of schizophrenia by up to 7 times according to dose as it interferes with the dopamine system. However, most people do not develop schizophrenia after smoking cannabis so there must also be other vulnerability factors.
There are several ways in which a combination of diathesis and stress can lead to the onset of schizophrenia. For example, relatively minor stressors may lead to the onset of the disorder for an individual who is highly vulnerable, or a major stressful event might cause a similar reaction in a person low in vulnerability.
Evaluate interactionist approach as an explanation for schizophrenia
+ Evidence to support the diathesis-stress model
P - One strength of the interactionist approach to schizophrenia is evidence to support the role of both vulnerability and triggers.
E - Tienari et al. studied 19,000 Finnish children whose biological mothers had schizophrenia compared to a control group of adoptees without a family history of schizophrenia, instead assessing the adoptive parents child-rearing styles. It was found that schizophrenia is more likely to be diagnosed in children with high genetic vulnerability and parents with child-rearing styles that are high in criticism and low in empathy, compared to a control group.
E - This suggests that both genetic vulnerability and family-related stress are important in the development of schizophrenia.
+ Practical applications for improved treatments
P - One further strength of the interactionist approach is in the combination of biological and psychological treatments.
E - If the onset of schizophrenia is a result of genetics and environmental stress, then this has implications for treatment. There is evidence to support increased effectiveness when using both biological and psychological treatments of schizophrenia. Tarrier et al randomly allocated participants to one of 3 conditions - 1) medication + CBT, 2) medication + counselling 3) medication only. Participants in the combination groups = lower symptoms but there was no difference in hospital readmission
E - This means that there is a clear practical advantage to adopting an interactionist approach to schizophrenia in terms of superior treatment outcomes.
Counterpoint: Researchers point out that saying that a successful treatment for mental disorders justifies a specific explanation is the logical equivalent of saying that because alcohol reduces shyness, shyness is caused by lack of alcohol. this logical error is called the treatment-causation fallacy. Therefore we cannot automatically assume that the success of combined therapies means interactionist explanations are correct.
- Urban environments are not necessarily more stressful
P - One limitation is that there is evidence to contradict research to support the interactionist approach
E - The differences in urban and rural areas may actually be due to differences in socioeconomic groups between the two. In addition, Romans-Clarkson (1990) found no urban-rural differences in mental health among women in New Zealand, challenging Vassos’ findings.
E - This questions the validity of the approach as schizophrenia may be more likely to be diagnosed in people who live in urban environments as they are usually from lower income groups and therefore the stress from having an unstable living condition may trigger the disorder in vulnerable individuals instead.
Outline the interactionist approach in treating schizophrenia
The interactionist explanation of schizophrenia acknowledges both biological and psychological factors in schizophrenia so therefore recommends both biological and psychological treatments. The model is associated with combining antipsychotic medication and psychological therapies, most commonly CBT.
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 psychological and biological models of schizophrenia and this may have led to slower adoption of an interactionist approach. Thus medication without an accompanying psychological treatment is more common than in the UK.
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 taking antipsychotics.
