interactionist approach of sz Flashcards
what is the interactionist approach for explaining schizophrenia??
- sz contains much variety that nature and nurture cannot explain the condition alone or treat the condition effectively. so nature and nurture share responsibility
- this can be explained through the diathesis stress approach which means we inherit a predisposition to develop sz and combined with stress within the environment could bring this as a trigger to this vulnerability.
what are the biological vulnerabilities of the diathesis??
- The 1st key proposal of this model is that certain factors make you more vulnerable to developing schizophrenia and create a predisposition (or increased likelihood) of developing the disorder. This is the diathesis part of the model. Many would suggest that this diathesis is biological (but modern explanations say it is more than this).
what are the environmental factors of the diathesis?
The 2nd key proposal is that certain situations, experiences, events, stressors etc. can trigger or activate this predisposition and cause the individual to develop schizophrenia, or cause an increase or relapse in symptoms if the individual is in remission. This is the stress part of the model.
what was meehls orginal diathesis stress model??
In the original diathesis stress model (Meel 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 was sensitivity to stress.
It was claimed that if a person does not have the schizogene then no amount of stress would lead to schizophrenia.
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.
what is the modern understanding of diathesis?
One way in which our understanding of diathesis has change is that it is now clear that MANY GENES each appear to increase genetic vulnerability slightly - there is NO single SCHIZOGENE (Ripke et al 2014) .
Modern views of diathesis also include a range of factors beyond the genetic, including psychological trauma ( Ingram & Luxton 2005) - so trauma become the diathesis rather than the stressor.
Read et al (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain.
Early & severe enough trauma, such as child abuse, can seriously affect many aspects of brain development e.g the HYPOTHALAMIC-PITUITARY- ADRENAL (HPA) system can become over- active, making the person much more vulnerable to later stress.
what is 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, as 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 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 be one or more vulnerability factors.
what are the positive evaluations for the diathesis stress approach for explaining sz?
- The diathesis-stress model incorporating nature and nurture in schizophrenia is well supported by adoption research.
Tienari et al. (2004) considered genetic risks and parenting style in a huge adoption study (involving 19,000 Finnish mothers with schizophrenia). Biological parents were assessed for rates of schizophrenia and adoptive parents had their child-rearing styles assessed. Results showed child-rearing styles that contained high levels of criticism/conflict and low empathy were implicated in the development of schizophrenia, but only for those with a high genetic risk.
This implies that both genetic risk (nature) and family related stress (nurture) are both vindicated in the cause of schizophrenia, supporting the diathesis-stress account. - The interactionist approach to explaining schizophrenia has further support from twin studies.
For example, MacDonald and Schultz (2009) have suggested that among MZ twins, if one twin is diagnosed with schizophrenia, then the other twin is 99 times more likely to suffer from the condition. As MZ twins share 100% of their DNA, is can be assumed they will have the same biological vulnerabilities (diathesis). However, we can also assume they have the same environmental influences so could experience the same stressors. The interaction of both the diathesis and stress could be the cause of this high concordance rate between MZ twins.
This indicates that an interactionist approach is well validated and could explain more incidence of schizophrenia than biological or psychological explanations alone. - The diathesis-stress model has developed / warranted a strong practical application of combined therapy, that tackles biological and psychological factors of schizophrenia simultaneously.
Tarrier et al (2004) used 315 patients with schizophrenia and randomly allocated them to one of 3 groups: antipsychotics and CBT; antipsychotics and supportive counselling; or a control group of antipsychotics alone.
Patients in the two combined groups showed significantly lower symptom levels than the control group, suggesting drug-therapy and psychological therapy combined is the most effective.
This implies the interactionist approach to explaining schizophrenia has helped reduce the distress experienced by many patients. - The diathesis stress model has great explanatory power for different cases of schizophrenia.
For example, by addressing both biological vulnerabilities and environmental factors, the model can explain diverse prognosis because patients may come from different environments that may help or hinder the recovery process, as well as having differing degrees of biological vulnerabilities.
This suggests the holistic account may improve descriptive and predictive validity of schizophrenia.
HOWEVER- the interactionist approach to explaining SZ has theoretical flaws. Although the model makes rational sense, it does not explain how stress impacts the nervous system to trigger the condition. For example, the model does not illustrate exactly how urban living could inflate dopamine levels or create hypofrontality in patients suffering schizophrenia. This implies that more research is needed to understand the full dynamics of the diathesis-stress model.
what are the negative evaluations for the diathesis stress approach for explaining sz?
- The original diathesis stress model was an oversimplification.
We now know that multiple factors contribute to the development of schizophrenia. It involves multiple genes and diathesis influenced by psychological factors and stress can be both biological and psychological.
Houston (2008) argued that child sexual abuse is major influence and cannabis use is a major trigger.
This suggests that… our current understanding of the diathesis-stress model is a more appropriate and useful explanation for schizophrenia
what is the interactionist approach for TREATING sz??
- sz uses anti psychotic drugs and uses psychological treatments like CBTp and family therapy which most theories use a combination of both
- drug therapy tackles biological correlates whilst psychological treatments address wider aspects of the condition
- means that a greater effect of treatment can be used which can bring greater treatments
studies for the interactionist approach of treatment??
- startup 2004
- Leff, 1982
what are the positive evaluations for the interactionist approach for treatment?
- The diathesis-stress model to treating schizophrenia has supporting research.
Tarrier et al (2004) used 315 patients with schizophrenia and randomly allocated them to one of 3 groups: antipsychotics and CBT, antipsychotics and supportive counselling or a control group of antipsychotics alone.
Patients in the two combined groups showed significantly lower symptom levels than the control group.
This implies the diathesis stress account provides a more comprehensive and effective treatment for schizophrenia.
- A combined, interactionist therapy for schizophrenia can be used in novel ways to help reduce the distress experienced by patients.
Usually, medication is prescribed to reduce the symptoms of a mental health condition to enable the patient to access psychological therapy such as CBT, e.g., reducing the delusions a schizophrenic patient may be having so they can start to trust their therapist and open up to them.
However, Garrett (2008) described successfully using CBT to change a patient’s mind about taking the antipsychotic drugs she was prescribed and therefore reducing her symptoms in that way.
This could suggest… there are multiple ways in which an interactionist approach to treating schizophrenia can benefit the patients.
what are the negative evaluations for the interactionist approach of treatment?
- However, the interactionist approach to treatment has economic implications that could affect the NHS / economy.
Combination therapies are more expensive than single therapies and this needs to be considered in a cash-strapped NHS. As the NHS is funded by the government through taxpayers money, funding these treatments could put further strain on public spending.
However, although combined therapies are more expensive in the short-term they are more cost-effective in the long term as they result in increased functioning and reduce relapse.
This implies the economy may be negatively impacted in the short-term costs of the treatments, but may be positively impacted in the long-term as individuals with schizophrenia are able to take back control of their lives, return to work and contribute more to the economy. - However- The interactionist approach to treating schizophrenia may still suffer from problems associated with each type of therapy that could hamper its effectiveness.
Expand on these points using your knowledge from previous lessons:
Drug therapy = side effects
CBT = issues with age / coherent thinking and insight
This suggests that although a combined approach to treatment may deliver twice the benefits, it could still present problems for patient’s wellbeing.
