**L6 - Interactionist Approach Flashcards
what is the INTERACTIONIST APPROACH?
the interactionist approach is an approach that ACKNOWLEDGES that there are BIOLOGICAL, PSYCHOLOGICAL and SOCIAL FACTORS in the DEVELOPMENT OF SZ.
Because it acknowledges that schizophrenia develops as the result of a COMBINATION OF FACTORS, the treatments that it suggests consist of biological and psychological treatments in combination.
Diathesis stress model - MEEHL
Originally, the most well known factor for SZ was the diathesis stress model proposed by MEEHL.
MEEHL suggested that the diathesis (VULNERABILITY) was ENTIRELY GENETIC and there was one specific gene which caused the illness called the ‘SCHIZOGENE’.
The model states that both a vulnerability to SZ and a STRESS TRIGGER are NECESSARY in order to develop the condition.
The underlying factors make a person vulnerable to developing the condition but the ONSET OF THE CONDITION IS TRIGGERED BY STRESS
Diathesis stress model - MODERN
However, the modern understanding of diathesis is that actually MANY GENES INCREASE GENETIC VULNERABILITY and there is NO SINGLE GENE (polygenic).
Modern views of diathesis include genes but also PSYCHOLOGICAL TRAUMA, so trauma becomes the diathesis RATHER THAN THE STRESSOR.
READ ET AL - neurodevelopmental mode, stress
The interactionist approach also considers how psychological factors like stress affects the conditions onset.
READ ET AL proposed a NEURODEVELOPMENTAL MODEL in which EARLY TRAUMA AFFECTS BRAIN DEVELOPMENT.
In fact, if the trauma is EARLY AND SEVERE ENOUGH, it can seriously affect brain development, making the person MORE VULNERABLE TO STRESS.
Stress - modern understanding
The modern understanding of stress however is that it’s ANYTHING that RISKS TRIGGERING SZ - e.g this could even be CANNABIS which makes it 7 TIMES MORE LIKELY for a person to develop SZ.
However, lots of people don’t take cannabis and still develop schizophrenic symptoms which suggests that there are OTHER STRESSORS WHICH CONTRIBUTE TO SZ DEVELOPING.
treatment according to the interactionist approach
Because the interactionist approach acknowledges BOTH BIOLOGICAL AND PSYCHOLOGICAL FACTORS OF SZ, it’s therefore compatible with BOTH BIOLOGICAL AND PSYCHOLOGICAL TREATMENTS.
In particular, this model is associated with COMBINING ANTIPSYCHOTIC MEDICATION AND PSYCHOLOGICAL THERAPIES SUCH AS CBT.
It’s unusual to treat SZ PATIENTS WITH PSYCHOLOGICAL THERAPIES ALONE, they are usually offered ALONGSIDE DRUG THERAPY.
+ evidence for the role of vulnerability and triggers (interactionist model)
A strength of this approach is that there is RESEARCH SUPPORT for the DUAL ROLE for GENETIC VULNERABILITY to SZ and STRESS TRIGGERS.
TIENARI ET AL STUDIED CHILDREN ADOPTED AWAY FROM SCHIZOPHRENIC MOTHERS. The adoptive parents’ PARENTING STYLES were ASSESSED AND COMPARED WITH A CONTROL GROUP of adoptees with NO GENETIC RISK.
A parenting style that was HARSH and LACKED COMPASSION was implicated in the development of SZ but only for children with a HIGH GENETIC RISK.
This is very strong research support the interactionist approach
+ support for effectiveness of COMBINATION TREATMENTS (interactionist approach)
+ another strength is the USEFULNESS OF THIS APPROACH IN TREATMENT OF SZ.
TARRIER ET AL RANDOMLY ALLOCATED 315 PATIENTS to either MEDICATION AND CBT GROUP or a MEDICATION AND COUNSELLING GROUP, or a CONTROL GROUP.
Patients in the TWO COMBINATION GROUPS showed LOWER SYMPTOM LEVELS THAN THE CONTROLS but NO DIFFERENCE in HOSPITAL ADMISSION.
This study showed that adopting an intersection isn’t approach is advantageous for treating SZ
- original diathesis stress model (interactionist approach)
- a limitation of this model is that the ORIGINAL DIATHESIS MODEL is TOO SIMPLISTIC.
MULTIPLE GENES INCREASE VULNERABILITY - there is NO SCHIZOGENE, stress comes in MANY FORMS and it may even be influenced by BIOLOGICAL FACTORS.
HOUSTON ET AL found CHILDHOOD SEXUAL TRAUMA was a DIATHESIS and CANNABIS WAS A TRIGGER. This shows that the old DIATHESIS model was much too simple
- don’t exactly know how DIATHESIS stress works
- there is strong evidence to suggest that an UNDERLYING VULNERABILITY COUPLED WITH STRESS can LEAD TO SZ.
But we DONT UNDERSTAND THE MECHANISMS THAT CAUSE THIS, this means we have an INCOMPLETE UNDERSTANDING OF THE WAY THE CONDITION DEVELOPS and how we should be treating it
- TREATMENT CAUSATION FALLACY (interactionist approach)
- a further limitation is the TREATMENT-CAUSATION FALLACY.
TURKINGTON ET AL argue that although COMBINED PSYCHOLOGICAL AND BIOLOGICAL THERAPIES are MORE EFFECTIVE than either on their own this doesn’t necessarily mean that the Interactionist approach to SZ is correct.
Similarly, the fact that drugs help does not mean that schizophrenia is BIOLOGICAL IN ORIGIN, we should be cautious when drawing conclusions about how the illness is developed even though the evidence points to these sources.
