Psychological Explanations

Question 1

What are the psychological explanations?

Answer 1

Family dysfunction

Cognitive explanations

Question 2

What is family dysfunction?

Answer 2

The presence of problems within a family that contribute to relapse rates in recovering schizophrenics, including a lack of warmth between parents and child, dysfunctional communication patterns and parental overprotection.

Question 3

What are the parts of family dysfunction?

Answer 3

Double bind theory

Expressed emotion

Question 4

What is the double bind theory?

Answer 4

Bateson (1956) suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia.

Question 5

What’s an example of the double bind theory?

Answer 5

If a mother tells her son that she loves him, yet at the same time turns her head away in disgust, the child receives two conflicting messages about their relationship on different communication levels, one of affection on the verbal level, and one of animosity on the non-verbal level.

Question 6

What happens to the child after contradictions?

Answer 6

The child’s ability to respond to the mother is incapacitated by such contradictions because one message invalidates the other.

These interactions prevent the development of an internally coherent construction of reality, and in the long run this manifests itself as schizophrenic symptoms (e.g. flattened affect and withdrawal).

Question 7

What is expressed emotion?

Answer 7

It’s a family communication style in which members of the family of a psychiatric patient talk about that patient in a critical or hostile manner or in a way that indicates emotional over-involvement or over-concern with the patient or their behaviour.

Question 8

What’s a study about EE?

Answer 8

Kuipers (1983) found that high EE relatives more and listen less.

High levels of EE are most likely to influence relapse rates (i.e. an increase in symptoms).
A patient retuning to a family with high EE is about 4 times more likely to relapse than a patient whose family is low in EE (Linszen, 1997).

Question 9

What do the findings of EE suggest?

Answer 9

That people with schizophrenia have a lower tolerance for intense environmental stimuli, particularly intense emotional comments and interactions with family members.

Question 10

How does EE affect a person with schizophrenia?

Answer 10

It appears that the negative emotional climate in these families arouses the patient and leads to stress beyond his or her already impaired coping mechanisms, thus triggering a schizophrenic episode.

In contrast, a family environment that is relatively supportive and emotionally undemanding may help the person with schizophrenia to reduce their dependence on antipsychotic medication and help reduce the likelihood of relapse (Noll, 2009).

Question 11

What are cognitive explanations?

Answer 11

Of mental disorders propose that abnormalities in cognitive function are a key component of schizophrenia.

Question 12

What’s dysfunctional thought processing?

Answer 12

Cognitive habits or beliefs that cause the individual to evaluate information inappropriately.

Question 13

What are the cognitive explanations of delusions?

Answer 13

During the formation of delusions, the patients interpretations of their experiences are controlled by inadequate information processing.

A critical characteristic of delusional thinking is egocentric bias, and so the individual jumps to conclusions about external events.
This is manifested in the patients tendency to relate irrelevant events to themselves and consequently arrive any false conclusions.

Question 14

What’s egocentric bias?

Answer 14

The degree to which the individual perceives him or herself as the central component in events.

Question 15

What are the cognitive explanations of hallucinations?

Answer 15

Hallucinating individuals focus excessive attention on auditory stimuli (hyper-vigilance) and so have a higher expectancy for the occurrence of a voice than normal individuals.

Question 16

What did Aleman suggest?

Answer 16

Aleman (2001) - suggest that hallucination-prone individuals find it difficult to distinguish between imagery and sensory-based perception.

For these individuals, the inner representation of an idea (e.g. what other people think of me) can override the actual sensory stimulus and produce an auditory image (he is not a good person) that is every bit as real as the transmission of actual sound.

Question 17

What did Baker and Morrison find? (1998)

Answer 17

Hallucinating patients with schizophrenia are significantly more likely to misattribute the source of a self-generated auditory experience to an external source than are non-hallucinating patients with schizophrenia.

These error are not corrected by disconfirming evidence because patients with schizophrenia do not go through the same processes of reality testing (such as checking external sources) that others would do.

Question 18

What are the evaluative points for family dysfunction?

Answer 18

Family relationships
Double bind theory
Individuals different in vulnerability to EE

Question 19

What is meant by family relationships?

Answer 19

The importance of family relationships in schizophrenia was demonstrated in an adoption study by Tienari (1994).

In this study, adopted children who had schizophrenic biological parents were more likely to become ill themselves than were children with non-schizophrenic biological parents.
However, this difference emerged only in situations where the adopted family itself was rated as disturbed.

This suggests that the illness only manifests itself under appropriate environmental conditions, therefore genetic vulnerability alone is not sufficient.

Question 20

What is meant by double bind theory?

Answer 20

There is some evidence to support this particular account of how family relationships may lead to schizophrenia.

For example, Berger (1965) found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics. However, other studies are less supportive.
Liem (1974) measured patterns of parental communication in families with a schizophrenic child and found no difference when compared to normal families.

Despite these inconsistencies in research support, Gibney (2006) claims that the real value of double bind theory is that it led to the development of family therapy.
If interactions could be problematic and pathology producing, then they might also be organised more constructively and so become health producing.

Question 21

What is meant by individual differences in vulnerability to EE?

Answer 21

Not all patients who live in high EE families relapse, and not all patients who live in low EE homes avoid relapse.

Research has found individual differences in stress response to high EE-like behaviours.
Altorfer (1998) found that 1/4 of the patients they studied showed no physiological responses to stressful comments from their relatives.

Vulnerability to the influences of high EE may also be psychologically based.
Lebell (1993) claims that how patients appraise the behaviour of their relatives is important.
In cases where high EE behaviours are not perceived as being negative or stressful, patients can do well regardless of how the family environment is objectively rated.

This shows that not all patients are equally vulnerable to high levels of EE within the family environment.

Question 22

What are the evaluative points for the cognitive explanations?

Answer 22

Supporting evidence for the cognitive model of schizophrenia
Support from the success of cognitive therapies
An integrated model of schizophrenia

Question 23

What is meant by supporting evidence for the cognitive model of schizophrenia?

Answer 23

Sarin and Wallin (2014) found supporting evidence for the claim that the positive symptoms of schizophrenia have their origins in faulty cognition.

For example, delusional patients were found to show various biases in their information processing, such as jumping to conclusions and lack of reality testing.
Likewise, schizophrenic individuals with hallucinations were found to have impaired self-monitoring and also tended to experience their own thoughts as voices.

A consequence of this is that a therapist can use this information when he or she chooses techniques for the treatment of patients.

Question 24

What is meant by support for the success of cognitive therapies?

Answer 24

The claim that the symptoms of schizophrenia have their origin in faulty cognition is reinforced by the success of cognitive-based therapies for schizophrenia.

The effectiveness of cognitive behavioural therapy for psychosis (CBTp) was demonstrated in the National Institute for Health and Care Excellence (NICE) review of treatments for schizophrenia (NICE, 2004).
This review found consistent evidence that, when compared with treatment by antipsychotic medication, CBT was more effective in reducing symptom severity and improving levels of social functioning.

This supports the view that faulty cognitions have an important causal influence in the development of schizophrenia.

Question 25

What is meant by an integrated model of schizophrenia?

Answer 25

A problem with the model of schizophrenia is that it deals adequately with one aspect of the disorder (e.g. cognitive impairment) but fails to explain, or ignores, other aspects (e.g. social adversity).

Howes and Murray (2014) addressed this problem with an integrated model of schizophrenia.
Early vulnerability factors (e.g. genes, birth complications, etc.), together with exposure to significant social stressors (e.g. social adversity), sensitises the dopamine system, causing it to increase the release of dopamine.
Biased cognitive processing of this increased dopamine activity results in paranoia and hallucinations and eventually the development of a psychosis.

By putting the impact of life events at the centre of the process leading to schizophrenia, this model fits in with more recent research showing that exposure to significant social stressors is associated with a considerable increase in risk of developing this disorder.