Psychological Explanations for Schizophrenia Flashcards
Family Dysfunction
• abnormal processes within a family such as poor family communication, cold parenting and high levels of expressed emotion
• these may be risk factors for both the development and maintenance of schizophrenia
Schizophrenogenic mother
• early theorists thought that a ‘schizophrenogenic mother’ who was cold, dominant, and created conflict, caused schizophrenia to emerge in the child (Fromm-Reichmann, 1948)
• these mothers were said to be rejecting, overprotective, self-sacrificing, moralistic about sex and fearful of intimacy
• the distrust, resentfulness and instability caused by such a parent creates a family climate characterised by tension and secrecy. This leads to distrust that later develops into paranoid delusions (i.e. the belief that one is being persecuted by another person), and ultimately schizophrenia
Double Bind Theory
• Bateson et al (1972)- one of the first researchers to look at the family dynamic of those people diagnosed with schizophrenia
• he agreed that family climate is important in the development of schizophrenia but emphasised the role of communication style within the family
• children who frequently receive contradictory messages (double binds) from their parents are more likely to develop schizophrenia
• according to the theory these interactions prevent the development of an internally coherent construction of reality, and in the long run, this manifests itself as symptoms of schizophrenia
Expressed Emotion
• explanation for relapse in patients with schizophrenia. Although it’s been suggested that it may be a source of stress that can trigger the onset of schizophrenia in someone who is already vulnerable
• This family variable associated with schizophrenia is a negative emotional climate, or more generally, a high degree of expressed emotion (EE).
• EE is a family communication style in which members of a family of a psychiatric patient talk about the 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
Expressed Emotion communiction style
-involves:
• critical comments through both tone and content, occasionally accompanied by violence
• hostility towards the patient, including anger and rejection
• emotional over-involvement in the life of the patient, including needless self-sacrifice
-if these factors are high, then the risk of a relapse is high
Cognitive Explanation
• schizophrenia is characterised by disturbance in language, attention, thought and perception
• this has led cognitive psychologists to explain the disorder as a result of dysfunctional thought processing
• lower then usual levels of (possibly caused by biological factors) suggest that cognition is likely to be impaired
Dysfunction in meta-representation Frith (1992)
• Frith suggested that people with schizophrenia fail to monitor their own thoughts correctly, misattributing them to the outside world
• when a person hears voices, it is actually their own inner speech being misinterpreted, however, sufferers may believe that someone or something in the external world is communicating with them
• such processing problems in people with schizophrenia are sometimes referred to as alien control symptoms because the sufferer feels as if external forces are influencing their thoughts and actions and they have no personal control
Dysfunction in central control
the cognitive ability to suppress automatic responses while we perform deliberate actions
• disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts
• derailment of thoughts and spoken sentences because each word triggers associations and the patient cannot suppress automatic responses to these
Auditory selective attention impairment
• the negative symptoms of schizophrenia may be the result of cognitive strategies used by the individual to keep mental stimulation to a manageable level
• this happens when people experience potentially over-whelming levels of information from the external world and their inner world. This may be due to auditory selective attention impairment
Socio-cultural theory
• Harrison et al. (2001) people born in deprived areas were more likely to develop schizophrenia
• poverty, unemployment, crowding
• correlational results that doesn’t show cause and effect
• the social drift hypothesis: more likely to be in deprived area because having schizophrenia gives them a lower social status
• ongoing research: neonatal vitamin D deficiency and diagnosis of schizophrenia
How does CBT help Schizophrenia
• helps to make sense of how delusions and hallucinations impact their feelings and behaviour
• understanding where symptoms came from can be helpful
• e.g. believing voices are demons- helped to understand the existence of hallucination can help to reduce anxiety
Family Therapy
deals with high levels of expressed emotion
• family therapy seeks to treat members of the family as well as the patient
• the hope is to reduce the high level of EE within the household which is causing the relapse
How does family therapy work?
• family therapy usually takes place within the people’s homes and typically two family therapists will work with the relatives and patient
• it lasts between 3-12 months with sessions every 2-4 weeks. A minimum of 10 sessions are recommended by NICE
• the therapists work with the family and the patient to develop strategies to cope better with the mental disorder and its symptoms
• helps the patient make better progress and the relatives to feel more positive about, and more effective in, their supporting roles
• the relatives are made more aware of the information regarding psychosis and the particular diagnosis their relative has been given
• the therapist encourages the relatives to ask questions and learn more about the disorder so they can properly understand the difficulties the patient faces
• the patient will also be asked to discuss their symptoms with the family as they are the expert in this situation
• lastly the family and the patient are trained to recognise the early signs of relapse so that they can respond rapidly to reduce the severity of it
Token Economies
• reward systems to manage behaviour, in particular those who have developed maladaptive behaviour after spending long periods in psychiatric hospitals
• modifying behaviour is there to improves quality of life and makes it more likely they can live outside of the hospital
• tokens (e.g. a coloured disk) are given when patients carry out desirable behaviour (e.g. getting dressed, making a bed etc)
• tokens can be swapped for rewards
• based on operant conditioning. Tokens are secondary reinforcers as they only have value once the patient has learned they can be used to obtain rewards (e.g. buying sweets/magazines)
(Evaluations of psychological Treatments) Evidence for Effectiveness
• Jauhar et al. (2014) reviewed the results of 34 studies of CBT and concluded that CBT had a significant but small effect on positive and negative symptoms
• Pharoah et al. (2010) reviewed family therapy, finding moderate evidence that it significantly reduces hospital readmission and improved quality of life
(Evaluations of Psychological Treatments) Token Economy
• McMonagle and Sultana (2009) found only three studies where patients were randomly allocated to conditions with a total of 110 patients
• only one of the three studies showed improvement in symptoms
• Schizophrenia remains one of the harder mental health problems to treat
(Evaluations of Psychological Treatments) Ethical Issues
• Token economy- privileges become more available to patients with mild symptoms and less so for those with severe symptoms that prevent them from complying with desirable behaviours
• This means severely ill patients suffer discrimination in addition to other symptoms
(Evaluation of Psychological Treatments) Alternative Psychological Treatments
• the national institute for Health and Clinical Excellence (NICE 2014) recommends art therapy, particularly for negative symptoms
• explore the patient’s inner world in a non-threatening way
• compliance was high but not enough evidence of effectiveness
