Psychological Explanations for Schizophrenia Flashcards
x2 psychological explanations for schizophrenia
family dysfunction
cognitive explanations
family dysfunction
5
explanations based on family dysfunction claim that schizophrenia is caused by abnormal patterns of communication within the family
family dysfunction is the presence of problems within a family that contribute to relapse rates in recovery schizophrenics
this may include a lack of warmth between parent and child, dysfunctional communication patterns and parental overprotection
by locating the causes of schizophrenia within the family, proponents of this view advocate family therapy as treatment, during which abnormal communication patterns can be pointed out and changed
features of the family dysfunction explanation…
• double bind theory
• expressed emotion
family dysfunction: double bind theory
6
Bateson et al (1956) suggest that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia
for example, a mother may tell her son that she loves him but at the same time, turns her head away in disgust
therefore, the child receives two conflicting messages about their relationship — one of affection on the verbal level and one of animosity on the non-verbal level
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
eventually manifesting itself as schizophrenic symptoms such as flattened affect and withdrawal
family dysfunction: expressed emotion
5
another family variable associated with schizophrenia is a negative emotional climate or a high degree of expressed emotion
expressed emotion (EE) = a family communication style in which a psychiatric patient’s family talks 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
Kuipers et al (1983) found that high EE relatives tend to talk more and listen less
high levels of EE are most likely to influence relapse rates and increase schizophrenic symptoms
Linszen et al (1997) found that a patient returning to a family with high EE is about four times more likely to relapse than a patient whose family is low in EE
family dysfunction: what does expressed emotion suggest?
3
this suggests that people with schizophrenia have a lower tolerance for intense environmental stimuli, particularly intense emotional comments and interactions with family members
the negative emotional climate in these families arouses the patient and leads to stress beyond their 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
cognitive explanations
5
cognitive explanations emphasise the role of dysfunctional thought processing and abnormalities in cognitive functioning in schizophrenia
researchers have found evidence of dysfunctional thought processing in people with schizophrenia
dysfunctional thought processing involves cognitive habits or beliefs that cause the individual to evaluate and process information inappropriately
such abnormalities can bias an individual towards developing cognitive schemas that see the world in a more threatening way
this is particularly evident in those who display the characteristic positive symptoms of schizophrenia such as delusions and hallucinations
cognitive explanations of delusions
6
during the formation of delusions, the patient’s interpretations of their experiences are controlled by inadequate information-processing
a critical characteristic of delusional thinking is that the individual may perceive themselves as the central component in events (known as an egocentric bias)
this leads them to jumps to conclusions about external events and relate irrelevant events to themselves, consequently arriving at false conclusions
for example, muffled voices are interpreted as people criticising them and flashes of light are signals from God
schizophrenics are considered to have impaired insight, meaning they tend to be unwilling or unable to consider that they may be wrong
they are unable to recognise cognitive distortions and substitute more realistic explanations for events
cognitive explanations of hallucinations
6
patients with schizophrenia experience some thoughts as external voices
hallucinating individuals focus excessive attention on auditory stimuli (known as hypervigilance) and so have a higher expectancy for the occurrence of a voice than normal individuals
Aleman (2001) suggests that hallucination prone individuals find it difficult to distinguish between imagery and sensory based perception
the inner representation of an idea can override the actual sensory stimulus, producing an auditory image that is just as real as the transmission of actual sound
hallucinating schizophrenics are significantly more likely to missattribute the source of a self generated auditory experience to an external source than non-hallucinating schizophrenics
these errors are not corrected by disconfirming evidence because patients with schizophrenia do not go through the same processes of reality testing as others, such as checking external sources
x3 evaluation points for family dysfunction
individual differences in vulnerability to expressed emotion
unreliable evidence for the double bind theory
research support for the importance of family relationships in schizophrenia
FAMILY DYSFUNCTION EVALUATION
individual differences in vulnerability to expressed emotion
6
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 et al (1998) found that 1/4 of the patients they studied showed no physiological responses to stressful comments from their relatives
Lebell et al (1993) suggests that how patients perceive the behaviour of their relatives is important in how vulnerable they are to the influences of high EE
some patients do not perceive high EE behaviours as being negative or stressful and such 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 expressed emotion within the family environment
FAMILY DYSFUNCTION EVALUATION
unreliable evidence for the double bind theory
6
there is some evidence to support the double bind theory and how it may lead to schizophrenia
Berger (1965) found that schizophrenics reported a higher recall of double bind statements by their mothers that non-schizophrenics
however, this evidence may not be reliable as patients’ recall may be affected by their schizophrenia
furthermore, other studies have challenged the double bind theory
Liem (1974) measured patterns of parental communication in families with a schizophrenic child and found no difference when compared to normal families
Hall and Levin (1980) analysed data from various previous studies and found no difference between families with and without a schizophrenic member in terms of how far their verbal and non-verbal communication was in agreement
FAMILY DYSFUNCTION EVALUATION
research support for the importance of family relationships in schizophrenia
4
the importance of family relationships in the development of schizophrenia can be seen in an adoption study by Tienari et al (1994)
in this study, the adopted children who had schizophrenic biological parents were more likely to become ill themselves than children with non-schizophrenic biological parents
however, this difference only emerged in situations where the adopted family was rated as disturbed
in other words, schizophrenia only manifested itself under appropriate environmental conditions — genetic vulnerability alone was not sufficient for schizophrenia to develop
x3 evaluation points for cognitive explanations
supporting evidence for the cognitive model of schizophrenia
support from the success of cognitive therapies
an alternative explanation may be more appropriate
COGNITIVE EVALUATION
supporting evidence for the cognitive model of schizophrenia
5
Sarin et al (2014) reviewed recent research evidence relating to the cognitive model of schizophrenia
they 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
in addition, they found that patients with negative symptoms also displayed dysfunctional thought processes, such as having low expectations regarding pleasure and success
COGNITIVE EVALUATION
support from the success of cognitive therapies
4
the claim that the symptoms of schizophrenia have that origin in faulty cognition is reinforced by the success of cognitive based therapies for schizophrenia
in cognitive behavioural therapy for psychosis (CBTp), patients are encouraged to evaluate the content of their delusions and voices they hear and consider ways in which they might test the validity of their faulty beliefs
the effectiveness of this approach was demonstrated in the NICE review of treatment for schizophrenia
this review found consistent evidence that when compared with treatment by antipsychotic medication, cognitive behaviour therapy was more effective in reducing symptom severity and improving levels of social functioning
