Psychological explanations for schizophrenia/ family therapy

Question 1

what is double bind communication?

Answer 1

is where a pair of messages are mutually contradictory the child doesn’t know how to respond to the conflict between the words and body language. this causes confusion and leads to a state of internal conflict

Question 2

how does double bind lead to the development of schizophrenia

Answer 2

the result is that the children lose their grip on reality. if double blind messages are presented continually and habitually within the family context from infancy, then by the time the child is old enough to have identified the double bind situation, it has already been internalised and the child is unable to confront it.

the solution then is to create an escape from conflicting logical demands of the double bind into the world of delusions.

Question 3

what is expressed emotion?

Answer 3

is a qualitative measure of the amount of emotion displayed when a family setting, usually by family members or caretakers

Question 4

what can expressed emotion be measured by?

Answer 4

it can be measured by the Camberwell family interview or the five minute speech sample.

Question 5

what can high levels of expressed emotion within the home result in with a schizophrenic patient?

Answer 5

• worsen the prognosis a high level EE within the home of the schizophrenic
• increase likelihood of relapse and readmission into hospital for the patient.

Question 6

what are the three dimensions that high EE household made up of?

Answer 6

1. hostility 2. emotional over-involvement 3.critical comments

Question 7

what is hostility

Answer 7

Hostility is a negative attitude directed at the patient because the family feels that the disorder is controllable and that the patient is choosing not to get better. ​Problems in the family are often blamed on the patient. ​The family believes that the cause of many of the family’s problems is the patient’s mental illness.

Question 8

what is emotional over-involvement

Answer 8

It is termed ‘emotional over-involvement’ when the family members blame themselves for the mental illness. ​This is commonly found in females. The family member shows a lot of concern for the patient and the disorder. ​This is the opposite of a hostile attitude, but still has the same negative effect on the patient as it makes the patient feel guilty. ​The pity from the relative causes too much stress and the patient relapses to cope with the pity.​

Question 9

what is critical comments

Answer 9

Critical attitudes are combinations of hostile and emotional over-involvement. ​It shows an openness that the disorder is not entirely in the patients control but there is still negative criticism. ​Critical parents often influence the patient’s siblings to be the same way.​

Question 10

how does expressed emotion result in a relapse ?

Answer 10

This high level of EE becomes too much for the patient to handle as they must deal with criticism from those they would need support from in their time of recovery.​
This stress may cause the patient to relapse and make them fall into a cycle of rehabilitation and relapse. ​The only way to escape this cycle is for the family to go through Family Intervention Therapy together.​This will greatly lower family conflicts and reduce the amount of EE within the household.

Question 11

what is the Camberwell family interview?

Answer 11

The CFI is conducted with the patient’s close relatives (family caregiver) without the patient being present.​During the interview, relative’s speech is recorded and later used for coding. ​The interview focuses on the level of stress in the household, irritability among the family members, participation of the patient in routine household tasks and the daily routines of the patient and various family members or overall family functioning.​If a close family member makes six or more critical comments and makes any statement that is rated as hostile, or shows indication of marked over involvement (a rating of 3 or more on a 0 – 5 scale), the relative is classified as high in EE.

Question 12

what is the five minute speech sample?

Answer 12

The five-minute speech sample (FMSS) is similar to the CFI in that family members talk about their patient and their relationship for five uninterrupted minutes and the speech is recorded and later coded for the overall level of EE. ​One or more critical comments, negative comments about their relationship, or a critical statement at the start of the interview are all indicative of high criticism on FMSS.​

Question 13

what type of symptoms can be cause by stress as a result of family dysfunctions

Answer 13

both positive and negative symptoms

Question 14

what is the family dysfunction explanation of schizophrenia ?

Answer 14

family conflict leads to stress and confusion in individuals, which causes the development of schizophrenia

Question 15

what is the consequence of the stress and confusion caused by double bind situations?

Answer 15

increased risk in developing schizophrenia

Question 16

what is a double bind?

Answer 16

a double bind is when someone experiences contradictory messages, confusing them on how the should behave. double bind can is a very stressful experience that can lead to the development of schizophrenia

Question 17

what is a high degree of expressed emotion

Answer 17

members of a family speak to each other in negative ways, consistently expressing lots of criticism and complaints about what everyone else is doing

Question 18

what does family conflict create ?

Answer 18

Family conflict creates tension and hostile conditions for children and young adults, where factors like double binds create paranoia and emotional distress. The family dysfunction explanation believes that this overall stress can then lead to the development of schizophrenia.

Question 19

what are the key defining features of high expressed emotion within the family dynamic ?

Answer 19

• complaints and general negativity are heavily expressed
• being constantly critical of the other person
• a negative over-involvement in each others lives

Question 20

what are the two types of family conflict that cause stress

Answer 20

a high degree of expressed emotion and double bind

Question 21

according to the family dysfunction explanation of schizophrenia how does double bind and a high degree of expressed emotion cause schizophrenia

Answer 21

they cause create stress and confusion for the child

Question 22

what did Berger study and what did he find

Answer 22

Berger conducted research on the effects of double binds on the development of schizophrenia. he conducted interviews on schizophrenic and non schizophrenic patients (control group) which they had to recall childhood experiences. Berger found that people with schizophrenia were able to recall more experiences of double binds from childhood, compared to a control group

Question 23

what did Vaugh and Leff’s study?

Answer 23

Vaugh and leff conducted research on the effects of expressed emotion on people with schizophrenia. Vaugh and Leff conducted observations to investigates the family relationships of people with schizophrenia. they found that schizophrenics with families displaying high expressed emotions were more likely to relapse after leaving the hospital.

Question 24

what are the limitations of the family dysfunction explanation: unreliable?

Answer 24

the evidence supporting the role of double binds in schizophrenia might be unreliable. the self report method may be unreliable , due to the fact that patients are recalling events that happened a long time ago. participants may be susceptible for leading questions. the researcher may have an influence on how the ppts respond. if the researcher asks a leading question, a ppts would be responding to demand characteristics in the study caused by investigator effects. ppts can sometimes forget what happened or miss out details. people with schizophrenia are less likely to recall past events accurately, because they have dysfunctional mental processes. this means that they may lack objectivity as their memory and and reasoning processes may be impaired making it even less likely to remember accurately

Question 25

what are the limitations of family dysfunction explanation: individual differences ?

Answer 25

Altorfer found that there are individual differences in responses to expressed emotions amongst people with schizophrenia. he found that a quarter of all patients with schizophrenia had no stress response to expressed emotion amongst people with schizophrenia

Question 26

what did Altorfer find ?

Answer 26

not all schizophrenic patients had families who displayed a high degree of expressed emotion, some families displayed low expressed emotion. he also found patients whose families displayed a high degree of expressed emotion sweated lots when they were criticised, indicating that they showed an increase in their stress response when they were criticised

Question 27

what did Altorfer find ?

Answer 27

not all schizophrenic patients had families who displayed a high degree of expressed emotion, some families displayed low expressed emotion. he also found patients whose families displayed a high degree of expressed emotion sweated lots when they were criticised, indicating that they showed an increase in their stress response when they were criticised. some patients were observed as displaying no stress responses to expressed emotion they experienced. This indicated that there are individual differences in patients responses to expressed emotions

Question 28

what can we conclude from Alforter’s study

Answer 28

this shows having a family with a high degree of expressed emotion cannot explain schizophrenia in all patients since not all patients have family with a high degree of expressed emotions. but also when a patient does have a family with a high degree of expressed emotion it doesn’t necessarily mean that they will get schizophrenia. for starters not all patients who have families with expressed emotions have a s tress response, some patients are more vulnerable to the effects of high expressed emotion than others, suggesting that having a family with high expressed emotion doesn’t necessarily even cause stress. even if expressed emotion does cause stress we cant be sure that this stress causes schizophrenia. this has caused researcher to believe that having a family with a high degree of expressed emotion doesn’t cause schizophrenia but increases the risk of developing schizophrenia and doesn’t necessarily cause it.

Question 29

describe the method that Berger used in his study of double binds

Answer 29

Berger interviewed two groups of patients. One group were patients who had schizophrenia, and the other group were patients who did not have schizophrenia. Berger asked questions about all of the participants’ relationships with their families, specifically asking of any instances where the patients’ parents gave them contradictory messages.

Question 30

describe the method used Vaugh and leff used in their study on expressed emotion

Answer 30

Vaughn and Leff used an observational technique to collect data on the relationships between people schizophrenia and their families. They did this by observing recently discharged patients interacting with their family, and categorising those interactions as either low or high expressed emotion.

Question 31

what is the aim of family therapy ?

Answer 31

family therapy aims to reduce the level of family conflict that the patient experiences. It aims to improve the quality of communication and interaction between family members, and reduce the stress of living as a family and so reduce rehospitalisation.

Question 32

what is family therapy ?

Answer 32

family therapy is a psychological intervention that involves both patient and their family members and aims to reduce family conflict and expressed emotions

Question 33

what are the steps involved in family therapy?

Answer 33

• first, educating the family about the symptoms of schizophrenia
• second, teaching new copying strategies to manage the patients symptoms
• third, changing the family’s communication style

Question 34

what must family therapy involve

Answer 34

a patient with schizophrenia and the patients family

Question 35

what did pharaoh find in his review about family therapy? ( strength)

Answer 35

-pharaoh et al’s review aimed to investigate the effectiveness of combining family therapy and medication compared to just taking medication. Pharaoh et al found that those who received family therapy were more likely to take medication consistently were less likely to relapse into severe symptoms and go back to hospital. but there was less clear evidence that family therapy reduced the number of symptoms experienced or improved the patients general health.

Question 36

what did NICE find about family therapy?(strength)

Answer 36

A review by NICE suggested that family therapy is cost effective treatment for sz, despite the extra costs of therapist sessions, because it reduces the likelihood of relapse

Question 37

limitations of family therapy

Answer 37

the studies in Pharaoh et al review did not do random allocation which they had already claimed. many studies did not control for ppts variables. some studies may have lacked objectivity as the researchers were not blind some studies lack reliability and validity.

Question 38

what are examples of high levels of expressed emotion?

Answer 38

high levels of criticism, hostility and over involvement. ​

Question 39

what is family therapy commonly used with

Answer 39

drug therapy and outpatient clinical care

Question 40

where does family therapy usually take place

Answer 40

Family therapy usually takes place within the people’s homes, with two family therapists

Question 41

why does family therapy take place in the patients home?

Answer 41

so they feel and comfortable

Question 42

why are there two therapists

Answer 42

for inter rater reliability

Question 43

why might you and your family benefit from therapy to reduce the risk of your family member relapsing? ​

Answer 43

it will reduce family conflict

Question 44

how long is family therapy ?

Answer 44

It lasts between 3-12 months with sessions every 2-4 weeks. ​A minimum of 10 sessions are recommended by NICE.

Question 45

how does family therapy improve relationships

Answer 45

It improves relationships within the household because the therapist encourages family members to listen to each other, discuss problems and negotiate potential solutions together. ​

Question 46

how does family therapy work?

Answer 46

• Helping the patient and their family to understand and be better able to deal with the illness.​
• Forming a therapeutic alliance with all family members.​
• Reducing the stress of caring for a relative with schizophrenia and the emotional climate within the family.​
• Improving the ability of the family to anticipate and solve problems.​
• Reduction of anger and guilt in family members.​
• Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.​
• Improving families’ knowledge, beliefs about and behaviour towards schizophrenia.​
• Maintaining reasonable expectations among family members for patient performance.​

Question 47

what did Garety find about family studies

Answer 47

Garety (2008) - Relapse rates are reduced to 25% following Family Therapy, as opposed to 50% for those receiving standard care alone (neuroleptics).

Question 48

pharaoh (Dubra)

Answer 48

Pharoah et al. (2010) reviewed the evidence for the effectiveness of family therapy (compared to antipsychotics alone). They found that:​
There was a reduction in the risk of relapse and a reduction in hospital readmission during treatment and in the 24 months after.​ Some studies reported an improvement in the overall mental state of patients whereas others didn’t.​ There was an increased compliance with medication.​Family therapy did not appear to have much of an effect on more concrete outcomes such as living independently or employment.
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