Schizophrenia: Interactionist approach

Question 1

What are the two divisions of the interactionist approach? (AO1)

Answer 1

• The diathesis stress model
  -Treatment according to the interactionist model

Question 2

What are the 3 divisions of the diathesis stress model within the interactionist approach? (AO1)

Answer 2

• Meehl’s model
• Modern understanding of diathesis
• Modern understanding of stress

Question 3

Explain ‘Meehl’s model’ as a part of the diathesis stress model:

Answer 3

• In the original diathesis stress model vulnerability was purely genetic, the result of a single ‘schizogene’.
• This led to the idea of a biologically based schizotypic personality, one characteristic of which is sensitivity to stress.
• Meehl argued that if a person does not have this schizogene then no amount of stress would lead to SZ.
• However in carriers of the gene, chronic childhood stress and trauma and the presence of a schizophrenogenic mother could result in the development of the disorder.

Question 4

Explain ‘modern understanding of diathesis’ as a part of the diathesis stress model:

Answer 4

• Our understanding of diathesis has changed now we know that there are many genes that increase genetic vulnerability (only slightly) to SZ and that there is no single schizogene.
• Modern views also take into account factors beyond genetics, such as psychological trauma.
• Read proposed a neurodevelopmental model in which early trauma alters the developing brain- outlining that significant trauma (e.g. child abuse) can seriously affect many aspects of brain development.
• E.g. the hypothalamic-pituitary-adrenal (HPA) system can become overactive, making an individual much more vulnerable to later stress.

Question 5

Explain ‘modern understanding of stress’ as a part of the diathesis stress model:

Answer 5

• In the original diathesis stress model of SZ, stress was seen as psychological in nature- particularly linked to parenting.
• Although psychological stress from parenting may still be considered important in the development of SZ, this stress will include anything that risks triggering SZ (not just parental).
• Most recent research into triggering SZ has been associated with cannabis use. In terms of the diathesis stress model cannabis is a stressor because it increases the risk of SZ by x7 dependent on the dose.
• However most people do not experience an onset of SZ after cannabis use because they lack genetic predisposition.

Question 6

Explain ‘treatment according to the interactionist model’ as a division of the interactionist approach:

Answer 6

• The interactionist model acknowledges both biological and psychological factors in SZ, and so it is compatible with both biological and psychological treatments.
• The model particularly links the use of antiopychotic drugs alongside CBT to treat SZ.
• An interactionist approach is favoured as it considers the treatments for both origins- e.g. it is not possible to purely adopt a biological approach to SZ and argue that there is no psychological significance to symptoms, to then treat them with CBT.
  -The use of the interactionist approach varies between societies/cultures e.g. in the UK common practice is to treat SZ with both antipsychotics and CBT, whereas in the USA it is conflict between biological and psychological models has led to a slower adoption of the interactionist approach, with only one treatment being used at a time.

Question 7

What are the 4 evaluation points for the interactionist approach to SZ?

Answer 7

1) Support for vulnerability and triggers (S)
2) Real-world application (S)
3) Urbanisation (L)
4) Diathesis and stress are complex (L)

Question 8

Explain ‘urbanisation (L)’ as an evaluation point for the interactionist approach to SZ:

Answer 8

• A strength is the frequency of SZ diagnosis in urban vs rural locations.
• SZ is more commonly diagnosed in urban areas compared to rural areas. This supports the interactionist approach, assuming that urban environments are more psychologically stressful e.g. crowds, noise, or that stressors may be biological e.g. pollution.
• However, it may be that SZ is more commonly diagnosed in cities or that people vulnerable to developing SZ migrate to cities.
• Greater population density in cities means more people will experience early SZ symptoms and refer to a doctor- naturally leading to more diagnosis.
• Suggests that greater diagnosis within cities is not a complete justification for the interactionist approach.

Question 9

Explain ‘support for vulnerability and triggers (S)’ as an evaluation point for the interactionist approach to SZ:

Answer 9

• A strength is that there is evidence supporting the role of both vulnerability and triggers.
• Tienari investigated the impact of both genetic vulnerability and psychological triggers on SZ. The study followed 19,000 Finnish children whose biological mothers had been diagnosed with SZ.
• In adulthood this vulnerable group was compared to a control group of adoptees without a family history of SZ.
• Adoptive parents had been assessed for child-rearing style and concluded that high levels of criticism and hostility were strongly associated with the development of SZ, but only in those with a genetic vulnerability.
• Suggests that a combination of genetic vulnerability and family stress can lead to a greatly increased risk of SZ.

Question 10

Explain ‘diathesis and stress are complex (L)’ as an evaluation point for the interactionist approach to SZ:

Answer 10

• A limitation is that the original diathesis stress model has been oversimplified.
• The original model portrayed vulnerability as a single schizogene and portrayed stress as a result of schizophrenogenic parenting oversimplifies the explanations for SZ.
• Stress comes in many forms- not just dysfunctional parenting.
• Houston concluded that childhood sexual abuse as a major influence on underlying vulnerability to SZ, and also the use of cannabis as a major trigger.
• Suggests that there are multiple factors affecting vulnerability and stress, supporting the modern understanding of the interactionist approach.

Question 11

Explain ‘real-world application (S)’ as an evaluation point for the interactionist approach to SZ:

Answer 11

• A strength of the interactionist approach is the combination of biological and psychological treatments used.
• A practical application of acknowledging the influence of biological and psychological factors has been the combination of drug treatment and cognitive therapies.
• Tarrier randomly allocated 315 participant to one of 3 treatments: drug therapy + CBT, medication + counselling, medication only (control group).
• Participants in the two combination groups showed lower symptoms following the trial than the medication only control group.
• Suggests that there is a clear practical advantage to adopting an interactionist approach to SZ in terms of superior treatment outcomes.