Schizophrenia: Interactionist Approach Flashcards
What is the interactionist approach?
It acknowledges there are biological, psychological and societal factors in the development of SZ.
Biological - genetic vulnerability and neurochemical and neurological abnormality
Psychological - stress resulting from life events and daily hassles, including poor quality interactions in the family
What is Meehl’s Model (Old interactionist model)?
- He believed diathesis was entirely genetic, the result of a single ‘schizogene’. This led to the development of a biologically based schizotypic personality (one characteristic is sensitivity to stress). According to Meehl, if a person didn’t have the schizogene, then no amount of stress would lead to SZ. However, in carriers of the gene, chronic stress through childhood and adolescence, particularly a schizophrenic mother could result in schizophrenia
What is the modern understanding of the diathesis?
It is now clear that many genes increases genetic vulnerability. There is no single ‘schizogene’. Modern views of diathesis also include a range of factors beyond the genetic, including psychological trauma (trauma becomes the diathesis rather than the stressor). Read et al. (2001) proposed a neurodevelopmental model in which early development in which early trauma enters the brain e.g. the hypothalamic-pituitary-adrenal system (HPA) becomes over-active and the person is more vulnerable to later stress
What is the modern understanding of stress?
Originally stress was seen as psychological in nature, in particular related to parenting. Psychological stress is still seen as important, a modern definition of stress includes anything that risks triggering SZ e.g. cannabis. Cannabis is a stressor because it increases the risk of SZ by 7x as it interferes with the dopamine system. However researchers point out how most people don’t develop schizophrenia after smoking cannabis so there must be other vulnerability factors
What is the interactionist approach to treatment?
This approach acknowledges both biological and psychological factors and is compatible with both types of treatment. Model combines antipsychotics with psychological therapies such as CBT. Standard practice in GB to combine the two and is unusual to treat psychological therapies alone
Evidence supporting for the role of vulnerability and triggers
Researchers investigated a combination of genetic vulnerability and parenting style (the trigger). Children adopted from 19,000 Finnish mothers with SZ between 1960-1979. Adoptive parents assessed for child-rearing style & rates of SZ were compared to those in a control group of adoptees without any genetic risk. Child rearing style for high levels of criticism and conflict and low levels of empathy was implicated in the development of SZ but only for the children with genetic risk but not in the control group. This suggests that both genetic vulnerability and family stress are important in development of SZ as genetically vulnerable children were more sensitive to parenting behaviour
Support for combination of treatments
315 patients were randomly allocated to a medication and CBT group, medication and supportive counselling or a control group. Patients in the two combination groups showed lower symptom levels than control, although there were no difference in rates of hospital readmission. This and other studies show there is clear advantage to adopting an interactionist approach
Criticisms of original diathesis stress model
Over simplistic. Idea of a single schizogene and schizophrenic parenting style as the major of stress is over simplistic. Multiple genes increase vulnerability, there is no single gene. Stress can also come in many forms nirvana just dysfunctional parenting. It’s now believed vulnerability can be caused by early trauma as well as genetic makeup & stress can come in many forms including biological. Researchers found childhood sexual trauma emerged as a vulnerability factor whilst cannabis was a trigger. This shows the old idea of diathesis as biological and stress as psychological is over-simple. This is a problem for the old idea of diathesis-stress but not for newer models
Criticism of diathesis stress model with how symptoms appear and how they are produced
We don’t exactly know how diathesis and stress work - strong evidence to suggest some sort of underlying vulnerability coupled with stress can lead to SZ. Also have well informed suggestions for how vulnerabilities and stress might lead to symptoms. However, we do not yet fully understand the mechanisms by which the symptoms appear and how both vulnerability and stress produce them.
Criticism of interactionist approach
Researchers argue that there is a good logical fit between the interactionist approach and using combining treatments. However, combining psychological and biological treatments is more effective, but it does not necessarily mean that the interactionist approach is correct
