Schizophrenia: interactionist approach to explaining and treating Sz

Question 1

Outline Meehls original diathesis stress model

Answer 1

Diathesis was entirely genetic, the result of a single schizogene.

This led to the development of a biologically based schizotypic personality, one characteristic of which is sensitivity to stress.

According to Meehl, if a person does not have the schizogene, then no amount of stress would lead to schizophrenia.

However, in carriers of the gene, chronic stress through childhood and adolescence, in particular in the presence of the schizophrenic mother, could result in the development of the condition.

Question 2

Outline modern understanding of stress

Answer 2

A modern definition of stress (in relation to diathesis-stress) includes anything that risks triggering schizophrenia (including psychological stress).

For example, cannabis use can increase the risk of schizophrenia up to 7x depending on frequency of use and usual doses. It is believed this is because it interferes with the dopamine system.

Question 3

Outline modern understanding og diathesis

Answer 3

It is now believed diathesis is not due to a single ‘schizogene’. Instead, it’s thought that many genes increase vulnerability i.e. polygenic

Also, diathesis doesn’t have to be genetic. It could be early psychological trauma affecting brain development.
For example, child abuse affects the hypothalamic-pituitary-adrenal (HPA) system, making the child vulnerable to stress.

Question 4

Outline Uncontrollable Stressors:

Answer 4

External sources outside of the person’s control are seen to be a bigger trigger of biological vulnerabilities than perhaps controllable aspects.

This implies early family factors or geographical location when young are highly implicated triggers in the diathesis-stress model.

Question 5

The Additive Nature of Diathesis and Stress:

Answer 5

The Additive Nature of Diathesis and Stress:

These factors combine together and lead to schizophrenia.

For example, relatively minor stressors may lead to the onset of schizophrenia for those with high biological vulnerabilities;

Or a major stressful and chronic event may cause a similar reaction to someone who has a much lower biological vulnerability.

Question 6

Evaluation of interactionist approach to sz: Supporting Research

Answer 6

The diathesis-stress model incorporating nature and nurture in schizophrenia is well supported by adoption research.
Tienari et al. (2004) considered genetic risks and parenting style in a huge adoption study (involving 19,000 Finnish mothers with schizophrenia). Biological parents were assessed for rates of schizophrenia and adoptive parents had their child-rearing styles assessed. Results showed child-rearing styles that contained high levels of criticism/conflict and low empathy were implicated in the development of schizophrenia, but only for those with a high genetic risk.
This implies that both genetic risk (nature) and family related stress (nurture) are both vindicated in the cause of schizophrenia, supporting the diathesis-stress account.

Question 7

Evaluation of interactionist approach to sz: Original Model was Simplified

Answer 7

The original diathesis stress model was an oversimplification.
We now know that multiple factors contribute to the development of schizophrenia. It involves multiple genes and diathesis influenced by psychological factors and stress can be both biological and psychological.
Houston (2008) argued that child sexual abuse is major influence and cannabis use is a major trigger in cases of schizophrenia
This suggests that… our current understanding of the diathesis-stress model is a more appropriate and useful explanation for schizophrenia.

Question 8

Evaluation of interactionist approach to sz: Further Support
( Joseph)

Answer 8

The interactionist approach to explaining schizophrenia has further support from twin studies.
For example, Joseph found MZ twins have a concordance of 40%, with DZ twins at 7% (similar to Gottesmans instrumental findings) As MZ twins share 100% of their DNA, is can be assumed they will have the same biological vulnerabilities (diathesis). However, we can also assume they have similar environmental influences but not EXACTLY the same stressors. Hence, the interaction of both the diathesis and diverse stressors could explain this low level
This indicates that an interactionist approach is well validated and could explain more incidence of schizophrenia than biological or psychological explanations alone.

Question 9

Evaluation of interactionist approach to sz: Practical Application

Answer 9

The diathesis-stress model has developed / warranted a strong practical application of combined therapy, that tackles biological and psychological factors of schizophrenia simultaneously.
Tarrier et al (2004) used 315 patients with schizophrenia and randomly allocated them to one of 3 groups: antipsychotics and CBT; antipsychotics and supportive counselling; or a control group of antipsychotics alone.
Patients in the two combined groups showed significantly lower symptom levels than the control group, suggesting drug-therapy and psychological therapy combined is the most effective.
This implies the interactionist approach to explaining schizophrenia has helped reduce the distress experienced by many patients.

Question 10

Evaluation point 5? for interactionist approach to schiz: Theoretical Flaw

Answer 10

Although the model makes rational sense, it does not explain how stress impacts the nervous system to trigger the condition.
For example, the model does not illustrate exactly how urban living could inflate dopamine levels or create hypofrontality in patients suffering schizophrenia.
This implies that more research is needed to understand the full dynamics of the diathesis-stress model.

Question 11

Evaluation point 5? for interactionist approach to explain schiz: Explanatory Power

Answer 11

The diathesis stress model has great explanatory powers for different cases of schizophrenia.
For example, by addressing both biological vulnerabilities and environmental factors, the model can explain diverse prognosis because patients may come from different environments that may help or hinder the recovery process, as well as having differing degrees of biological vulnerabilities.
This suggests the holistic account may improve descriptive and predictive validity of schizophrenia.

Question 12

The Interactionist Approach to treating schiz: Startup 2004

Answer 12

Startup (2004)
Investigated the effectiveness of CBT, by recruiting 90 patients who had been admitted to hospital with an acute episode. 43 were given standard care i.e., antipsychotics and nursing care, whilst the other 47 were given standard care plus up to 25, 90 minute sessions of CBT. They found that 60% of CBT group showed reliable and clinical improvement, with fewer positive AND negative symptoms, compared to 40% of the control group. More importantly, these benefits stood the test of time and remained at 6 and 12 month follow ups, compared to just 17% of the control group.

Question 13

Describe the Interactionist Approach to Treating Schizophrenia

Answer 13

Drug therapy tackles biological correlates of the condition whilst more psycho-therapeutic approaches simultaneously address the wider aspects of the condition.

I.e., antipsychotics help reduce their psychotic symptoms which allows them to engage more fully with the demands of CBT and/or family therapy.

This combined approach is very effective and can lead to a reduced chance of relapse.

Question 14

The Interactionist Approach to Treating Schizophrenia: Vaughn and Leff (1976)

Answer 14

Researched schizophrenic patients returning to either high or low EE in the household and also noted how taking medication influenced relapse. The effect of no medication on low EE was insignificant. In the high EE household, relapse increased with more face-to face contact, and with no medication relapse rate rose to 92%.

Question 15

The Interactionist Approach to Treating Schizophrenia: Leff et al. (1982)

Answer 15

Researched the effectiveness of family therapy by studying patients who were taking antipsychotics only, and patients who were taking antipsychotics whilst also undergoing family therapy.
Those receiving both forms of therapy (biological and psychological) had significantly fewer relapses (14%) compared to those only taking antipsychotics (78%).

Question 16

Evaluation of The Interactionist Approach to Treating Schizophrenia: Supporting Research

Answer 16

The diathesis-stress model to treating schizophrenia has supporting research.
Tarrier et al (2004) used 315 patients with schizophrenia and randomly allocated them to one of 3 groups: antipsychotics and CBT, antipsychotics and supportive counselling or a control group of antipsychotics alone.
Patients in the two combined groups showed significantly lower symptom levels than the control group.
This implies the diathesis stress account provides a more comprehensive and effective treatment for schizophrenia.

Question 17

Evaluation of The Interactionist Approach to Treating Schizophrenia: Impact on the Economy

Answer 17

However, the interactionist approach to treatment has economic implications that could affect the NHS / economy.
Combination therapies are more expensive than single therapies and this needs to be considered in a cash-strapped NHS. As the NHS is funded by the government through taxpayers money, funding these treatments could put further strain on public spending.
However, although combined therapies are more expensive in the short-term they are more cost-effective in the long term as they result in increased functioning and reduce relapse.
This implies the economy may be negatively impacted in the short-term costs of the treatments, but may be positively impacted in the long-term as individuals with schizophrenia are able to take back control of their lives, return to work and contribute more to the economy.

Question 18

Evaluation of The Interactionist Approach to Treating Schizophrenia: Threats to Effectiveness

Answer 18

The interactionist approach to treating schizophrenia may still suffer from problems associated with each type of therapy that could hamper its effectiveness.
Drug therapy = side effects
CBT = issues with age / coherent thinking and insight
This suggests that although a combined approach to treatment may deliver twice the benefits, it could still present problems for patient’s wellbeing.

Question 19

Evaluation of The Interactionist Approach to Treating Schizophrenia: Effectiveness

Answer 19

A combined, interactionist therapy for schizophrenia can be used in novel ways to help reduce the distress experienced by patients.
Usually, medication is prescribed to reduce the symptoms of a mental health condition to enable the patient to access psychological therapy such as CBT, e.g., reducing the delusions a schizophrenic patient may be having so they can start to trust their therapist and open up to them.
However, Garrett (2008) described successfully using CBT to change a patient’s mind about taking the antipsychotic drugs she was prescribed and therefore reducing her symptoms in that way.
This could suggest… there are multiple ways in which an interactionist approach to treating schizophrenia can benefit the patients.