Schizophrenia: Physchological Explanations And Psychological Therapies Flashcards
What is family dysfunction?
Abnormal processes within a family such as poor family communication cold parenting and high levels of expressed emotion. These may be risk factors for both the development and maintenance of SZ
What did Freud suggest about a ‘schizophrenogenic mother’?
Early theorists believed that a “schizophrenogenic mother” who was cold, dominant and created conflict, caused SZ to emerge in the child. These mothers were said to be rejecting, overprotective, self-sacrificing, moralistic about sex and fearful of intimacy, the distrust, resentfulness, and instability caused by such a parent creates a family climate characterised by tension and secrecy. This leads to distrust that later develops into paranoid delusions (I.e. the belief that one is being persecuted by another person), and ultimately SZ
What is the ‘double bind theory’?
Bateson et Al. (1972) argued that family climate is important in the development of SZ, but with emphasis on communication style within the family. He suggested children who receive ‘double binds’ (contradictory messages from parents), are more likely to develop SZ, according to the theory these interactions prevent the development of an internally coherent construction of reality, and in the long run this manifests itself as symptoms of SZ
What is expressed emotion?
Explanation for relapse in patients with SZ. It has been suggested that it may be a source of stress that can trigger the onset of SZ in someone who is already vulnerable. This family variable associated with SZ is a negative emotional climate, or more generally a high degree of expressed emotion (EE). EE is a family communication style in which members of a family of a psychiatric patient talk about the patient in a critical or hostile manner or in a way that indicates emotional over-investment or over-concern with the patient or their behaviour. It involves critical comments through both tone and content, occasionally accompanied by violence, hostility towards the patient, including anger and rejection, emotional over-involvement in the life of the patient, including needless self-sacrifice. If these factors are high, then the risk of relapse is high.
What is the cognitive explanation of SZ?
SZ is characterised by disturbance in language, attention, thought and perception, this has led cognitive psychologists to explain the disorder as a result of dysfunctional thought processing, lower than usual levels of processing (possibly caused by biological factors) suggesting that cognition is likely to be impaired for people with SZ
What did Frith suggest about people with SZ and their dysfunction in meta-representation?
Frith suggested that people with SZ fail to monitor their own thoughts correctly, mis attributing them to the outside world. When a person hears voices, it is actually their own inner speech being misinterpreted, however, sufferers may belive that someone or something in the external world is communicating with them. Such processing problems are sometimes referred to as alien control symptoms because the sufferer feels as if external forces are influencing their thoughts and actions and they have no personal control
What is auditory selective attention impairment in people with SZ?
Auditory selective attention impairment refers to the difficulty people with SZ have in focusing on specific auditory stimuli while filtering out irrelevant background noise. The negative symptoms of SZ may be the result of cognitive strategies used by the individual to keep mental stimulation to a manageable level. This happens when people experience potentially over-whelming levels of information from the external world and their inner world.
What is the socio-cultural theory - Harrison et al. (2001)?
People born in deprived areas were more likely to develop SZ. Poverty, unemployment, crowding. However these results are correlational and not cause and effect
What is the social drift hypothesis?
People with SZ more likely to be in deprived areas because having SZ gives them a lower social status
Evaluations for family dysfunction as a risk factor
Researchers reviewed 46 studies of child abuse and SZ and concluded that 69% of adult women in-patients with a diagnosis of SZ had a history of physical abuse, sexual abuse or both, in childhood, men - 59%
Researchers have suggested adults with insecure attachments are more likely to have SZ
Leads to parent blaming
Biased assessing in observational studies assessing for ‘crazy-making characteristics’
Evaluations for EE as a risk factor
Positive: Research: People with SZ and discharged from hospital were followed up over a 9 month period, interviews with family members conducted to determine EE levels. High EE resulted in 58% of SZ returning to hospital for further treatment, compared to only 10% from low EE families. So family relationships can effect the degree of recovery rates for people with SZ, however opposite could be true also.
Negative: EE unclear if it’s a causal agent in the relapse rates or just a reaction to patients behaviour, high EE is not just for SZ (neuroses, eating disorders) problem with how EE is measured, usually one interview so unreliable. More causal in western families
Supporting evidence for dysfunctional information processing
Researchers compared 30 patients with SZ to 18 controls on a range of cognitive tasks. Results indicated that in line with Frith’s theory of central control dysfunction, patients took over twice as long to name the ink colours as controls
Weaknesses of research evidence support
Info was gathered after the development of symptoms and the diagnosis of SZ may have distorted the patients’ recall so validity issues.
Research was conducted investigating children following childhood experiences to see if they predicted any adult characteristics. This neglects the influence of biological factors.
Against the ‘schizophrenogenic mother’
By the 1980s, research concluded that there was no such thing. It had become apparent that only a small % of women who might arguably fit criteria had actually produced SZ kids, conversely, people with SZ were found to have mothers not in criteria.
Also criticised for hindering progression in psychiatry and understanding of disorder
Explanation leads to parent blaming.
Research on SZ mother has biased assessing in observational studies as they assessed mothers for ‘crazy-making characteristics’
Evaluations for double-bind theory
Positive: Some support, researchers found SZ reported higher recalls of double bind statements of mothers than controls, however their recall could be affected by SZ.
Negative: Other studies found little support in patterns of parental communication in families with SZ compared to normal families (no difference was found)
Parent blaming
Observational studies are biased, as they assessed mothers characteristics for ‘crazy-making characteristics’
Evaluation against the cognitive explanation
Cognitive approach does describe affected info processing, but not a distal cause explanation, may also be a symptom rather than an explanation
Approach doesn’t adequately consider biological factors
Evidence for biological factors not adequately considered, b and p factors can separately produce the same symptoms, which raises the question of whether both outcomes actually are SZ. Diathesis stress model
What is CBT and how does it help people with SZ?
It’s usually 5-20 sessions and it helps to make sense of how delusions and hallucinations impact their feelings and behaviour, understanding where symptoms came from can be helpful, e.g. believing voices are demons - understanding the existence of hallucinations can help to reduce anxiety, only works when patient is not in psychosis
CBT evidence on patients with SZ
Researchers used CBT to challenge paranoid delusions, therapist challenges the delusion, by saying what they’re saying could be true, but that there are also other explanations
Explain family therapy to treat expressed emotion
Family therapy seeks to treat members of the family as well as the patient, the hope is to reduce the high level of EE within the household which is causing the relapse, done within the people’s houses and typically two family therapists will work with the relatives and patient, lasts between 3-12 months with sessions every 2 to 4 weeks, a minimum of 10 sessions recommended by NICE. The therapists work with the family and the patient to develop strategies to cope better with the mental disorder and its symptoms, helps the patient make better progress and the relatives to feel more positive about and more effective in their supporting roles
How does family therapy actually work?
Relatives are made more aware of the info regarding psychosis and the particular diagnosis their relative has been given, the therapist encourages the relatives to ask questions and learn more about the disorder so they can properly understand the difficulties the patient faces. The patient will also be asked to discuss their symptoms with the family as they are the expert in this situation. The family and the patient are trained to recognise the early signs of relapse so that they can respond rapidly to reduce the severity of it
Explain the role of token economies in managing the behaviour of SZ patients
Token economies are reward systems to manage behaviour, in particular those who have developed maladaptive behaviour after spending long periods in psychiatric hospitals, modifying behaviour is there to improve quality of life and make it more likely they can live outside the hospital. Tokens are SECONDARY REINFORCERS as they only have value once the patient has learned they can be used to obtain rewards, e.g. to buy sweets / magazines
Evidence for CBT and family therapy effectiveness
Researchers reviewed results of 34 studies of CBT, concluded that it had a significant but small effect on positive and negative symptoms. Researchers reviewed family therapy, moderate evidence that it significantly reduces hospital readmission and improved quality of life
Mixed results for token economy
Researchers found only three studies were randomly allocated to conditions with a total of 110 patients only one or the three studies showed improvement in symptoms, SZ remains one or the harder mental health problems to treat
Negative evaluation for psychological treatments
CBT can help make SZ more manageable and improve quality of life, CBT allows patients to make sense of symptoms, family therapy reduces stress for family and patient, token economies make behaviour more socially acceptable so they can reintegrate with society, all of these benefits, yet they fail to completely treat SZ
Ethical issues with psychological treatments
CBT may involve challenging a persons paranoid, but at what point does this interfere with an individuals freedom of thought, CBT also challenges patients in a highly controlling government, this can easily stray into modifying their belief system.
Token economy privileges are more available to patients with mild symptoms and less so for severe that prevent them from complying with desirable behaviours, this means that severely ill patients suffer discrimination in addition to other symptoms
Positive evaluations for alternative psychological treatment proposed by NICE
NICE recommends art therapy, particularly for negative symptoms, explores the patients inner world in a non-threatening way, compliance was high but not enough quantitative evidence for effectiveness
