Schizophrenia: Psychological explanations for schizophrenia Flashcards
What does it mean by the cognitive explanations of schizophrenia?
Mental disorders propose that abnormalities in cognitive function are a key component of schizophrenia.
What are the two explanations of family dysfunction?
- Double bind theory
- Expressed emotion
What is the double bind theory?
Bateson et al (1956) suggest that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia. For example, if a mother tells her son that she loves him, yet at the same time turns her head away in disgust, the child received two conflicting messages about their relationship from different communicative levels, one of affection on the verbal level, and one of animosity on the non- verbal level. The child’s ability to respond to the mother is incapacitated by such contradictions because one message invalidates the other. These interactions prevent the development of an internally coherent construction of reality and in the long run, this manifests itself in schizophrenia symptoms.
What is expressed emotion?
Another family variable associated with schizophrenia is a negative emotional climate or, more generally, a high degree of expressed emotions. Expressed emotion is a family communication so members of the family of the psychiatrist patient talk about that patient in a critical or hostile manner or in a way that indicates emotional over-involvement or over-concern with the patient or their behaviour. For example, Kuipers et al (1983) found that high EE relatives talk more and listen less. High levels of EE are most likely to influence relapse rates. A patient returning to a family with high EE is 4x more likely to relapse than a patient whose family is low EE (Linzen et al 1997). This suggests that people with schizophrenia have a lower tolerance for intense environmental stimuli, particularly intense emotional comments and interactions with family members.
What are the two cognitive explanations of schizophrenia?
- Cognitive explanations of delusions
- Cognitive explanations of hallucinations
What is the cognitive explanation of delusions?
During the formation of delusions, the patient’s interpretations of the experience are controlled by inadequate information processing. A critical characteristic of delusional thinking is a degree to which the individual perceives him or herself as an essential component in events (egocentric bias) and so jumps to conclusions about external events. This is manifested in the patient’s tendency to relate irrelevant events to themselves and consequently arrive at false conclusions. Muffled voices are interpretated as people criticising them and flashes of light are a signal from God. Delusions in schizophrenics are relatively impervious to reality testing. They are considered to have impaired insight, and an inability to recognise cognitive distortions and substitute more realistic explanations for events.
What is the cognitive explanation of hallucinations?
Hallucinating individuals focus excessive attention on auditory stimuli and so have a higher expectancy for the occurrence of a voice the normal individuals. Aleman (2001) suggests that hallucination-prone individuals find it difficult to distinguish between imagery and sensory-based perception. For these individuals, the inner representation of an idea can override the actual sensory stimulus and produce an auditory image that is every bit as real as a transmission of actual sound. Hallucinating patients with schizophrenia are significantly more likely to miss attribute the source of a self-generated auditory experience to an external source than non-hallucinating patients with schizophrenia. These errors are not corrected by disconfirming evidence because patients with schizophrenia do not go through the same process a reality testing that others will do.
A03: Family dysfunction
+ Family relationships
- Individual differences in vulnerability to EE
A03: Cognitive explanations
+ Supporting evidence for the success of cognitive therapies
+ Supporting evidence for the cognitive model of schizophrenia
A03: Family dysfunction: Family relationships
The importance of family relationships in the development of schizophrenia can be seen in an adoption study by Tienari (1994). In the study, those adopted children who had schizophrenic biological parents were more likely to become ill themselves than those with non-schizophrenic biological parents. However, this difference only emerged in situations where the adopted family was rated as disturbed. In other words, the illness only manifests itself under appropriate environmental conditions. Genetic vulnerability alone was not sufficient.
A03: Family dysfunction: Individual differences in vulnerability to EE
Not all patients who live in high EE families relapse and not all patients who live in low EE homes avoid relapse. Research has shown individual differences in stress response to high EE behaviour. The vulnerability may be physiological for example, one-quarter of patients’ studies showed no physiological responses to stressful comments made by their relatives.
This is a weakness as it shows not all patients, are equally vulnerable to high levels of expressed emotion within the family environment.
A03: Cognitive explanations: Supporting evidence for the success of cognitive therapies
The claim that symptoms of schizophrenia have their origin in faulty cognition is reinforced by the success of cognitive-based therapies for schizophrenia. In cognitive behavioural therapy for psychosis (CBTp), patients are encouraged to evaluate the content of their delusions or of any voices and to consider ways in which they might test the validity of their faulty beliefs. The effectiveness of this approach was demonstrated in the NICE review of treatment for schizophrenia. This review found consistent evidence that, when compared with treatment by antipsychotic medication, cognitive behavioural therapy was more effective in reducing symptom severity and improving levels of social functioning.
A03: Cognitive explanations: Supporting evidence for the cognitive model of schizophrenia
Sarin and Wallin (2014) reviewed recent research evidence relating to the cognitive model of schizophrenia. They found supporting evidence for the claim that positive symptoms of schizophrenia have their origins in faulty cognition. For example, delusional patients were found to show various biases in their information processing, such as jumping to conclusions and lack of reality testing. Likewise, schizophrenic individuals with hallucinations were found to have impaired self-monitoring and also tend to experience their own thoughts as voices. In addition, they found that patients with negative symptoms also displayed dysfunctional thought processes such as having low expectations regarding pleasure and success.
