Schizophrenia: Psychological explanations / treatments

Question 1

List the psychological factors which can result in schizophrenia

Answer 1

• family dysfunction
• schizophrenogenic mother
• Double Bind theory
• Expressed Emotion (EE)

Question 2

What is the cognitive factor which can lead to schizophrenia

Answer 2

• Dysfunctional thought processing

Question 3

Explain how family dysfunction is a psychological factor to schizophrenia

Answer 3

• 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 schizophrenia.

Question 4

Explain how the schizophrenogenic mother is a psychological factor (Fromm-Reichmann)

Answer 4

• Early theorists thought a ‘schizophrenogenic mother’, who was cold, dominant and created conflict, caused schizophrenia to emerge in the child (Fromm-Reichmann, 1948).
• The distrust, resentfulness and instability caused by such a parent creates a family climate characterised by tension and secrecy.
  -> leads to distrust that later develops into paranoid delusions (i.e. the belief that one is being persecuted by another person), and ultimately schizophrenia.

Question 5

Explain how the Double Bind theory is a psychological factor (Bateson)

Answer 5

• Bateson suggested children who frequently receive contradictory messages (double binds) from their parents are more likely to develop schizo (e.g. parent asks for a Hug and then suddenly pushes them away in disgust).
  -> these interactions prevent the development of a coherent construction of reality -> in the long run -> this manifests itself as symptoms of schizophrenia.
• theory suggests children will become confused and lose their grip on reality.

Question 6

Explain how expressed emotion is a factor in schizophrenia

Answer 6

• Explanation for relapse in patients with schizophrenia -> been suggested it may be a source of stress that can trigger the onset of schizophrenia in someone who is already vulnerable.
• family -> a negative emotional climate, or more generally, a high degree of expressed emotion (EE).
• EE is a family communication style in which members talk about the patient in a critical manner or in a way that indicates emotional over-concern with the patient or their behaviour.

Question 7

What is high expressed emotion (EE)

Answer 7

• Family communication style that involves:
  -> Critical comments through both tone and content, occasionally accompanied by violence.
  -> Emotional over-involvement in the life of the patient, including needless self-sacrifice.
• If these factors are high, then the risk of a relapse is high.

Question 8

explain how dysfunctional thought processing is a psychological factor

Answer 8

• Schizophrenia is characterised by disturbance in language, attention, thought and perception.
• Lower than usual levels of processing suggest that cognition is likely to be impaired.

Question 9

what did Frith suggest about dysfunctional thought

Answer 9

• people with schizophrenia fail to monitor their own thoughts correctly, misattributing them to the outside world.
• When a person hears voices, it is actually their own inner speech being misinterpreted, however, sufferers may believe that someone or something in the external world is communicating with them.
  -> this is 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.

Question 10

What is dysfunction in central control (thought dysfunction -> psychological explanation)

Answer 10

• Central control -> Cognitive ability to suppress automatic response set while we perform deliberate actions.
  -> disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts.
  -> Derailment of thoughts and spoken sentences because each word triggers associations and the patient cannot suppress automatic responses to these.

Question 11

What is auditory selective attention (psychological factor)

Answer 11

• in normal functioning, allows us to filter info.
• Brain selects info to pay attention to and ignores the rest -> we are bombarded with info from the outside world yet our processing abilities are limited.

Question 12

What is auditory selective attention impairment (thought dysfunction -> psychological factor)

Answer 12

• negative symptoms of schizophrenia may be the result of cognitive strategies used by the individual to keep mental stimulation to a manageable level.
• people may experience over-whelming levels of info from the external world and their inner world.
  -> may be due to auditory selective attention impairment.

Question 13

what is the socio-cultural theory (psychological factor) (Harrison)

Answer 13

• Harrison -> people born in deprived areas were more likely to develop schizophrenia.
• poverty, unemployment and crowding.
  -> however, correlational results do not show cause and effect.
• social drift hypothesis: schizophrenia likely to be developed in deprived area because having schizophrenia gives them a lower social status.

Question 14

(+) explain research that supports family dysfunction as a risk factor (Read, Berry)

Answer 14

• Read et al. (2005) reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of adult women with schizophrenia had a history of physical abuse, sexual abuse or both, in childhood.
  -> Men-59%.
• Berry et al. (2008) found adults with insecure attachments are more likely to have schizophrenia.

Question 15

(-) What are the weaknesses of family dysfunction as a risk factor

Answer 15

• Information gathered after the development of symptoms and the diagnosis of schizophrenia may have distorted the patients’ recall -> negatively impacts validity.

Question 16

(-) Explain the weaknesses of the schizophrenogenic mother as a risk factor

Answer 16

• By the 1980s research had concluded that there was no such thing as a ‘schizophrenogenic mother’.
• only a small percentage of women who might arguably fit the criteria of schizophrenogenic mother had actually produced schizophrenic children.
• Conversely, people with schizophrenia were found to have mothers who did not fit the criteria.

Question 17

(-) explain the weaknesses of the double-bind theory

Answer 17

• Liem (1994) and Hall and Levin (1980) found no difference in the patterns of parental communication in families with a child with schizophrenia in comparison to normal families.

Question 18

(-) explain evidence that goes against the EE theory

Answer 18

• unclear whether EE is a casual agent in the relapse rates or just a reaction to the patient’s behaviour.
  -> high EE communication patterns are not specific schizophrenia (neuroses, eating disorders -> can’t for sure state cause and effect.
• More evident in Western families.
• problem with how EE is measured (usually only one interview), unreliable.

Question 19

(+) explain how there is strong evidence for dysfunctional info processing

Answer 19

• Stirling compared 30 patients with schizophrenia to 18 controls on a range of cognitive tasks.
• patients took over twice as long to name the ink colours as controls.

Question 20

(-) explain the weakness of the cognitive approach

Answer 20

• does not provide a distal cause explanation.
• Also, cognitive disturbances may be symptoms of the disorder rather than an explanation.

Question 21

Explain how CBT helps with treatment of schizophrenia

Answer 21

• 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 – helped to understand the existence of hallucinations can help to reduce anxiety.

Question 22

What are the general features of CBT

Answer 22

• Usually 5-20 sessions, in groups or as an individual.
• Helps patients to identify irrational thoughts and tries to change them.
• May involve argument or discussion of how likely the beliefs are to be true.
• Helps patients cope.

Question 23

Explain the aims of family therapy

Answer 23

0- seeks to treat members of the family as well as the patient.
- hope is to hopefully reduce the high level of EE within the household which is causing the relapse.

Question 24

How does family therapy work

Answer 24

• therapists work with the family and the patient to develop strategies to cope better with mental disorders and symptoms.
  -> more supportive and warm atmosphere -> more progress.
• patient also discusses symptoms with the family as they are the expert in this situation.
• family and patient trained to recognise early signs of relapse so they can response to reduce the severity.

Question 25

Explain how token economies can help with treatment of schizophrenia

Answer 25

• Reward systems to manage maladaptive behaviour.
• Modifying behaviour doesn’t cure schizophrenia but improves quality of life and makes it more likely they can live outside of the hospital.
• based on operant conditioning -> tokens only have value once the patient has learned they can be used to obtain reward -> e.g. buying sweets/magazines.

Question 26

Give examples of tokens for a token economy

Answer 26

• e.g. colour disks are given when patients carry out desirable behaviour.
• Getting dressed, making a bed etc.
• Tokens can be swapped for rewards.

Question 27

(+) Give evidence of effectiveness for CBT

Answer 27

• Jauhar et al. (2014) reviewed the results of 34 studies of CBT.
• Concluded that CBT had a significant but small effect on + and – symptoms.

Question 28

(+) Give a supporting study for the effectiveness of token economy (McMonagle and Sultana)

Answer 28

• McMonagle and Sultana (2009) found only three studies where patients were randomly allocated to conditions with a total of 110 patients.
• only one of the three studies showed improvement in symptoms.
• Schizophrenia remains one of the harder mental health problems to treat.

Question 29

(-) Explain why cognitive treatments are limited because they do not cure

Answer 29

• Help make Schizophrenia 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 the above fail to cure schizophrenia.

Question 30

(-) Explain how there are ethical issues with cognitive treatments on schizophrenia

Answer 30

• privileges (token economies) etc. become more available to patients with mild symptoms and less so for those with severe symptoms that prevent them from complying with desirable behaviours.
• CBT: may involve challenging a person’s paranoia, but at what point does this interfere with an individuals freedom of thought?
• E.g. CBT challenges a patients belief in a highly controlling government, this can easily stray into modifying their political beliefs.

Question 31

(+) support for family therapy

Answer 31

• Pharoah et al. (2010) reviewed family therapy.
• Moderate evidence that it significantly reduces hospital readmission and improved quality of life.