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SCHIZOPHRENIA: PSYCHOLOGICAL EXPLANATIONS AND TREATMENTS - Coggle Diagram
SCHIZOPHRENIA: PSYCHOLOGICAL EXPLANATIONS AND TREATMENTS
EXPLANATION: FAMILY DYSFUNCTION
DOUBLE BIND THEORY
Bateson et al. (1972) identified this as a risk factor to schizophrenia. He believes it does not need to be the main method of communication in a family and it is not the only factor to developing schizophrenia.
When a child is regularly in situations where they fear doing the wrong thing, but receive mixed messages on what this is, and they feel unable to comment on the unfairness of the situation or ask for clarification. When they get it wrong (often), they are punished by the withdrawal of love. For example, a verbal message is given but opposite behaviour is exhibited. This causes them to see the world as confusing and dangerous.
The skewed perspective of how the world is is seen in disorganised thinking and paranoid delusions - positive symptoms. Social withdrawal and flat effect (a lack of emotional expression) - negative symptoms.
SCHIZOPHRENOGENIC MOTHER
Fromm-Reichmann (1948) proposed a psychodynamic explanation that she found through talking to her patients about their childhoods. She identified that the ‘schizophrenogenic mother’ was often mentioned: one who acts cold, rejecting, and controlling, and who creates an environment full of tension and secrecy.
The environment full of tension and secrecy leads to distrust, developing into paranoid delusions.
EXPRESSED EMOTION (EE)
Refers to the level of emotion, in particular negative, expressed by carers towards the patient. Involves: 1. VERBAL CRITICISM, occasionally accompanied by violence; 2. HOSTILITY, including anger and rejection; 3. EMOTIONAL OVER-INVOLVEMENT in the patient's life, including needless self-sacrifice
This causes a great amount of stress in the patient, and has been linked as a primary factor to relapse in schizophrenics, and has been suggested as a cause for the onset of schizophrenia in people with genetic predispositions to the disorder (diathesis-stress model).
EVALUATION
Support for the family dysfunction explanation comes from Berger (1965) who found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics.
This suggests that there is a correlation between schizophrenics and family environments where this is the norm, which could perhaps mean that the onset of schizophrenia is linked to this type of family dysfunction
Support for the family dysfunction explanation comes from Kalafi and Torabi who found that the negative emotional climate in Iranian culture (over-protective mothers and rejecting fathers) led to a higher relapse rate in schizophrenia.
This could indicate that Expressed Emotion is related to the relapse of schizophrenics when they interact with their families.
COGNITIVE EXPLANATIONS
EVALUATION
Support for the cognitive explanation comes from Myer-Lindberg who found reduced activity in the prefrontal cortex of schizophrenics when they did a task involving working memory. /This shows there is a link between dysfunctional information processing and schizophrenia./
This implies that the deficits in the prefrontal cortexes of schizophrenic people leads to problems involving memory, which correlates with the findings of dysfunctional thought processing.
The highlighting of dysfunctional thinking as an important factor in the development of schizophrenia indicates that therapies such as CBT should be used.
This would allow for targeting of specific areas of metacognitive impairment.
Research suggests that dysfunctional thought processing in schizophrenics occurs before the onset of the disorder and therefore is not an effect of being schizophrenic.
This may mean that it is not necessarily a causative factor, but may instead itself be an effect of abnormal brain functioning, which in turn leads to dysfunctional thought processing.
The cognitive explanation can account for both positive and negative symptoms.
This makes it a more complete explanation of the disorder.
Cognitive theories in themselves do not explain what led to the cognitive dysfunctions seen in schizophrenia.
This means that they cannot be seen as explaining the causes of schizophrenia.
reduced processing in: the
ventral striatum
linked to
negative
symptoms;
temporal and cingulate gyri
linked to
positive
symptoms eg. hallucinations. the lower levels of information processing suggests that cognition is likely to be impaired
Frith et al. (1992) identified two types of dysfunctional thought processing (information processing is not functioning normally and produces undesirable consequences)
METAREPRESENTATION/ METACOGNITION
The cognitive ability to reflect on thoughts and behaviour - gives us insight into our intentions and goals, as well as the ability to interpret others' actions
disruption would cause the inability to recognise our own actions and thoughts as being carried out by ourselves, explaining hallucinations of voices and delusions such as thought insertion
CENTRAL CONTROL
Stirling et al. (2006) compared the results of 30 schizophrenic patients with 18 controls when they performed a variety of cognitive tests, including the Stroop Test. Patients took twice as long to name the colours than the control. This is due to the difficulty in suppressing the impulse to read the words instead of the colours.
the cognitive ability to suppress automatic responses while we perform deliberate actions instead.
the inability to suppress automatic thoughts and speech triggered by other thoughts could explain disorganised speech and thought disorder. eg. thought/ speech derailment as each word triggers associations and the patient cannot suppress automatic responses to these.
ABNORMALITIES IN THE STRUCTURE OF THE BRAIN (suggesting a biological component as well as a cognitive cause)
metarepresentation - positive symptoms - auditory hallucinations, delusions (of thought insertion)
central control - disorganised speech/ thoughts (inability to keep attention on what they are saying and frequently going off on a tangent)
executive functioning - problems with memory, attention inhibition, physical motor control of the body
TREATMENT: CBT (CSE "COPING STRATEGY ENHANCEMENT")
Tarrier devised a specific form of CBT for schizophrenia known as Coping Strategy Enhancement which focused on building on schizophrenics’ existing coping strategies.
Tarrier noted that patients were able to identify triggers (eg. a person, being alone, stress) for schizophrenic episodes and had devised their own coping strategies.
COPING STRATEGIES
cognitive strategies, such as distraction - concentrate on a specific task; positive self talk
behavioural strategies, such as relaxation techniques (eg. breathing exercises), social withdrawal/ increasing social contact, loud music to drown out voices, behavioural experiments
THREE PARTS:
Develop a rapport with the patient, and identify triggers of psychotic symptoms as well as reviewing existing and developing new coping strategies
Target specific symptoms and find strategies to deal with them
Participants have homework assignments to consolidate their learning of strategies between sessions
Support for the effectiveness of CSE comes from Chadwick (1992) who worked with a schizophrenic who had the delusion that his thinking could influence the future. However, he failed to predict what would happen in 50 video clips shown to him which helped provide him with evidence to show that his delusional beliefs were false.
EVALUATION
CBT has limited usefulness as it is not suitable for all patients. Those who are too disoriented, agitated, or paranoid to form trusting relationships with their therapist will not be able to engage in the treatment
Ethical concerns have been raised about the use of CBRB. There is an argument that as the therapy is practitioner directed, freedom of thought may be interfered with.
Comparing CBT with drug therapy showed that there are fewer side effects. However, it is a more expensive treatment and with cost being a factor in health-care budgets, it may not be widely available.
CBT when combined with antipsychotics has been shown to be an effective treatment. This emphasises the need for combined treatments rather than each in isolation.
TREATMENT: FAMILY THERAPY
a form of psychotherapy based on the idea that family dysfunction can play a role in the development of schizophrenia. by altering relationship and communication patterns, and lowering levels of expressed emotion, people with schizophrenia can be helped to recover
THREE GOALS:
To improve positive and decrease negative forms of communication
To decrease feelings of guilt and responsibility for causing the illness among family members
To increase tolerance levels and decrease criticism levels between family members
The patient and their family meet regularly with the therapist and they are encouraged to talk openly about the symptoms, behaviour, and treatment progress of the person with schizophrenia. The family is also asked to discuss how the patient's illness affects them
Family members are taught how to support each other, with each person being given a specific role in the rehabilitation of the patient. Boundaries are set as to what is acceptable and unacceptable, openness is encourages and all those involkved have to consent to participate
lasts for between 9-12 months with the aim that the skills that are developed are continued to be used when the therapy has ended
EVALUATION
Family therapy can be useful for patients who lack insight into their illness or cannot speak coherently about it. Family members will be able to assist by providing lots of useful information about a patient's behaviour and moods. They can also speak on their behalf.
Family therapy is not always successful as it requires an openness to speak about family issues. Some family members may be reluctant to share information or talk about, and admit to, family problems. This will reduce the effectiveness of the treatment.
As well as decreasing relapse rates and lowering the need for hospitalisation, family therapy can educate family members to help manage a patient’s medication regime. This will decrease the need for intervention of clinicians and make the treatment more cost effective
TREATMENT: TOKEN ECONOMIES
EVALUATION
A problem with token economies is that desirable behaviour becomes dependent on being reinforced. Upon release into the community reinforcements cease and this can lead to relapse and re-admittance to hospital.
Token economies can be tailored to meet the individual requirements of different patients as the technique uses the same principles to target different behaviours. This means that the technique has flexibility, allowing it to be used in a variety of settings.
Token economies work best when used alongside anti-psychotic drugs. This means that it cannot be seen as a treatment for schizophrenia in itself.
There are ethical and methodological concerns about the use of token economies. Some clinicians believe that participating in this treatment is humiliating and that they do not generalise well to real-life settings.
reward systems used to manage the behaviour of schizophrenic patients, in particular those who have developed patterns of maladaptive behaviour through spending long periods institutionalised, such as bad hygiene, wearing pyjamas constantly. this does not cure schizophrenia, but it improves their quality of life and makes it likely that they can live outside of a hospital setting
tokens are awarded immediately to patients when they carry out a desirable behaviour, eg. getting dressed in the morning, making their bed, to reinforce it (immediately as it prevents 'delay discounting') and are awarded depending on the patient's individual behavioural issues.
tokens are swapped for tangible rewards, that make tokens act as secondary reinforcers as they only have value once the patient has learned that they can be used to obtain rewards, such as sweets, cigarettes, a walk outside the hospital
based on the behaviourist principle of operant conditioning