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Psychological Explanations and Therapies for Schizophrenia - Coggle Diagram
Psychological Explanations and Therapies for Schizophrenia
Family Dysfunction:
Fromm-Reichman (1948)
Based on accounts that she had heard from her patients about childhood - she noticed commonality in the characteristics that the patient explained about their parents, particularly mothers
Proposed that parents of schizophrenics often display cold, rejecting, and controlling characteristics
Problems with how data was collected: (affects validity)
Retrospective data - in the past and could be remembered incorrectly (could be experiencing hallucinations/delusions)
Social desirability + biased data
Investigator effects
Lack of temporal validity
This explanation believes that maladaptive or dysfunctional family relationships place stress on a person, which can influence the development of schizophrenia
Childhood experiences influence adult behaviour:
Read et al (2005):
reviewed 46 studies of child abuse and schizophrenia and discovered that 69% of women with a diagnosis had an history of abuse. The figure was 59% in men.
Berry et al (2008):
found that many adults with schizophrenia had insecure attachments to their caregivers
This evidence is all based on retrospective data:
W - All rely on recall which can lead to false data - decreases validity
W - Correlational studies - only see a link, cannot determine cause and effect
Double bind and EE:
Double bind theory: Bateson (1956)
Sometimes parents give one instruction verbally, but their body language and behaviour gives the opposite message - leads to confusion and social withdrawal due to their confusion between which behaviour is correct
Expressed Emotion:
Refers to the attitudes expressed by family members when talking about the schizophrenic family member along five separate scales (high/low)
Critical comments
Over involvement
Positive remarks
Warmth
Hostility
Family therapy has two goals - education and reconstruction
Evaluation:
S - Evidence for EE both show that low EE can prevent relapse
S - Both theories have led to the development of family therapy which is generally successful
S - Modern thinking now takes account of both biological and family therapy
W - All evidence is correlational, we don't know if EE causes schizophrenia or is a consequence
W - Explorations may prevent families addressing issues due to them feeling guilt/blame
W - Criteria may be ethno-centric, not applicable to all cultures
Cognitive theories:
Cognitive theories centre on the idea that the schizophrenic person has developed maladaptive thought processes. These are thought to lead to the illness.
Dysfunctional thought processing:
Schizophrenics have metacognition dysfunction. This means they can't:
Think about their own feelings and actions
Monitor their behavioural triggers (the things that make them act in a certain way)
Think about their own wishes, intentions etc.
Make sense of their environment
Frith's Alien Control Systems (1992)
- proposed abnormal info processing is associated with schizophrenia
Meta-representation
: cognitive ability to reflect on thoughts and behaviour
Allows insight into our own intentions and goals - allows us to interpret the actions of others
Dysfunction disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else - explains hallucinations of hearing voices and delusions like thought insertion
Central control
: issues with cognitive ability to suppress automatic responses while we perform deliberate actions
Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts eg. derailment of thoughts because each word triggers associations, and the person cannot suppress automatic responses to these
Evaluation:
S - Evidence comes from Stirling et al (2006)
Schizophrenics took twice as long on a stroop test task where they took longer to name colours of ink words were written in
This shows that schizophrenics have difficulty supressing words and automatic responses which they wish to ignore giving support for Frith's concept of central control
S - Betall et al (1991) found that schizophrenics had difficulty remembering words within categories
Schizophrenics found it difficult to recall if they had read the word themselves, not seen it at all or created it themselves
This shows that schizophrenics seems to have issues with metarepresentation - they struggle to recognise their own actions giving support for Frith's concept of metarepresentation
S - It has helped to develop CBT
Understanding schizophrenic patterns of cognition has helped to develop strategies to address these that can be used within CBT sessions
If these sessions are effective then it allows patients to recover quicker and live a more 'normal' life, also benefitting the economy
W - Much of the evidence for cognitive explanations comes from lab-based studies
Tasks that are used to test cognition skills are often artificial in nature such as the stroop test and are also conducted in lab-based environments
Participants may not be behaving in a way that is normal to them and their everyday life, therefore we can't be sure that schizophrenics experience this in everyday life
W - It is unclear if problems with cognition are a cause or consequence of symptoms
The links between cognition and symptoms are clear, however theory does not tell us anything about the origins of the cognitive problems
Therefore difficult to tell if these are a cause or consequence, suggesting there may be another explanation required to understand the cause
Psychological therapies:
Family therapy:
Evaluation:
W - Family therapy relies on the cooperation of the families, and their willingness to share sensitive info
If families are not in the frame of mind to engage in therapy then it is less likely to be effective
S - Family members can often help patients gain insight into their condition
With these insights it can allow patients to see their disorder from many viewpoints and increase their understanding of the disorder
S - Family therapy can decrease relapse rates, lower the need for hospitalisation, and can educate family members to help manage a sufferers condition
If family members are educated then they will be aware of when a patient may be suffering a particularly bad episode and can help them seek support quicker
W - Drug treatments work well with family therapy - but cost often means it can't be offered as combined therapy
Can be preventatively expensive even though evidence suggests a combination is better
Vaugh + Leff demonstrated the effectiveness of anti-psychotics and low rates of EE with only 12% relapsing compared to 15% low EE and no medication
S - The Schizophrenia Commission (2012) estimates that family therapy is cheaper than standard care by £1,004 per patient over 3 years. This could make it more cost effective
This can positively help the economy as a whole as well as the patients as it means that the NHS are spending less money but still achieving the same outcome in terms of success
S - It can be very beneficial for younger patients
In the early stages, patients are often still living at home so family relationships are crucial in improving chances of recovery
Leff et al (1985)
- compared family therapy with routine outpatient care for families with high EE. Within 9months, 50% of those having routine care relapsed, but only 8% of those receiving family therapy did
Demonstrates effectiveness - relapse rates are much lower than the control group
CBT:
CBT process for schizophrenia patients:
Assessment - The patient expresses their thoughts about experiences. Goals for therapy are discussed
Engagement - The therapist empathises with the patient and their feelings. The emphasis is is on working through issues together
ABC Model - Patients gives their activating events, beliefs and consequences of these as a way of explaining what they are experiencing
Normalisation - Psychotic experiences are discussed as part of a continuum, that many people may sometimes experience delusions. Patient will now feel less stigmatised
Critical Collaborative Analysis - Questioning is used to help the patient understand that delusions and hallucinations are illogical
Developing Alternative Explanations - Patient develops their own alternative explanations for delusions or hallucinations. The therapist can also help construct ideas
Evaluation:
NICE (2014) - found that using CBT and antipsychotics reduced rehospitalisation rates for up to 18 months after CBT was stopped (S)
Haddock et al (2103) - found that13/187 UK sufferers were offered CBT - not accessible treatment (W)
No side effects - could be ethical (S)
Social engagements with others/therapist could encourage attendance (S)
Trower et al (2004) - cause is not addressed and the disorder is not necessarily treated/removed it can significantly increase the quality of life for the patient (S)
Addington and Addington (2005) - in the initial phase, medication is more important as they are not experienced in understanding their disorder (W)
Token economies:
Evaluation:
Some psychologist have criticised the token economy in psychiatric units as manipulative, inhumane, and treats people like animals
Studies into token economies often lack a control group or patients are not randomly allocated, this can lead to false, optimistic conclusions
Token economies can be abused; staff can choose to reward behaviour that makes their lives easier rather than to benefit the patients, the institutions may use their power inappropriately
Learned behaviour may not transfer to the outside world
If the cause of behaviour is biological, then token economy programmes may not be successful, as they do not address the root of the problem
Mcgonagle and Sultana (2009) - 1/3 token economy studies designed to test effectiveness showed improved outcome for patients
Based on a behaviourist idea (operant conditioning)
Used to manage the behaviour not treat - modifying bad habits does not cure the disorder but improves quality of life
Tokens are secondary reinforcers