Psychological explanations

• Family dysfunction

  • This refers to any forms of abnormal processes within a family such as conflict, communication problems, cold parenting, criticism and control.
  • These may be risk factors for both the development and maintenance of schizophrenia.
• Double Blind Theory

  • The role of communication
  • Where an individual receives mixed messages from someone who is a figure of authority e.g. a parent.
  • Can be stated explicitly or expressed implicitly (tone of voice or from body language - it could be as simple as being affectionate one minute and nasty the next).
  • When a child gets something ‘wrong’ they are punished by a withdrawal of love
  • Leaves them with an understanding of the world as confusing and dangerous.
• Schizophrenogenic Mother

   Fromm-Reichmann proposed a psychodynamic explanation based on interviewing schizophrenia patients regarding their childhoods. Many clients had a particular type of parent (cold, rejecting, controlling, created a family full of secrets and tension). This leads to distrust, followed by paranoid delusions and ultimately schizophrenia.
• Expressed emotion

  EE is the level of emotion expressed towards a patient by their carers. High Expressed Emotional families show:

  • High levels of control
  • Exaggerated over-involvement in life of patient.
  • Verbal criticism of the patient, including rejection
  • Hostility towards the patient

  These high levels of expressed emotion are a serious cause of stress. This is primarily an explanation for the relapse of  patients with schizophrenia. 
• Cognitive explanations

  Schizophrenia is associated with abnormal information processing. Reduced processing in the ventral striatum is associated with negative symptoms. Reduced processing in temporal and cingulate gyri is associated with hallucinations. This lower level of information processing suggests that cognition is likely to be impaired.
• Dysfunctional Thought processing

  Term to describe information processing that is not working normally and produces undesirable consequences. Christopher Frith et al identified two kinds of dysfunctional thought processing that could underlie some symptoms:

  Sufferers of schizophrenia tend to be unable to use central control (the cognitive ability to suppress automatic responses), leading to disordered thoughts and speech. 

  Sufferers of schizophrenia may have problems with metarepresentation (the cognitive ability to reflect on thoughts and behaviour), leading to hallucinations and delusions.
• Family therapy

  • Aim: reduce levels of expressed emotion
  • Reduce hostility in family
  • Build positive relationships
  • Therapist meets family members and patient for open, productive discussion.
  • Educates family about disorder and what to expect
  • Encourages family to develop problem-solving and communication Skills to support patient.
• Strength of psychological therapies

  • A strength of psychological therapies is research support. Pharaoh et al’s (2010) meta analysis of family therapy found improvement in social functioning and mental state. Patients were also less likely to relapse. This suggests therapy is effective.
  • However, the researchers suggested that this effectiveness may have had more to do with the fact that the therapies increase medication compliance than family therapies themselves, undermining support for psychological therapies as a-stand-alone treatment.
• Weakness of psychological therapies

  • A weakness of psychological therapies is that they may not be worthwhile. Garety et al (2008) failed to show any better outcomes for patients given family therapy compared to those that were simply given carers which displayed low levels of expressed emotion. Both groups had low relapse rates compared the no therapy / carer group.
  • This suggests family intervention may not be any more effective than a good standard of care.
• Token economies

  • Is a reward system based on Skinner‘s operant conditioning and is used for management of schizophrenia.
  • Desirable behaviours are encouraged by the use of selective positive reinforcement.
• How do token economies work?

  • Undesirable behaviour is repeated as it is being reinforced (patients who are institutionalised)
  • Patients may develop bad hygiene and remain in pyjamas all day (comfortable/doesn't need effort).
  • When desired behaviour is displayed tokens are given immediately. Immediacy important as it prevents delay discounting. (Reduced effect of delayed reward).
  • Tokens exchanged for rewards; sweets, tv, ciggs.
• Evaluations of token economies

  • A weakness of token economies is that they only manage behaviour rather than addressing the underlying symptoms of disorders like schizophrenia, so improvements may not transfer outside structured settings.
  • A strength of token economies is that they can increase desirable behaviours (like self-care or social interaction), helping patients function better in daily life, especially in institutional settings.
• CBT – Cognitive Behavioural Therapy

  • Aims: Identify irrational thoughts and replace this thinking with more realistic and useful thoughts.

  This can be achieved through REALITY TESTING:

  • Challenging intrusive or delusional thoughts (including origin of ‘voices’) to reduce distress.
  • CBT develops strategies (e.g. positive self-talk) to deal with the distressing experiences – aiming to improve general level of functioning.
• Strength of CBT.

  • A strength of CBT is that there is evidence to support its effectiveness.
  • For example, Jauhar 2014 analysed 34 studies and found CBT to be significantly effective on reducing positive and negative symptoms.This shows how CBT improves the quality of the patient's life, making it more manageable, and this could perhaps have positive economic implications, allowing people with schizophrenia to leave costly institutions and get back into their jobs and contribute to the economy.
  • However, CBT fails to cure SZ - it is a palliative treatment which teaches people how to challenge their symptoms, rather than eliminating the symptoms all together. This could call into question the effectiveness of the therapy overall.
• Weakness of CBT.

  • Another weakness of CBT is that there are practical issues. For example, it takes approximately 5-20 sessions to be effective. This prolonged time may cause individuals to drop out of CBT as they may not be seeing immediate effects and therefore feel like it is not helpful. Likewise, CBT requires self-awareness and a willingness to engage with the process which are often prohibited by the patients’ symptoms (positive symptoms lead to a lack of awareness; negative symptoms lead to reluctance / inability to engage).
  • Therefore, these issues call its appropriateness as a treatment into account meaning the treatment may be seen as ineffective without accompanying drug treatment.
• Briefly explain one advantage of cognitive behavioural therapy in the treatment of schizophrenia. (2 marker)

  • One strength of CBT in treating schizophrenia is unlike antipsychotics there are no side effects. Therefore, patients may be more willing to continue cognitive behaviour therapy which leads to patients recovering.