cognitive explanations

• cognitive explanation for sz?

  • refers to dysfunctions in internal mental processes
  • theres a disruption/impairment to normal thought processes in someone with sz
• 2 theories in cognitive explanation?

  1. dysfunctional thought processing - metarepresentation
  2. dysfunctional central control
• what is metarepresentation?

  • ability to reflect on our own thoughts & behaviour
• metarepresentation in sz patient?

  • inability to distinguish between their own thoughts & external events
  • may not recognise that their thoughts belong to them
  • struggle to interpret actions of others - misinterpreted
• link metarepresentation to symptoms?

  • positive symptons
  • auditory hallucinations - can hear voice speaking to them that no one else can which sounds real to them but not real to anyone else delusions of persecution - misinterpret intentions of others so feel they can get hurt
• what is central control?

  • ability to surpress some thoughts that we have & instead perform different task
• central control in sz patient?

  • cannot control & surpress things that come into head - end up saying them out loud even in middle of sentence
• link central control to symptoms?

  • speech poverty - what they say does not always fit into context/makes sense to those theyre talking to
  • are not able to stop things that come into head even when talking normally
  • speech will not make sense/low quality/socially inappropriate
• 2 X of cognitive explanations of sz?

  1. does not actually explain sz
  2. issues with cause & effect
• 3 * of cognitive explanations of sz?

  1. evidence from stirling
  2. led to effective therapy
  3. provides explanation for both types of symptoms
• X does not actually explain sz?

  • cog explanation shows cognitive dysfunction links to sz but doesnt tell us why individuals develop problems with cognitive functioning in first place
  • no explanation provided as to what occured to make them have cognitive problems
  • cannot explain why they have problems so harder to create effective treatment
• * evidence from stirling 2006?

  • compared 30 patients with sz to 19 control without sz on stroop test
  • need to surpress desire to read word & instead focus on colour they see
  • people with sz took twice as long
  • unable to surpress desire to read word & had difficulty focusing on colour they saw as they have dysfunctional central control
  • shows people with sz do have problem with central control
  • development of + & - symptoms must be at least in part caused by dysfunctional cognition
• * led to effective therapy?

  • cbt developed to support patients to recognise impaired cog processing
  • delusions enable therapist to challenge irrational beliefs - logically dispute reality of delusions & help patients to adopt alternative more rational belief
  • sensky et al 2000 showed patients who resisted drug therapy - reduction in +/- symptoms when treated by 19 sessions of cbt
  • improved 9 months after cbt ended
  • shows for cbt to work must be underlying cog dysfunction to minimise symptoms
  • economic implications patients able to minimise sz symptoms to improve social functionings & return to work
• X issues with cause & effect?

  • not clear whether changes to cognitive ability causes sz/whether persons cognitive ability changes as a result of getting disorder
  • eg unclear whether dyfunctional metarep causes auditory hallucinations/whether person has them which causes dyfunction with metarep
  • may be 3rd intervening variable - enlarged ventricles cause changes to cognitive ability & symptoms
  • cause & effect relationship between dyfunctional thought processes & sz cannot be established
• * provides explanations for both types of sz?

  • cog explantions explain positive symptoms - problems with metarep cause auditory hallucinations - cannot understand own thoughts so do not recognise own inner voice & believe its someone else talking to them
  • negative symptoms - problems with central control cause speech poverty - not able to surpress thoughts
  • gives global account of sz by explaining all symptoms
  • can leads to more effective treatment of sz