evaluation

• One strength of psychological explanations, such as family dysfunction and cognitive explanations, is their practical applications in therapy. Family-based interventions, such as those derived from the double-bind theory or expressed emotion (EE), have been shown to reduce relapse rates in individuals with schizophrenia.
• This has significant economic implications, as effective psychological treatments reduce the financial burden on healthcare systems by decreasing the need for hospitalization and long-term institutional care. For instance, the NHS spends billions annually on schizophrenia-related treatments, and interventions that lower relapse rates can lead to considerable cost savings. This supports the validity of psychological explanations by demonstrating their usefulness in real-world applications.
• One strength of cognitive explanations for schizophrenia is their ability to account for the specific symptoms associated with the disorder, such as hallucinations and delusions. Frith’s model, for instance, explains how dysfunctions in metarepresentation and central monitoring lead to symptoms like auditory hallucinations, where individuals misattribute their inner thoughts as external voices.
• This explanation is supported by neuroimaging studies showing abnormal activity in the anterior cingulate cortex and prefrontal regions, which are involved in self-monitoring and error detection (Allen et al., 2007)
• Additionally, research using the Stroop test has found that individuals with schizophrenia struggle with cognitive flexibility and executive functioning, supporting the idea that cognitive dysfunction plays a role in the disorder. However, while these findings reinforce the cognitive approach, they do not establish causation—abnormal brain activity could be a consequence rather than a cause of schizophrenia.
• Despite their strengths, cognitive explanations have limitations, particularly in terms of treatment implications. While cognitive therapies such as Cognitive Behavioral Therapy (CBT) have shown success in reducing symptom severity by challenging dysfunctional thought patterns, they do not work equally well for all patients, especially those with severe positive symptoms or cognitive impairments
• A key criticism of the cognitive explanation is that it is reductionist, as it focuses primarily on cognitive deficits while neglecting biological and environmental influences. Cognitive dysfunctions are often linked to abnormalities in brain structure and neurotransmitter activity, particularly dopamine dysregulation. For example, excessive dopamine activity in the mesolimbic pathway has been associated with delusions and hallucinations, suggesting a neurobiological basis for the cognitive impairments observed in schizophrenia.
• This highlights the need for a more holistic approach that integrates cognitive, biological, and environmental factors. The diathesis-stress model, which considers both genetic vulnerabilities and environmental triggers, offers a more comprehensive understanding of schizophrenia. The cognitive approach, therefore, may be best viewed as a complementary rather than a standalone explanation.
• Cognitive Behavioral Therapy (CBT) is based on the principles of cognitive dysfunction and aims to help individuals challenge and reframe irrational beliefs associated with delusions and hallucinations. Research has shown that CBT can be effective in reducing symptom severity and improving overall functioning when used alongside antipsychotic medication. For example, studies have found that patients receiving CBT experience fewer distressing symptoms and lower relapse rates compared to those receiving medication alone.
• This demonstrates the practical value of the cognitive approach, as it has contributed to non-pharmacological interventions that improve the quality of life for individuals with schizophrenia. However, CBT may not be effective for all patients, particularly those with severe cognitive impairments who struggle with insight into their condition. Therefore, while the cognitive explanation has led to useful applications, it may not be sufficient as a sole treatment approach.
• • Evidence supporting the role of expressed emotion: A meta-analysis of 26 studies by Butzlaff and Hooley (1998) found relapse rates are higher among schizophrenic patients who return to live with families with a high degree of expressed emotion. The role of expressed emotion in schizophrenia is further supported by the success of family therapies that aim to reduce expressed emotion. However, this research doesn’t support expressed emotion as a cause of schizophrenia, but it does suggest it contributes to maintaining schizophrenia.
• There is research supporting family dysfunction as a risk factor in developing schizophrenia. Tienari (1994) measured the prevalence of schizophrenia in adopted children finding children with biological parents with the Schizophrenia were most likely to develop the disorder but this only emerged when the adopting family were rated as disturbed. This supports the case for how psychological factors such as family dysfunction (nurture) can trigger a genetic vulnerability (nature) in people leading to the development of schizophrenia.
• Although evidence links family dysfunction to schizophrenia, one criticism is the information about childhood experiences has generally been gathered after the development of symptoms. Schizophrenia itself may have distorted the patients recall of childhood experiences which raises the problem of validity undermining this explanation. Another problem with the dysfunctional family explanation is this has historically led to “parent-blaming” raising ethical and moral issues. Parents have gone through the trauma of watching their children develop schizophrenia and bear the lifelong responsibility for their care and then blame is added for the condition adding further insult to injury.
• In addition, having a schizophrenic within the family can be stressful and problematic on family relationships itself and rather than dysfunctions within the families causing schizophrenia, it may well be that having someone with the disorder leads to family dysfunction as they struggle to cope. This is the major issue with such correlational data as you cannot be certain of cause and effect.
• The theory is however supported by the fact that therapies which successfully focus on reducing expressed emotions within the family have low relapse rates when compared with other therapies suggesting the explanation does have validity. However it could be argued that this merely masks the symptoms or teaches family members to tolerate them more rather than provide an effective solution for the disorder.