cognitive (psychological)

• Dysfunctional thought processing

  • perception deficits
  • cognitive errors
• Perception deficits

  • misinterpretation of a sense
  • configuration is impaired so struggle to identify emotions leading to misinterpretation of peoples intent so social dysfunction.
  • have a lack of theory of mind (the ability to understand that other people have their own thoughts, feelings, and beliefs, which can differ from one's own) and higher level of decentering
• cognitive errors

  • biases in cognition leads to errors in processing
  • Egocentric bias
  • impaired reality testing
  • internationalising bias
  • externalising bias
• Egocentric bias

  • centre stage
  • all happenings relevant to them
  • personalisation
  • eg. delusions of grandeur and control
• impaired reality testing

  • disregard common sense assumptions
  • fail to test reality of decisions
  • eg. delusions of persecution
• internationalising bias

  • events are motivated by others emotions
  • and everything is done with intent
  • eg. delusions of persecution
• Externalising bias

  • attach personal meanings to irrelevant external events
  • use extraordinary explanations for their ordinary physical, mental, emotive experiences
  • forgo plausible explanations
  • impossible external attributions
  • eg. delusions of persecution
• AO1 - treatment CBTp

  • cognitive behavioural therapy psychosis
  • identify irrational thoughts and change them
  • looks at oration of delusions and hallucinations and helps patents challenge them and understand that they are not based in reality.
  • uses reality testing (rationalisation and confrontation)
  • consideration of cause and effect (alternative interpretations)
  • coping strategy through education and symptom targeting
  • homework to improve functioning and societal integration
  • Beck and Ellis - ABCDE framework
  • (focus is management of symptoms not cure)
• treatment - token economies

  • awarding of tokens which work as a neutral stimulus and secondary reinforcer given when patients show desirable behaviour
  • tokens can be exchanged later for primary reinforcement
  • based on operas conditioning principles of - positive reinforcement
  • use extrinsic motivation to mould behaviour - behavioural shaping/management/modification
  • behavioural point system
  • rather than cure
  • used in hospitals to promote acceptable behaviours among inpatients so easier to manage
• AO3 - research to support

  • shin et al research into perception deficits
  • found that SZ patients were airier at all feature recognition tasks but specifically bad a configuration tests eg. stroop test
  • demonstrates inability to identify emotions accurately and explains high levels of social dysfunction
• AO3 - descriptive rather than explanatory

  • cognitive distortions are underpinned by disconnection in memory centres of the brain - hippocampus and prefrontal cortex
  • SZ better explained by neural correlates in comparison to faulty cognitive processes
  • cognitive explanation merely describes the symptoms
  • frith argued diathesis stress model approach more `poropri`te `s considers genetic vulnerability for behaviours
  • cause and effect can be questioned
• A03 - there is effective treatments

  • CBT
  • but aetiological treatment fallacy - aims to manage symptoms and integrate into society rather than cure suggesting that may not be the true cause
• AO3 - diathesis stress model

  • acknowledges role of a range of factors taking a multidisciplinary approach
  • stressful life events could trigger psychotic symptoms in individuals with biological predisposition
  • genetic factors or adverse conditions in womb lead to vulnerability that is biochemical or neuroanatomical
  • lead to psychological vulnerability - inability to appropriately process information in the form of cognitive processing deficits
  • these deficits could lead to distortions if exposure to stressful life events like family environment being overstimulating go having high expressed emotion
  • cognitive difficulties may be exacerbated and lead to psychotic symptoms seen in SZ patients (delusions and hallucinations)
• AO3 - treatment CBTp effective

  • NICE review found when compared to drugs CBTp was effective in reducing rehospitalisation and at reducing symptom severity
  • majority studies on patients taking drugs and participating in CBTp therefore hard to isolate each as independent variable - contamination effect - extraneous variable - can not establish cause and effect.
• AO3 - treatment CBTp effective

  • kuipers et al 1997
  • significant reduction in the severity if delusional symptoms
  • CBTp is effective in targeting correct symptoms and providing a viable treatment method
• AO3 - treatment CBTp limitation

  • argument that effectiveness of treatment is dependent on the stage
  • Addington initial acute phase of SZ self reflection is not appropriate
  • psychotic symptoms better treated with medication and CBTp can then aid social integration once therapy is more accessible to patient
  • reality testing change perception rather than presence of delusions
  • main use is to prevent relapse and ensure compliance with drugs
• A03 - alternate treatment

  • drugs eg.
  • avatar therapy - professor tom Craig
  • attempts to target the cause rather than stick to management
  • treatment resistant cases with auditory hallucinations provided personalised treatments in 6 10 minute sessopna and found that out of 75 patients 9 stopped hearing voices in 3 months and others experienced decrease in distress or frequency of symptoms
• AO3 - treatment token economy - effectiveness

  • Azrin 1968 tokens are effective in motivating behavioural changes helping to manage SZ symptoms
  • recognised that motivation is extrinsic and not internalised so can only be used as a short term measure
• AO3 - treatment token economy - not cure

  • manage symptoms but do not cure
  • make behaviour more socially acceptable in effect silencing symptoms and encouraging patients not to talk about experiences honestly in order to fit in with socially acceptable model of behaviour encouraged by tokens
  • while this may aid reintegration to society, it does not help to reduce symptoms by any means or provide coping strategies
• AO3 - treatment token economies appropriateness

  • do not have severe side effects compared to drugs
  • but socially sensitive and controversial in nature as privileges and services are more accessible to those without severe symptoms and discrimination based on extent of illness
  • some families aim to challenge the legality of this and reduce the use in psychiatric systems