cognitive explanations

• cognitive explanation


  assumes that mental processes cause our behaviours, faulty mental processes are seen as the explanation behind a variety of mental health disorders e.g. depression

  cognitive therapies: CBT, therefore are seen as the main cognitive treatment to address cognitive problems in mental health

  three explanations: cognitive deficit, cognitive biases, dysfunctional thought processing
• cognitive deficit 


  sufferers experience problems with attention, communication and information overload

  Sz are unable to deal with inappropriate thoughts: such as misperceiving voices in their heads

  cognitive deficits have been suggested as possible explanations for a range of behaviours associated with Sz: reduced levels of emotional expression, disorganised speech and delusions

  there is evidence that SZ have difficulties in processing visual and auditory information
• cognitive biases


  refer to selective attention

  delusions: most common delusion reported is of others trying to harm them, associated with specific biases in reasoning about social situations, general tendency to assume that other people cause the things that go wrong with their lives

  auditory hallucinations: hearing voices, related to cognitive biases, bias can lead them to see themselves as worthless, useless and incompetent, people experience an inner voice when thinking in words, Sz mistake their inner voice as speech from an external source
• dysfunctional thought processing (1992)

  metarepresentation: our ability to reflect on thoughts and behaviour, identify our goals and intentions and interpreting the actions of others, disturb our ability to recognise our own actions and thoughts as being ours therefore explaining hallucinations as an inner voice

  central control: ability to suppress automatic responses while we perform deliberate actions

  derailment of thoughts and spoken words as each word triggers an association, the Sz cannot stop the automatic responses to these associations
• evaluation:

  strengths: real life applications, virtual reality technology can be used on Sz patients, good economic implications, understanding of cognitive deficits allow for the design of effective treatments, supported by CBT

  weaknesses: problems with cause and effect, doesn't explain negative symptoms, machine reductionism, too simplistic to describe Sz, includes elements of free will, an understanding that own thoughts can be changed and controlled
• evaluation: research evidence 


  sarin and wallin (2014): delusional patients were found to show biases in their informational processing, hallucinating patients found to have impaired self-monitoring and experiences

  supports theory that Sz patients have cognitive biases that aren't present in normal controls
• CBTp: drugs must be given first to make it effective 


  helps with residual symptoms that persist even when taking drugs

  helps patients to identify their faulty cognitions and faulty interpretations of events, helps them to correct their beliefs and maladaptive thinking

  NICE (2014) states that all patients diagnosed with Sz are offered CBTp, recommend 16 sessions
• stages of CBTp

  can be delivered in groups or an individual basis

  aim of CBTp is to find connections between Sz thoughts and actions and consider alternative ways of thinking/behaving

  patients are taught skills to help them recognise their own relapse, to taken an active part in their therapy and do homework tasks between sessions

  cognitive techniques: learning distractions from intrusive thoughts, challenging these intrusive thoughts and identify they aren't real, developing relaxation techniques as a coping strategy
• evaluation

  research support:

  Drury (1996): 25-50% reduction in recovery time for patients given both drugs and CBTp

  CBTp has no side effects unlike drugs

  far more expensive and takes a lot of budget from health care providers this has economic implications

  may not be suitable for everyone as everyone has to be engaged

  isn't suitable for all patients who aren't stabilised, agitated or highly paranoid.
• token economy

  based on the theory of operant conditioning

  positive reinforcement, increase in the frequency of a behaviour when it has desirable consequences

  primary reinforcer: anything gives pleasure like food, no learning required

  secondary reinforcer: initially have no value until they are paired with the primary reinforcer

  tokens given are therefore secondary reinforcers
• token economy

  a form of behaviour therapy where clinicians set target behaviours that they believe will improve the patient's engagement in daily activities

  target may be as simple as brushing their hair, tokens are rewarded when a patient engages in one of the target behaviours

  tokens can later be exchanged for rewards and privileges

  patients encouraged to engage more often in the behaviour that is associated with the reward

  positive reinforcement to encourage target behaviours, frequent exchange of tokens ensures this behaviour is maintained

  a management of Sz not a treatment
• process of assigning value to the tokens

  to begin with tokens are neutral, to have value it needs to be presented alongside or immediately before the reinforcing stimulus

  by pairing the reinforcing stimulus with neutral token, the token eventually acquires the same reinforcing properties

  CLASSICAL CONDITIONING

  generalised reinforcer- tokens can be exchanged for a variety of different privileges and rewards- OPERANT CONDITIONING
• evaluation:

  token economy has been found to be successful, only the case in a hospital setting

  doesn't work in the long term as the desired behaviours become conditioned to the receipt of a token

  real life home environments: don't have the constant reinforcement therefore relapse of symptoms may occur

  ethical: clinicians may exercise control over food, privacy, could violate human rights, could be humiliating/degrading

  form of social control/behaviour management and not a treatment, symptoms of SZ are not addressed
• evaluation

  Corrigan argues that there are problems administrating this with patients who live in the community

  Ayllon and Arzin (1968): used token economy on a ward of female Sz patients, some had been hospitalised for many years

  given plastic tokens with the words 'one gift' for behaviours such as making their bed

  exchanged for privileges such as watching a movie

  findings: the se of token economy with these patients increased the number of desirable behaviours, supporting that token economy can help manage Sz patients behaviours and increase motivation