Psychological explanations of schizophrenia and therapies

What you need to know

• 2 psychological explanations of schizophrenia

• 2 psychological therapies of schizophrenia

Behavioural approach

Cognitive approach

Psychodynamic approach

Socio-cultural factors

We will do the behaviourist explanation and the cognitive explanations together and you will do a third one on your own as this will help you add depth to the evaluation of the approaches we are covering.

Behavioural explanation

Assumption: schizophrenia like any other behaviour is learnt from the environment

Operant conditioning: if the behaviour is positively reinforced then the behaviour will be repeated. If it is punished then the frequency of the behaviour will decrease.

How is schizophrenic behaviour positively

reinforced?

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There is another way....

If an individual observes the schizophrenic behaviour being reinforced in another person i.e. parent (vicarious reinforcement) the individual might reproduce the behaviour to obtain the same reinforcements.

Social learning theoryAO1

Social learning and operant conditioning combine

An individual starts imitating schizophrenic behaviour observed in another then this is maintained and developed through operant

conditioning. AO1

EvaluationThe disorder tends to run in families so it is possible that people may learn to exhibit symptoms through observing other people who do and want to imitate these people to get the same reinforcements.

This approach cannot really account for the core features of schizophrenia: hallucinations, delusions and disorganization of thinking.

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• It cannot explain why so many people with schizophrenia exhibit similar symptoms regardless of where they originate.

• It cannot explain why an individual who has never had contact with a schizophrenic display symptoms of schizophrenia.

• Experiments with behaviour modification for schizophrenia have indicated that, whilst symptoms can be modified, the accompanying experiences tend to persist, which suggests that the cause cannot be only the learning of the behaviour.

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Wilder et al. (2001) Every time a Sz patient made a statement unrelated to the topic being discussed, the therapist would ignore the statement and ask to take a break, then look away for 30 seconds. The sessions lasted for 10 mn and took place 2-3 times a week. The patients’ bizarre vocalisations reduced dramatically over 30 sessions. Which shows that?????

Ayllon and Haughton (1964) trained hospital staff to ignore an inpatient' s delusional remarks . The staff responded normally to non-delusional speech. There was a large reduction of delusional speech.

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Although these studies seem to suggest a significant improvement we do not know whether there was an improvement of the delusion itself or whether the patients felt they could not speak about them.Also it is likely as they were in hospital that they were on medication so the improvement could have been due to medications rather than the therapy

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• is the theory based on research carried out on an unrepresentative sample? Gender bias

• does the theory/approach attempts to explain phenomena in terms of basic elements? Reductionism

• is the theory based on research carried out in one particular type of culture (i.e. Individualistic culture) ?Ethnocentrism

• Does the theory/approach explain phenomena in terms of nature i.e. genetics neglecting other factors i.e. social factors?

Nature/Nurture

• Situate the theory in one approach (biological, behavioural, cognitive, psychodynamic) Approach

• Does the theory/approach acknowledge a sense of individual free-will or does it argue that our behaviour is determined by a particular set of factors?

Determinism

• Does the theory/approach propose/research issues which could be socially controversial ? (i.e. correlation between race and IQ)

Ethics

• Is the theory based on evidence which is objective/ valid/ reliable?

Scientific method

Behavioural therapy

Token economy

Link the therapy with the explanation

According the behavioural approach, schizophrenia, like any other behaviour is learnt

from the environment through operant conditioning or social

learning

The behaviour can be unlearnt and replaced by a more

adaptive behaviour using the same processes

Token economyIt is based on operant conditioning therefore it is called a behaviour modification technique

The aim is to modify directly observable

behaviours

It involves three main steps

•Identifying the undesirable or maladaptive behaviour•Identifying the reinforcers that maintain such behaviour•Restructuring the environment so that the undesirable behaviour is no longer reinforced

How it works ....

Undesirable behaviour is repeated because it is being reinforced

Remove reinforcers (behaviour then becomes less likely to be repeated)

Punishment will also decrease the likelihood of the behaviour being repeated

Desired behaviour is displayed

Positive reinforcement is given i.e. token

The tokens then can be exchanged for privileges i.e. Watching TV,

listening to music, sports activity.

Basic commodities like food, water and sleep are human rights they

cannot be withheld from patients

Evaluation• It changes only

observable behaviours but does it change delusions, hallucinations?

• Ayllon and Azrin(1968) found that tokens were effective in eliminating undesired behaviours and maintaining desired behaviours.

• Kazdin & Bootzin(1972) have claimed that the token economy does not lead to permanent behavioural change, and that once the reinforcement is removed, the undesirable behaviours return to their initial level.

• The token economy system is only effective if the tokens are given immediately after the desired behaviour has occurred. The longer the interval between the behaviour and the token the less likely it is that learning will take place.

• There ethical problems (i.e. punishments).

• It requires an environment where the therapist is in total control. It might not work when the patient goes back in the community.

• When the tokens are stopped the undesirable behaviours are displayed again leading to rehospitalisation.

• Patients in psychiatric hospitals are also on drugs so it is difficult to say what lead to the improvement.

• It fails to address the underlying causes of schizophrenia.

• It does not have serious side-effects unlike drugs.

• It require consistency so staff have to be trained.

• It is expensive as it requires a lot of input from the staff

Cognitive explanation

Cognitive explanationAssumption: mental disorders including schizophrenia are caused by “faulty” thinking.

We are normally able to filter incoming stimuli and process them to extract meaning it is thought that these filtering mechanisms and processing systems are defective in the brains of schizophrenics

Cognitive theorists assume that these cognitive deficits are due to underlying

physiological abnormalities

In a non-schizophrenic

Filter

The person is able to filter out the unwanted stimuli

This non-schizophrenic individual is discussing a newspaper article with the woman.He filters out all other irrelevant auditory stimuli.

In a schizophrenic

Filter

Schizophrenics become overwhelmed with sensory information that they are unable to process and interpret.

This schizophrenic individual is discussing a newspaper article with the woman.He is unable to filter out all other irrelevant auditory stimuli.

Frith’s model

• Frith distinguishes between conscious and preconscious processing.

• Conscious processing is where the highest level of cognitive functioning takes place, we are aware of this level. This has a limited capacity so we can only carry out one task at a time.

• The preconscious processing, takes place without our awareness, this an automatic process and we can carry out many tasks at any one time

• Usually only important information arrives into conscious awareness, in schizophrenics, Frith proposes that the attentional filter breaks down and the unimportant information also gets in the conscious so it is seen as something important which needs to be acted upon.

• Frith believes that it is how delusions happen

• Frith explains auditory hallucinations in a similar way.

• We are bombarded with sounds constantly and preconscious mechanisms interpret these sounds and only the significant sound reach the conscious level of processing. If the conscious/preconscious filter is defective, it is possible that we misinterpret non-speech sounds as speech and experience them as voices.

Hemsley’s model

• Non-schizophrenic individuals give meaning to new sensory input by using subconsciously previously stored knowledge (schemas).

• Hemsley proposes that this process breaks down in schizophrenics and that the schemas are not activated, therefore they are subjected to an overload of sensory information and do not know which to attend to.

Incidents which would be considered as superficial and without meaning could be seen as highly relevant by a schizophrenic.

The conversation between two people in a restaurant could be interpreted as having high personal relevance.

Internal speech and thoughts are not recognised as such but as experienced as coming from an external source and experienced as auditory hallucinations

Over to you....

Evaluation

Remember me!!

EvaluationMeyer-Lynderberg et al. (2000) found a link between excess level of dopamine in the prefrontal cortex and dysfunctions of the working memory. Working memory dysfunction is associated with cognitive disorganisation typical of schizophrenics. This supports the idea that underlying biological factors are involved in schizophrenia.

• The models cannot explain why the voices heard are so negative and abusive or suggest reprehensible acts.

• The cognitive approach explain mainly positive symptoms.

• Bental et al. (1991) found that Szsstruggled to identify words belonging to a certain category, such as birds, that they had seen before, created themselves or had not seen before , supporting Frith’s theory that people with Sz had metarepresentationproblems.

• It could explain why delusions are often influenced by cultural factors i.e. a French schizophrenic might think he is Napoleon whereas a British one might think he is Nelson

• It is reductionist because despite the fact that it takes into account physiological factors, it does not take into account the influence of early childhood conflicts (psychodynamic explanation) or social factors such as stress or urbanicity

• It has given rise to CBT which seems to improve the outcome for many schizophrenics (see therapy) and has no side-effects.

Cognitive Behavioural Therapy

Link the therapy with the explanation

According the cognitive approach, schizophrenia, like any other mental disorder is caused by faulty thinking

The aim of CBT is to change faulty belief

systems.

CBTThe form of CBT used with schizophrenics is personal therapy

Therapies involve identifying the particular problem the individual has (e.g. auditory hallucinations, delusional beliefs), what triggers the problem, and the strategies the person uses to deal with the problem.

1. The therapist first aims to develop a trusting and respectful relationship with the patient

2. Let the patient explain his/her confusing, distressing experiences i.eabusive voices

3. Uncover any patterns or triggers in the client’s distressing experiences

4. Challenge gently the clients beliefs

5. Develop strategies to deal with the distressing experiences

“How long do you think others have been talking about you?”

“Are there any other possible explanations for what happened?”

Involves at least 16 one to one sessions

Evaluation• The metaanalysis carried out by NICE (2009)

on 2118 patients did not show statistically significant differences between CBT and standard care for outcomes related to mortality (suicide), relapse or treatment adherence.

• It is a palliative treatment not a cure however it seems to produce long-term improvement in some patients but is uncertain whether it is caused by cognitive remodelling or the relationship between the client and the therapist.

• It is more effective in treating the positive symptoms than the negative symptoms.

• Lewis et al. 2002: if CBT is used during the first episode it shortens the lenght of that episode but 18 months later the patients suffer the same relapse rate as pateients who did not have CBT.

• It is usually given to individuals who are also on antipsychotic treatment and might also be involved in other therapies so it is difficult to determine whether the improvements are due to CBT rather than the other therapies used.