Psychological Explanation & Treatments of Schizophrenia L Psychological Explanation & Treatments of Schizophrenia L.O: Describe and evaluate COGNITIVE explanations and treatments of schizophrenia

Psychological Explanations Psychological explanations: Psychodynamic, Behavioural, Cognitive Sociocultural factors: The role of social and family relationships  life events, double bind, Expressed Emotion

What’s going on inside the ‘black box’? I can’t hear what parents are saying My family is plotting against me My papers are not where I left them People are trying to sabotage my career There’s something wrong with me People are laughing on the bus

Cognitive EXPLANATIONS Acknowledges biological factors as a cause of initial sensory experiences e.g. hearing voices. BUT claims further features of the disorder appear as individuals attempt to understand those experiences. E.g. When an individual experiences first sensory symptoms, turn to friends, relatives to help understand them and validate them. When this fails Sz may believe they are hiding things from them  paranoia. This causes the individual to reject feedback and develop delusional beliefs that they are being manipulated.

Cognitive approach Schizophrenia symptoms are the result of faulty information processing. Bentall (2004) presents an account of how psychotic symptoms may occur (but rejects the idea that Sz is a discrete diagnostic entity) Misattributed speech & behaviour* Faulty self-monitoring* Deficits in STM & semantic memory* * make note of these! Executive Function!

Cognitive Deficits & Sz Hallucinations Misattributed inner speech Delusions Attempts to make sense of hallucinatory experiences Once delusion arises, attentional bias maintains it (i.e. you look out for thing that support what you already believe) Disorganised thinking & speech Difficulty distinguishing between thinking and speech Deficits in STM and semantic memory Exacerbated by emotional arousal, resulting in ‘vicious circle’ of disorganisation

Evaluation of Approach Evidence for physical basis of Sz cognitive deficits McGuigan (1966) found the larynx of patients with SZ was often active during the time they claimed to be experiencing auditory hallucinations. This suggests that they mistook their own inner speech for that of someone else. McGuire et al. (1996) found SZs to have reduced activity in those parts of the brain involved in monitoring inner speech. PET scans also show under-activity in the frontal lobe of the brain, which is linked to self-monitoring and so provides biological support for this explanation.

Evaluation of Approach Evidence for physical basis of Sz cognitive deficits Meyer-Lindenberg et al. (2002) : Link between poor working memory & reduced pre-frontal cortex activity Schielke et al. (2000) : auditory hallucinations experienced by individual with abscess in dorsal pons (functions of these includes sensory roles in hearing)

Evaluation of Approach +ve: Accounts for positive symptoms. The cognitive approach provides a reasonable account of many of the positive symptoms of schizophrenia BUT -ve: Generalisability. The self-monitoring explanation accounts for the positive symptoms but not the negative symptoms. Cause or effect? It is not clear whether the cognitive dysfunction is a cause or effect of the disorder. Prospective and longitudinal research with children at risk for schizophrenia being assessed over time or with self-monitoring is necessary to establish the direction of the effect. Brain-damaged patients. Many brain-damaged patients have problems with attention or with the relationship between memory and perception. Despite having these cognitive deficits, however, they fail to develop the symptoms of schizophrenia and so this challenges the cognitive explanations.

‘Where’ & how would YOU intercept faulty cognitions? Cognitive TREATMENT Treatment involves getting the patient to modify their beliefs about their experiences Events in the world Perception Inference Belief Search for new info Source: Bentall (1990) ‘Where’ & how would YOU intercept faulty cognitions?

Cognitive Behavioural Therapy (CBT) Based on the idea that most unwanted thinking patterns, and emotional and behavioural reactions are learnt over a long period of time. Aims to identify thinking patterns causing unwanted feelings and behaviour, and learn to replace them with more realistic and useful thoughts Set behavioural assignments to improve general functioning

CBT Therapeutic Aims CBT strategies to challenge & help modify delusory beliefs Identify delusions Challenge evidence on which delusions are based Design ‘experiments’ to test reality of this evidence Normalising strategies where patient is taught to understand the nature of Sz symptoms Challenge ‘catastrophising’ beliefs about Sz Help patient feel that symptoms are understandable and ‘normal’

Cognitive Treatments – case study Bradshaw, 1998: CBT in long-term outpatient care of a young woman with Sz Measures of psychosocial functioning, severity of symptoms, compliance with treatment and reductions in hospital visits were used to assess change over 3- year treatment period and at 1-year follow-up Results indicate considerable improvement in all outcomes

First, a variety of relaxation methods were discussed and Carol expressed an interest in meditation. She was taught meditation and practised meditation for short periods in each session. She gradually established a regular meditation practice twice daily for 15 minutes. Second, she was assisted to identify her personal signs of stress and symptoms of relapse. These were organised as low, medium and high signs on her ‘stress thermometer’. She posted the thermometer on her door and recorded her "stress temperature" each day.

CBT Efficacy Drury et al (1996): CBT & drugs = 25-50% reduction in positive symptoms and recovery time vs. drugs alone Kuipers et al (1997): when using CBT there was increased satisfaction and low therapy drop-out rates Patients are usually treated with both CBT and drugs therefore it is hard to assess the effectiveness and appropriateness of CBT on its own Helps 70% of patients although other 30% may deteriorate (Kingdon & Turkington, 1996) Chadwick & Lowe (1993) – significant reductions in delusions in 10 out of 12 patients