Objectives To be able to: Apply your knowledge of psychological treatments of schizophrenia to 3 short exam question Discuss the explanations and treatments of schizophrenia in relation to various case studies To outline and evaluate the interactionist approach to schizophrenia Challenge: To outline the treatment-causality fallacy and to include this point when evaluating the interactionist approach to schizophrenia

ABC: schizophrenia treatments Operant conditioning Primary reinforcers Secondary reinforcers Number yourself 1-2 1 minute to explain each key term Person 2, 1 minute to explain any key term that your partner did not explain 1 minute to use your notes from today to look up any key term you will still unsure of. Challenge: can you answer the key terms with the * next to them after todays lesson?

Check your understanding psychological treatments Individually, answer the following questions on page 61 Describe token economies as a method used in the management of schizophrenia (4 marks) Briefly outline how cognitive behaviour therapy (CBT) is used to treat schizophrenia (4 marks) Briefly outline how family therapy is used to treat schizophrenia (4 marks) Extension: plan an answer to the following exam question ‘outline and compare two treatments for schizophrenia (16 marks)’

Describe token economies as a method used in the management of schizophrenia (4 marks) Token Economies based on the principles of operant conditioning are reward systems used to manage the behaviour of patients with schizophrenia, in particular those who have developed patterns of maladaptive behaviour through spending prolonged periods in hospital.  It is based on the idea of reinforcement - tokens are given after desirable behaviour has been carried out. The tokens themselves have no value but they can be swapped for rewards that do have value to the patient. So the tokens are the secondary reinforces as they only have a value once the patient realises they can be used to get what they actually want.

Briefly outline how cognitive behaviour therapy (CBT) is used to treat schizophrenia (4 marks) CBT works on the premise of challenging beliefs (including origin of ‘voices’) and attempting to reduce distress that the individual feels. The therapist will offer alternative explanations for the patients beliefs through a method of cognitive restructuring. This uses the ABCDE framework based on the work of Ellis and Beck. Firstly the therapist and client will Identify the activating event (A). Then explore the patients beliefs (B) and recognise the consequences from holding the beliefs (C). The therapist will then work with the client in the session to dispute the irrational beliefs (D) ending in restructuring the beliefs of the client (E). Task: If that was a 6 mark question, what else would I have to add to ensure that I was awarded all 6 marks?

Briefly outline how family therapy is used to treat schizophrenia (4 marks) Family interventions are offered for between 3-12 months and are aimed at reducing the level of negative expressed emotions in families that have developed. The main aim of family therapy is to provide support for carers in an attempt to make family life less stressful and so reduce re-hospitalisation. The aim is to develop a trusting and cooperative family. It provides family members with more practical ways of dealing with the schizophrenia that will help them deal with living with schizophrenia (building relationships, decreasing feelings of guilt and responsibility). They are taught constructive ways of communicating and to focus on the good things that happen. They are also taught to recognise the early signs of relapse.

A01/A02: Discuss the explanations and treatments of schizophrenia in relation to various case studies Task: Read the following scenarios. Discuss the possible explanations. Discuss which treatment(s) would be most effective for the individual, and why? Joel is a 20-year-old Chemistry Student. For the last month or so, his family and friends have noticed his behaviour becoming increasingly bizarre. His friends have caught him talking to himself in whispers even though there was no one there. Lately, he refuses to answer or make calls, claiming that his phone has been tapped by the CIA. When a friend goes to visit he finds it very difficult to understand what Joel is saying as it is very disjointed. He states that his family environment is difficult and feels like his father is blaming him for the illness but his mum won’t stop fussing over him.

A01/A02: Discuss the explanations and treatments of schizophrenia in relation to various case studies Task: Read the following scenarios. Discuss the possible explanations. Discuss which treatment(s) would be most effective for the individual, and why? Carol is a 26-year-old single female who has just dropped out of university whilst studying for Medicine. Carol is starting to become withdrawn and socially isolated. She has stopped going to the gym and work and has recently moved back home to live with her family. Carol has been raised in an upper-middle-class family where academic and career success are extremely important. There is a history of mental illness within her family. Carol is hardworking and somewhat self-critical. Currently Carol is experiencing auditory persecutory hallucinations and delusions as well as frequent cognitions like, "I'm no good," "I can't do anything," "I'll always be this way."

Who wants to volunteer? To recap Biopsychology, I would like 4 volunteers to recreate a model of the brain 1) unlimited time / 4 playdough colours 2) unlimited time / due to deficit in dopamine / faulty c4 gene – 3 playdough colours 3) 15 seconds / 4 playdough colours 4) 15 seconds / due to deficit in dopamine / faulty c4 gene – 3 playdough colours

Diathesis-Stress model Go back to the students models Diathesis-Stress model

Real case: Genain quadruplets All four girls share exactly the same genes, and lived in the same family environment. Unfortunately for them but fortunately for science, they share exactly the same genetic predisposition to schizophrenia. Read through the article. Answer the following questions: What happened to the quadruplets? What does the case study tell us about schizophrenia? Extension: develop a peel evaluation point for the interactionist approach https://www.researchgate.net/publication/278328389_The_Genain_Quadruplets_A_55-year_follow-up_of_two_of_four_monozygous_sisters_with_schizophrenia

The Diathesis-Stress Model Symptoms of SZ are triggered or made worse when significant stressors in a persons life are combined with ‘bio’ vulnerability. SZ is result of combination of psychological/environmental and Biological/genetic influences Can explain why not all people who have a genetic predisposition go on to develop the disorder A vulnerability and a stress-trigger are necessary to develop sz

Complete the handout Diathesis-stress model

Meehl’s Model Believed diathesis was entirely genetic, the result of a single ‘schizogene’ This led to the development of a biologically based schizotypic personality, one characteristic is sensitivity to stress According to Meehl, if a person doesn’t have the schizogene then no amount of stress would lead to sz. However, in carriers of the gene, chronic stress through childhood and adolescence, particularly a schizophrenic mother could result in sz

Modern Understanding of Diathesis It is now clear that many genes increase genetic vulnerability. There is no single ‘schizogene’ Modern views of diathesis also include a range of factors beyond the genetic, including psychological trauma – trauma becomes the diathesis rather than the stressor Read (2001) proposed a neurodevelopmental model in which early development in which early trauma alters the developing brain. E.g. The hypothalamic-pituatry-adrenal system (HPA) becomes over-active and the person is more vulnerable to later stress

Modern Understanding of Stress Originally stress was seen as psychological in nature, in particular related to parenting Psychological stress is still seen as important, a modern definition of stress includes anything that risks triggering schizophrenia e.g cannabis Cannabis is a stressor: it increases the risk of schizophrenia x7 as it interferes with the dopamine system However most don’t develop schizophrenia after smoking cannabis so there must be other vulnerability factors Extension: Interesting article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632429/ Remember, you can read the abstract to get a good idea as to what the research did and found. Please at least read the abstract.

Outline the diathesis-stress model of schizophrenia. (6 marks) Exam focus Outline the diathesis-stress model of schizophrenia. (6 marks) Extension: complete the exam questions at the front of your pack on the interactionist approach  

The diathesis-stress model says that both a vulnerability to schizophrenia and a stress-trigger are necessary in order to develop the condition. One or more underlying factors make a person particularly vulnerable to developing the disorder but the onset of the condition is triggered by stress. Meehl’s model saw the diathesis as entirely genetic the result of a single ‘schziogene’. According to Meehl, if a person doesn’t have the schizogene then no amount of stress would lead to sz. However, it is now clear with the modern understanding of diathesis that many genes appear to increase genetic vulnerability slightly (Ripke et al. 2014) However, there is no single ‘schizogene’, the diathesis include a range of factors beyond the genetic, including psychological trauma. In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting. However, modern definitions of stress include anything that is a risk for triggering schizophrenia This can include such things as family dysfunction, substance abuse, critical life events etc. Recent research had focused on cannabis use as a risk factor for triggering schizophrenia. Cannabis is a stressor because it increases the risk of sz x7 as it interferes with the dopamine system

(A02): Apply it

How does Tiernari’s (1987) Finnish Adoption Study provide evidence for the diathesis stress model? Key Study: Tienari et al (2004) Procedure - Hospital records were reviewed for nearly 20,000 women admitted to Finish psychiatric hospitals between 1960 and 1979, identifying those that had been diagnosed at least once with schizophrenia. The list was checked to find those mothers who had one or more of their offspring adopted away. The resulting sample of 145 adopted-away offspring (the high-risk group) was then matched with a sample of 158 adoptees without this genetic risk (low risk group). Both groups of adoptees were independently assessed after an interval of 12 years, with a follow up after 21 yrs. Psychiatrists also assessed family functioning in the adoptive families using a scale – the Oulu Family Rating Scale (OPAS scale). It measures families on various aspects of functioning such as parent-offspring conflict, lack of empathy and insecurity. The interviewing psychiatrists were kept blind as to whether the biological mother was schizophrenic or not. Findings – of the 303 adoptees, 14 developed schizophrenia over the course of the study. 11 of these were from the high risk group and 3 from the low risk group. However, being reared in a ‘healthy’ adoptive family appeared to have a protective effect even for those that had a high genetic risk. In adoptees at high risk of schizophrenia, but not in those at low genetic risk adoptive-family stress was a significant predictor of the development of schizophrenia.

Treatment The interactionist approach also acknowledges both biological and psychological factors is compatible with both types of treatment Model combines antipsychotics with psychological therapies such as CBT Standard practice in GB to combine the two and is unusual to treat using psychological therapies alone

Plan an answer to the following question: A01/A03: 16 mark essay Plan an answer to the following question: Discuss the interactionist approach as an explanation for schizophrenia (16 marks) Extension: before planning an answer to the essay title, what is meant by the term treatment-causation fallacy. Add this as an evaluation point to your pack.

treatment-causation fallacy. Turkington et al argue that there is a logical fit between the interactionist approach and combination treatments. However, the fact that combined treatments are more effective than either on their own does not necessarily mean that the interactionist approach to schizophrenia is correct. This error of logic is called the treatment-causation fallacy.