1. Treatments/Interactionist approach

2. Identify and discuss two reasons why people have criticised Zimbardo’s prison study (6)
One way Zimbardo’s research has been criticised was because of ethical concerns. It has been argued that Zimbardo failed to protect his participants from psychological harm as the prisoners suffered visible distress during the experiment. However, Zimbardo did stop the experiment after only six days even though it was due to take place over two weeks. A further criticism is that Zimbardo himself had a role as prison superintendent. It can be argued that this stopped him from viewing the study in an objective way and that his own behaviour contributed to the findings. This therefore, could have influenced the validity of the findings because if he hadn’t taken part the findings may have been different.

3. Check your understanding
Answer the following question: (make sure all 3 are covered by your group)
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)
Activity: Swap your question: can you improve your friends answer?

4. 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.

5. 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).

6. 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.

7. Apply it. Read the following scenarios
Apply it! Read the following scenarios. 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.

8. Apply it. Read the following scenarios
Apply it! Read the following scenarios. 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. 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."

9. Possible Essay titles: SZ
Issues with classification and diagnosis
Biological explanations
Biological treatments
Psychological explanations
Psychological treatments
Compare and contrast biological and psychological treatments
Interactionist approach

10. Interactionist approach
Schizophrenia
Interactionist approach

11. Make sure you can justify their positions!
To Start…
Nature
Nurture
Place the following into the diagram above:
Dopamine Hypothesis -Expressed Emotion
Double Bind CBT
Anti-Psychotics Schizophrenia
Make sure you can justify their positions!

12. Exam focus
Describe and evaluate the interactionist approach to both explaining and treating schizophrenia (16 marks).

13. The Interactionist Approach
Acknowledges there are biological, psychological and societal factors in the development of sz. Biological = genetic vulnerability and neurochemical and neurological abnormality Psychological = stress resulting from life events and daily hassles, including poor quality interactions in the family

14. The Diathesis-Stress Model
SZ is result of combination of psychological/environmental and Bio/genetic influences
Symptoms of SZ are triggered or made worse when significant stressors in a persons life are combined with ‘bio’ vulnerability.
Explains why not all people who have a genetic predisposition go on to develop the disorder
- A vulnerability to sz and a stress-trigger are necessary to develop sz
- One or more underlying factors make a person vulnerable but the onset of the condition is triggered by stress

15. 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

16. Modern Understanding of Diathesis
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

17. 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 sz e.g cannabis
Cannabis is a stressor because it increases the risk of sz x7 as it interferes with the dopamine system
However most don’t develop sz after smoking cannabis so there must be other vulnerability factors
Interesting article:
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.

18. Outline the diathesis-stress model of schizophrenia. (6 marks)
Exam focus
Outline the diathesis-stress model of schizophrenia. (6 marks)  

19. 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 yrs, 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 ‘health’ 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.

20. 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

21. Apply it: Alison

22. Apply it: The interactionist approach
In the article by Houston et al (2008) regarding cannabis and Sz, the participants responded to a survey; 543 reported a childhood sexual trauma and 643 reported using cannabis before the age of 16.
1. is the data above quantitative or qualitative? Explain your answer (2 marks)
2. Surveys can involve questionnaire or interview. Outline one advantage of using a questionnaire to gather this data (2 marks)
3. what is a closed question? (1 mark)
4. why might a closed question be used here? (2 marks)
5. explain one ethical issue with the study (2 marks)

23. A03 Evaluation Graph
Create an evaluation graph for the Interactionist approach to schizophrenia.
Each bar represents a strength/weakness.
The length of the bar depends on how far you think it’s a strong or weak point.
Inside each bar, describe/state/explain what the point is.
Interactonist Approach
Limitation of approach
Strength of approach
Challenge: Annotate each of your bars with a justification on it’s length. Why have you made each bar the length that it is?

24. Mind-map all of schizophrenia
Plenary
Mind-map all of schizophrenia