Therapy For Schizophrenia (Schizophrenia Model Answers) (Paper 3 Model Answers)
Describe and evaluate psychological treatments in explaining schizophrenia (16 marks)
Model Answer
Token economies are based on the principles of operant conditioning, which involve learning through reinforcement. They are used in institutional settings to encourage patients to exhibit socially desirable behavior. When patients display such behavior, they receive tokens that can be exchanged for rewards, such as sweets.
One strength of token economies is the evidence supporting their high ecological validity. Ayllon and Azrin conducted a study involving 45 institutionalised females who received rewards for good behavior and had tokens taken away for undesirable behavior. The study demonstrated significant improvements in behaviour. Since the study was conducted in a natural setting, it possesses high ecological validity and directly addresses symptoms of schizophrenia through token economies. This approach motivates individuals with schizophrenia to engage in more desirable behavior, making it an effective method of symptom management.
However, a limitation of token economies is their superficial nature and short-term effectiveness. Once the rewards cease, the desirable behavior tends to stop as well, indicating that the management of schizophrenia through token economies is temporary. This approach teaches patients that once they obtain what they want, they can return to engaging in undesirable behavior, rendering it unsuccessful in the long run.
Family therapy is another psychological intervention that involves working with members of a family to improve communication, reduce family stress, and resolve conflicts. It also aims to decrease expressed emotion, which refers to negative emotions expressed by caregivers towards the individual with schizophrenia. Pharaoh et al. identified various strategies used in family therapy to enhance family functioning, such as helping family members balance caring for their schizophrenic relatives and their own personal lives.
A strength of family therapy is its effectiveness in managing schizophrenia. Pharaoh et al. found that family therapy reduces the likelihood of readmission to hospitals and improves the quality of life for both patients and their families. However, family therapy alone is often not sufficient for treating schizophrenia, and drug treatments are commonly used in conjunction with it. When used together with drugs, the relapse rate is less than 5%, which is more than double the chance when family therapy is used alone. This finding highlights that schizophrenia is not solely a psychological condition but can also be influenced by biological factors, supporting the diathesis-stress model.
Cognitive-behavioral therapy (CBT) is based on Ellis's ABC model, which involves identifying the activating event, challenging false beliefs, and recognizing the consequences of one's thoughts and behaviors. It aims to help patients identify and correct faulty thinking patterns through techniques like role plays and homework assignments. For example, individuals with schizophrenia are encouraged to reality test their hallucinations and delusions.
A strength of CBT is the evidence demonstrating its effectiveness in managing schizophrenia symptoms. Chadwick et al. reported a case study involving Nigel, who believed he had the ability to predict others' speech. Through reality testing, Nigel was shown over 50 videos, asked to predict the dialogue at specific points, and got none of them right. This experience helped him realize that he did not possess the previously believed ability. While this is valid evidence, it is important to note that it is a case study and cannot be generalized to a wider population. Further research should be conducted to establish the effectiveness of CBT.
A limitation of CBT is the presence of ethical issues. Challenging a person's paranoid beliefs in CBT may interfere with their freedom of thought and potentially have negative effects on individuals with schizophrenia and the wider population. For instance, if CBT challenges a patient's belief in a controlling government, it could result in altering their political views. Such ethical concerns may diminish the validity of psychological therapies like CBT as a method of treating schizophrenia.
Describe the interactionist approach to both explain schizophrenia and as a treatment for schizophrenia (16)
Model Answer
The interactionist approach offers an explanation of schizophrenia that combines genetic vulnerability with a triggering stressor, as described in the diathesis-stress model. The original diathesis model, proposed by Meehl, attributed schizophrenia solely to a biological cause represented by a single "schizogene." According to this model, individuals without genetic vulnerability would not develop schizophrenia, regardless of the level of stress they experienced.
However, the original model's limitation lies in its oversimplified nature. Current understanding recognizes that multiple genes contribute to an increased susceptibility to schizophrenia. There is no single gene that acts as the sole cause of the illness, as acknowledged in the modern diathesis-stress model. This limitation highlights the weakness of the original model and the strength of the updated approach.
In the contemporary understanding of vulnerability (diathesis), it is acknowledged that there is no specific "schizogene" as initially proposed by Meehl. Instead, numerous genes can increase the risk of developing schizophrenia. Research by Ripke et al. identified 108 variations in genetic coding associated with the condition. Additionally, vulnerability may also arise from childhood trauma, such as sexual abuse. The modern understanding also considers the role of the hypothalamic-pituitary-adrenal system, which, when overactive, may increase the likelihood of stress-related factors contributing to the development of schizophrenia.
Furthermore, the current understanding of stress highlights its interaction with genetic vulnerability, as it can serve as a trigger for schizophrenia. For example, Houston et al. found that cannabis use acts as a stressor and significantly elevates the likelihood of developing schizophrenia by interfering with the dopamine system.
Turkington et al. propose that a combination of treatments, including medications and cognitive-behavioral therapy (CBT), should be employed for more effective outcomes. However, successfully implementing this approach relies on adopting an interactionist perspective. While the USA primarily relies on drug treatments alone, the UK combines drugs with CBT.
One strength of the interactionist approach lies in its efficacy as a treatment method. Tarrier et al. conducted a study where patients were randomly assigned to different groups receiving medications, therapies, or a control group with medication only. The results demonstrated that patients in the combined treatment group exhibited lower symptoms compared to those in the control group. This finding underscores the practical advantage of applying an interactionist approach that combines multiple treatments for improved results.
Another strength of the interactionist approach is its consideration of vulnerability. For instance, Tienari et al.'s research on Finnish adoptees revealed that genetic vulnerability from biological parents, combined with stressors from adoptive families, could trigger schizophrenia. This finding supports the interactionist approach by illustrating that the presence of both stress and genetic vulnerability increases the likelihood of developing schizophrenia.
However, a weakness of the interactionist approach lies in the limited understanding of the mechanisms through which the diathesis-stress model operates. The specific process by which schizophrenia manifests and how vulnerability and stress interact to produce symptoms remains unknown. This limitation diminishes the explanatory validity of the interactionist approach, as it provides limited information about the causal mechanisms of schizophrenia concerning genetic vulnerability and stress.
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