Psychological explanations of schizophrenia and therapies

1. Psychological explanations of schizophrenia and therapies

2. Behavioural explanation Assumption: schizophrenia like any other behaviour is learnt from the environment AO1 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? AO1

3. Psychological Explanations;Behavioural approach • Behaviourists argue that learning plays a key role in the development of schizophrenia. One suggestion is that early experience of punishment may lead the child to retreat into a rewarding inner world. Others then label them as ‘odd’ or ‘strange’. • Scheff’s (1966) labelling theory suggests that individuals labelled in this way may continue to act in ways that conform to this label. Bizarre behaviour is rewarded with attention, and becomes more and more exaggerated in a continuous cycle before being labelled as ‘schizophrenic’

4. Psychological Explanations;Behavioural approach • Behaviourists have attempted to explain schizophrenia as the consequences of faulty learning. • If a child receives little or no social reinforcement early on in life, the child will attend to inappropriate and irrelevant environmental cues, instead of focusing on social stimuli in the normal way. • Behaviourists explain the fact that schizophrenia runs in families as a function of social learning. Bizarre behaviour by parents is copied by children. Parents then reinforce this behaviour and the behaviour becomes progressively more unusual, until eventually the child acquires the label of being ‘schizophrenic’

5. There is another way.... Social learning theory AO1 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.

6. 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

7. Evaluation The 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. AO2 AO2

8. 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. AO2 AO2 AO2

9. 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. AO2 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 AO2 AO2

11. Behavioural therapy Token economy

12. 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

13. Token economy It 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

14. How it works .... Remove reinforcers (behaviour then becomes less likely to be repeated) Ethics Undesirable behaviour is repeated because it is being reinforced 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

15. 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.

16. 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.

17. 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

18. Psychological Treatment;Behavioural • Implosion- Extinguishing anxiety by inducing the client to imagine intensely anxiety-provoking scenes that, because they produce no harmful consequences, lose their power to induce fear. • Flooding- Extinguishing anxiety by exposing the clients to actual fear-producing situations that, because they produce no harmful consequences, lose their power to induce fear. • Modeling- Exposing clients to desired behaviour that is modeled by an other person, and rewarding the client for imitating that behaviour.

19. Evaluation • The validity of the behavioural model is moderately supported by the success of behavioural therapies used with schizophrenic patients. • Social skills training techniques have been used to help schizophrenics acquire useful social skills (Rodger et al.,2002). Allyon & Azrin (1968) have shown that schizophrenics have learned to make their own beds, comb their own hair etc. when given rewards for doing so. • Finally Roder et al. (2002) has demonstrated that social skills training techniques have been used to help schizophrenics acquire social skills.

20. Evaluation • The success of such programmes in teaching new skills and reintegrating schizophrenics back into the community suggests that these are skills that schizophrenics failed to learn in the first place. • Overall this research can explain how schizophrenia symptoms are maintained but it does not adequately explain where they came from in the first place. • Critics claim that labelling theory ignores strong genetic evidence and trivialises a serious disorder. In what ways could it be argued that the behaviourist approach to schizophrenia is reductionist?

21. Potential Exam Questions Describe two psychological explanations of the Schizophrenia Evaluate these explanations of Schizophrenia “Psychologists believe that Schizophrenia can be explained solely by biological factors” Discuss this claim with reference to the above quotation. Describe and evaluate at least two issues in classifying or diagnosing schizophrenia a) Explain issues relating to classifying schizophrenia as a mental disorder (5) b) Discuss two explanations of schizophrenia from different perspectives in psychology Describe and evaluate two psychological treatments of Schizophrenia Describe the clinical characteristics of Schizophrenia Explain and evaluate issues relating to the diagnosis of Schizophrenia as a mental disorder Discuss the extent to which biological therapies can be used to treat Schizophrenia.