Psychological Approach to Schizophrenia


Explanations - Behavioural

The behavioural approach does not see schizophrenia as a mental disorder, rather a learned condition through social learning theory and the principles of classical and operant conditioning. 

Scheff reported that people behave bizarrely as children and are then 'labelled' as this. They then fulfill this label by playing the role, and are positively reinforced for the behaviour by recieving the reward of attention. 

Ullman and Krasner supported this theory, reporting that staff in hospitals reinforce schizophrenic behaviours by paying more attention to these behaviours. However this could a way for genuinely ill patients to gain more support from hopsital staff.

The explanation has been criticised for being extremely reductionist, ignoring strong genetic evidence and simplifying a very serious disorder. However, the approach does have some supporting evidence, and so it may be more appropriate to use the diathesis-stress model in order to explain the causes of schizophrenia. 

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Explanations - Cognitive

Cognitive explanations see faulty thoughts as the cause for schizophrenic symptoms. For example, the role of attention is involved as schizophrenics struggle to filter out irrelevant external information, causing them to become overwhelmed and subject to sensory overload. Laboratory studies support this, showing that schizophrenic participants struggle with tasks that require them to pay attention to some stimuli whilst ignoring others. 

Positive symptoms are believed to be liked with problems in meta-representations and an inability to distinguish internal thoughts and external speech. This may lead to hallucinations and 'hearing voices'. Negative symptoms such as disorganised thinking are thought to be due to problems in central control.

Frith conducted a study giving schizophrenics and non-schizophrenics a task involving two choices. They were asked to predict the next playing card in a deck as either black or red. Schizophrenics tended to produce predictable patterns such as RBRBRB, whereas non-schizophrenics produced more random responses. This suggests sufferers tend to struggle generating spontaneous responses. This supports Frith's theory that negative sympotoms are caused by a lack of central control. 

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Treatments - Token Economies

Token economies are derived from the behavioural approach, that suggests that schizophrenia is acquired through a learning process and can therefore be replaced by other behaviours in the same way. 

Token economies provide instant reinforcement for desirable behaviours that can be later exchanged for goods or privalleges by patients. The technique is most appropriate for long term institutional patients, as the therapy does not work as effectively with social reinforcers. 

Ayllon found that special attention paid to resistant patients at mealtimes was acting as a reinforcer for the behaviour, and that locking late patients out of the hall and making thme pay one penny to regain entry caused an increased motivation among patients and staff. To earn pennies, the patients had to display desired behaviours. 

Sultana et al conducted a review of token economy regimes and found that they reduced negative sympotoms in schizophrenic patients, although it was unclear whether these changes were maintained beyond treatment programmes. 

The major issue with the use of token economies is that they undermine patients and treat them as simple simulus-response machines with no free will, meaning the system is deterministic.

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Treatments - CBT

Cognitive behavioural therapy is the main therapy used in treating schizophrenia. It works to modify delusional beliefs and hallucinations within sufferers. Patients are encouraged to identify faulty and distorted beliefs that may have caused the maladaptive behaviours and address them. 

The treatment is questionable in it's appropriateness as it is often used alongside drug therapy, meaning it is difficult to see whether the CBT or the drug therapy is causing the improvement. Encouraging patients to reduce symptoms may be forcing them to mask symptoms, reducing the possible support they may recieve. This raises ethical concerns.

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