8. Cognitive explanations for schizophrenia

What are the underpinning principles of the cognitive approach?

• Behaviour is dictated by thought processes.

• Our behaviour can be explained as a series of responses to external stimuli.

• It is a nomothetic approach - universal.

• This approach does start off by acknowledging that some symptoms are biological in nature so it is not purely cognitive.

• The explanation focuses on Type 1 or positive symptoms which are a result of increased levels of dopamine.

• The cognitive element comes in when the patient tries to make sense of these symptoms.

What is Frith’s attention deficit theory?

• Frith suggests that schizophrenics have a higher self-awareness compared to ‘normal’ people which means they struggle to filter out unnecessary noises.

• Every day, we have hundreds of thoughts - some we process and do something with, some of which are subconscious and have no effect on us.

• Frith says that people with schizophrenia can’t do this - they can’t ignore the more minor thought process we all have and instead try and process all thoughts that result in ‘cognitive noise’.

• The thoughts we can ignore, may be experienced an an external voice telling them what to do which can lead to further delusions and worsening of existing symptoms.

• PET scans of people with schizophrenia show under-activity in the frontal lobe of the brain, which is linked to self-monitoring, processing centre.

Explain how we actually need to use a holistic approach to understanding schizophrenia

• This approach does start off with acknowledging that some symptoms are biological in nature so it is not purely cognitive.

• The explanation focuses on type 1 or positive symptoms which are a result of increased levels of dopamine.

• The cognitive element comes in when the patient tries to make sense of these symptoms.

• When schizophrenics try and explain their hallucinations or delusions, they do not receive any kind of conformation or reinforcement that this is true.

• People will tell them they can’t confirm what they are saying, this may increase feelings of persecution and paranoia in the patient, and symptoms become worse.

• The cognitive approach says that the symptoms arise as a mistaken attempt to understand their experience that results from abnormal biological functioning in the brain.

• In addition patients experience ‘cognitive overload’ - reduced levels of a neurotransmitter cause the brain to struggle more in processing information.

• This leads to cognitive insufficiency, and sets the person on the pathway to developing psychosis.

• This suggests that there is a pre-existing biological risk factor, which then affects the person’s cognitive abilities.

• If there is a significant stressor in the individuals life, this will lead to continuing decline in cognitive processing, which could result in schizophrenia.

• Thus, although focusing on cognitive explanations for the disorder, separating the biological factors is not easy and ultimately the explanation may be rooted in biology.

How does Hugdhal (2008) research give evidence to suggest that auditory hallucinations have a biological basis?

• Auditory hallucinations are among the most common symptoms in schizo, affecting more than 70% of patients.

• Research suggests a strong link between the left hemisphere of the brain, particularly the temporal lobe, and the occurrence of auditory hallucinations in individuals with schizophrenia.

• Research using dichotic listening tests (where different sound are presented to each ear simultaneously) often shows a left ear advantage in schizophrenia patients with hallucinations, suggesting a deficit in the left hemisphere’s ability to process auditory information.

• Hugdhal’s research hypothesised that auditory hallucinations are internally generated speech perceptions that are lateralised to the left temporal lobe, in the peri-sylvian region.

• This shows the difference in brain activity so we have to accept the biological factor as well.

What is social drift theory? - alternative

• Evidence has suggested that schizophrenia is more prevalent in lower social classes in society and this has been explained by the social drift hypothesis.

• This theory suggests that the symptoms of schizophrenia make it difficult for patients to hold down jobs, achieve well in education, and maintain relationships - so they often drop down into lower social and economic classes in society.

• Therefore, there are greater concentrations of people with schizophrenia in the more deprived areas than in more affluent areas in society.

• People with schizophrenia also drift into the more urban areas because they can gain better access to support services than is possible in rural areas.

• E.g. there is generally more cheap housing, food kitchens, and social service provision available in cities than in small towns or villages, which can encourage people with schizo to drift into these different societal areas.

What has research evidence supported?

• Research evidence has supported the idea that cognitive deficits are often associated with schizophrenia.

How does Gold and Harvey’s (1933) research support the idea that cognitive deficits are often associated with schizophrenia? - A03 support

• Gold and Harvey report that people with schizophrenia often score lower on tests of attention, memory and problem solving, than similar people without the disorder.

• Supports Friths attention deficit - people with schizophrenia couldn’t concentrate.

How does McGuigan (1966) research support the idea that cognitive deficits are often associated with schizophrenia? - A03 support

• McGuigan identified that immediately before episodes of auditory hallucination were reported, some schizophrenic patients showed activation of the vocal centres.

• Which may suggest they misinterpreted their own ‘inner voice’ as belonging to someone else.

How does McGuire (1996) support McGuigan? - A03 support

• Supported by McGuire who discovered that during hallucinations, the part of the brain in the temporal lobe responsible for identifying and monitoring ‘inner speech’ recorded reduced activity.

• Suggests that the individuals might have been experiencing an internal conversation, but were more likely to perceive the voice as belonging to someone else.

• McGuire is support for hallucinations being biological.

How do these findings support Frith’s explanaion? - A03 support

• These findings support Frith’s explanation as it suggests that patients with schizophrenia were unable to distinguish their own thoughts, that is, they had problems with perception.

What is one criticsm of the cognitive explanation to do with biological factors? - A03 criticisms

• One criticism of this explanation is that, although the explanation focuses on the cognitive processing of the patient and how this may result in symptoms of psychosis, the underlying cause of the cognitive processing deficits is often attributed to biological factors.

• It is actually biological abnormalities that cause the cognitive deficits.

How does Beck (2009) show biology’s role? - A03 criticisms

• For example in a book by Beck (2009) the researchers summarise the effect of dopamine reduction on ‘cognitive loading’ - meaning that reduced levels of the neurotransmitter cause the brain to struggle more in processing information.

• Leads to cognitive insufficiency, and sets the person on the pathway to developing psychosis.

• Suggets that there is a pre-existing biological risk factor, which then affects the person’s cognitive abilities.

• If there is a significant stressor in the individuals life, this will lead to a continuing decline in cognitive processing, which could result in schizophrenia.

• Thus, although focusing on cognitive explanations for the disorder, separating out the biological factors is not easy and ultimately the explanation may be rooted in biology.

What did Sitskoom (2004) find in terms of cognitive deficits - A03 criticisms

• Sitskoom found that the cognitive deficits found in patients with schizophrenia were also found in relatives of the patients who did not have the disorder.

• Suggests that there may be some genetic component underlying the cognitive deficit that is triggered in some people and not others.

Nature vs Nurture evaluation - synoptic A03

• Biological explanations of schizophrenia suggest nature has the biggest influence on developing the illness, while social explanations would focus more on nurture as the cause.

• These two opposing views are part of a fundamental debate underpinning work in clinical psychology in relation to whether disorders are something that develop due to internal factors mostly beyond our control, or whether mental health problems stem from external factors.

• The cognitive explanation of schizophrenia suggets that the disorder is rooted in nature as the ability of the brain to process information will be best explained by biological factors.

• However cognitive psychologists often talk about ‘stressors’ triggering the underlying problem, and these are usually external/environmental issues.

• This may suggest that there is a combination of factors that must be present in order for a person to develop schizophrenia.

• This diathesis-stress model would suggest schizophrenia develops as a result of an interaction between biological vulnerability and environmental stressors.

• This could explain why not everyone who has the genes associated with schizophrenia goes on to develop it (e.g. only 48& concordance rate in MZ twins) and why there are more diagnoses of schizophrenia in city-dwellers (e.g. increased social stress.)

Reductionism vs Holism evaluation - synoptic A03

• The cognitive explanation can be considered somewhat holistic because it acknowledges the role of biological factors in shaping cognition.

• Cognitive psychologists also talk about 'stressors' which can trigger the underlying problem - and these can be environmental issues/social.

• However it is still reductionist as it mainly focuses on internal mental processes and doesn't fully integrate biological and environmental influences into a holistic explanation.

Psychological knowledge in society evaluation - synoptic A03

• The cognitive explanation fosters psychological knowledge in society as it has led to effective treatments such as CBT, improving patients' quality of life.

• However its reliance on a combination with drug therapy suggests it may not provide a complete explanation of schizophrenia.

Psychology as a science evaluation - synoptic A03

• It is difficult to empirically test/measure thoughts and the actual information processing because they are not tangible.

• Therefore it makes the cognitive approach less scientific.