the interactionist approach to schizophrenia

what is the interactionist approach to schizophrenia

acknowledges there is a interaction between biological , psychological and social factors in the development of schizophrenia

what are the

• biological factors 

• psychological factors

• social factors 

biological factors - genetic vulnerability and neurochemical/ neuroabnormality 

psychological factors - stress

social factors - poor equality interactions in the family

the diathesis-stress model 

• the diathesis- stress model is a way to present an i____ a___ 

• what does diathesis mean?

• what does stress part mean ?

• the diathesis-stress model says what 2 things? are necessary in order to develop the disorder

• a person may have an u____ f____ of g____ v____ but the disorder will only develop if what?

• stronger diathesis (vulnerability) means what?

the diathesis-stress model 

• the diathesis- stress model is a way to present an interactionist approach 

• diathesis = vulnerability 

• stress = a negative experience 

• the diathesis-stress model says both a vulnerability to schizophrenia and a stress trigger are necessary in order to develop the disorder

• a person may have an underlying factor of genetic vulnerability but the disorder will only develop if they also experience stressful life events that trigger

• stronger diathesis (vulnerability) - less stress to trigger

the diathesis-stress model 

• what are 4 examples of diathesis ?

• what are 3 stressors ?

the diathesis-stress model 

Diathesis 

• genetic factors 

• physical trauma prenatally or during birth 

• structural abnormalities in the brain 

• abnormalities in neurotransmitter system 

stressors 

• e,g social status associated with poverty 

• family environment with high expressed emotion 

• drug use (especially marijuana) 

original diathesis-stress model

• In the original diathesis-stress model (M____ 1962) diathesis (vulnerability) was entirely g____ - the result of what?.

• This led to the idea of a what?

• According to P___ M____, if a person does not have the s____ then no amount of s____ would lead to schizophrenia.

• However, in c____ of the g___, c____ s___ through c____ and a____, in particular the presence of a s____ mother could result in the d_&& of the disorder.

original diathesis-stress model

• In the original diathesis-stress model (Meehl 1962) diathesis (vulnerability) was entirely genetic - the result of a single 'schizogene.

• This led to the idea of a biologically based schizotypic personality, one characteristic of which is sensitivity to stress.

• According to Paul Meehl, if a person does not have the schizogene then no amount of stress would lead to schizophrenia.

• However, in carriers of the gene, chronic stress through childhood and adolescence, in particular the presence of a schizophrenogenic mother could result in the development of the disorder.

Modern understanding of diathesis

• what is one way our understanding of diathesis has changed ? and which psychologists is linked?

• Modern views of diathesis also include a range of factors beyond the g____, including p____ t_____ (I____ and L___ 2005) - so trauma becomes the d___ rather than the s____.

J___ R___ et al. (2001) proposed a n_____ model in which e____ t____ alters the d____ b___  

• e____ and severe enough t___, such as c___ a____, can seriously affect many aspects of b___ d___.

• For example the h____-p___-a____ (HPA) system can become o____, making a person much more v____ to l___ s___

Modern understanding of diathesis

• One way in which our understanding of diathesis has changed is that it is now clear that many genes each appear to increase genetic vulnerability only slightly, there is no single 'schizogene' (Ripke et al. 2014).

• Modern views of diathesis also include a range of factors beyond the genetic, including psychological trauma (Ingram and Luxton 2005) - so trauma becomes the diathesis rather than the stressor.

John Read et al. (2001) proposed a neurodevelopmental model in which early trauma alters the developing brain  

• Early and severe enough trauma, such as child abuse, can seriously affect many aspects of brain development.

• For example the hypothalamic-pituitary-adrenal (HPA) system can become overactive, making a person much more vulnerable to later stress.

modern understanding of stress

• In the original diathesis-stress model of schizophrenia, stress was seen as what and related to what?

• Although psychological stress (including that resulting from p____) may still be considered important, a m___ definition of stress (in relation to the diathesis-stress model) includes what (H____ et al. 20___)

• Much of the recent research into f___ t____ an episode of schizophrenia has concerned c____ u___.

• In terms of the diathesis-stress model c____ is a s___ because it i___ the r___ of schizophrenia by up to s___ times according to dose.

• This may be because c___ interferes with what?

• however, most people do not develop schizophrenia after smoking c____- why?

modern understanding of stress

• In the original diathesis-stress model of schizophrenia, stress was seen as psychological in nature, in particular related to parenting.

• Although psychological stress (including that resulting from parenting) may still be considered important, a modern definition of stress (in relation to the diathesis-stress model) includes anything that risks triggering schizophrenia (Houston et al. 2008)

• Much of the recent research into factors triggering an episode of schizophrenia has concerned cannabis use.

• In terms of the diathesis-stress model cannabis is a stressor because it increases the risk of schizophrenia by up to seven times according to dose.

• This may be because cannabis interferes with the dopamine system.

• however, most people do not develop schizophrenia after smoking cannabis presumably because they lack the vulnerability factors.

treatment according to the diathesis-stress model

• The interactionist model of schizophrenia acknowledges what? and is therefore compatible with what 

• In particular the model is associated with combining what? what 

• T_____ et al. (20___) point out that it is possible to believe in ahat? and still practise what? 

• ↓

• However, this requires adopting an i____ model - it is not possible to adopt a purely b____ approach and tell people diagnosed with schizophrenia that their condition is purely b____ and that there is no p___ significance to symptoms, and then to simultaneously treat them with what?

treatment according to the diathesis-stress model

• The interactionist model of schizophrenia acknowledges both biological and psychological factors in schizophrenia and is therefore compatible with both biological and psychological treatments.

• In particular the model is associated with combining antipsychotic medication and psychological therapies, most commonly CBT.

• Douglas Turkington et al. (2006) point out that it is possible to believe in biological causes of schizophrenia and still practise CBT to relieve psychological symptoms.

• ↓

• However, this requires adopting an interactionist model - it is not possible to adopt a purely biological approach and tell people diagnosed with schizophrenia that their condition is purely biological and that there is no psychological significance to symptoms, and then to simultaneously treat them with CBT.

treatment according to the diathesis-stress model

• In Britain it is increasingly standard practice to treat people diagnosed with schizophrenia how?

• In the US there is more of a history of c____ between p_____ and b____ models of s____ and this may have led to slower adoption of an interactionist approach.

• Thus medication what? is more common in the US than in the UK.

treatment according to the diathesis-stress model

• In Britain it is increasingly standard practice to treat people diagnosed with schizophrenia with a combination of antipsychotic drugs and CBT.

• In the US there is more of a history of conflict between psychological and biological models of schizophrenia and this may have led to slower adoption of an interactionist approach.

• Thus medication without an accompanying psychological treatment is more common in the US than in the UK.

evaluation of the interactionist approach to schizophrenia- ✓strengths

✓- One strength of the interactionist approach to schizophrenia is evidence supporting what?

• In a large-scale study, T___ et al. (2004) investigated the impact of what 2 things.

• The study followed how many F___ children? whose biological mothers had what?

• In adulthood this h____ g____ r___ group were compared to a c___ group of a____ without a f____ h____ of schizophrenia (l___ g___ risk).

• Adoptive parents had been assessed for what? and it was found that high levels of what 2 things?  and low levels of e___ were strongly associated with the development of schizophrenia, but only in the h___ g___ r___ group

• This shows that a combination of what 2 things? can lead to greatly increased risk of schizophrenia.

evaluation of the interactionist approach to schizophrenia- ✓strengths

✓- One strength of the interactionist approach to schizophrenia is evidence supporting the role of both vulnerability and triggers.

• In a large-scale study, Tienari et al. (2004) investigated the impact of both genetic vulnerability and a psychological trigger (dysfunctional parenting).

• The study followed 19,000 Finnish children whose biological mothers had been diagnosed with schizophrenia.

• In adulthood this high genetic risk group were compared to a control group of adoptees without a family history of schizophrenia (low genetic risk).

• Adoptive parents had been assessed for child-rearing style and it was found that high levels of criticism, hostility and low levels of empathy were strongly associated with the development of schizophrenia, but only in the high genetic risk group

• This shows that a combination of genetic vulnerability and family stress can lead to greatly increased risk of schizophrenia.

evaluation of the interactionist approach to schizophrenia- ✓strengths

✓- One further strength of the interactionist approach is in r____-w__ application the combination of biological and psychological treatments.

• A practical application of has been the combination of what 2 things? . Studies show that combining treatments e___ their e____.

• For example T___ et al. (20__) r___ a___ how many participants to what 3 groups?

• Participants in the two c____ groups showed lower symptoms following the trial than the m____-o___ group, though there was no difference in hospital readmission.

• This means that there is a clear practical advantage to what?

evaluation of the interactionist approach to schizophrenia- ✓strengths

✓- One further strength of the interactionist approach is in real-world application the combination of biological and psychological treatments.

• A practical application of has been the combination of drug treatment and psychological therapies. Studies show that combining treatments enhances their effectiveness.

• For example Tarrier et al. (2004) randomly allocated 315 participants to :

(1) medication + CBT

(2) medication + counselling,

(3) control group (medication only)

• Participants in the two combination groups showed lower symptoms following the trial than the medication-only group, though there was no difference in hospital readmission.

• This means that there is a clear practical advantage to adopting an interactionist approach to schizophrenia in terms of superior treatment outcomes.

evaluation of the interactionist approach to schizophrenia- ✘limitations

✘- One limitation of the original diathesis-stress model is o____.

• It is now clear that the original model that portrayed diathesis how? portrayed stress as what? is simplistic

• m____ g____ in m____ c____ influence diathesis.

• Stress also comes in m___ f___, including but not l___ to dysfunctional parenting

• . In fact diathesis can also be influenced by p____ factors and s___ can be b____ as well as p___.

• This is shown in a study by H____ et al. (20___), in which whatemerged as the major influence on underlying vulnerability to schizophrenia? and what as the major trigger?

• This means that there are multiple factors, both biological and psychological, affecting both diathesis and stress, supporting the modern understanding of both diathesis and stress.

evaluation of the interactionist approach to schizophrenia- ✘limitations

✘- One limitation of the original diathesis-stress model is oversimplicity.

• It is now clear that the original model that portrayed diathesis as a single schizogene and portrayed stress as schizophrenogenic parenting is simplistic

• Multiple genes in multiple combinations influence diathesis.

• Stress also comes in many forms, including but not limited to dysfunctional parenting

• . In fact diathesis can also be influenced by psychological factors and stress can be biological as well as psychological.

• This is shown in a study by Houston et al. (2008), in which childhood sexual abuse emerged as the major influence on underlying vulnerability to schizophrenia and cannabis use as the major trigger.

• This means that there are multiple factors, both biological and psychological, affecting both diathesis and stress, supporting the modern understanding of both diathesis and stress.

evaluation of the interactionist approach to schizophrenia- ✘limitations

✘– One limitation of the interactionist approach is that the success of combined treatments does not necessarily prove what?

• J___ and O____ (2019) argue that this makes a t____-c _____ f____ — assuming that because a treatment works, it must reflect the true cause of the disorder.

• For example, just as alcohol reducing shyness doesn’t mean shyness is caused by a lack of alcohol, the fact that combining drug therapy and CBT helps schizophrenia doesn’t prove that schizophrenia is what?

evaluation of the interactionist approach to schizophrenia- ✘limitations

✘– One limitation of the interactionist approach is that the success of combined treatments does not necessarily prove that the interactionist explanation is correct.

• Jarvis and Okami (2019) argue that this makes a treatment-causation fallacy — assuming that because a treatment works, it must reflect the true cause of the disorder.

• For example, just as alcohol reducing shyness doesn’t mean shyness is caused by a lack of alcohol, the fact that combining drug therapy and CBT helps schizophrenia doesn’t prove that schizophrenia is caused by both biological and psychological factors.