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Cognitive explanations for schizophrenia focus primarily on how a patient processes information. It is concerned with how they think, and how this may affect their cognitive functions. In this case, we are looking at how cognitive explanations may illustrate how an individual developed schizophrenia by considering their thought processes and cognitive functions, and where impairments in this process exist.
Frith (1979) suggested that schizophrenia was due to a faulty attention system, known as the attention-deficit theory. Preconscious thoughts (thoughts occurring without active awareness or attention, which are an automatic response) filter the world so we are not bombarded with information. If this does not occur, the mind can be overloaded with information.
According to Frith, this is responsible for a majority of the positive symptoms associated with schizophrenia and psychosis (delusions, disorganised speech etc.)
Hemsley (1993) argued that there is a fundamental breakdown between memory and perception in those with schizophrenia. This means memory and perception do not work together as they should. When people with schizophrenia encounter new situations, their schemas do not activate properly, whereas healthy individuals schemas would activate normally.
Schemas are cognitive frameworks that help organise the mind. Proposed by Piaget (Cherry, 2020), they are categories of information and knowledge. Schemas help organise past experiences so an individual can process future events.
This disconnect or lack in the schemas causes patients with schizophrenia to become overloaded when faced with new situations, as their schemas are not activating properly. They don’t know what areas of the situation to attend to, and which parts to ignore, leading to disorganised thinking and abnormal behaviour.
Bentall (1994) states that abnormal attention in those with persecutory delusions in schizophrenia (an inability to recognise what is real), is given to threatening stimuli. They are biased towards these stimuli as a result of a lack of self-monitoring. In one sense, they blame their delusions and hallucinations on the outside world or external sources.
As these thoughts do not come from the patient's mind, they become ‘alien’.
Navalón et al. (2021) found that there is an attentional bias towards threatening scenes in patients with schizophrenia. After viewing a 20-second video with four emotional scenes, positive symptoms were associated with a ‘late avoidance’ of sad scenes, and negative symptoms were associated with heightened attention to threats.
This suggests that, for patients with schizophrenia, there is a threat-related bias (they actively look for threats) and a lack of sensitivity to positive information. This plays a key role in the onset of schizophrenia.
Frith (1992) proposed the idea that in patients with schizophrenia, dysfunctional thought processes (in other words, a disruption in the processes of thinking) affect their ability to filter preconscious thoughts due to a faulty attention system. Their conscious minds are, in a sense, overloaded by information that would normally be filtered out in a healthy person. A patient is then unable to ignore these thoughts, and this can account for many of schizophrenia’s positive symptoms.
Deficits exist in patients having trouble processing different types of information. Auditory and visual senses are the most commonly affected. This can affect social situations, too, as patients misunderstand or completely miss social cues and emotional prompts. This can account for reduced levels of emotional expression and confusing speech patterns, as patients have consequently avoided or not learned this skill.
Meta-representation
Central Control
This is how we understand that we are responsible for our thoughts, behaviours, and actions. By paying attention to our thought processes and how we got from A to B, we can justify our decisions!
Meta-representation in schizophrenia, Tyler Smith - StudySmarter Originals.
Being able to reflect on thought processes and feelings allows for an insight into personal behaviours, intentions and, ultimately, a person’s goals for future decisions - it is what gives a person self-awareness.
Faults in this system result in delusions of control. If someone is not able to follow their train of thought, and there’s no logical consistency or an ability to outright say ‘I did this because I thought of this,’, it can feel like someone else is controlling your thoughts and actions.
After all, if this process is faulty, how can you say that a particular action was your own when you don’t truly know what led to this action?
As a result, this can manifest in hallucinations and delusions in patients with schizophrenia. Positive symptoms (like hearing voices) in meta-representation make it hard for a person with schizophrenia to distinguish their thoughts from the voices they hear.
Meta-representation has its own strengths and weaknesses:
In Frith’s (1992) study, 30 schizophrenic patients had PET scans. This is where radioactive ‘tracing’ fluid is injected into the body, which shows where highly metabolic and biochemical areas are. This means there’s a high level of activity in those portions of the brain. The scans in this study revealed that there was reduced blood flow to the frontal cortex in the brain.
This, in turn, is associated with negative symptoms such as avolition and the inability to suppress automatic thoughts and behaviours.
There was also increased activity in the temporal lobe, which is responsible for retrieving memories. For those patients who have issues with reality distortion, this suggests a biological difference in schizophrenic patients and the way they process thoughts.
This is the ability to suppress or override automatic thoughts, actions and speech in response to stimuli. This can be faulty in patients with schizophrenia.
So, if you saw a button, you may feel an urge to press it, an urge to simply go ahead and do it.
Central Control in schizophrenia, Tyler Smith - StudySmarter Originals.
Patients with schizophrenia, who have immense difficulty in resisting such urges, press the button. But they are unable to fully explain why they chose to do it.
This can result in delusions. When an individual with schizophrenia cannot explain why they did something, or identify where the thought came from in the thought process, it can create feelings of paranoia. Sometimes the line of thought is jumbled, or sections are missing completely. They then question reality and themselves, and ultimately cannot find an internal, rational source for their decision making.
Speech can also be affected. Conversation topics will frequently shift and change. It’s hard to resist speaking out loud when such thoughts would usually be filtered out or dismissed.
Central control has its own strengths and weaknesses:
Stirling (2006) conducted a study where he used the Stroop Test on 30 patients and 18 control patients, coming to the conclusion that thought disorders are linked to semantic processing impairments.
The Stroop Test is where patients are given the name of a colour, for instance, blue, but the actual word will be in different coloured ink. So, blue would be written in yellow ink. Patients are asked to say the colour of the ink, NOT the actual written word.
Central control would help a person resist the urge to simply shout the written word.
In schizophrenic patients, it took twice as long to name the ink colour than the controls, suggesting issues with thought processing and ultimately a dysfunction with central control.
Overall, this theory also has problems with reductionism.
It helps explain positive symptoms (hallucinations) but does not identify exactly where they come from.
Cognitive explanation is where, in the case of schizophrenia, a psychiatrist is interested in how a patient thinks, and how this may affect their cognitive functions and ultimately develop into schizophrenia.
The cognitive explanations for schizophrenia are dysfunctional thought processes (attentional biases and deficits, known as the attention-deficit theory), meta-representation, and central control.
This is the assumption that the disorder is due to a person’s dysfunctional thought processes, concerned with their cognitive perspective.
As depression is a disorder concerning mood and thought processes, the cognitive explanation would focus on how their dysfunctional thought processes (such as feeling hopeless and sad and dwelling on the negatives of life) would explain their diagnosis and how it developed.
The main idea of cognitive theory is that the key to understanding a disorder is by addressing the thoughts and emotions of a person, and suggesting that these are the driving force behind their dysfunctional behaviour.
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