How can our thoughts affect our mental health? If there's a fault in our thought processes, can this fault lead to mental health disorders? Cognitive explanations for schizophrenia focus primarily on how a patient processes information and how dysfunctional thought processing impacts the development of schizophrenia. It concerns how patients think and is a psychological explanation of schizophrenia.
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.
- First, we will explore the various cognitive explanations of schizophrenia,
- We will then discuss dysfunctional thought processing in more detail, exploring how this affects the development of schizophrenia.
- Next, we will explore attentional biases and deficits in the cognitive explanations of schizophrenia.
- Moving on, we will discuss metarepresentation and central control.
- Finally, we will evaluate cognitive explanations for schizophrenia, discussing the strengths and weaknesses of cognitive explanations.
Fig. 1 - Cognitive explanations explore dysfunctional thought processes in schizophrenia.
Cognitive Explanations of Schizophrenia
Cognitive explanations for schizophrenia explore how dysfunctional thought processes enable the development of schizophrenia, including theories on abnormal thought processes, meta-representation, and central control. According to the cognitive explanation, dysfunctional thought processing leads to symptoms of schizophrenia by facilitating the development of delusions and memory and perception issues.
Dysfunctional Thought Processing
Dysfunctional thought processing focuses primarily on the faults in our thought processes. In schizophrenia, it is suggested dysfunctional thought processing leads to the development of the disorder.
Firth (1992) highlighted how cognitive issues are linked to schizophrenia by discussing how those with schizophrenia show an impairment with Theory of Mind (ToM), known as the cognitive neuropsychological model. Firth (1992) identified two key aspects of dysfunctional thought-processing issues:
- Metarepresentation (a disorder of understanding the self and others)
- Central Control (a disorder of controlling actions)
Firth (1979) also 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 automatic responses) filter the world, so we are not bombarded with information. If filtering does not occur, the mind can be overloaded with information.
According to Firth, this is responsible for most of the positive symptoms associated with schizophrenia and psychosis.
Schemas are cognitive frameworks that help organise the mind. As proposed by Piaget, they are categories of information and knowledge. Schemas help organise past experiences so an individual can process future events.
Matussek (1952; as cited in Hemsley, 2005) highlighted how, in a patient with schizophrenia, there was a:
lack of continuity of his perceptions both in space and over time. He saw the environment only in fragments. There was no appreciation of the whole. He saw only details against a meaningless background” (p. 92)
Fig. 2 - Firth (1992) identified metarepresentation and central control as key cognitive aspects of schizophrenia.
What are Attentional Biases and Deficits?
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 due to 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. Patients also showed increased attention to threatening scenes.
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.
Deficits exist in patients having trouble processing different types of information and can range from moderate to severe. This can affect social situations, as patients misunderstand or completely miss social cues and emotional prompts. Deficits can account for reduced levels of emotional expression and confusing speech patterns, as patients have consequently avoided and struggled with social situations.
Dysfunctional Thought Processing: Metareprersentation and Central Control
Firth (1992) highlighted two key aspects to dysfunctional thought processing in schizophrenia and linked them to the symptoms. These are:
- Meta-representation
- Central Control
Firth (1992) tended to focus on positive symptoms as the symptoms of schizophrenia.
What is Metarepresentation?
Metarepresentation is about 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 thought A to B to C and so on, we can justify our decisions! We can also tell that these thoughts are our own.
Schizophrenic patients struggle to differentiate between external sources of information, such as speech, and their own thoughts.
Fig. 3 - Metarepresentation is our ability to understand our thoughts, behaviours, and actions.
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 (similar to ToM). It also allows you to interpret the actions of others and understand their intentions and goals.
Faults in this system result in delusions of control. If someone is not able to follow their train of thought or identify their thoughts as their own due to external inputs interfering (such as speech from others), and there’s no logical consistency or ability to say outright, ‘I did this because I thought of this’, it can feel like someone else is controlling your thoughts and actions (thought insertion).
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. In meta-representation, positive symptoms (like hearing voices) make it hard for a person with schizophrenia to distinguish their thoughts from the voices they hear.
Evaluation of Metarepresentation
Meta-representation has its own strengths and weaknesses:
In Firth’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 activity level in those brain portions. 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 patients with reality distortion, this suggests a biological difference in schizophrenic patients and the way they process thoughts, supporting the theory.
Beech (1989) also supported Firth's theories (1979) on selective attention issues.
What is Central Control?
Central Control is the ability to suppress or override automatic thoughts, actions and speech in response to stimuli. Self-control can be faulty in patients with schizophrenia.
So, if you saw a button, you may feel the urge to press it and simply go ahead and do it.
Fig. 4 - Central control is the ability to suppress and override automatic thoughts.
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.
Evaluation of Central Control
Central control has its own strengths and weaknesses.
Stirling (2006) conducted a study where he used the Stroop Test on 30 and 18 control patients, concluding 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 shout the written word.
In schizophrenic patients, it took twice as long to name the ink colour as the controls, suggesting issues with thought processing and, ultimately, a dysfunction with central control.
However, this theory has problems with reductionism. It tends to ignore other factors and explain the complex disorder of schizophrenia through the lens of dysfunctional thought processing.
It helps explain positive symptoms (hallucinations) but does not identify exactly where they come from.
Cognitive Explanations - Key takeaways
- Cognitive explanations for schizophrenia explore how dysfunctions in the thought process affect the development of schizophrenia.
- Firth (1979) proposed the attention-deficit theory, which suggested that schizophrenia was due to a faulty attention system.
- Schizophrenic patients with persecutory delusions (an inability to recognise what is reality) have attentional biases towards threatening stimuli. Delusions are blamed on external/outside sources, not their minds, resulting in ‘alien thoughts’.
- Dysfunctional thoughts can be separated into two categories: meta-representation (this is how we identify that we are responsible for our thoughts, behaviours and actions, giving self-awareness) and central control (this is the ability to suppress or override automatic thoughts, actions and speech in response to stimuli).
- In Firth (1992) it was revealed that there is reduced blood flow to the frontal cortex in the brain in schizophrenic patients (negative symptoms, inability to control thoughts, avolition), and there was also increased activity in the temporal lobe, which is responsible for retrieval of memory (issues with recognising reality).
- Overall, this theory helps explain most positive symptoms but does not identify where they come from exactly. It is also reductionist.
References
- David R Hemsley, M.A., M.Phil, Ph.D., The Schizophrenic Experience: Taken Out of Context?, Schizophrenia Bulletin, Volume 31, Issue 1, January 2005, Pages 43–53,
- Beech, A., Powell, T., McWilliam, J., & Claridge, G. (1989). Evidence of reduced 'cognitive inhibition' in schizophrenia. The British journal of clinical psychology, 28(2), 109–116.
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