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Interactionist Approach

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Interactionist Approach

The origin and development of schizophrenia is a hot topic of debate amongst most psychologists and medical professionals. Whilst some suggest that the origin of schizophrenia is purely biological in nature, others disagree, suggesting external factors, such as a persons social environment, play a large role in the development of the disorder.

Ultimately, each theory holds some form of truth. However, what’s not to say that all these theories have the potential to be somewhat correct? And what’s stopping us from combining these theories?

The interactionist approach to schizophrenia examines how the combination of biological, psychological, and social factors explains the development of schizophrenia.

In this approach, these factors are linked to the cause of schizophrenia to understand how the symptoms develop and help treat the disorder.

The best-known mechanism of the interactionist approach is the diathesis-stress model.

Interactionist Approach Schizophrenia StudySmarter

Four sections showing the factors in the interactionist approach, Tyler Smith - StudySmarter Originals

What is the diathesis-stress model?

The diathesis-stress model, first introduced by Meehl (1962), is a psychological concept that holds that schizophrenia is due to a diathesis (an internal vulnerability) and an environmental trigger (stressor). This internal vulnerability or diathesis is predisposed, and Meehl initially held that this was due to a single ‘schizogene’.

If a person did not have this gene or genetic susceptibility, Meehl argued, no external stressors could cause schizophrenia. However, if they did have the gene, childhood trauma (such as experiencing expressed emotions, family dysfunction) or a negative life event could trigger schizophrenia.

Further research refutes the notion that schizophrenia results from a specific gene. Instead, it is a polygenetic disorder in which dopamine imbalances, external factors, and environmental factors can cause a predisposition to the disorder. These events can be the cause or the result of developmental problems, such as complications at birth or abuse in childhood that affects brain development.

Interactionist Approach Development of schizophrenia thresholds predisposition support effects StudySmarterDevelopment of schizophrenia (thresholds, predisposition, and support effects), Tyler Smith, StudySmarter Originals

In addition, potential problems arise from negative psychological experiences such as academic pressure or relationship failure.

Evaluation of internal vulnerabilities and triggers

  • Husted et al. (2010) found that early childhood trauma is significantly associated with the expression of schizophrenia. Early childhood trauma may trigger psychotic illness in individuals with a genetic susceptibility to schizophrenia. This supports the effect of external stress triggers on genetic susceptibility.

  • Janssen et al. (2004) came to a similar conclusion in their study. They analysed 4000 samples of individuals aged 18 to 64 years, recording the first onset of psychotic symptoms with a two-year follow-up period. Childhood trauma was assessed at baseline (before exposure to any form of intervention, treatment, or study).

  • This study suggests that early childhood trauma increases the risk of positive symptoms and that early adversity can lead to psychological and biological changes in the brain. This increases vulnerability to psychosis.

  • Read (2001) developed the idea that vulnerability might be related to nervous system development. They proposed that when traumatic experiences occur early enough in life or are particularly severe, these experiences are associated with biological abnormalities such as dopamine, norepinephrine, and serotonin abnormalities, acting as a diathesis by altering neurological development. Read (2001) presented the traumagenic neurodevelopmental model (TN) of schizophrenia.

  • Cannon et al. (2002) conducted a meta-analysis of studies examining obstetric complications (pregnancy complications) as a risk factor for schizophrenia. They found that three categories had a high association with schizophrenia:

    • Complications during pregnancy (bleeding, diabetes, rhesus incompatibility, preeclampsia).

    • Abnormal fetal growth and development (low birth weight, congenital malformations, small head circumference).

    • Birth complications (uterine atony, asphyxia, emergency cesarean section).

Factors such as substance abuse, particularly cannabis, have also been linked to the development of schizophrenia.

The above studies have made it clear that it is necessary to reconsider a stress trigger, as many different aspects of life can influence a diathesis.

Interactionist approach examples

The interactionist approach explains two prominent studies associated with schizophrenia that have been presented in previous articles.

Gottesman (1991)

Gottesman (1991) studied cases of schizophrenia in identical and non-identical twins:

  • They found a concordance rate of 48% for identical twins (monozygotic/MZ twins).

  • In non-identical twins (dizygotic/ DZ twins) they found a concordance rate of 17%.

Identical twins share 100% of their DNA. These results suggest that schizophrenia is most likely genetic. However, if schizophrenia were exclusively genetic, the concordance rate for identical twins would have to be 100%. Since this is not the case, this suggests that both twins have a genetic susceptibility to schizophrenia, but only one of them had a psychological experience that triggered the disorder.

Tienari (2004)

Tienari (2004) studied biological children of schizophrenic mothers who had been adopted:

  • 5.8% of the children developed schizophrenia in a healthy family environment.

  • 36.8% of the children developed schizophrenia in a dysfunctional family environment.

This study suggests a biological diathesis (internal vulnerability) to schizophrenia triggered by a psychological stressor. In this case, it is the dysfunctional family environment because children in this environment were more likely to develop schizophrenia than children who grew up in a healthy environment.

The interactionist approach to treating schizophrenia

Because a large body of research suggests that schizophrenia is both a genetic and an environmental disorder, the interactionist approach indicates that a combination of biological and psychological therapy is the most effective way to treat schizophrenia.

The interactionist approach is considered a more holistic explanation of human behaviour (it looks at the patient as a whole person, not just their psychological needs). It considers all possible causal factors and does not reduce them to one (reductionism). It has more validity in its interpretation of what causes schizophrenia.

It considers the nature-nurture debate and the importance of heredity and environmental influences.

  • In patients with extreme or severe schizophrenic symptoms (hallucinations, extreme aggression, delusions, and paranoia), as described in the article on drug therapy, the patient can first be treated with biological drugs to combat these symptoms and then receive psychological treatment. Thus, the severe symptoms can be alleviated if the patient receives cognitive behavioural therapy (CBT), which provides him with the cognitive skills to change his maladaptive behaviours.

    • Antipsychotic medications lower dopamine levels and act on serotonin and acetylcholine, reducing both positive and negative symptoms. CBT then addresses the psychological aspects of schizophrenia and helps patients develop coping strategies and process symptoms logically.

  • Tarrier (2004) found evidence of the effectiveness of combined treatment plans CBT was combined with antipsychotic medication treatment in patients with schizophrenia. They found significant benefits to combined therapy over 18 months compared to treatment with antipsychotic medication alone. Patients had fewer positive symptoms, were less severe, and spent fewer days in the hospital. Therefore, the interactionist approach is more effective than antipsychotic treatments alone.

Despite the support for combined treatments and the links between biological components and external stressors, there is still a problem with the interactionist approach as a complete explanation of schizophrenia.

There continue to be problems with patients affecting the efficacy of their treatments. Using a multidisciplinary approach seems to improve treatment efficacy. However, patients may still drop out of treatment (single treatment problems), and severe symptoms may affect their ability to participate in treatment, even with medication.


Interactionist Approach - Key takeaways

  • The interactionist approach is concerned with how the interaction of biological, psychological, and social factors explains the development of schizophrenia.
  • Initially, it was assumed that schizophrenia was due to a single ‘schizogene’ (Meehl, 1962), which was later revised, and it is now considered a polygenetic disorder.
  • The diathesis-stress model, first introduced by Meehl (1962), is a psychological concept that holds that schizophrenia is due to a diathesis (an internal vulnerability) and an environmental trigger (stressor).
  • Studies support the link between early childhood trauma, negative life experiences, and an internal vulnerability to schizophrenia that increases the likelihood of developing the disorder.
  • A combination of treatment therapies is a vital feature of the interactionist approach and shows promising treatment results (fewer symptoms and hospitalisations).
  • The interactionist approach is a holistic view and avoids issues of reductionism. It considers the nature-nurture debate and the importance of hereditary and environmental influences (substance abuse, childhood trauma, problems with parents).

Frequently Asked Questions about Interactionist Approach

The interactionist approach considers how the combination of biological, psychological, and social factors explains the development of schizophrenia.

An example would be acknowledging a patient's social and familial circumstances, say, if they have difficulties and trauma at home whilst growing up, whilst also taking into account their genetic background. For instance, if they have a history of schizophrenia in their family, it may mean that the patient was predisposed to developing the disorder, and their environmental circumstances helped 'trigger' the disorder. 

Ultimately, it is to identify all possible causes and stressors affecting the patient. It aims to understand these stressors to aid treatment and reduce the likelihood of the patient developing more symptoms of schizophrenia. It is a holistic view of the disorder, taking genetic vulnerabilities and environmental factors into account.

It considers the social aspect of development in children when they interact with knowledgeable adults and how this affects language development. 

As it considers many different factors, it is a highly valid interpretation of the disorder in question, in this instance, schizophrenia. It is holistic.

Final Interactionist Approach Quiz

Question

What is the interactionist approach to schizophrenia?

Show answer

Answer

The interactionist approach to schizophrenia examines how the combination of biological, psychological, and social factors explains the development of schizophrenia.

Show question

Question

What is the best-known mechanism of the interactionist approach?

Show answer

Answer

The best-known mechanism of the interactionist approach is the diathesis-stress model.

Show question

Question

What is the diathesis-stress model?

Show answer

Answer

The diathesis-stress model, first introduced by Meehl (1962), is a psychological concept that holds that schizophrenia is due to a diathesis (an internal vulnerability) and an environmental trigger (stressor).

Show question

Question

Is the internal vulnerability in the diathesis-stress model predisposed?

Show answer

Answer

Yes.

Show question

Question

What did Meehl (1962) argue about the genetics of schizophrenia? 


Show answer

Answer

Meehl argued it was due to a single gene ('schizogene'). If a person did not have this gene or genetic susceptibility, no external stressors could cause schizophrenia.

Show question

Question

Is schizophrenia caused by a vulnerability to one 'schizogene'? 


Show answer

Answer

No, it is now considered a polygenetic disorder.

Show question

Question

What did Gottesman (1991) find in their study?

Show answer

Answer

They found a concordance rate of 48% for identical twins (monozygotic/MZ twins). and in non-identical twins (dizygotic/ DZ twins) a concordance rate of 17%. 


These results suggest that schizophrenia is most likely genetic. However, if schizophrenia were exclusively genetic, the concordance rate for identical twins would have to be 100%. Since this is not the case, this suggests that both twins have a genetic susceptibility to schizophrenia, but only one of them had a psychological experience that triggered the disorder.

Show question

Question

What did Tienari (2004) find in their study?

Show answer

Answer

Tienari found that:


  • 5.8% of the children developed schizophrenia in a healthy family environment.
  • 36.8% of the children developed schizophrenia in a dysfunctional family environment.


This study suggests a biological diathesis (internal vulnerability) to schizophrenia triggered by a psychological stressor.

Show question

Question

What is a diathesis?

Show answer

Answer

An internal vulnerability.

Show question

Question

How is the interactionist approach holistic?

Show answer

Answer

It considers the patient as a whole person, not just their mental disorder.

Show question

Question

How does combining drug therapy and psychological therapy help a patient with schizophrenia?

Show answer

Answer

In patients with extreme or severe schizophrenic symptoms (hallucinations, extreme aggression, delusions, and paranoia), as described in the article on drug therapy, the patient can first be treated with biological drugs to combat these symptoms and then receive psychological treatment.

Show question

Question

What did Tarrier (2004) find in their study of combined treatments compared to drug treatment alone?

Show answer

Answer

They found significant benefits to combined therapy over 18 months compared to treatment with antipsychotic medication alone. Patients had fewer positive symptoms, were less severe, and spent fewer days in the hospital. Therefore, the interactionist approach is more effective than antipsychotic treatments alone.

Show question

Question

What did Read (2001) find in their study?

Show answer

Answer

Read (2001) developed the idea that vulnerability might be related to nervous system development. They proposed that when traumatic experiences occur early enough in life or are particularly severe, these experiences are associated with biological abnormalities such as dopamine, norepinephrine, and serotonin abnormalities, acting as a diathesis by altering neurological development.

Show question

Question

What did Cannon (2002) find in their study?

Show answer

Answer

When reviewing pregnancy complications related to schizophrenia, they found that three categories had a high association with schizophrenia: pregnancy complications, abnormal growth and development, and delivery complications.

Show question

Question

Name three external factors that may affect an internal vulnerability to schizophrenia.

Show answer

Answer

Substance abuse, early childhood trauma, academic failure.

Show question

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