Psychological: Cognitive Theories (AQA A-Level Psychology): Revision Notes
Psychological: Cognitive theories
Overview of cognitive explanations
Cognitive explanations focus on maladaptive thought processes as a central feature of schizophrenia. These theories suggest that the development and maintenance of schizophrenia symptoms result from abnormal ways of thinking and processing information.
Beck & Rector (2005) proposed an influential cognitive model that combines multiple factors to explain schizophrenia. Their model suggests that abnormalities within brain functioning increase vulnerability to stressful life experiences, which then lead to dysfunctional beliefs and behaviours.
The cognitive approach identifies several key deficits in people with schizophrenia:
- Problems with attention, communication and information overload
- Inability to deal with inappropriate ideas appropriately
- Misperceiving voices in their head as people actually trying to speak to them, rather than experiencing them as 'inner speech'
Positive and negative symptoms explained
Positive symptoms such as delusions are understood through the lens of active cognitive biases. People with schizophrenia may engage in external attributions, believing they are being persecuted when this isn't the case. Hallucinations are explained as biassed information processing, whilst alien control symptoms occur when individuals believe external people and forces are influencing their thoughts and behaviour.
Understanding Symptom Development
Negative symptoms develop as cognitive strategies to manage high levels of mental stimulation. Patients may actually experience greater emotional intensity than they physically display, but not expressing emotions becomes a way to control overwhelming internal experiences.
Research evidence supporting cognitive theories
Cognitive impairment studies
Research Findings: Cognitive Impairment Prevalence
O'Carroll (2000) reviewed available evidence and found that cognitive impairment occurs in 75% of patients with schizophrenia. These impairments particularly affected memory, attention, motor skills, executive function and intelligence, supporting Beck & Rector's cognitive model. Importantly, cognitive problems often pre-dated illness onset and weren't simply results of substance abuse.
Elvevåg & Goldberg (2000) reported that schizophrenia is better characterised by cognitive deficits rather than symptoms. They found these deficits are enduring features that aren't specific to particular subtypes of the disorder, with memory and attention forming the core cognitive dysfunction.
Attention and monitoring deficits
Experimental Evidence: Self-Monitoring Deficits
Knoblich et al. (2004) conducted an experiment where people with and without schizophrenia drew circles on a writing pad connected to a PC monitor. Participants had to continuously monitor the relationship between their hand movements and visual consequences.
Key Finding: Patients with schizophrenia were impaired in their ability to detect mismatches between self-generated movement and consequences, suggesting that cognitive inability to self-monitor may underlie core schizophrenia symptoms.
Bowie & Harvey (2006) reviewed evidence showing that cognitive impairments are the core feature of schizophrenia, mainly affecting attention, working memory, verbal learning and executive functions. These impairments pre-date disorder onset and continue throughout the illness course, supporting Beck & Rector's cognitive model.
Dysfunctional thought processing
Dysfunctional thought processing refers to the abnormal ways of thinking that characterise schizophrenia. This concept is central to cognitive explanations of the disorder.
Metacognition deficits
All humans use metacognition - the cognitive monitoring of one's own thought processes. This includes detecting errors in cognitive processing and thinking about feelings and behavioural reactions triggered by thoughts. Metacognition allows individuals to 'view' their mental states and understand others' intentions, helping them make sense of their lives and environments.
Critical Concept: Metacognitive Dysfunction
People with schizophrenia experience metacognitive dysfunction, resulting in dysfunctional thought processes. These deficits particularly affect executive functioning - the higher-level cognitive processes that control and manage other cognitive and behavioural processes.
Executive functioning impairments
Dysfunctional thought processing in schizophrenia leads to serious impairments in:
- Goal-directed behaviour
- Attention and memory
- Cognitive flexibility
- Self-monitoring
- Inhibition of inappropriate responses
- Physical motor control
Research evidence for dysfunctional thought processing
Experimental Studies: Executive Function Testing
Joshua et al. (2009) used the Hayling Sentence Completion Test comparing 39 people with schizophrenia, 40 people with bipolar disorder, and 44 healthy participants.
Result: People with schizophrenia had slower response times and slower suppression of inappropriate responses, indicating impaired executive functioning and supporting dysfunctional thought processing as important in schizophrenia development.
Evans et al. (1997) gave executive function tests to 31 schizophrenia patients, 35 brain-injured patients and 26 healthy participants. Patients with schizophrenia and brain-damage had impaired executive functioning compared to healthy participants, showing special impairments in memory functioning and illustrating the role of dysfunctional thought processing.
Lysaker et al. (2008) used metacognition tests with 49 male schizophrenia patients. Schizophrenic symptoms were linked to inability to have awareness of one's thoughts and feelings and other people's needs, supporting the idea that metacognitive impairments connect to the disorder.
Brüne et al. (2011) reviewed 20 years of evidence showing that many schizophrenia symptoms and social functioning impairments result from poor metacognition, especially difficulties with self-reflection and empathising with others.
Evaluation of cognitive theories
Strengths
Key Strengths of Cognitive Theories:
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Comprehensive symptom explanation: The cognitive explanation can account for both positive and negative symptoms of schizophrenia, providing a more complete understanding than approaches focusing on only one type of symptom
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Integration with other approaches: A major strength is that cognitive explanations can be combined with other explanations, such as biological ones, to provide a fuller understanding of the disorder's causes and maintenance
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Treatment implications: Highlighting metacognition as important indicates that therapies should concentrate on improving metacognitive abilities in patients. This allows for targeted interventions focusing on specific areas of metacognitive impairment
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Research support: Extensive evidence demonstrates cognitive deficits in schizophrenia patients, with studies showing these impairments are core features rather than secondary effects of the disorder
Limitations
Critical Limitations to Consider:
Lack of causal explanation: Cognitive theories don't explain what initially causes the cognitive dysfunctions seen in schizophrenia, so cannot be considered complete explanations of the disorder's origins.
Causation vs correlation: Research suggests dysfunctional thought processing occurs before disorder onset and isn't simply an effect of having schizophrenia. However, dysfunctional thought processing may itself result from abnormal brain functioning rather than being a primary cause.
Specificity issues: If schizophrenia is better characterised by cognitive deficits rather than symptoms, this suggests possible construction of specific cognitive deficit profiles for better diagnosis. However, deficits may not be unique to schizophrenia.
Limited scope: Although dysfunctional thought processing links to memory impairments, research indicates deficits occur mainly in specific memory areas, particularly the central executive component of working memory, whilst other memory systems like phonological processing remain less affected.
Remember!
Key Points to Remember:
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Cognitive theories focus on maladaptive thought processes as central to understanding schizophrenia, with Beck & Rector's model combining neurobiological, environmental, behavioural and cognitive factors
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Research consistently shows cognitive impairments in 75% of schizophrenia patients, particularly affecting attention, memory, executive function and metacognitive abilities
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Dysfunctional thought processing involves metacognitive deficits that impair people's ability to monitor their own thoughts and understand others' mental states
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Positive symptoms result from biassed information processing whilst negative symptoms develop as strategies to cope with overwhelming mental stimulation
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Cognitive explanations can integrate with biological approaches and inform targeted therapeutic interventions, but don't fully explain what initially causes the cognitive dysfunction