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A-Level · Psychology

PSY.OPT11 Psychological Explanations for Schizophrenia: Family and Cognitive Theory

AQA 7182 · Calculators not allowed · about 60 minutes

Total Marks

Name: _______________________________ Date: ____ / ____ / ______

Answer ALL questions. Show all your working.

Outline the schizophrenogenic mother concept in the context of family-based psychological explanations for schizophrenia; name the maternal behaviours implicated and the proposed family atmosphere.

Outline the schizophrenogenic mother concept in the context of schizophrenia explanations.

(Total for Question 1 is 3 marks)

Outline Bateson et al. double bind theory as a family communication explanation for psychotic symptoms in schizophrenia; state what a double bind involves and its proposed effect on thinking.

Outline Bateson et al. double bind theory in the context of schizophrenia explanations.

(Total for Question 2 is 3 marks)

Outline expressed emotion (EE) as a family-related explanation for relapse in schizophrenia, specifying the typical EE features and how EE is proposed to affect relapse risk.

Outline expressed emotion as an explanation for relapse in schizophrenia.

(Total for Question 3 is 3 marks)

Outline impaired metarepresentation as a cognitive explanation for positive symptoms such as thought insertion and auditory hallucinations in schizophrenia.

Outline impaired metarepresentation as a cognitive explanation for positive symptoms in schizophrenia.

(Total for Question 4 is 2 marks)

Outline the cognitive concept of central control dysfunction as an explanation for disorganised speech and thought disorder in schizophrenia.

Outline central control dysfunction as a cognitive explanation for disorganised speech in schizophrenia.

(Total for Question 5 is 3 marks)

Outline the idea that lowered cognitive processing speed or efficiency is part of cognitive explanations for schizophrenia, and briefly state how this might relate to attention and executive tasks.

Outline lowered cognitive processing as a cognitive explanation for schizophrenia.

(Total for Question 6 is 3 marks)

Explain one strength and one limitation of family-based explanations (for example expressed emotion or double bind accounts) for schizophrenia.

Explain one strength and one limitation of family-based explanations for schizophrenia.

(Total for Question 7 is 2 marks)

Application: A psychiatrist, Dr Khan, sees a patient, Mina, who reports frequent voices that comment on her actions and sometimes tell her what she is thinking. Mina also describes her home as very critical, with carers who frequently shout and accuse her of laziness. Using knowledge of family and cognitive explanations, explain which explanation(s) best account for Mina's symptoms and family context. Refer to both EE and impaired metarepresentation or another cognitive mechanism where appropriate.

(Total for Question 8 is 6 marks)

Outline one piece of empirical evidence that supports a role for expressed emotion (EE) in relapse for people with schizophrenia.

Outline evidence linking expressed emotion to relapse in schizophrenia.

(Total for Question 9 is 3 marks)

Identify one methodological problem that affects family-based theories such as double bind or schizophrenogenic mother accounts, and explain how this problem limits the conclusions that can be drawn.

Identify and explain a methodological problem for family-based theories of schizophrenia.

(Total for Question 10 is 2 marks)

Outline one cognitive explanation that links a specific cognitive deficit to a particular symptom of schizophrenia, giving the deficit and the symptom it is used to explain.

Outline a cognitive deficit and the symptom of schizophrenia it explains.

(Total for Question 11 is 3 marks)

Discuss psychological explanations for schizophrenia, focusing on family dysfunction (schizophrenogenic mother, double bind, expressed emotion) and cognitive accounts (metarepresentation, central control, lowered processing). Evaluate their explanatory power, strengths and limitations, and consider how they compare with biological explanations in accounting for symptoms and relapse.

Discuss psychological explanations for schizophrenia and compare them with biological accounts.

(Total for Question 12 is 16 marks)

Mark scheme · PSY.OPT11 Psychological Explanations for Schizophrenia: Family and Cognitive Theory

Question 1

M1 identifies the core idea: a mother whose cold, domineering or rejecting behaviour is implicated in causing schizophrenia in her child oe
M1 mentions that such parenting creates a family climate of emotional tension, secrecy or unpredictability oe
A1 links this family atmosphere to a proposed causal contribution to later development of schizophrenic symptoms oe
Answer: A mother described as cold, domineering or rejecting creates a climate of emotional tension and secrecy in the family, which is suggested to contribute to the development of schizophrenia in the child.

Question 2

M1 identifies a double bind as repeated contradictory messages where a child cannot comment on the contradiction and cannot resolve the conflict oe
M1 states that Bateson et al. proposed such communication patterns may lead to confusing thinking and disordered communication oe
A1 links the double bind to the development of odd thought patterns or delusional beliefs as a proposed causal mechanism oe
Answer: A double bind involves repeated contradictory messages a child cannot challenge or escape, and Bateson et al. suggested such family communication can produce confusing thinking and symptoms associated with schizophrenia.

Question 3

M1 identifies typical EE features: critical comments, hostility and emotional overinvolvement from carers oe
M1 states EE is associated with a greater risk of relapse for someone with schizophrenia compared with low EE families oe
A1 explains that the stress of living in a high EE environment is proposed to trigger symptom relapse or worsen outcomes oe
Answer: High expressed emotion, characterised by criticism, hostility and emotional overinvolvement from family carers, is associated with increased stress and a higher risk of relapse for people with schizophrenia.

Question 4

M1 states metarepresentation is the ability to reflect on and represent one own thoughts and intentions oe
A1 explains that impairment could lead to misattributing inner speech to external sources, producing symptoms like thought insertion or auditory hallucinations oe
Answer: Metarepresentation is the capacity to reflect on one own thoughts; if impaired, people may misattribute their own inner speech or thoughts to external sources, which can explain thought insertion and auditory hallucinations.

Question 5

M1 identifies central control as the cognitive ability to suppress automatic responses and coordinate thoughts and behaviour oe
M1 states that dysfunction in central control leads to disrupted organisation of thought and speech, and to loose associations oe
A1 links this dysfunction to observable symptoms such as disorganised speech and difficulty maintaining a goal-directed sequence of thought oe
Answer: Central control is the ability to suppress automatic responses and coordinate thought processes; if it is impaired, someone may show disorganised speech, loose associations and difficulty maintaining coherent, goal-directed thought.

Question 6

M1 states lowered processing speed or efficiency means cognitive tasks take longer or are performed less accurately than typical oe
M1 links lowered processing to problems with divided attention, working memory or executive function in people with schizophrenia oe
A1 explains that slower or less efficient processing could contribute to disorganised thinking, poor problem solving or difficulties in goal-directed behaviour oe
Answer: Lowered cognitive processing speed or efficiency means tasks are performed more slowly or less accurately; this is linked to problems with attention, working memory and executive function, and may contribute to disorganised thinking and poor goal-directed behaviour in schizophrenia.

Question 7

M1 strength: identifies a genuine strength, e.g. family theories draw attention to psychosocial contributors and explain relapse links such as EE leading to higher relapse risk oe
A1 limitation: identifies a genuine limitation, e.g. family theories risk blaming parents and often lack consistent causal evidence, correlation not causation oe
Answer: Strength: family theories highlight psychosocial contributors and help explain why high EE families are linked to higher relapse risk. Limitation: they can blame parents and rely on correlational evidence, so they do not prove that family factors cause schizophrenia.

Question 8

M1 identifies that the voices commenting are characteristic of auditory hallucinations that can be explained by impaired metarepresentation or misattribution of inner speech oe
M1 explains how impaired metarepresentation leads to misattribution of inner speech to external sources, matching Mina's reported voices oe
M1 identifies that the described critical home environment matches high expressed emotion (EE), which is linked to increased relapse and stress for someone with schizophrenia oe
M1 explains how EE might worsen Mina's condition by increasing stress and reducing coping, contributing to symptom persistence or relapse oe
M1 integrates both explanations: cognitive mechanisms explain the content and experience of hallucinations, while high EE explains environmental stress that may maintain or exacerbate symptoms oe
A1 gives a clear applied conclusion that both cognitive impairment (metarepresentation) and family EE are relevant and together offer a more complete account of Mina's presentation oe
Answer: Mina's commenting voices fit a cognitive account such as impaired metarepresentation, which causes inner speech to be misattributed as external. Her critical, hostile home fits a high EE description, which increases stress and risk of relapse. Both accounts together explain her subjective experiences and why symptoms may be maintained or worsened in her environment.

Question 9

M1 identifies an empirical finding, e.g. studies have found higher relapse rates among patients returning to high EE families compared with low EE families oe
M1 gives a basic statistic or comparative statement, e.g. relapse rates are substantially higher, typically reported as around 2 to 3 times greater in high EE families in some studies oe
A1 briefly explains why this supports the EE account, e.g. high EE may increase stress which triggers symptom exacerbation or relapse oe
Answer: Research shows that patients returning to high EE families have higher relapse rates than those returning to low EE families; some studies report relapse rates around two to three times higher in high EE settings, supporting the idea that family stress contributes to relapse.

Question 10

M1 identifies a methodological problem, e.g. reliance on retrospective reports, observer bias or confusing cause and effect (correlational data) oe
A1 explains limitation: retrospective or biased reporting may reflect current illness effects not causal family patterns, and correlational designs cannot establish causation oe
Answer: A problem is reliance on retrospective reports and correlational data: parents or patients may recall family interactions differently after illness, and such designs cannot prove family patterns caused the disorder rather than result from it.

Question 11

M1 identifies a specific cognitive deficit, e.g. impaired central control, impaired metarepresentation, or reduced processing speed oe
M1 states the specific symptom it explains, e.g. central control dysfunction explains disorganised speech; metarepresentation impairment explains auditory hallucinations or thought insertion oe
A1 briefly links how the deficit produces the symptom, e.g. impaired central control produces loose associations, leading to incoherent speech oe
Answer: E.g. impaired central control is linked to disorganised speech because difficulties suppressing automatic associations lead to loose connections between ideas; impaired metarepresentation is linked to auditory hallucinations or thought insertion by causing misattribution of inner speech.

Question 12

Level 4 (13-16): Knowledge of family and cognitive psychological explanations is accurate and detailed. Evaluation is thorough, balanced and explicit, including methodological critique, empirical support and comparison with biological explanations. The answer shows clear judgement about explanatory power and limitations, and uses relevant examples and research. Specialist terminology is used accurately and the response is coherent and well structured.
Level 3 (9-12): Knowledge of the psychological explanations is clear with some detail. Evaluation is developed and shows awareness of strengths and limitations, and makes some comparison with biological accounts. The answer is mostly organised and uses appropriate terminology, though some points may be less well developed.
Level 2 (5-8): Knowledge of psychological explanations is present but limited or partially accurate. Evaluation is superficial or one-sided, and comparison with biological explanations is limited. The answer may lack organisation or detail and use terminology inconsistently.
Level 1 (1-4): Knowledge is minimal or inaccurate. Evaluation is very limited or absent, with little or no comparison to biological accounts. The answer lacks structure and uses few specialist terms.
Level 0 (0): No creditable content.
Indicative content:
- AO1: Family dysfunction explanations include the schizophrenogenic mother (cold, rejecting, domineering parenting creates a climate that may contribute to schizophrenia), Bateson et al. double bind communication (repeated contradictory messages that the child cannot resolve lead to confusing thinking and disordered communication), and expressed emotion (high levels of criticism, hostility and emotional overinvolvement from carers are linked to higher relapse rates).
- AO1: Cognitive explanations include impaired metarepresentation (reduced ability to reflect on and recognise own thoughts, leading to misattribution of inner speech as external, explaining hallucinations and thought insertion), central control dysfunction (difficulty suppressing automatic responses and organising thought, explaining disorganised speech and thought disorder), and lowered processing efficiency (slower or less efficient attention and executive function contributing to disorganisation).
- AO3: Strengths of family accounts: draw attention to psychosocial and environmental contributors, help explain relapse and family interactions that affect course of illness, and have informed family intervention strategies. Weaknesses: risk of blaming families, many studies are correlational or retrospective so causality is uncertain, and findings have not shown consistent causal mechanisms across populations.
- AO3: Strengths of cognitive accounts: offer mechanistic, symptom-level explanations linking specific cognitive deficits to particular symptoms, are supported by cognitive testing showing deficits in attention and executive function, and can integrate with psychological therapies targeting thinking. Weaknesses: cognitive accounts may describe processes but not fully explain why deficits arise; some cognitive findings overlap with effects of medication or illness chronicity.
- AO3: Empirical support: EE studies show higher relapse risk in high EE families; cognitive research finds impairments in central control, working memory and source monitoring in patients with schizophrenia. Limitations include heterogeneity of findings and difficulties separating cause from effect.
- AO3: Comparison with biological explanations: biological accounts (genetic vulnerability, dopamine hypothesis, neural correlates) explain some aspects such as onset, heritability and some neurobiological correlates, whereas psychological accounts explain symptom phenomenology and environmental maintenance factors like relapse. Interactionist perspectives integrate both, but psychological explanations alone may struggle to explain the strong genetic and neurobiological findings.
- AO3: Overall evaluation: psychological explanations provide useful, clinically relevant accounts for specific symptoms and for environmental influences on relapse, but are limited by methodological problems and by not accounting for biological risk factors; the most persuasive position is that psychological and biological factors together provide a fuller explanation, with psychological models contributing important proximate mechanisms and treatment targets.

Psychological Explanations for Schizophrenia: Family and Cognitive Theory - Worksheets, Questions and Revision