Interactionist Approach Schizophrenia

Interactionist Approach: Definition

The interactionist approach combines explanations to explain a behaviour or phenomenon, incorporating biological, psychological, and social perspectives. It combines all aspects of nature and nurture debates to determine potential causes of behaviours and, ultimately, the best way to treat mental health issues. Schizophrenia is a good example.

Fig. 1 - The interactionist approach to schizophrenia examines the combination of approaches to explaining schizophrenia.

In the interactionist approach to schizophrenia, biological, psychological, and social factors are linked to the cause of schizophrenia to understand how the symptoms develop. We can then use the interactionist approach to help treat the disorder. The best-known example of the interactionist approach in schizophrenia is the diathesis-stress model.

Interactionist Approach: Schizophrenia

The interactionist approach to schizophrenia combines multiple approaches to explain the disorder's origin and explore potential treatment plans. Schizophrenia, according to the interactionist approach, can be explained by biological, social, and psychological factors.

• Biological factors include genetic vulnerabilities, neural correlates, and biochemical factors (dopamine imbalances).
• Psychological factors include family dysfunction, expressed emotions, and traumatic childhood experiences.
• Social factors include low social status.

To treat schizophrenia from an interactionist perspective, we can examine these areas and address them appropriately. An example of an interactionist approach in schizophrenia is the diathesis-stress model.

Interactionist Approach Example: The Diathesis-Stress Model

The diathesis-stress model is an example of the interactionist approach. It explores how predispositions (vulnerabilities) to disorders can be triggered by environmental stressors, resulting in disorders such as depression and schizophrenia.

Further research refutes the notion that schizophrenia results from a specific gene.

We now know schizophrenia is a polygenetic disorder in which dopamine imbalances, external factors, and environmental factors can cause a predisposition to the disorder. These events can cause or the result of developmental problems, such as complications at birth or abuse in childhood that affects brain development.

Fig. 2 - The development of schizophrenia, including its symptoms, can be affected by resources and support.

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

Psychology: Interactionist Approach

The interactionist approach in psychology uses a combination of approaches to explain behaviour and phenomena across various psychological discussions. It is often integrated into explanations and treatments to help treat those with certain disorders.

Examples include depression, anxiety, and schizophrenia, amongst other mental health disorders.

Evaluation of Internal Vulnerabilities and Triggers

Let's examine some of the research investigating the approaches.

• Husted et al. (2010) investigated 194 subjects and 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 4045 samples of individuals aged 18 to 64, recording the first onset of psychotic symptoms with a two-year follow-up period. Childhood trauma was assessed at baseline (before exposure to any 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 during delivery (uterine atony, asphyxia, emergency cesarean section).

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

The interactionist approach is explored in two prominent studies associated with schizophrenia. Let's examine them further.

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 had a psychological experience that triggered the disorder.

Tienari et al. (2004)

Tienari (2004) studied a Finnish national sample of 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.

Tienari (2004) 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.

Advantages and Disadvantages of the Interactionist Approach

The interactionist approach is not without its advantages and disadvantages. First, let's examine some advantages.

• The interactionist approach is holistic, considering all factors rather than reducing a disorder to individual components. The biological approach to schizophrenia, for instance, has issues with reductionism. The interactionist approach avoids these issues by combining different factors.
• The interactionist approach is often supported by research, as demonstrated above, as well as Gottesman (1991) and Tienari (2004).

Criticism of the Interactionist Approach

Now, let's examine the criticisms of the interactionist approach.

• However, the interactionist approach has treatment issues, as we cannot conclusively say which treatment plan addressing each area works best. Is the medication treating the issue, or is the therapy proving more effective?
• When considering multiple approaches, how to address these areas becomes more complex and more expensive. Providing cognitive behavioural therapy, family therapy, antipsychotic medication, and social support is costly, time-consuming, and addresses many different areas. Treatment can become increasingly complex and convoluted as a result.

The Interactionist Approach to Treating Schizophrenia

As a large body of research suggests that schizophrenia is both a genetic and an environmental disorder, the interactionist approach indicates that combining 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 before 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 positive and negative symptoms. CBT then addresses the psychological aspects of schizophrenia and helps patients develop coping strategies and process symptoms logically.

• Tarrier et al. (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 on symptom measures. 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.

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.