Cognitive & biological treatments
- The interactionist approach to treating schizophrenia is to combine both drug therapy with cognitive behavioural therapy (CBT)
- The ‘interaction’ element of the interactionist approach refers to the idea that schizophrenia may not have one, true cause and may in fact develop due to a range of factors so it makes sense to treat both the biological and the psychological/cognitive symptoms/effects of the illness (as suggested by the diathesis-stress model)
- Drug therapy consists of the use of antipsychotic medication which addresses the possible biological cause of schizophrenia
- Psychological/cognitive therapy consists of CBT which is a talking therapy aimed at enabling the client to cope with their symptoms and to manage their dysfunctional thoughts and behaviours
- Interactionist treatment usually starts with the patient taking antipsychotic medication to control their symptoms, followed by CBT: this process is designed to enable the schizophrenic person to be able to participate in CBT more successfully as the drug therapy should have reduced some of their symptoms prior to the CBT sessions
- The interactionist approach to treating schizophrenia is more common in the UK compared to, for example, the USA which has a history of struggling to combine both biological and psychological approaches to treatment
Drugs or talking therapy? The interactionist approach says, ‘Why not combine both?’
Exam Tip
If you are evaluating the interactionist approach to treating schizophrenia remember that you can use the AO3 points from other topics in your A Level studies e.g. drug therapy and CBT for treating schizophrenia which are dealt with as separate topics as part of the Schizophrenia option.
Research which investigates treatment using the interactionist approach
- Tarrier et al. (2004) found that patients (total sample size = 315)who were prescribed a combination of drug therapy and CBT showed reduced symptoms compared to patients who were prescribed drugs only
- Guo et al. (2010) - patients who followed an interactionist treatment regimen whilst in the early stages of schizophrenia showed improvement in their symptoms and were less likely to relapse than those who took drugs alone
- Morrison et al. (2018) conducted a single-blind pilot study with 75 schizophrenic patients in Manchester: patients were allocated to drugs-only, CBT-only or a combination of CBT plus drugs and the findings showed that the combination condition was the most promising for the successful treatment of first-episode schizophrenia
Evaluation of treatment using the interactionist approach
Strengths
- Strong supporting evidence as seen in, for example, Tarrier et al. (2018) above gives the interactionist approach good validity
- Using the interactionist approach may prove to be cost-effective (i.e. good for the economy) if it is more successful than other treatments as the patient will improve more quickly and is less likely to relapse, saving money on health services and getting the patient back into the workplace more quickly
Weaknesses
- The interactionist approach may not suit all patients: some patients may have difficulty understanding or interpreting the side-effects of their drugs which CBT sessions could actually make worse with the emphasis they place on challenging dysfunctional thought processes i.e. the effects of the drug are exacerbated by the effects of the CBT
- The treatment-causation fallacy suggests that the interactionist approach may be mistaken in treating the (supposed) biological causes of the illness first as there is no hard evidence that schizophrenia has its roots in biological factors
Link to Issues & Debates:
There is a lack of cultural relativism in the interactionist approach so it could be accused of culture bias i.e. some cultures may respond to neither drug therapy nor CBT as both of these treatments may misalign with some cultural norms and culture bound syndromes.
Worked example
Outline and evaluate the interactionist approach to explaining and treating schizophrenia.
[8]
AO1 = 3 marks, AO3 = 5 marks
For 6-8 marks the answer should clearly and concisely outline the interactionist approach, using appropriate detail. Effective use of examples should be given to support the points made. There should be confident use of terminology. Evaluation should be effective.
For 4-6 marks the answer will show some knowledge of the interactionist approach. There may be some lack of expansion or development of ideas. There should be some use of terminology. Evaluation will be present but may lack depth or detail.
For 1-3 marks the answer will only partially outline the interactionist approach. Terminology will be sparse and there may be some vagueness or ambiguity to the response. Evaluation is likely to be sparse or absent altogether.
Possible answer content could include:
AO1: The interactionist approach assumes that schizophrenia does not develop due to one explanation, instead it states that biological, psychological/cognitive factors all have their role to play in the development of the disorder. The diathesis-stress model is based on the idea that stressors can trigger vulnerability to schizophrenia e.g. cannabis use, abusive home environment, childhood trauma. Someone may inherit a predisposition to developing schizophrenia but a positive home environment and robust coping skills may mean that the disorder does not develop. Interactionist treatments involve the combination of drug therapy and CBT.
AO3: There is some robust evidence that supports the interactionist approach (e.g. Tienari et al’s 2004 longitudinal research of 19,000 adoptees from Finland which found that children with a genetic vulnerability to schizophrenia are more at risk of developing the disorder in the presence of stressors). Using a combination of treatments e.g. CBT and drugs appear to produce the most favourable outcomes for patients (Tarrier et al. 2004). The interactionist approach is more holistic than other approaches as it takes a number of factors into consideration rather than simply focusing on biology or psychology. However, the diathesis-stress model only provides a simplistic explanation of the development of schizophrenia, plus it is unclear as to exactly how stressors may trigger schizophrenic symptoms. Interactionist treatment may also be prone to the treatment-causation fallacy with its emphasis on biological factors as the first point of treatment which may not be valid in terms of what is the root cause of the patient’s schizophrenia.
