Cognitive explanations for Schizophrenia | AQA A-Level Psychology Revision

For 7182 specification, first teach in September 2025

AQA A-Level Psychology | Free Revision Notes

Estimated study time: 60 minutes

Cognitive explanations propose that schizophrenia is associated with dysfunctional ways of processing, monitoring and interpreting information. These Cognitive explanations A-Level Psychology revision notes explore how difficulties recognising self-generated thoughts, controlling attention and organising information may contribute to hallucinations, delusions and disturbed communication.

The explanation focuses on how symptoms are produced rather than solely on biological vulnerability or family experience. It therefore complements dopamine activity and brain functioning and provides the theoretical basis for challenging distressing beliefs and interpretations. Dysfunctional thought processing is explicitly required by the current AQA specification.

Learning Objectives 🎯

By the end of this revision page, you should be able to:

• Explain dysfunctional thought processing as an explanation of schizophrenia.

• Explain metacognition and the monitoring of self-generated thoughts.

• Explain central control and executive-functioning difficulties.

• Link cognitive-processing difficulties to hallucinations, delusions and disturbed speech.

• Apply cognitive explanations to unfamiliar scenarios.

• Evaluate cognitive explanations using evidence, methodological issues and alternative accounts.

Revision Notes 📚

Cognitive explanations of schizophrenia overview

A cognitive explanation focuses on the mental processes involved in:

• Attention.

• Perception.

• Memory.

• Language.

• Reasoning.

• Monitoring thoughts.

• Interpreting events.

• Planning and controlling behaviour.

The explanation proposes that schizophrenia symptoms may arise when these processes become dysfunctional.

AQA mark schemes identify several relevant forms of dysfunctional processing:

• Maladaptive or dysfunctional thinking.

• Poor memory functioning.

• Problems understanding and monitoring one’s own thoughts.

• Difficulty distinguishing self-generated mental activity from external events.

• Difficulty recognising one’s own output.

• Impaired executive functioning.

• Deficits in central control.

The central cognitive argument

A simplified cognitive pathway is:

dysfunctional information processing → inaccurate interpretation of internal or external information → schizophrenia symptoms

For example:

failure to recognise inner speech as self-generated → voice experienced as external → auditory hallucination

The explanation does not necessarily claim that dysfunctional thinking is the original cause of every case.

It may instead explain:

• How symptoms take a particular form.

• Why unusual experiences are interpreted in particular ways.

• How symptoms are maintained.

• Why some cognitive tasks are difficult.

What is dysfunctional thought processing?

Dysfunctional thought processing occurs when the cognitive systems used to receive, organise, monitor or interpret information do not operate effectively.

Possible difficulties include:

• Failing to identify the source of a thought.

• Failing to distinguish internal events from external events.

• Allowing irrelevant information to interrupt thinking.

• Difficulty controlling automatic responses.

• Difficulty organising ideas into a coherent sequence.

• Problems monitoring one’s own actions.

• Memory impairment.

• Maladaptive interpretations of ambiguous events.

The cognitive explanation does not claim that the person deliberately chooses to think incorrectly.

The dysfunctional processing may be:

• Automatic.

• Outside conscious control.

• Associated with biological vulnerability.

• Made worse by stress.

Cognition and symptoms

A symptom is not simply the cognitive deficit itself.

The cognitive deficit is the proposed process that helps produce or maintain the symptom.

Cognitive difficulty	Possible symptom
Failure to recognise inner speech as self-generated	Auditory hallucinations
Difficulty monitoring one’s own intentions or actions	Delusions of control
Maladaptive interpretation of ambiguous information	Persecutory delusions
Weak central control	Confused or disorganised speech
Poor executive functioning	Difficulty maintaining goal-directed behaviour
Memory difficulty	Confusion and reduced ability to organise experience

This lesson builds on hallucinations, delusions, speech poverty and avolition.

Metacognition

What is metacognition?

Metacognition means awareness and understanding of one’s own thinking.

It involves recognising:

• What one is thinking.

• Where a thought came from.

• Whether an idea is a memory, intention or perception.

• Whether information was generated internally or received externally.

• How confident one should be in a judgement.

AQA mark schemes describe people with schizophrenia as sometimes having difficulty understanding their own thinking and distinguishing it from environmental stimuli.

Thinking about thinking

An ordinary metacognitive judgement might be:

“That sentence occurred in my mind. I imagined it rather than hearing someone say it.”

The person identifies:

• The mental event.

• Its internal source.

• The difference between thought and external speech.

A dysfunctional judgement might be:

“I experienced a sentence, so somebody outside me must have said it.”

The thought is not identified correctly as self-generated.

Metacognition is not ordinary self-reflection alone

Metacognition includes more than consciously considering one’s personality or feelings.

It also includes rapid, automatic monitoring of:

• Thoughts.

• Speech.

• Memories.

• Intentions.

• Actions.

People normally make many source judgements without noticing that they are doing so.

Metarepresentation

What is metarepresentation?

A metarepresentation is a mental representation of another mental representation.

In schizophrenia explanations, the term is often used for the ability to represent and monitor:

• One’s own thoughts.

• One’s own intentions.

• Another person’s mental states.

A metarepresentational system allows someone to recognise:

“This is my own thought.”

or:

“This action followed from my own intention.”

Failure of metarepresentation

A failure of metarepresentation means that self-generated thoughts or intentions are not represented accurately as belonging to oneself.

The person may have difficulty recognising:

• Inner speech as their own.

• An intention as self-generated.

• An action as resulting from their own decision.

• A memory as an internally reconstructed event.

This may contribute to:

• Auditory hallucinations.

• Thought insertion.

• Delusions of control.

• Beliefs that an outside force produces one’s actions.

📌 Exam precision: It is the failure or impairment of metarepresentation that is used to explain symptoms, not successful metarepresentation.

The 2022 examiner report warned that students sometimes wrote that metarepresentational processes themselves explained schizophrenia rather than explaining how a failure in cognitive monitoring produces symptoms.

Source monitoring

What is source monitoring?

Source monitoring is the process of identifying where information came from.

Possible sources include:

• Something another person said.

• One’s own speech.

• An imagined event.

• A memory.

• A dream.

• Inner speech.

• Something read or watched.

A person usually distinguishes:

“I thought that.”

from:

“Someone said that.”

Source-monitoring failure

When source monitoring is impaired, an internally generated experience may be attributed to an external source.

For example:

1. The person silently thinks, “You are in danger.”

2. The thought is not recognised as self-generated.

3. It is experienced as if another person produced it.

4. The person reports hearing a threatening voice.

This provides a cognitive explanation of an auditory hallucination.

Internal versus external events

AQA’s 2022 mark scheme identifies difficulty distinguishing one’s own thinking from environmental stimuli as central to cognitive explanations.

The key distinction is:

• Internal event: thought, memory, inner speech or intention.

• External event: another person’s voice, an object or an environmental stimulus.

Inner speech

What is inner speech?

Inner speech is the silent verbal thought people experience internally.

Examples include:

• Mentally rehearsing a sentence.

• Reminding oneself of a task.

• Planning what to say.

• Silently commenting on an event.

Inner speech is an ordinary cognitive process.

Inner speech and hallucinations

The cognitive explanation proposes that hallucinations may occur when inner speech is not correctly identified as one’s own.

The sequence is:

self-generated inner speech → failure of self-monitoring → external attribution → auditory hallucination

For example:

Lewis silently thinks, “Nobody trusts you.” Because he fails to recognise the sentence as self-generated, he experiences it as a voice coming from outside himself.

Why the voice may feel real

The person genuinely experiences the thought as external.

They are not:

• Pretending.

• Deliberately imagining a voice.

• Lying about hearing it.

• Choosing to misunderstand the experience.

The problem lies in the cognitive attribution of the experience’s source.

Delusions of control

What is a delusion of control?

A delusion of control is the belief that an outside force controls one’s:

• Actions.

• Thoughts.

• Feelings.

• Decisions.

For example:

A person believes that a device is moving their arm or placing thoughts into their mind.

Cognitive explanation

Normally, an intention is generated before an action.

The person monitors the connection:

“I decided to raise my hand, and then I raised it.”

If self-monitoring is impaired, the intention may not be recognised.

The action then appears to occur without personal authorship.

The person may conclude:

“Someone else controlled my movement.”

The cognitive pathway is:

impaired monitoring of intention → action not experienced as self-generated → external explanation → delusion of control

Thought insertion

Thought insertion involves believing that thoughts have been placed into one’s mind by an outside source.

A possible cognitive explanation is:

• A thought enters awareness.

• The person does not recognise its self-generated source.

• The unfamiliar experience requires explanation.

• The person attributes it to an external agent.

Recognising one’s own output

AQA’s 2022 mark scheme notes that people with schizophrenia may be poor at recognising their own output, including something they have produced themselves.

Output can include:

• Speech.

• Writing.

• Drawings.

• Actions.

• Generated ideas.

A person may later have difficulty distinguishing their own output from material produced by somebody else.

This supports the wider idea that monitoring of self-generated material is impaired.

Delusions and dysfunctional interpretation

Interpreting unusual experiences

A delusion may form when a person tries to explain an unusual or confusing experience.

For example:

1. An ordinary event feels unusually important.

2. The person searches for an explanation.

3. The explanation is based on dysfunctional processing.

4. A delusional belief develops.

Suppose someone notices two strangers looking towards them.

Possible ordinary explanations include:

• The strangers are looking at something nearby.

• Their gaze is accidental.

• They briefly noticed the person’s clothing.

A maladaptive interpretation might be:

“They are watching me because an organisation is tracking me.”

Persecutory delusions

A persecutory delusion is a fixed belief that another person or group intends to harm or target the individual.

Cognitive processes that may contribute include:

• Misinterpreting ambiguous social information.

• Attributing threatening meaning to neutral events.

• Failing to consider alternative explanations.

• Giving excessive importance to an unusual experience.

The cognitive explanation focuses on how the event is interpreted, not simply on the event itself.

Cognitive explanation and dopamine

The cognitive and dopamine explanations can be combined.

A possible sequence is:

1. Abnormal dopamine activity makes an ordinary event feel unusually significant.

2. Dysfunctional cognitive processing produces a threatening interpretation.

3. The interpretation becomes a delusional belief.

The dopamine explanation describes a possible biological source of unusual salience.

The cognitive explanation describes how the experience is interpreted.

Central control

What is central control?

Central control is the cognitive ability to:

• Direct attention.

• Suppress irrelevant responses.

• Select relevant information.

• Organise ideas.

• Maintain a goal.

• Move coherently from one thought to another.

A person with effective central control can prevent irrelevant associations from disrupting their thinking.

Failure of central control

A central-control deficit occurs when irrelevant thoughts or automatic responses are not inhibited effectively.

The person may:

• Change topics suddenly.

• Produce loosely connected ideas.

• Lose the original point.

• Include irrelevant information.

• Struggle to organise speech.

• Be distracted by competing thoughts.

AQA’s mark schemes link central-control difficulties with disordered thinking and language deficits, including reduced fluency and severely disorganised speech.

Automatic and controlled responses

An automatic response occurs quickly with little deliberate effort.

A controlled response involves consciously selecting information relevant to a goal.

Central control allows the controlled response to override irrelevant automatic associations.

For example, when asked:

“What did you do this morning?”

many ideas may enter awareness:

• Breakfast.

• A television advert.

• An old memory.

• A word that rhymes with “morning”.

• A worry about tomorrow.

Effective central control selects the information relevant to the question.

A deficit may allow unrelated ideas to enter the response.

Executive functioning

What is executive functioning?

Executive functioning refers to the cognitive processes used to organise and control purposeful behaviour.

It includes:

• Planning.

• Working memory.

• Inhibition.

• Flexible thinking.

• Monitoring performance.

• Maintaining attention.

• Switching appropriately between tasks.

AQA’s 2023 mark scheme identifies impaired executive functioning and central control as cognitive explanations of schizophrenia.

Executive functioning and communication

Speech requires the speaker to:

1. Hold the question in working memory.

2. Select relevant information.

3. Organise ideas.

4. Suppress irrelevant associations.

5. Produce a coherent response.

6. Monitor whether the response still makes sense.

Difficulties at these stages may produce:

• Rapid switching between ideas.

• Confused speech.

• Reduced fluency.

• Incomplete answers.

• Difficulty maintaining a topic.

Applying executive dysfunction

Jay’s speech is rapid and confused, and he constantly changes from one idea to something completely different.

AQA’s 2023 mark scheme states that this behaviour may be explained through:

• Impaired cognitive processing.

• Poor executive functioning.

• Deficient central control.

A developed application would state:

“Jay may have difficulty inhibiting irrelevant associations and maintaining one organised train of thought. This central-control deficit could explain why he rapidly switches between unrelated ideas.”

Cognitive processing and speech poverty

Speech poverty is a reduction in the amount or quality of speech.

Executive-functioning difficulties may contribute if the person struggles to:

• Generate ideas.

• Hold information in working memory.

• Organise an answer.

• Maintain a line of thought.

• Select suitable words.

The person may therefore:

• Give very brief answers.

• Pause for long periods.

• Produce limited information.

• Avoid initiating speech.

However, the cognitive explanation may be stronger for certain forms of disorganised speech than for all cases of speech poverty.

Cognitive processing and avolition

Avolition is a reduction in initiating and maintaining goal-directed behaviour.

Executive-functioning difficulties might contribute by disrupting:

• Planning.

• Decision-making.

• Maintaining a goal.

• Organising the steps of an activity.

For example:

A person intends to prepare food but cannot organise the sequence of actions needed to begin.

However, AQA’s 2022 mark scheme identifies the limited explanation of negative symptoms as an important weakness of the cognitive approach.

Avolition may also involve:

• Reward processing.

• Dopamine activity.

• Low mood.

• Medication effects.

• Environmental factors.

The cognitive explanation should not be presented as equally successful for every symptom.

Memory difficulties

Memory and schizophrenia

Memory is needed to:

• Follow conversations.

• Compare present information with past experience.

• Maintain a goal.

• Organise a response.

• Distinguish a memory from a current perception.

• Evaluate whether an event has happened before.

AQA mark schemes accept poor memory functioning as part of the cognitive explanation.

Working memory

Working memory is the limited system used to hold and manipulate information during a task.

For example, following a conversation requires someone to remember:

• The original question.

• What they have already said.

• What the other person said.

• Which point they are developing.

Poor working memory may lead to:

• Losing the thread of a conversation.

• Repeating information.

• Moving to an unrelated idea.

• Difficulty completing multi-stage activities.

Memory and source monitoring

Memories contain information about their source.

For example, someone may remember whether an idea came from:

• A real conversation.

• A dream.

• Their imagination.

• A book.

• Their own previous thought.

Weak memory for the source may contribute to confusion between internal and external events.

Linking cognitive processes to symptoms

Hallucinations

A cognitive explanation may involve:

• Poor source monitoring.

• Failure of metarepresentation.

• Misidentification of inner speech.

• Difficulty recognising self-generated output.

The pathway is:

internal thought → source-monitoring failure → external attribution → hallucination

Delusions of control

A cognitive explanation may involve:

• Failure to monitor one’s own intentions.

• Failure to experience an action as self-generated.

• Attribution of the action to an outside force.

The pathway is:

action without recognised intention → loss of personal authorship → delusion of external control

Persecutory delusions

A cognitive explanation may involve:

• Maladaptive interpretation of ambiguous events.

• Excessive attention to possible threats.

• Failure to consider ordinary alternatives.

• An attempt to explain confusing experiences.

The pathway is:

ambiguous event → threatening interpretation → fixed persecutory belief

Disturbed speech

A cognitive explanation may involve:

• Deficient central control.

• Poor inhibition of irrelevant associations.

• Weak working memory.

• Impaired executive functioning.

The pathway is:

competing thoughts not controlled → disrupted train of thought → confused or disorganised speech

Negative symptoms

Possible cognitive links include:

• Difficulty planning activity.

• Weak executive control.

• Problems generating speech.

• Reduced ability to maintain goals.

However, cognitive explanations are generally more successful in explaining:

• Hallucinations.

• Delusions.

• Disturbed thought and speech.

than in explaining the full range of negative symptoms.

Complete symptom-link table

Symptom or behaviour	Dysfunctional cognitive process	Explanation
Hearing a voice	Source-monitoring failure	Inner speech is misidentified as external
Thought insertion	Failure of metarepresentation	A self-generated thought is not recognised as one’s own
Delusion of control	Impaired intention monitoring	An action is attributed to an outside force
Persecutory delusion	Maladaptive interpretation	Neutral events are interpreted as threatening
Rapid switching between ideas	Central-control deficit	Irrelevant associations interrupt the train of thought
Confused speech	Executive dysfunction	Ideas are not selected and organised coherently
Speech poverty	Difficulty generating and organising output	Verbal responses become reduced
Avolition	Impaired planning and goal maintenance	Purposeful activity is difficult to begin or sustain

A worked cognitive formulation

Consider the following scenario:

Amira experiences the sentence “You are being followed” in her mind. She believes that a nearby stranger placed the sentence into her thoughts. When speaking about the experience, she repeatedly moves to unrelated topics.

Internal thought

The sentence may begin as inner speech.

Failure of metarepresentation

Amira does not recognise the sentence as her own mental activity.

External attribution

She attributes the thought to the stranger.

Delusion

She develops the belief that the stranger inserted the thought.

Central-control deficit

Her movement between unrelated topics may reflect difficulty inhibiting irrelevant ideas and maintaining a coherent train of thought.

Applying the explanation to hallucinations

When a room is silent, Rohan hears a voice commenting on his actions.

A cognitive explanation would state:

• The voice may originate as Rohan’s inner speech.

• Rohan may have impaired metacognition or source monitoring.

• He fails to recognise the thought as self-generated.

• He attributes the experience to an external speaker.

• This produces an auditory hallucination.

Applying the explanation to delusions

Elena believes that an outside organisation is controlling her arm movements.

A cognitive explanation would state:

• Elena may fail to monitor the intention preceding her movement.

• The movement therefore does not feel self-generated.

• She attempts to explain the missing sense of authorship.

• She attributes the movement to an external organisation.

• This produces a delusion of control.

Applying the explanation to confused speech

When asked about college, Theo begins discussing a lecture, changes suddenly to a childhood holiday and then starts talking about the colour of the interviewer’s shoes.

A cognitive explanation would state:

• Theo shows impaired central control.

• He cannot suppress irrelevant associations.

• Working memory may also fail to maintain the original question.

• His ideas are therefore not organised into a coherent response.

Applying the explanation to speech poverty

During an interview, Niamh pauses for long periods and gives very limited answers despite appearing to understand the questions.

A cognitive explanation might suggest:

• Niamh has difficulty generating and organising verbal information.

• Impaired executive functioning may make it difficult to select and maintain a response.

• Her verbal output is reduced, producing speech poverty.

This explanation should be used cautiously because speech poverty may also involve motivational or neural processes.

Applying the explanation to avolition

Malik wants to complete his coursework but repeatedly loses track of the task, cannot plan the required steps and abandons it shortly after starting.

A cognitive explanation might suggest:

• Malik has impaired executive functioning.

• He struggles to organise and maintain a goal.

• This contributes to failure to continue purposeful activity.

However, if the scenario only states that Malik lacks motivation, reduced reward processing may provide a stronger neural explanation.

Cognitive explanations versus cognitive behaviour therapy

These must not be confused.

Cognitive explanation

Explains how dysfunctional processing may contribute to symptoms.

Examples include:

• Failure of metarepresentation.

• Source-monitoring difficulty.

• Central-control deficits.

Cognitive behaviour therapy

A treatment that helps a person:

• Examine beliefs.

• Consider alternative explanations.

• Understand thoughts.

• Develop coping strategies.

The treatment is explored in challenging beliefs and developing coping strategies.

Cognitive explanation	Cognitive behaviour therapy
Explains symptoms	Treats or manages symptoms
AO1 explanation content	Treatment content
Focuses on dysfunctional processing	Focuses on identifying and challenging thoughts
May involve metacognition and central control	May involve reality testing and coping strategies

Comparing cognitive and family explanations

Cognitive explanation	Family dysfunction
Focuses on internal mental processing	Focuses on family communication and emotion
Includes metacognition and central control	Includes double binds and expressed emotion
May explain how symptoms are formed	May explain stress, development or relapse
Can imply individual cognitive dysfunction	Can imply parental responsibility
Leads towards CBT	Leads towards family therapy
Cognitive reductionism	Environmental reductionism
May be caused by neural dysfunction	May interact with biological vulnerability

Both are psychological explanations required by AQA.

Comparing cognitive and neural explanations

Cognitive explanation	Neural explanation
Focuses on information processing	Focuses on brain structure and chemistry
Hallucination caused by misattributed inner speech	Hallucination linked with altered neural or dopamine activity
Uses cognitive tasks and interviews	Uses scans, drugs and biological measures
Leads towards CBT	Leads towards antipsychotic medication
Describes the psychological mechanism	May describe the biological basis of that mechanism
Cognitive level of explanation	Biological level of explanation

The explanations can be complementary.

A possible sequence is:

genetic vulnerability → altered dopamine or brain functioning → dysfunctional source monitoring → hallucination

This avoids assuming that the cognitive and biological accounts are competitors.

Evaluating cognitive explanations

Strength: cognitive deficits are associated with schizophrenia

Research has found differences in cognitive functioning among people diagnosed with schizophrenia.

AQA identifies Leeson and colleagues’ findings of memory impairment as evidence relevant to evaluating psychological explanations.

Memory difficulties are consistent with the proposal that dysfunctional information processing contributes to the condition.

Why memory evidence supports the explanation

If people diagnosed with schizophrenia show poorer memory functioning, this suggests that their difficulties extend beyond unusual beliefs.

They may struggle with processes needed to:

• Monitor information.

• Maintain a train of thought.

• Organise behaviour.

• Identify the source of experiences.

However, memory impairment does not prove that cognitive dysfunction caused schizophrenia.

Strength: cognitive explanations account for specific symptoms

A major strength is that the explanation links particular cognitive processes with particular experiences.

For example:

• Failure of source monitoring explains hearing one’s inner speech as a voice.

• Failure to recognise intentions explains delusions of control.

• Poor central control explains rapidly changing or confused speech.

This is more precise than saying simply that “thinking is abnormal”.

It offers a mechanism showing how the symptom may be produced.

Limitation: the explanation may describe rather than explain

Cognitive explanations identify how people with schizophrenia process information.

They may not explain why that dysfunctional processing developed.

For example:

“The person hears a voice because they cannot identify inner speech.”

still leaves the question:

“Why can they not identify their inner speech?”

Possible underlying causes include:

• Genetic vulnerability.

• Dopamine dysfunction.

• Altered brain development.

• Environmental stress.

• A combination of factors.

AQA’s 2022 mark scheme identifies failure to explain the underlying, possibly biological cause as an important limitation.

Explanation at different levels

The cognitive account may explain the mechanism of a symptom.

The biological account may explain why the mechanism became dysfunctional.

Both levels may therefore be needed.

Limitation: direction of causality

Most cognitive evidence compares:

• People with schizophrenia.

• People without schizophrenia.

If the diagnosed group performs less successfully on cognitive tasks, researchers cannot conclude automatically that the deficit caused schizophrenia.

Alternative explanations include:

1. Schizophrenia symptoms impair cognitive performance.

2. Long-term stress affects memory and attention.

3. Medication affects concentration.

4. Social isolation reduces cognitive stimulation.

5. A neural abnormality causes both symptoms and cognitive deficits.

AQA mark schemes explicitly recognise the possibility that disturbed cognitive processing may be an effect rather than a cause.

Limitation: medication is a confounding variable

Many participants in cognitive studies take antipsychotic medication.

Medication may affect:

• Alertness.

• Reaction time.

• Memory.

• Attention.

• Motivation.

If a diagnosed group performs poorly, the difference could partly result from treatment.

Researchers may try to:

• Compare participants taking similar medication.

• Measure dosage.

• Test people before treatment.

• Statistically control medication effects.

Complete control remains difficult.

Limitation: cognitive explanations are less successful for negative symptoms

The explanation gives a relatively clear account of:

• Hallucinations.

• Delusions.

• Some language difficulties.

It is less successful in explaining:

• Avolition.

• Reduced emotional expression.

• Social withdrawal.

• The full range of negative symptoms.

AQA’s 2022 mark scheme identifies this limited symptom coverage directly.

A more complete account may need:

• Neural reward-processing explanations.

• Depression or co-morbidity.

• Environmental factors.

• Medication effects.

Strength: practical application to CBT

Cognitive explanations have contributed to treatments that help people:

• Recognise thoughts as mental events.

• Examine evidence for beliefs.

• Generate alternative interpretations.

• Develop coping strategies for voices.

• Reduce distress caused by symptoms.

The practical usefulness of CBT for schizophrenia supports the importance of beliefs and interpretations.

If changing a person’s interpretation reduces distress, cognition is likely to play some role in symptom maintenance.

Treatment does not prove original cause

CBT effectiveness does not prove that faulty cognition originally caused schizophrenia.

A treatment may:

• Change the response to a symptom.

• Reduce distress.

• Improve coping.

without removing the initial biological vulnerability.

For example, helping someone reinterpret a voice may reduce its impact even if altered neural activity contributed to the voice’s appearance.

Limitation: CBT may treat consequences rather than causes

Cognitive therapy may help the person manage:

• Hallucinations.

• Delusional interpretations.

• Anxiety.

• Distress.

It may not correct:

• Genetic vulnerability.

• Dopamine dysfunction.

• Structural brain differences.

• The complete range of negative symptoms.

This is consistent with the AQA criticism that cognitive accounts may explain or treat some aspects without addressing the underlying cause.

Strength: cognitive tasks can be controlled and standardised

Researchers can give participants identical:

• Memory tasks.

• Source-monitoring tasks.

• Attention tasks.

• Executive-function tests.

• Instructions.

Performance can be measured using:

• Accuracy.

• Reaction time.

• Number of errors.

• Correct source judgements.

This creates quantitative data that can be:

• Compared.

• Analysed statistically.

• Replicated.

The approach therefore has scientific strengths.

Limitation: cognitive tasks may lack ecological validity

A computerised memory or source-monitoring task may not reproduce the complexity of:

• Hearing a distressing voice.

• Forming a persecutory delusion.

• Communicating during a crisis.

• Living with conflicting beliefs.

Poor performance in a laboratory does not necessarily demonstrate the exact cognitive process operating during a real symptom.

The task may measure:

• General concentration.

• Motivation.

• Familiarity with computers.

• Education.

• Medication effects.

rather than one specific schizophrenia mechanism.

Limitation: construct validity

Construct validity concerns whether a task genuinely measures the theoretical process it claims to measure.

For example, a low score on a source-monitoring task could reflect:

• Weak source monitoring.

• Poor memory.

• Misunderstanding instructions.

• Low attention.

• Slow processing.

• Lack of motivation.

Researchers must avoid treating one score as a pure measure of metarepresentation.

Strength: cognitive explanations avoid some family blame

Unlike the schizophrenogenic-mother or double-bind accounts, cognitive explanations do not directly blame relatives.

They focus on the person’s information-processing system.

This may reduce the assumption that parents caused the condition through their behaviour.

However, another ethical concern arises.

Limitation: the explanation may blame the individual

A cognitive explanation can be misunderstood as suggesting that the person:

• Chooses irrational thoughts.

• Is responsible for their delusions.

• Should simply “think differently”.

• Causes their own symptoms.

AQA’s 2021 mark scheme recognises the risk that cognitive explanations make the individual appear actively responsible.

This would be inaccurate because dysfunctional processing may be:

• Automatic.

• Associated with biology.

• Outside voluntary control.

• Difficult to change.

CBT should not be presented as telling the person that their experiences are their fault.

Limitation: cognitive reductionism

A cognitive explanation may be cognitively reductionist because it explains schizophrenia through individual processing failures.

This may overlook:

• Genetic vulnerability.

• Neurotransmitters.

• Brain functioning.

• Family stress.

• Trauma.

• Poverty.

• Discrimination.

• Cultural context.

AQA’s 2022 mark scheme identifies reductionism as a limitation because the explanation reduces a complex condition to individual cognitive symptoms.

Value of reductionism

Reductionism can also be useful.

Breaking cognition into processes such as:

• Source monitoring.

• Working memory.

• Inhibition.

• Executive control.

allows researchers to:

• Test clear predictions.

• Operationalise variables.

• Compare groups.

• Develop targeted therapies.

The limitation arises when one process is treated as the whole explanation.

Cognitive determinism

A strong cognitive explanation may suggest that dysfunctional processing determines the person’s beliefs or actions.

For example:

A source-monitoring deficit inevitably produces hallucinations.

This is too strong because:

• Not everyone with a deficit experiences hallucinations.

• Symptoms vary over time.

• Context affects interpretation.

• People can develop coping strategies.

• Psychological treatment can change outcomes.

A more appropriate position is soft cognitive determinism:

cognitive deficits increase the likelihood of certain symptoms but do not produce an inevitable outcome

Individual differences

People diagnosed with schizophrenia may differ in:

• Memory.

• Attention.

• Language.

• Metacognition.

• Executive functioning.

• Symptoms.

• Treatment response.

One person may experience hallucinations with relatively organised speech.

Another may show severe cognitive disorganisation without prominent hallucinations.

This heterogeneity suggests that:

• Different cognitive deficits may operate in different people.

• One universal cognitive mechanism is unlikely to explain every case.

Diagnosis and symptom overlap

Cognitive research depends on the validity of the schizophrenia diagnosis.

However, cognitive difficulties may also occur in:

• Depression.

• Anxiety.

• Other psychological conditions.

• Neurological conditions.

• People experiencing high stress.

This creates symptom overlap and diagnostic uncertainty.

If participants in a schizophrenia study also have other conditions, researchers may not know which diagnosis explains the cognitive deficit.

Comparison with biological evidence

Biological explanations may have greater apparent scientific status because they use:

• Brain scans.

• Genetic analysis.

• Neurochemical measurements.

However, an objective biological measure still requires interpretation.

Similarly, cognitive research can produce objective performance measures.

The explanations address different questions:

• Biological explanation: what neural system is altered?

• Cognitive explanation: how does the altered system affect thought and experience?

A multi-level account may therefore be more valuable than ranking one approach as automatically more scientific.

Interactionist explanation

Cognitive dysfunction may operate as part of an interactionist account.

One possible sequence is:

1. Genetic variants create vulnerability.

2. Neural development or dopamine activity is altered.

3. Stress places pressure on cognitive systems.

4. Source monitoring or central control becomes less effective.

5. An unusual experience occurs.

6. The person develops a maladaptive interpretation.

7. Hallucinations or delusions emerge.

The full combination of vulnerability and stress is explored in biological and psychological factors working together.

Are cognitive deficits a diathesis or a stressor?

Cognitive processing could be interpreted in different ways.

Cognitive dysfunction as a diathesis

A person may possess a long-standing vulnerability involving:

• Poor source monitoring.

• Weak executive control.

• Memory difficulties.

Environmental stress may then overwhelm the system.

Cognitive interpretation as a trigger or maintenance factor

The initial unusual experience might have a biological origin.

The person’s interpretation may then:

• Increase fear.

• Strengthen the belief.

• Maintain the symptom.

• Cause avoidance.

AQA’s 2025 mark scheme recognises discussion of whether dysfunctional thought processes should be understood as a diathesis or as a trigger within an interactionist account.

Research methods used to investigate cognitive explanations

Quasi-experiments

Researchers often compare naturally occurring groups:

• People diagnosed with schizophrenia.

• People without the diagnosis.

The diagnosis cannot be randomly assigned.

The research is therefore often quasi-experimental.

Independent variable

The naturally occurring independent variable may be:

• Diagnostic group.

• Presence or absence of hallucinations.

• High or low symptom severity.

Dependent variable

Possible dependent variables include:

• Memory score.

• Reaction time.

• Source-monitoring accuracy.

• Number of errors.

• Performance on an executive-functioning task.

Participant variables

Groups may differ in:

• Age.

• Education.

• Medication.

• Sleep.

• Substance use.

• Physical health.

• Motivation.

• Duration of diagnosis.

These variables may affect cognitive performance.

Matching participants

Researchers may improve validity by matching groups on relevant characteristics.

For example:

• Age.

• Education.

• General cognitive ability.

• Language.

• Gender.

Matching cannot control every difference.

Correlational research

Researchers may correlate:

• Hallucination severity with source-monitoring errors.

• Disorganised speech with executive-function scores.

• Negative symptoms with memory performance.

A correlation can demonstrate an association.

It cannot show which variable caused the other.

Longitudinal research

A stronger design would measure cognition:

• Before symptoms develop.

• During the emergence of symptoms.

• After treatment.

If cognitive deficits appear before schizophrenia, this strengthens the claim that they are a vulnerability rather than a consequence.

However, such studies are:

• Expensive.

• Time-consuming.

• Vulnerable to attrition.

• Difficult because most high-risk participants will not develop schizophrenia.

Applying research methods to a cognitive study

Researchers compare 30 people with schizophrenia and 30 controls on a source-monitoring task. Participants hear words spoken by the researcher and silently generate other words themselves. Later, they identify whether each word was heard or self-generated.

Relevant dependent variable

The researcher could measure:

• Number of correct source judgements.

• Percentage of self-generated words incorrectly labelled as externally presented.

• Reaction time.

Predicted finding

The cognitive explanation predicts that the schizophrenia group may make more source-monitoring errors.

Supporting interpretation

More errors involving self-generated words would be consistent with difficulty identifying internal output.

Alternative explanation

The result might instead reflect:

• Poor general memory.

• Medication.

• Reduced attention.

• Difficulty understanding the procedure.

Improving validity

Researchers could:

• Use standardised instructions.

• Test memory separately.

• Match the groups.

• Record medication.

• Use several cognitive tasks.

• Replicate the study.

How to answer application questions

Step 1: Identify the symptom or behaviour

Look for:

• Voices.

• Thoughts believed to come from outside.

• Controlled movements.

• Threatening interpretations.

• Confused speech.

• Rapid topic changes.

• Poor memory.

Step 2: Select the cognitive process

Scenario clue	Cognitive explanation
Voice experienced as external	Source-monitoring or metarepresentational failure
Thought inserted by another person	Failure to recognise own thought
Body controlled by an outside force	Failure to monitor intention
Neutral event interpreted as threatening	Maladaptive interpretation
Rapidly changing ideas	Central-control deficit
Difficulty planning and completing a response	Executive dysfunction
Losing track of information	Working-memory impairment

Step 3: Explain the mechanism

Do not merely name the process.

Weak:

“This is central control.”

Stronger:

“Impaired central control means that the person cannot suppress irrelevant associations, so unrelated ideas repeatedly interrupt the original train of thought.”

Step 4: Link to the scenario

Quote or paraphrase the specific detail.

Step 5: Use cautious language

Use:

• “May explain.”

• “Is consistent with.”

• “Could contribute.”

• “Suggests impaired processing.”

Avoid:

• “Proves.”

• “Always causes.”

• “The person chooses to think this.”

Application structure

Use:

scenario detail → cognitive deficit → processing mechanism → symptom

For example:

“Kian’s rapid movement between unrelated topics suggests impaired central control. He may be unable to inhibit irrelevant associations and maintain the original goal of the conversation, resulting in confused and disorganised speech.”

Structuring a six-mark answer

The June 2022 question asked students to outline a cognitive explanation and one limitation.

The marks were divided equally:

• AO1: 3 marks

• AO3: 3 marks 

A useful structure is:

Cognitive explanation

1. State that dysfunctional information processing contributes to symptoms.

2. Explain one process, such as source monitoring or central control.

3. Link the process to a specific symptom.

Limitation

1. State the limitation.

2. Explain why it weakens the account.

3. Reach a focused conclusion.

Example:

“The cognitive explanation proposes that people with schizophrenia may fail to distinguish self-generated thoughts from external stimuli. Inner speech may therefore be experienced as an external voice, producing auditory hallucinations. However, this explains how the hallucination is experienced rather than why the monitoring deficit first developed. A biological abnormality might underlie the cognitive problem, so the explanation may be incomplete.”

Structuring a 16-mark essay

A strong essay could use the following structure.

Paragraph 1: General cognitive explanation

Define dysfunctional information processing and explain the cognitive level of analysis.

Paragraph 2: Metacognition and hallucinations

Explain:

• Inner speech.

• Source monitoring.

• External attribution.

• Auditory hallucinations.

Paragraph 3: Intention monitoring and delusions

Explain:

• Failure to recognise self-generated intentions.

• Delusions of control.

• Thought insertion.

Paragraph 4: Central control and language

Explain:

• Inhibition.

• Working memory.

• Executive functioning.

• Confused speech or reduced fluency.

Paragraph 5: Supporting evidence

Use:

• Memory research.

• Cognitive-task findings.

• Application to symptom patterns.

Explain what the evidence supports.

Paragraph 6: Cause and effect

Discuss whether cognitive dysfunction is:

• A cause.

• A consequence.

• A symptom.

• A process caused by neural abnormalities.

Paragraph 7: Scope and reductionism

Discuss:

• Better explanation of positive symptoms.

• Weaker explanation of negative symptoms.

• Cognitive reductionism.

• Individual differences.

Paragraph 8: Practical and interactionist conclusion

Use CBT as an application but explain that treatment success does not prove initial cause.

Conclude that cognitive processing may mediate between biological vulnerability and symptoms.

Overall conclusion

Cognitive explanations propose that schizophrenia symptoms result partly from dysfunctional thought and information processing.

Important processes include:

• Metacognition.

• Metarepresentation.

• Source monitoring.

• Central control.

• Executive functioning.

• Memory.

These mechanisms can explain why:

• Inner speech is experienced as an external voice.

• Self-generated actions appear externally controlled.

• Neutral events are interpreted as threatening.

• Speech becomes confused or poorly organised.

The approach is supported by evidence of cognitive and memory difficulties and has useful applications in CBT.

However:

• It may describe how symptoms occur without explaining their underlying cause.

• Cognitive deficits may be consequences of schizophrenia or medication.

• It explains positive symptoms more convincingly than many negative symptoms.

• It can be cognitively reductionist.

• Biological and environmental factors remain important.

The strongest conclusion is that dysfunctional cognition is one part of a wider pathway linking biological vulnerability, stressful experiences and schizophrenia symptoms.

Hints from the Examiner Reports 💡

Examiner hint: Explain a failure in cognitive processing.

The 2022 examiner report noted that some students wrote as though metarepresentation itself caused schizophrenia. The explanation concerns a deficit or failure to monitor cognition correctly.

Examiner hint: Keep the correct theory in focus.

A considerable number of students answering the 2022 cognitive-explanation question mistakenly described family dysfunction or the dopamine hypothesis instead.

Use:

• Thoughts.

• Memory.

• Metacognition.

• Source monitoring.

• Executive functioning.

• Central control.

Do not turn the answer into a biological or family explanation.

Examiner hint: Connect the process to a symptom.

For example:

“Failure to recognise inner speech as self-generated may cause it to be experienced as an external auditory hallucination.”

Examiner hint: Confused speech and rapid movement between ideas are strong application clues.

The 2023 mark scheme linked these behaviours with impaired cognitive processing, executive functioning and central control.

Examiner hint: The 2022 six-mark question divided marks equally between the explanation and one limitation.

Do not provide five marks of description followed by one undeveloped criticism.

Examiner hint: Distinguish the explanation from the treatment.

• Cognitive explanation: why dysfunctional processing may produce symptoms.

• CBT: how beliefs and coping strategies may be addressed.

Examiner hint: Avoid saying simply that people with schizophrenia “think irrationally”.

Identify the particular cognitive process and explain what it does.

Examiner hint: Develop cause and effect.

State how:

• Cognitive dysfunction could produce symptoms.

• Symptoms, medication or neural abnormalities could instead produce cognitive dysfunction.

Examiner hint: Use cautious conclusions.

A cognitive-task difference is:

• “Consistent with.”

• “Evidence of an association.”

• “Support for a possible deficit.”

It does not prove the original cause.

Examiner hint: Keep applications explicit.

AQA’s 2023 extended-response mark scheme awarded application for connecting Jay’s confused, rapidly changing speech to poor executive functioning or central control.

Common Mistakes ⚠️

Mistake: Saying cognition means intelligence

Why this is incorrect:

Cognition includes attention, memory, monitoring, language and interpretation.

How to improve:

Name the specific mental process involved.

Mistake: Saying dysfunctional thoughts are deliberate

Why this is incorrect:

Processing failures may be automatic and outside conscious control.

How to improve:

Avoid blaming the person for choosing their symptoms.

Mistake: Saying metarepresentation causes schizophrenia

Why this is incorrect:

Successful metarepresentation supports accurate monitoring.

How to improve:

Refer to a failure or impairment of metarepresentation.

Mistake: Defining source monitoring as checking whether a source is reliable

Why this is incorrect:

In this explanation, source monitoring means identifying where a mental event came from.

How to improve:

Distinguish an internally generated thought from an externally heard statement.

Mistake: Saying hallucinations are imaginary

Why this is misleading:

The hallucination is experienced as a genuine perception.

How to improve:

Explain that inner speech may be attributed incorrectly to an external source.

Mistake: Saying the person hears their thoughts normally and then decides they are voices

Why this is too deliberate:

The monitoring failure itself changes how the experience is attributed.

How to improve:

Describe automatic external attribution.

Mistake: Confusing delusions and hallucinations

Why this is incorrect:

A hallucination is a sensory experience. A delusion is a belief.

How to improve:

Identify whether the cognitive failure produces perception or interpretation.

Mistake: Saying central control means being controlled by somebody else

Why this is incorrect:

Central control is an internal cognitive process involving attention and inhibition.

How to improve:

Use delusions of control for beliefs about external control.

Mistake: Saying central control is the same as a delusion of control

Why this is incorrect:

One is an executive process. The other is a symptom.

How to improve:

Explain how impaired intention monitoring might produce the delusion.

Mistake: Describing confused speech as speech poverty automatically

Why this is incorrect:

A person may produce a large amount of disorganised speech.

How to improve:

Speech poverty specifically involves reduced speech.

Mistake: Claiming cognitive explanations explain every symptom equally

Why this is inaccurate:

They generally explain hallucinations and delusions more successfully than negative symptoms.

How to improve:

Evaluate their limited explanatory range.

Mistake: Treating memory impairment as proof of causality

Why this is incorrect:

Memory difficulties may follow from schizophrenia, medication or another variable.

How to improve:

Discuss direction of causality.

Mistake: Saying CBT proves schizophrenia is cognitive

Why this is incorrect:

A treatment can help without identifying the original cause.

How to improve:

Use CBT as evidence for cognitive involvement in maintenance or distress.

Mistake: Describing CBT when asked for an explanation

Why this loses focus:

The command requires AO1 about dysfunctional processing.

How to improve:

Use CBT briefly as evaluation only.

Mistake: Saying the cognitive explanation disproves biology

Why this is incorrect:

Neural abnormalities may underlie cognitive-processing deficits.

How to improve:

Present biological and cognitive levels as compatible.

Mistake: Giving a generic reductionism criticism

Why this is incomplete:

The examiner needs to know what is reduced and what is ignored.

How to improve:

Explain that the account reduces schizophrenia to source monitoring or executive functioning while overlooking genes, dopamine and social stress.

Mistake: Naming a researcher without explaining the evidence

Why this is incomplete:

A study name does not show why the theory is supported.

How to improve:

State the cognitive finding and its implication.

Exam-Style Questions ✍️

Questions

1. What is meant by dysfunctional thought processing?[2 marks]

2. Explain what is meant by metacognition.[2 marks]

3. Explain how a source-monitoring deficit may produce an auditory hallucination.[4 marks]

4. Explain how impaired monitoring of intentions may contribute to a delusion of control.[4 marks]

5. Explain what psychologists mean by a central-control deficit.[4 marks]

6. Tariq reports hearing a voice criticising him when nobody is speaking.

Explain Tariq’s experience using a cognitive explanation.[4 marks]

7. Anya believes that an outside organisation controls her hand movements.

Explain Anya’s belief using dysfunctional thought processing.[4 marks]

8. When answering a question, Jordan speaks rapidly, moves repeatedly between unrelated ideas and appears to forget the original topic.

Explain Jordan’s behaviour using a cognitive explanation.[6 marks]

9. Outline one cognitive explanation for schizophrenia and outline one limitation of this explanation.[6 marks]

10. Researchers compare 40 people with schizophrenia and 40 controls on a source-monitoring task.

Group	Mean number of source-monitoring errors
Schizophrenia group	12
Control group	5

a) Calculate the difference between the mean numbers of errors.[1 mark]

b) Calculate the percentage by which the schizophrenia group’s mean exceeds the control group’s mean.[2 marks]

c) Explain one conclusion and one limitation of these findings.[4 marks]

11. Explain one strength and one limitation of cognitive explanations of schizophrenia.[6 marks]

12. Compare cognitive and neural explanations of schizophrenia.[8 marks]

13. Discuss cognitive explanations of schizophrenia. Refer to the following scenario in your answer.

Ezra hears a threatening voice despite being alone. He believes that a neighbour is placing thoughts into his mind. During conversations, Ezra changes rapidly between unrelated ideas and struggles to answer questions coherently.

[16 marks]

Answers and Mark Scheme

Question 1

Award up to two marks:

• Dysfunctional thought processing involves mental information being monitored, organised or interpreted inaccurately.

• This may contribute to symptoms such as hallucinations, delusions or disorganised thought.

Question 2

Award up to two marks:

• Metacognition is awareness or understanding of one’s own thinking.

• It includes identifying thoughts, memories or intentions as self-generated.

Question 3

Award up to four marks:

• Inner speech is normally recognised as self-generated.

• A person with a source-monitoring deficit may fail to identify its internal origin.

• The thought is attributed to an external source.

• It is consequently experienced as a voice or auditory hallucination.

Question 4

Award up to four marks:

• A person normally monitors the intention preceding an action.

• Impaired self-monitoring may mean that the intention is not recognised.

• The resulting action does not feel self-generated.

• The person attributes the action to an outside force.

• This produces or contributes to a delusion of control.

Question 5

Award up to four marks:

• Central control is the ability to direct attention and inhibit irrelevant responses.

• A deficit means competing or automatic associations are not suppressed.

• Irrelevant ideas may interrupt the current train of thought.

• This may produce rapid topic changes, confused speech or disorganised thinking.

Question 6

Award up to four marks:

• Tariq’s experience may begin as inner speech.

• He may have impaired metacognition or source monitoring.

• He fails to recognise the words as self-generated.

• He attributes the thought to an outside speaker.

• The thought is therefore experienced as an auditory hallucination.

Question 7

Award up to four marks:

• Anya may fail to monitor the intention producing her hand movement.

• The action may not feel self-generated.

• She attempts to explain the lack of personal authorship.

• She attributes the movement to an outside organisation.

• This produces a delusion of control.

Question 8

Award up to six marks:

• Jordan’s rapid movement between unrelated ideas suggests impaired central control.

• He may be unable to suppress irrelevant associations.

• Working-memory difficulties may cause him to lose the original question.

• Poor executive functioning may prevent him from organising his answer.

• His thoughts therefore fail to follow a coherent sequence.

• This produces confused or disorganised speech.

Question 9

Award up to three marks for the explanation and three marks for the limitation.

Possible explanation:

• People with schizophrenia may have difficulty distinguishing self-generated thoughts from external information.

• Inner speech may therefore be attributed to an external source.

• This may produce an auditory hallucination.

Possible limitation:

• The account explains how a hallucination is produced but not why the monitoring deficit developed.

• Neural or genetic abnormalities may underlie the cognitive dysfunction.

• The cognitive account may therefore describe a symptom mechanism rather than provide a complete cause.

Alternative limitations include:

• Limited explanation of negative symptoms.

• Cause-and-effect problems.

• Cognitive reductionism.

• Medication confounds.

• Individual blame.

Question 10a

12−5=7

The difference is 7 errors.

Question 10b

512−5​×100=57​×100=140%

The schizophrenia group’s mean is 140% higher than the control group’s mean.

Question 10c

Award up to four marks.

Possible conclusion:

• The schizophrenia group made more source-monitoring errors.

• This is consistent with the cognitive explanation that people with schizophrenia may have difficulty distinguishing self-generated and external information.

Possible limitation:

• The result is an association and does not show that source-monitoring errors caused schizophrenia.

• Medication, memory, attention or another participant variable may explain the difference.

• No inferential-test result is provided, so statistical significance cannot be claimed.

Question 11

Award up to three marks for a developed strength and three marks for a developed limitation.

Possible strength:

Cognitive explanations provide specific mechanisms for particular symptoms. Failure to recognise inner speech as self-generated offers a clear explanation of how an auditory hallucination may be experienced.

Possible limitation:

The explanation may describe the processing difficulty without explaining its underlying cause. Neural or genetic factors might produce the source-monitoring deficit, making the cognitive explanation incomplete.

Alternative creditworthy points include:

• Evidence of memory impairments.

• Practical application to CBT.

• Treatment effectiveness does not prove causation.

• Limited account of negative symptoms.

• Cognitive reductionism.

• Direction of causality.

• Medication confounds.

Question 12

A strong comparison may include:

• Both attempt to explain schizophrenia symptoms.

• Cognitive explanations focus on information processing.

• Neural explanations focus on brain activity and neurotransmitters.

• Cognitive accounts explain hallucinations through misattributed inner speech.

• Neural accounts link positive symptoms with excessive subcortical dopamine activity.

• Cognitive research uses memory, attention and source-monitoring tasks.

• Neural research uses scans, receptor studies and drug evidence.

• Cognitive explanations lead towards CBT.

• Neural explanations lead towards antipsychotic medication.

• Both can be reductionist.

• Both rely largely on naturally occurring group comparisons and correlations.

• Both face direction-of-causality problems.

• Neural dysfunction may cause cognitive dysfunction, making the accounts compatible.

• A combined account may provide a fuller explanation than either one alone.

Higher marks require direct, connected comparisons.

Question 13

A strong response should include:

Knowledge and understanding

• Cognitive explanations as accounts based on dysfunctional information processing.

• Metacognition.

• Metarepresentation.

• Failure of metarepresentation.

• Source monitoring.

• Inner speech.

• External attribution.

• Monitoring of intentions and actions.

• Delusions of control or thought insertion.

• Central control.

• Inhibition of irrelevant associations.

• Executive functioning.

• Working memory.

• Links with hallucinations, delusions and language difficulties.

• Possible role of maladaptive interpretation.

Application

• Ezra’s threatening voice may be self-generated inner speech.

• Failure to recognise its internal source causes external attribution.

• This produces an auditory hallucination.

• His belief that a neighbour places thoughts in his mind may result from failure to recognise thoughts as self-generated.

• Rapid movement between unrelated ideas suggests weak central control.

• He may fail to inhibit irrelevant associations.

• Difficulty answering coherently suggests impaired executive functioning or working memory.

Evaluation

• Cognitive-task and memory evidence supports the presence of dysfunctional processing.

• Specific mechanisms explain particular symptoms.

• The approach has practical applications in CBT.

• CBT effectiveness supports a role for interpretation and coping.

• Treatment success does not prove original causation.

• Cognitive deficits may be consequences rather than causes.

• Medication and symptom severity may affect cognitive performance.

• The explanation may describe how rather than why.

• Neural abnormalities may underlie cognitive processing failures.

• Biological and cognitive explanations may be compatible.

• The account explains positive symptoms more effectively than negative symptoms.

• It may be cognitively reductionist.

• Laboratory tasks may lack ecological validity.

• Cognitive-task measures may have limited construct validity.

• Individual differences and diagnostic heterogeneity weaken universal claims.

• The explanation may unintentionally blame the individual.

• An interactionist account combining biological vulnerability, stress and cognitive interpretation is more complete.

Higher-level responses will explain the cognitive mechanisms in detail, connect each separate element of the scenario to the relevant process and evaluate whether dysfunctional cognition is a cause, consequence or mediator of schizophrenia symptoms.