4.4 Management of Schizophrenia

Question 1

What are token economies?

Answer 1

A form of behavioural modification where desirable behaviours are encouraged by the use of selective reinforcement

Question 2

Describe Ayllon and Azrin’s demonstration of token economies

Answer 2

• Trialled a token economy system in a ward of women diagnosed with schizophrenia
• Each time participants carried out a task e.g make bed, they were given a plastic token
• Tokens could be swapped for ward privileges e.g a film
• The number of tasks carried out increased significantly

Question 3

What are 2 reasons why the use of token economies in the UK has reduced?

Answer 3

• The growth in community-based care/closure of many psychiatric hospitals
• Ethical issues (restricting rewards to those with disorders)

Question 4

What did Matson et al identify about rationale for token economies?

Answer 4

• Identified three categories of institutional behaviour tackled by token economies:

1. Personal care
2. Condition-related behaviours (e.g apathy)
3. Social behaviour

Question 5

What are the 2 benefits of modifying the behaviours identified by Matson et al?

Answer 5

1. Improves quality of life within hospital setting (e.g social interaction for a typically social person)
2. Normalises behaviour (easier for intitutionalised to adapt back into life in community e.g making bed)

Question 6

Describe the process of token economies

Answer 6

• Tokens are immediately given to individuals when they carry out desirable behaviour
• Tokens can be swapped for tangible rewards e.g sweets, magazines, or access to activities

Question 7

How are token economies an example of behaviour modification?

Answer 7

It is a behavioural therapy based on operant conditioning

Question 8

Describe the theoretical model of token economies

Answer 8

• Tokens are secondary reinforcers = only have value when recipient learns they can be used for meaningful rewards
• Meaningful rewards are primary reinforcers
• For tokens to become secondary they have to be paired with primary reinforcers (beginning of token economy)

Question 9

One strength for management of schizophrenia

Answer 9

Evidence of effectiveness:
- Glowacki et al: identified 7 high quality studies (1999-2013) that examined effectiveness of token economies for chronic health issues e.g schizophrenia
- All studies showed a reduction in negative symptoms + decline in frequency of unwanted behaviours

Question 10

Two limitations for management of schizophrenia

Question 11

Why are immediate rewards important in token economies?

Answer 11

• Immediate rewards for target behaviour are more effective than delayed rewards (should be administered as soon as possible after target behaviour)

Question 12

What are generalised reinforcers?