6. behavioural modification: token economies Flashcards
TOKEN ECONOMY SYSTEMS
Are an example of behaviour modification (based on operant conditioning). Tokens are secondary reinforcers because
they only have value once the person receiving them has learned that they can be used to obtain meaningful rewards such as a walk outside. These meaningful rewards are primary reinforcers.
Tokens are given immediately to individuals when they have carried out a desirable behaviour having some form of immediate reward for the target behaviour is important
because delayed rewards are less effective.
Once they have received the reward, they are positively reinforced to continue the desirable behaviours.
Ayllon and Azrin trialled a token economy system in a ward of women with a diagnosis of schizophrenia. Every time the patients carried out a task such as making their bed, they were
given a plastic token embossed with the words ‘one gift’. These tokens could be swapped for ward privileges. They found that the number of positive tasks carried out by the women increased significantly.
this led to token economies being used extensively in the 60s and 70s when the norm for treating schizophrenia was long term hospitalisation.
Their use declined in the UK due to the closure of many psychiatric wards.
RATIONALE FOR TOKEN ECONOMIES
Institutionalisation develops under circumstances of prolonged hospitalisation. One outcome is that people often develop bad habits, such as not maintaining good hygiene.
Matson et al. identified 3 categories of institutional behaviour tackled by token economies:
personal care, condition related behaviours and social behaviours.
Modifying behaviours does not cure schizophrenia but has 2 major benefits:
- IMPROVES THE PERSON’S QUALITY OF LIFE within the hospital setting, for example it allows the person to make friends.
- NORMALISES BEHAVIOUR - encourages the patients to do normal behaviours such as making the bed or brushing their teeth, which make adapting back into the real world easier.
AO3: strength of token economies
EVIDENCE OF EFFECTIVENESS - Glowacki
Token economies are effectiveness for the management of schizophrenia.
Glowacki et al. identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as schizophrenia and involved patients living in a hospital setting. All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.
This supports the value of token economies in helping improve the quality of life of the patients.
AO3: limitation of token economies
ETHICAL ISSUES
Using token economies for the management of schizophrenia raises ethical issues.
The use of token economies raises ethical issues because it gives professionals power to control the behaviour of patients. Restricting the availability of pleasures (e.g. sweets) to people who don’t believe as desired means that seriously ill people who are already experiencing distressing symptoms have an even worse time. This has led to legal action by families who see their relatives in this position, which led to the decline of token economy systems.
This means that the benefits of token economies might be outweighed by their impact on personal freedom and short-term reduction in quality time.
AO3: limitation of token economies
ALTERNATIVE APPROACHES - Chiang
More pleasant and ethical alternatives exist.
There are other alternative approaches that have a comparable evidence base that do not raise the same ethical issues. A review by Chiang concluded that art therapy might be a good alternative, as evidence shows it is a high-gain low-risk approach to managing schizophrenia. Unlike alternatives, art therapy is a pleasant experience without major risks of side effects or ethical abuses. NICE guidelines also recommend art therapy for schizophrenia.
This means that art therapy might be a good alternative to token economies.
