Anorexia: Social Treatments - Token Economy

Question 1

Which learning theory does token economy base its principles on to shape behaviour?

Answer 1

Operant conditioning.

Question 2

Define ‘positive reinforcement’.

Answer 2

Receiving something positive due to displaying a desired behaviour.

Question 3

Define ‘negative reinforcement’.

Answer 3

Avoiding something negative due to displaying a desired behaviour.

Question 4

Define a ‘primary reinforcer’.

Answer 4

A direct reward based on our basic urges and needs.

Question 5

Give an example of what a primary reinforcer would be for a token economy.

Answer 5

Family time.

Question 6

Define a ‘secondary reinforcer’.

Answer 6

A reward that can help gain a primary reinforcer.

Question 7

Give an example of what a secondary reinforcer would be for a token economy.

Answer 7

A token to accumulate in order to access a primary reinforcer.

Question 8

Define ‘punishment’.

Answer 8

Receiving something negative for not displaying a desirable behaviour.

Question 9

Give an example of what a punishment would be for a token economy.

Answer 9

Not receiving a token when promised, or getting one taken away.

Question 10

Define a ‘variable ratio’ schedule of reinforcement.

Answer 10

Changing the number of times a desired behaviour is displayed before a reward is received.

Question 11

Define a ‘fixed ratio’ schedule of reinforcement.

Answer 11

Having a set number of times the desired behaviour should be displayed before rewarding a reinforcer.

Question 12

Define a ‘variable interval’ schedule of reinforcement.

Answer 12

Changing the time between each reinforcer rewarded as long as the desired behaviour is shown at least once.

Question 13

Define a ‘fixed interval’ schedule of reinforcement.

Answer 13

Having a fixed time in which a reinforcer is rewarded after as long as the desired behaviour is shown at least once.

Question 14

Describe how a token economy programme is used for treating anorexia.

Answer 14

• They take place in closed institutions with controlled environments, such as in hospitals
• The staff and patient establish primary reinforcers and when secondary reinforcers should be awarded for target behaviours, such as eating a full meal
• Primary reinforcers can include time with family with secondary reinforcers of tokens
• Negative reinforcement can also be used with things such as a target behaviour being show, leading to removal from a task they don’t enjoy
• The reinforcers should be given immediately to maintain trust and engagement in the programme
• Shaping is used with tokens being easy to gain at first but getting increasing harder as they progress in order to become more subtle to mirror the outside world, such as sitting at a table to eat food being reinforced at the start changing to eating the whole meal
• Objective measures such as weight gain or number of tokens received are a reflection of progress

Question 15

Using the acronym ‘DESSERT’, evaluate a ‘different treatment’ point.

Answer 15

P - Drug treatments as an alternative therapy
E - Antipsychotics and SSRIs are administered to reduce co-morbid symptoms of depression and anxiety that also cause weight gain
E - This may be more effective due to the more immediate effect of weight gain rather than a long procedure of TEP

Question 16

Using the acronym ‘DESSERT’, evaluate an ‘expense’ point.

Answer 16

P - Token economy programmes can take a long time
E - Certain patients may need a longer time on the programme due to the severity of their case
E - This can therefore become very expensive due to paying for stay in an institution as well as the therapy sessions

Question 17

Using the acronym ‘DESSERT’, evaluate 2 supporting ‘studies’ point.

Answer 17

P - Stunkard (1976) supports
E - He successfully used positive reinforcement with ANs to encourage them to eat normally
E - Therefore showing that positive reinforcements are effective at treating restrictive anorexia
P - Sonoda (1974) supports
E - Reports the case of a 10 year old with AN treated with appetite stimulants without results then recovered after using token economy instead
E - Therefore showing that token economy is more effective than other treatments

Question 18

Using the acronym ‘DESSERT’, evaluate 2 rejecting ‘studies’ point.

Answer 18

P - Field (2004) rejects
E - They found that although programmes were effective on the whole there was still a number of young people who didn’t respond
E - Therefore showing it’s not completely effective as doesn’t work for all
P - Paul and Lentz (1977) rejects
E - Found that 11% of patients in a psychiatric unit needed drugs alongside a TEP programme
E - Showing its insufficiency due to needing other treatment alongside

Question 19

Using the acronym ‘DESSERT’, evaluate a ‘side effects’ point.

Answer 19

P - No side effects
E - The treatment itself has no side effects however sometimes cases are so severe medication must be taken alongside for additional psychological support
E - Therefore side effects from antipsychotics such as drowsiness and blurred vision may cause someone to stop taking them and lose faith in the programme

Question 20

Using the acronym ‘DESSERT’, evaluate an ‘ethics’ point.

Answer 20

P - Low social control
E - The staff and patient both establish reinforcers, target behaviours, and when they should be rewarded
E - This therefore gives the patient an element of control over their programme, however staff still have more social control with the power to withhold tokens

Question 21

Using the acronym ‘DESSERT’, evaluate a ‘reason or mask’ point.

Answer 21

P - Mask
E - The programme only shapes the behaviour of those with anorexia by getting them to learn desired behaviours with reinforcers given in a controlled setting
E - This therefore doesn’t address the reason anorexia was developed and so there is a possibility it may come back when outside of the controlled hospital environment

Question 22

Using the acronym ‘DESSERT’, evaluate a ‘time commitment’ point.

Answer 22

P - Some cases can take a while
E - It involves a lengthy process of staying in a hospital for a couple of months in order to ensure target behaviours are being shown
E - Therefore drug treatments may be more effective as there is little time commitment in comparison, making someone more likely to complete the treatment

Question 23

Any other evaluative points?

Answer 23

P - High reliability
E - Progress is measured by the amount of tokens, therapy sessions, and desired behaviours shown
E - Therefore success of the programme is easy to measure and analyse objectively