Behavioural Therapy - Token Economy

Question 1

What is the token economy?

Answer 1

-form of Behaviour Modification Therapy, based on the principles of
operant conditioning where desirable behaviours are encouraged by the use of selective
reinforcement.

-Patients are given rewards in the form of tokens, as secondary reinforcers
when they engage in desirable behaviours. The tokens can then
be exchanged for primary reinforcers – e.g. foods or privileges.

-To be maximally effective, a reinforcer needs to be delivered immediately after the
performance of the desired behaviour. If the token does not follow immediately, then
another behaviour (e.g. arguing with a fellow patient) may have been performed in the
intervening period.

-Further, the needs of the individual patient need to be considered. For instance, an
individual with catatonic symptoms such as withdrawal from activity may be given rewards
when engaging in social activities.

Question 2

A03 - Appropriateness

Answer 2

• For a patient whose symptoms include a lack of motivation and a general disengagement,
  token economies are specifically designed to provide adequate rewards to increase their
  motivation.

-From these experiences, patients may learn or become reacquainted with the positive consequences of being sociable and engaging in activities.

• Such learning may even be transferable outside of the institutionalise setting of a psychiatric hospital.
• Hence, token economies may be appropriate for some of the negative symptoms of schizophrenia, but in the treatment of the positive symptoms, its usefulness may be questionable.

Question 3

A03 - Research

Answer 3

• Research suggest that token economy is effective for schizophrenia in certain circumstances.
• Dickerson et al (2005) found that in 11/13 studies examining the effectiveness of the use of
  token economy systems in the treatment of schizophrenia, reported beneficial effects that
  were directly attributable to the use of token economies.

-However, only 1 out of the 13 studies compared outpatients who received token economy
therapy with outpatients did not receive token economy therapy.
-Only a minimal difference was found in the reduction of symptoms between the two conditions.

-Token economies are likely to work because the inpatient environment is carefully
structured so that good behaviour is consistently rewarded and bad behaviour is not.
- Hence, the transfer of behaviours learnt in a token economy therapy has very little research support in outpatient settings, questioning its overall applicability.

Question 4

A03 - Ignores undesired behaviours

Answer 4

• Ignoring undesired behaviours may be beneficial to the Sz patient, as they don’t receive
  attention for these.
  -However, if the behaviour of the Sz patient is aggressive or frightening to others, then ignoring the behaviour may be detrimental to other patients.
  -This means that the use of Token Economy for some Sz patients within some institutions may be an inappropriate treatment because if its negative impact on others, questioning its usefulness
  to all patients