Management for schizophrenia Flashcards
what are token economies
reward systems used to manage the behaviour of people with schizophrenia, in particular those who have developed patterns of maladaptive behaviour through prolonged periods in psychiatric hospitals
who carried out a demonstration for token economies with schizophrenia
Ayllon and Azrin (1968)
how did Ayllon and Azrin trial token economies with schizophrenia
trialled in a ward of women with schizophrenia
every time participants carried out a task such as making their bed they were given an embossed token
these could be swapped for ward privileges such as watching a film
they found number of desirable tasks carried out increased significantly
explain the use of token economies
token economies were extensively used in the 1960s and 70s when the norm for treating schizophrenia was long term hospitalisation
use has now declined in the UK, due to ethical issues and decrease in psychiatric hospitals
still remain a standard approach to managing schizophrenia
what is institutionalisation
develops under circumstances of prolonged hospitalisation, where people often develop bad habits like ceasing to maintain good hygiene or stopping socialisation
what are the three categories of institutionalised behaviour
Matson et al (2016) identified three categories of institutionalised behaviour which can be tacked by token economies:
personal care, condition-related behaviours (apathy) and social behaviour
what are the two major benefits of modifying these institutionalised behaviours
improves the person’s quality of life within the hospital setting
normalises behaviour which makes it easier for people who have spent time in a hospital adapt back to everyday life
what is the methodology for token economies
the concept is that a physical token is given to a patient when a desirable behaviour is carried out
target behaviours are custom set for each individual
the tokens can be exchanged for rewards
provides an immediate reward which is most effective
what is the theoretical understanding of token economies
based on the principles of operant conditioning
tokens are secondary reinforcers because they only have value once it has been learned they can be used for meaningful rewards
these meaningful rewards are primary reinforcers
what is the evidence of effectiveness for token economies (strength)
Glowacki et al (2016) identified 7 high quality studies from 1999-2013 that examined the effectiveness of token economies
all studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
what is the issue with a small evidence base (limitation)
7 studies is a small evidence base to support the effectiveness of a technique
creates the file drawer problem
bias towards positive published findings because undesirable results have been ‘filed away’
what are the ethical issues with token economies (limitation)
token economies raise ethical issues because it gives professionals considerable power to control the behaviour of patients
involves imposing ones norms on to other, which can be problematic
restricting pleasures can make people have a worse time
benefits outweighed by short-term reduction in quality of life
