Management of schizophrenia

Question 1

Token economies are a form of ___________ modification

Answer 1

behavioural

Question 2

Token economies are a form of modification, where desirable behaviours are encouraged by the use which type of reinforcement?

Answer 2

Selective reinforcement

Question 3

Tokens are primary/secondary reinforcers

Answer 3

secondary

Question 4

What are tokens secondary reinforcers for?

Answer 4

Primary reinforcers - food or privileges

Question 5

Give an example of a primary reinforcer in a token economy

Answer 5

Food or privileges

Question 6

What are token economies in relation to schizophrenia?

Answer 6

Reward systems used to manage the behaviour of people with schizophrenia

Question 7

In particular token economies have helped those who have developed which patterns of behaviour?

Answer 7

Patterns of maladaptive behaviour

Question 8

In particular token economies have helped those who have developed patterns of maladaptive behaviour through spending long periods where?

Answer 8

In psychiatric hospitals

Question 9

What did Ayllon and Arzin trial in 1968?

Answer 9

A token economy system in a ward of women with a diagnosis of schizophrenia

Question 10

In Ayllon and Arzin’s trial in 1968, every time the participants carried out a task they were given…

Answer 10

a plastic token embossed with ‘one gift’ on it

Question 11

In Ayllon and Arzin’s trial in 1968, participants were given a token every time they carried out a task such as what?

Answer 11

Such as making their bed, cleaning up, etc.

Question 12

In Ayllon and Arzin’s trial in 1968, what could tokens be swapped for?

Answer 12

Ward privileges such as being able to watch a film

Question 13

What did Ayllon and Arzin find the effect of using a token economy was in their trial in 1968?

Answer 13

Number of tasks carried out increased significantly

Question 14

When were token economies used most extensively?

Answer 14

In the 60s and 70s

Question 15

Token economies were used most extensively in the 60s and 70s, when the norm for treating schizophrenia was what?

Answer 15

Long-term hospitalisation

Question 16

Why has the use of token economies declined in the UK?

Answer 16

Partly because of the growth of community-based care and closure of many psychiatric hospitals, and partly because of the complex ethical issues raised

Question 17

How do token economies raise complex ethical issues?

Answer 17

They restrict rewards to people with mental disorders

Question 18

True/False: Despite the complex ethical issues raised by token economies, they still remain a standard approach to managing schizophrenia in many parts of the world

Answer 18

True

Question 19

Institutionalisation develops under circumstances of prolonged _______________

Answer 19

hospitalisation

Question 20

One outcome of institutionalisation is that people often develop bad habits such as what?

Answer 20

They might cease to maintain good hygiene/stop socialising with others

Question 21

People living in institutionalisation may cease to maintain good hygiene and stop socialising with others. This is an understandable response to living without…

Answer 21

the routine and small pleasures we experience in everyday life

Question 22

What did Matson et al. (2016) identify?

Answer 22

Three categories of institutional behaviour commonly tackled by means of token economies

Question 23

What were the three categories of institutional behaviour (identified by Matson et al. (2016)) that were commonly tackled by means of token economies?

Answer 23

Personal care, condition-related behaviours such as apathy and social behaviour

Question 24

True/False: Modifying institutional behaviour such as social behaviour, personal care and condition-related behaviours as identified by Matson et al. (2016) cures schizophrenia

Answer 24

False, it doesn’t

Question 25

What are the two major benefits of modifying institutional behaviour such as social behaviour, personal care and condition-related behaviours as identified by Matson et al. (2016)?

Answer 25

Improves the person’s quality of life within the hospital setting and ‘normalises’ behaviour

Question 26

How can modifying institutional behaviour through the use of token economies improve the person’s quality of life within the hospital setting?

Answer 26

E.g. make-up for someone who usually takes lots of pride in their appearance and social interaction for a usually sociable person

Question 27

How can modifying institutional behaviour through the use of token economies ‘normalise’ behaviour?

Answer 27

Makes it easier for people who have spent time in hospital to adapt to life in the community, e.g. getting dressed in the morning or making their bed

Question 28

The idea with token economies is that tokens are given when?

Answer 28

Immediately to individuals when they have carried out a desirable behaviour

Question 29

With token economies, on what basis are target behaviours decided?

Answer 29

An individual basis

Question 30

Cooper et al. (2007) said that it is important to do what in order to set appropriate target behaviours within a token economy?

Answer 30

Know the person in order to identify the most appropriate target behaviours

Question 31

Within token economies, although tokens don’t have a value in themselves they can be swapped for what?

Answer 31

More tangible rewards

Question 32

Why is having some form of immediate reward for a target behaviour (such as a token in a token economy) important?

Answer 32

Delayed rewards are less effective - tokens are therefore administered as soon as possible after a target behaviour

Question 33

Give 2 examples of what rewards in a token economy in a hospital might include

Answer 33

Any 2 from objects like sweets or magazines, access to activities like a film or walk outside or perhaps an appointment with a social worker to plan for life after hospitalisation

Question 34

Token economies are an example of behaviour ____________

Answer 34

modification

Question 35

Token economies are a behavioural therapy based on which type of conditioning?

Answer 35

Operant

Question 36

In token economies, tokens are primary/secondary reinforcers

Answer 36

secondary

Question 37

Within a token economy, when do tokens have value?

Answer 37

Once the person receiving them has learned that they can eb used to obtain meaningful rewards

Question 38

In token economies, the meaningful rewards that tokens can be traded in for are primary/secondary reinforcers

Answer 38

primary

Question 39

Token that can be exchanged for what are particularly powerful secondary reinforcers?

Answer 39

A range of different primary reinforcers

Question 40

Tokens that can be exchanged for a range of different reinforcers are particularly powerful secondary reinforcers, also often called what?

Answer 40

Generalised reinforcers

Question 41

In order for token to become secondary reinforcers they are…

Answer 41

paired with primary reinforcers

Question 42

At the start of a token economy programme, how are primary reinforcers and tokens administered?

Answer 42

Together

Question 43

In Glowacki et al.’s (2016) evidence for the effectiveness of token economies, how many high quality studies were identified?

Answer 43

seven

Question 44

What did Glowacki et al. (2016) examine?

Answer 44

The effectiveness of token economies for people with chronic mental health issues such as schizophrenia

Question 45

Glowacki et al. (2016)’s examination involved patients living in which setting?

Answer 45

A hospital setting

Question 46

Glowacki et al. (2016) found that all studies showed what as a result of token economies?

Answer 46

A reduction in negative symptoms and a decline in the frequency of unwanted behaviours

Question 47

What is the main criticism of Glowacki et al. (2016)’s review?

Answer 47

Seven studies is quite a small evidence base to support the effectiveness of a technique

Question 48

The ‘file drawer problem’ is a particular problem in…

Answer 48

reviews that only include a small number of studies

Question 49

The fact that Glowacki et al. (2016)’s review may suffer from the ‘file drawer problem’ means that…

Answer 49

there is a serious question over the evidence for the effectiveness of token economies

Question 50

What does the ‘file drawer problem’ lead to?

Answer 50

Bias towards positive published findings as undesirable results have been ‘filed away’

Question 51

What is the ‘file drawer problem’?

Answer 51

When, in a review, there is bias towards positive published findings as undesirable results have been ‘filed away’

Question 52

Why are token economies difficult to continue once a person is outside of a hospital setting>

Answer 52

Target behaviours cannot be monitored closely and tokens cannot be administered immediately

Question 53

What is the argument about token economies being difficult to use outside of a hospital setting, but still worth doing within this setting?

Answer 53

Some people with schizophrenia may only get the chance to live outside a hospital if their personal care and social interaction can be improved - perhaps the best way to do this is using token economy during hospital care

Question 54

True/False: There are ethical issues involved in using token economies

Answer 54

True

Question 55

Token economies give professionals considerable power to do what?

Answer 55

Control the behaviour of people in the role of patient

Question 56

Token economies inevitably involve imposing one person’s (or institution’s)…

Answer 56

norms onto others

Question 57

When can the fact that token economies inevitably involve imposing one person/institution’s norms onto others be especially problematic?

Answer 57

If target behaviours are not identified sensitively - e.g. someone who likes to look scruffy and get up late might have these personal freedoms curtailed

Question 58

The fact that token economies give pleasures to people who show desired behaviours means they may also restrict the availability of pleasures to people who don’t behave as desired, meaning that…

Answer 58

seriously ill people, who are already experiencing distressing symptoms, have an even worse time

Question 59

What has been a major factor in the decline in the use of token economies?

Answer 59

Restricting pleasures from seriously ill people who are already experiencing distressing symptoms because they don’t behave as desired - this has led to legal action by families who see their relative in this position

Question 60

The fact that legal action has been taken by families who see their relative in a position of not receiving pleasures when they are already suffering means that the benefits of token economies may be…

Answer 60

outweighed by their impact on personal freedom and short-term reduction in quality of life

Question 61

True/False: There are more pleasant and ethical alternatives to token economies

Answer 61

True

Question 62

What did Chiang et al. (2019) conclude might be a good alternative to token economies?

Answer 62

Art therapy

Question 63

The evidence-base for art therapy being a good alternative to token economies is relatively large/small

Answer 63

small

Question 64

True/False: There has been some methodological limitations in the evidence-base for art therapy being a good alternative to token economies

Answer 64

True

Question 65

Chiang et al. (2019)’s study appears to show that art therapy is a ____-gain. ___-risk approach to managing schizophrenia

Answer 65

high-gain, low-risk

Question 66

Even if the benefits of art therapy are modest for schizophrenia, this is generally…

Answer 66

true for all approaches to treatment and management of schizophrenia

Question 67

Unlike alternative therapies for schizophrenia, art therapy is a pleasant experience without…

Answer 67

major risks of side effects or ethical abuses

Question 68

Which therapy do NICE guidelines recommend for schizophrenia?

Answer 68

Art therapy