Management of schizophrenia Flashcards
Definition of token economies
form of behavioural modification
desirable behaviours encouraged, use of selective reinforcement.
Rewards (tokens) engage socially desirable behaviours.
Tokens secondary reinforcers exchanged for primary reinforces- food/privileges. Help manage behaviour of pp with schiz.
Describe Ayllon and Azrin’s study involving token economies.
trialled token economy system ward of women with schiz.
Ppts carried out task (making bed) given token, swapped for ward privileges (watching movies).
Number of tasks carried out increased.
Token economies declined with reduced psychiatric hospitals and ethics (restricting rewards to people with mental disorders).
Definition of institutionalisation
prolonged hospitalisation, develop bad habits (lack hygiene, no small pleasures).
What institutional behaviour which could be tackled by token economies did Mason et al identify?
- Personal care.
- Condition-related behaviours.
- Social behaviour.
Modifying the behaviours that Mason et al found didn’t cure schiz but offered what benefits?
Improves quality of life within hospitals (using make-up if someone takes pride in appearance).
Normalises behvaiour makes it easier for those who spent time in hospital to adapt into community life (getting dressed).
What’s involved in a token economy?
Given when desirable behaviour carried out.
Target behaviours decided on individual basis- Cooper.
Tokens no value, swapped for rewards.
Immediate reward for target behaviour important because delayed rewards less effective.
E.g., in psychiatric hospital- tv, outings etc.
Define tokens as secondary reinforcers.
Only have value once received.
What are token economies based on?
Operant conditioning- form of behvaiour modification.
What are primary reinforcers?
Meaningful rewards.
Define generalised reinforcers.
tokens exchanged for different primary reinforcers, powerful secondary reinforcers.
How do tokens become secondary reinforcers?
paired with primary reinforcers, at start of token economy.
Give a strength of token economies for managing schiz.
There’s evidence of their effectiveness.
Glowacki- identified 7 high quality studies examined effectiveness of token economies for pp with chronic mental illness.
Involved patients living in hospital setting.
All studies showed reduction in negative symptoms and decline in frequency of unwanted behaviour.
Supports value of token economies.
Give a counterpoint of evidence of token economy effectiveness for managing schiz.
7 studies small evidence base to support effectiveness of technique- file drawer problem (bias towards positive findings because undesirable results have been filed away.
Problem in reviews, only include small number of studies.
Questions evidence for effectiveness of token economies.
Give a limitation of token economies in managing schiz.
Token economies give professionals power to control behaviour.
Involves imposing person’s norms on to others- problematic if target behaviours aren’t identified sensitively.
E.g., someone whose scruffy may have this personal freedom restricted.
Legal action from families who witness change contributes to decrease in token economies.
Benefits token economies outweighed by impact on personal freedom/ short-term reduction in quality of life.
Give a limitation of token economies.
Chiang- review concluded, art therapy good alternative.
Evidence base small and methodological limitations.
Art therapy high-gain low-risk approach to managing schiz- modest benefits, pleasant experience, ethical.
