Management of schizophrenia Flashcards
6 point summary AO1
1) Development of token economies
2) Rationale for token economies
3) 1. Quality of life
4) 2. Normalises behaviour
5) What is involved in a token economy?
6) The theory behind token economies (operant conditioning)
Development of token economies AO1 point
Ayllon and Azrin (1968) used a token economy in a schizophrenia ward. A gift token was given for every tidying act. Tokens were later swapped for privileges e.g. films. Token economies were extensively used in the 1960s and 70s. Decline in the UK due to a shift towards care in the community rather than hospitals and because of ethical concerns. Token economies still remain a standard approach to managing schizophrenia in many parts of the world.
Rationale for token economies AO1 point
Institutionalisation occurs in long term hospital treatment. Mason et al (2016) identified three categories of institutional behaviour that can be tackled using token economies: personal care, condition-related behaviours (e.g. apathy) and social behaviour. Modifying these behaviours does not cure schizophrenia but does have two major benefits.
- Quality of life AO1 point
Token economies improve the quality of life within the hospital setting e.g. putting on make-up or becoming more sociable with other residents.
- Normalises behaviour AO1 point
Encourages return to more normal behaviours, making it easier to adapt back into the community e.g. getting dressed or making your bed.
What is involved in a token economy? AO1 point
Tokens (e.g. coloured disks) given immediately after a desirable behaviour. Target behaviours are decided individually based on knowledge of the person (Cooper et al 2007). Tokens have no value themselves but are swapped for rewards e.g. sweets or magazines, or activities like a film or a walk outside. Tokens are given immediately after target behaviours because delayed rewards are less effective.
The theory behind token economies (operant conditioning) AO1 point
Token economies are an example of behaviour modification based on operant conditioning. Tokens are secondary reinforcers - exchanged for rewards (primary reinforcers which are directly rewarding e.g. food). Tokens that can be exchanged for a range of different primary reinforcers are called generalised reinforcers. These have a more powerful effect.
Ethical issues evaluation
One limitation is the ethical issues raised.
Professionals have the power to control people’s behaviour and this means imposing one person’s norms on others (e.g. a patient may like to look scruffy). Also restricting the availability of pleasures to people who don’t behave as desired means that very ill people, already experiencing distressing symptoms, have an even worse time. This means that benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life.
Alternative approaches evaluation
Another limitation is the existence of more pleasant and ethical alternatives. Other approaches do not raise ethical issues, e.g. art therapy is a high-gain low-risk approach to managing schizophrenia (Chiang et al 2019). Even if the benefits of art therapy are modest, this is true for all approaches to treatment and management of schizophrenia and art therapy is a pleasant experience. This means that art therapy might be a good alternative to token economies - no side effects or ethical abuses.
Evidence of effectiveness evaluation
One strength is evidence of effectiveness. Glowacki et al (2016) identified seven high quality studies published between 1999 and 2013 on the effectiveness of token economies in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours. This suggests the value of token economies.
Counterpoint for evidence of effectiveness evaluation
However, seven studies is quite a small evidence base. One issue with such a small number of studies is the file drawer problem - a bias towards publishing positive findings. This means that there is a serious question over the effectiveness of token economies.
Token economies
a form of behavioural modification, where desirable behaviours are encouraged by the use of selective reinforcement. For example, people are given rewards (tokens) when they engage in socially desirable behaviours. The tokens are secondary reinforcers and can be exchanged for primary reinforcers - food or privileges.
