Management of schizophrenia Flashcards
What are token economies?
Management of SZ
Reward systems used to manage behaviour of people with SZ
Allyon and Azrin (1968) - Token Economies
Management of SZ
Trialled a token economy in ward of women with diagnosis of SZ
Everytime ppts carried out task such as making their bed or cleaning up, they were given a plastic token (one gift)
The tokens could be swapped for ward privileges (e.g. watching a film)
Number of tasks increased significantly
Use of token economies
Management of SZ
Extensively used in 60s and 70s when norm for treating SZ was long-term hospitalisation
Use has now declined in UK due to closure of many psychiatric hospitals and complex ethical issues
Token economies remain a standard approach to managing SZ in many parts of the world
Rationale for token economies
Management of SZ
Institutionalisation can lead to people developing bad habits (e.g. bad hygiene)
Understandable response to living without the small pleasures experienced in everday life
Matson et al (2016) identify 3 catergories of institutional behaviour commonly tackled by means of token economies: personal care, condition-related behaviours and social behaviour
How would modifying institutional behaviours help those with SZ?
Management of SZ
Does not cure SZ but has two major benefits:
1. Improves person’s quality of life within hospital setting
2. ‘Normalises’ behaviour and this makes it easier for people who have spent time in a hospital to adapt back into a community
What is involved in a token economy?
Management of SZ
Target behaviours are decided on an individual basis
It is important to know the person in order to indentify the most appropriate target behaviours for them (Cooper et al 2007)
The tokens are traded for rewards - immediate reward is important as delayed rewards are less effective
Behavioural understanding of token economies
Management of SZ
Behaviour modification - behavioural therapy based on operant conditioning
Tokens are secondary reinforces (only have value once indiviual learns they can traded)
The rewards are primary reinforcers
Evidence of effectiveness (token economy)
Management of SZ
Strength
Glowacki et al (2016) identified seven high quality studies published between 1999 & 2013 that examined effectiveness of token economies for people with SZ and involved patients living in a hospital setting.
All studies showed reduction in neg symptoms and decline in frequency of unwanted behaviours
Therefore, supports value of token economies
Counterpoint - Evidence of effectiveness (token economies)
Management of SZ
Seven studies is small evidence base
One issue with small number of studies is file drawer problem
This phenomenon leads to bias toward pos published finding because undesirable results have been ‘filed away’.
This is a particular problem in reviews that only include a small number of studies
Therefore, there’s a serious question over evidence for effectiveness of token economies
Ethical issues (token economy)
Management of SZ
Limitation
Gives professionials considerable power to control behaviour of people in rol of patients - imposing one’s norms onto the other, especially problematic if target behaviours are not identified sensitively
Restricting the avaliability of pleasures to people who don’t behave as desired means serious ill people have an even worse time
Legal action by families who see their relative in this position has been a major factor in decline of use of token economies
Therefore, benefits of token economies may be outweighed by their impact on personal freedom & short-term reduction in quality of life
Alternative approaches (token economies)
Management of SZ
Limitation
Other approaches that don’t raise same ethical issues
Chiang et al (2019) review, concluded art therapy might be good alternative
Evidence base is regularly small and has methodological limitations but shows that art therapy is high-gain low-risk approach to managing SZ
Benefits of art therapy are modest - generally true for all approaches to treatment and management
Art therapy is pleasant experience without side effects or ethical abuses
NICE guidelines recommend art therapy
Therefore, art therapy might be good alt
Benefits (token economy)
Management of SZ
Difficult to continue once person is outside of hospital - target behaviours cannot be monitored closely and tokens not given immediately
However, some people may only get chance to leave if personal care & social interaction is improved - best way to use token economy in hospital?
