Management Of Schizophrenia

Question 1

How were token economies developed to treat schizophrenia?

Answer 1

• Ayllon and Aaron trialled a token economy system in a ward of women with Sz, every time pps carried out desirable task e.g making bed they were given a token which could be swapped for privileges e.g watching a film. Number of tasks carried out increased significantly
• used in 60/70s when norm treatment for Sz was long term hospitalisation, use has declined due to ethical issues

Question 2

What is the rationale behind token economies?

Answer 2

• institutionalisation develops under prolonged hospitalisation, includes developing bad habits e.g bad hygiene and lack a socialisation
• Matson et al identified 3 categories of institutional behaviour tackled by token economies: personal care, condition-relayed behaviour (apathy) and social behaviour
• Modifying said behaviours does not cure SZ but has 2 benefits:
  1. Improves quality of life in hospital setting, e.g makeup for someone who takes pride in appearance or social interaction for a usually sociable person
  2. ‘Normalises’ behaviour, makes it easier for people who have spent time in hospital to adapt back into community life e.g getting dressed/making bed

Question 3

What is involved in a token economy?

Answer 3

• tokens are given immediately to individuals when they have carried out a desirable behaviour/target behaviour (decided on an individual basis depending on patient)
• swapped for tangible rewards, immediate reward (token) necessary because delayed rewards are less effective
• rewards e.g sweets, magazine, film, walk outside

Question 4

What is the Theoretical understanding of Token economies?

Answer 4

• Behaviour modification - a behavioural therapy based on operant conditioning, tokens are secondary reinforcers and the meaningful rewards are primary reinforcers
• tokens are particularly powerful secondary reinforcers known as generalised reinforcers
• in order for tokens to become secondary reinforcers they are paired w primary reinforcers, so at the start of the programme tokens and primary reinforcers are administered together

Question 5

What evidence is there for the effectiveness of token economies?

Answer 5

• Glowacki et al identified 7 high quality studies from between 1999-2013 examining effectiveness for those with chronic mental health issues living in a hospital setting. All showed reduction in negative symptoms and a decline in the frequency of unwanted behaviours

Question 6

How is the evidence for effectiveness potentially invalid?

Answer 6

• 7 studies small evidence base and also ‘file drawer problem’. Bias towards positive published findings because undesirable results have been ‘filed away’

Question 7

What are the potential ethical issues associated with token economies?

Answer 7

• gives professionals considerable power to control behaviour of patients. Imposing one person/institutions norms onto others (especially problematic if target behaviours are not identified sensitively
• restricting rewards e.g walking outside may worsen a patients condition