Management of Schizophrenia Flashcards
Ayllon and Azrin used token economy in a schizophrenia ward …
How are token economy systems used and is this continued?
A gift token for every tidying act, tokens were later swapped for privileges (e.g. films)
Token economies were extensively used in the 1960s and 70s, a decline in the UK due to a shift towards care in the community rather than hospitals and because of ethical concerns
TE still remain a standard approach to managing schizophrenia in many parts of the world
what is occurs in long term hospital treatment and what did Matson identify that can be tackled using token economy systems?
Institutionalisation occurs in long term hospital treatment
Matson identified three categories of institutional behaviours that can be tackled using token economy systems
personal care, condition-related behaviours (apathy) and social behaviours
modifying these behaviours is not a cure for schizophrenia, but has two major benefits
what is the first major benefit of token economy systems?
quality of life, token economies improve this within the hospital setting e.g. putting make-up on or becoming more sociable with other residents
what is another major benefit of token economy systems?
it encourages return to more ‘normal’ behaviour, making it easier to adapt back into the community e.g. getting dressed or making your bed
how does a token economy system work?
Tokens (coloured discs) are given immediately after a desirable behaviours
target behaviours are decided individually based on knowledge of the person (Cooper)
tokens have no value themselves but are swapped for rewards e.g. sweets, magazines, activities, films
tokens are given immediately following target behaviours because delayed rewards are less effective
what is the theory behind token economy systems?
token economy systems are an example of behaviour modification - based on operant conditioning
tokens are secondary reinforcers - exchanged for rewards - whereas primary reinforces directly reward)
tokens that can be exchanged for a range of different primary reinforces are called generalised reinforces
they have a more powerful effect
Strength of token economy systems - there’s evidence for their effectiveness
- Glowacki
Glowacki identified seven high quality studies published between 1999 and 2013 on the effectiveness of token economies in hospital settings
all the studies show a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
supports the value of token economy system
what is a counterpoint to using token economy systems ?
Seven studies is quite a small evidence base
and 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
limitation about ethical issues, including restricting access of pleasures and personal opinions.
professionals have the power to control people’s behaviours and this means imposing one person’s norms onto another - 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 the benefits of token economy systems may be outweighed by the impact of freedom and short term reduction in the quality of life
a limitation is that these ethical issues can be avoided in other more pleasant alternatives
other approaches do not raise ethical issues e.g. art therapy is a high gain, low risk approach to managing schizophrenia (Chiang)
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 economy systems - there are no effects or ethical abuses
extra evaluation - problem and positives of token economies
a problem with token economy systems is that they are hard to continue outside of a hospital setting
target behaviours cannot be monitored as closely and tokens cannot be given immediately
but, some people may only get the chance to live outside a hospital if their personal care and social interaction improves
suggests that it is worth it, despite the issues around using them , it gives people a chance outside the hospital
