Management of schizophrenia Flashcards
token economies definition
a form of behavioural modification where desirable behaviours are encourages by the use of selective reinforcement. for example, people are given rewards (tokens) when they engage in socially desirable behaviours, the token are secondary reinforcers and can then be exchanged for primary reinforcers - food or privileges
who are token economies for
those who have developed patterns of maladaptive behaviour through spending long periods of time in psychiatric hospitals
who did a demonstration of token economies
Ayllon and Azrin
Ayllon and Azrin demonstration of token economy
-trialled in a ward of women with diagnosis of schizophrenia
-every time participants carried out tasks such as making their bed or cleaning up they were given a plastic token embossed with the words ‘one gift’. these could be swapped for ward privileges such as being able to watch a film
-number of tasks carried out increased significantly
when did token economies start being used
used extensively in 1960s and 70s when the norm for treating schizophrenia in Uk was long term hospitalisation
current use of token economies
use now declined in UK, partly due to growth of community based care and closure of many psychiatric hospitals, but also due to complex ethical issues raised by restricting rewards to people with medal disorders. however token economies are still remaining a standard approach to managing schizophrenia in many parts of the world
when does institutionalisation develop
under certain circumstances for prolonged hospitalisation
what are common outcomes for institutionalised people
develop bad habits such as cease to maintain good hygiene or perhaps stop socialising with others
who identified 3 kinds of institutionalised behaviour tackled by token economies
Matson et al
what were the 3 institutionalised behaviour identified by Matson et al that can be tackled by token economies
-personal care
-condition-related behaviours
-social care
3 institutionalised behaviour identified by Matson et al that can be tackled by token economies. what does modifying these behaviours cause
-doesn’t cure schizophrenia but has 2 major benefits
-improves person’s quality of life in hospital setting for example, make-up for someone who usually takes a lot of pride in their appearance or social interaction for usually sociable person
-normalises behaviour and this makes it easier for people who have spent time in hospital to adapt back unto life in community, for example getting dressed or making their bed
what is involved in a token economy
-idea that tokens such as in the form of coloured disks are given immediately to individuals when they have carried out a desirable behaviour
what behaviours are rewarded
desirable behaviours. target behaviours are decided on an individual basis and it is important to know the person in order to identify most appropriate target behaviours for them (cooper et al)
how are tokens exchanged
=although tokens themselves have no value are exchanged for more tangible rewards
-having some form of immediate reward is important as delayed rewards are less effective
-tokens are therefore administered as soon as possible after a target behaviour
-rewards in hospital settings are often objects like sweets, magazines, or access to activities like a film or a walk outside, or perhaps an appointment with a social worker to plan life after hospitalisation
what are token economies an example of
behaviour modification
what is behaviour modification
a behavioural therapy based on operant conditioning
what are the role of tokens explained in terms of behaviour modification
secondary reinforcers because they only have value once the person receiving them has learned that they can be sued to obtain meaningful rewards
what are the meaningful rewards as explained by behaviour modification
primary reinforcer
what are tokens that can exchanged for many rewards by as explained by the behaviour modification
those tokens that can be exchanged for a range of different primary reinforcers are particularly powerful secondary reinforcers . these secondary reinforcers are called generalised reinforcers
according to behaviour modification what needs to happen for tokens to become secondary reinforcers
need to be paired with primary reinforcers, so at the start of a token economy programme tokens and primary reinforcers are administered together
strength of token economies as a way of managing schizophrenia - evidence of effectiveness
-Glowacki et al identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as schizophrenia and involved patients living in a hospital setting. all studies showed a reduction in negative symptoms and decline in frequency of unwanted behaviours –> supports token economies
limitation of token economies as a way of managing schizophrenia - counterpoint of evidence for effectiveness
-7 studies is a small evidence base to support the effectiveness of a technique. one issue with a small number of studies is the file drawer problem. this phenomenon leads to a bias towards positive published findings because in reviews that only include a small number of studies –> serious question over evidence for the effectiveness of token economies
limitation of token economies as a way of managing schizophrenia - ethical issues
-use of token economies raise ethical issues as it gives professional considerable power to control the behaviour patients. this inevitably involves imposing one person’s target behaviours are not identified sensitively. for example someone who likes to look scruffy may have personal freedoms curtailed, perhaps more seriously, restricting the availability of pleasures such as having sweets to people who don’t behave as desired means that seriously ill people, who are already experiencing distressing symptoms, have an even worse time. legal actions by families who see their relatives in this position has been a major factor in decline of use of token economies –> means that benefits if token economies may be outweighed by their impact of personal freedom and short-term reduction may be outweighed by their impact on personal freedoms and short-term reduction in quality of life
limitation of token economies as a way of managing schizophrenia - alternative approaches
-there are more pleasant and ethical alternatives
-even if token economies are helpful for managing schizophrenia there are other approaches with comparable evidence base that do not have the same ethical issues. for example, Chiang et al concluded that art therapy might be a good alternative. the evidence base is regularly small and has some methodological limitations, but it appears to show that art therapy is a high-gain low risk approach to manging schizophrenia. even if the benefits of art-therapy are modest, this is generally true for all approaches to treatment and management of schizophrenia and, unlike alternatives, art therapy is a good pleasant experience without major risks of side effects or ethical abuses. NICE guidelines recommend art therapy for schizophrenia –> means art therapy might be a good alternative to token economies
