Management of schizophrenia

Question 1

What are token economies?

Answer 1

• A form of behavioural modification where desirable behaviours are encouraged by the use of selective reinforcement.
  -These are used to manage the behaviour of schizophrenia as they have maladaptive behaviours

Question 2

How were token economies developed?

Answer 2

• They were demonstrated by Teodoro Ayllon and Azrin
• They trailed a token economy system in a ward of women with a diagnosis of schizophrenia
• Every time they carried a task like cleaning up and making their bed they were given a plastic token that read one gift
• These tokens could be swapped for ward priveleges
• The number of tasks carried out increased significantly

Question 3

What is the rationale for token economies?

Answer 3

• This is because institutionalisation develops due to prolonged hospitalisation
• They may develop bad habits like bad hygiene and no socialisation with others

Question 4

What did Matson discover?

Answer 4

• Matson identified three categories of institutional behaviour that can be tackled by token economies:
• personal care, conditioned related behaviours and social behaviour
• modifying these can have benefits

1. improves quality of life in a hospital setting, like taking pride in their appearance and better social interaction
2. It normalises behaviour and makes it easier for people who have spent time in hospital to adapt into life as a community

Question 5

What occurs in a token economy?

Answer 5

• Tokens are given immediately after a desired behaviour is carried out
• These tokens are swapped for tangible rewards
• Having the rewards immediately is important as delayed rewards are ineffective

Question 6

How can we understand token economies?

Answer 6

• This is an example of behaviour modification which is a behavioural therapy based on operant conditioning
• Tokens are secondary reinforces as they only have value when a person learns they can be swapped for something else. Tokens are generalised reinforces as they are powerful due to their ability to be exchanged
• Primary reinforces are the actual primary reinforces
• in order for tokens to become secondary reinforcers they are paired with primary reinforcers

Question 7

What is a strength of token economies?

Answer 7

• There is evidence for their effectiveness
• Glowacki identified seven high quality studies and examined their effectiveness of people with schizophrenia
• All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours

C = Seven studies is a small evidence base. File drawer problems = A bias to positive studies as undersirable results are filed away.

Question 8

What are the limitations of token economies?

Answer 8

• There are ethical issues raised
• This is because it gives professionals power to control the behaviour of people who are paitents
• token economies involve imposing an institutes norms on to others which can be problematic if the target behaviours are not identified sensitively
• For example someone who prefers to get up late may have these personal freedoms taken away
• Restricting people who are ill of pleasures also may cause stress and worsen their symptoms
• Legal action has caused a decrease in usage of token economies
• Another limitation is that there are more pleasant ethical alternatives. Chiang concluded that art therapy may be a better alternative. The evidence is small but art therapy does not involve the unpleasant side effects or ethical issues of other treatments of schizophrenia. Therefore, art therapy may better a better alternative
• Another limitation is that it is hard to continue behaviours learned by token economy outside a hospital setting as target behaviours are not monitored and tokens can not be administered immediately. However, there are benefits such as increased social interaction and personal care.