Management of Schizophrenia Flashcards
What is a token economy?
- A form of behavioural modification where desirable behaviours are encouraged by the use of selective reinforcement
- e.g. people are given rewards/tokens when they engage in socially desirable behaviours
An idea based on behavioural principles of operant conditioning
The tokens are secondary reinforcers & can be exchanged
What was the classic demonstration for token economies within schizophrenia?
Ayllon & Azrin (1968)
- They trialled a token economy system in a ward of women w a diagnosis of schizophrenia
- Every time ppts carried out a task such as making their bed or cleaning up they were given a plastic token embossed w the words ‘one gift’
- These tokens could then be swapped for ward privileges e.g. being able to watch a film
- The number of tasks carried out increased significantly
Why has the use of token economies began to decline?
- Partially due to their complex ethical issues
- Raised by restricting rewards to people w mental disorders
Hwvr they still do remain a standard approach to managing schizophrenia in many parts of the world
How can token economies help patients w schizophrenia?
and what research is there to support this
- Institutionalisation develops under circumstances of prolonged hospitalisation- people often develop poor habits e.g. poor hygeine etc.
Jonny Matson et al (2016) - Identify three categories of institutional behaviour commonly tackled by means of token economies: personal care, condition related behaviours (e.g. apathy) & social behaviour
Modifying these behaviours does not cure schizophrenia but has two major benefits:
1. Improves the persons quality of life within the hospital setting e.g. make up for someone who takes a lot of pride in their appearance
2. ‘Normalises’ behaviour & this makes it easier for people who have spent a time in hospital to adapt into life in the community, e.g. getting dressed in the morning or making their bed.
What is the theoretical understanding of token economies?
- TE are an example of behaviour modification- a behavioural therapy based on operant conditioning
- Tokens are secondary reinforcers because they only have value once the person receiving them has learned they can be used to obtain meaningful rewards, such as sweets or a walk outside
- These meaningful rewards are primary reinforcers
- Those tokens that can be exchanged for a range of different primary reinforcers are powerful secondary reinforcers
Give one strength of token economies.
- Social skills training & token economy do not target symptom reduction but are focused on management of the disorder
- May work for chronically ill to give them a better quality of life when they dont know they want it
- Research suggests they do work to change behaviours
Paul & Lentz (1977) - Found token economy to be successful in promoting reduction in bizarre motor behaviour & improvements in social interactions
- Hwvr did not have an impact on hallucinations & delusions
- Research suggests more likely to positively impact negative symptoms than positive symptoms
Give one limitation with the use of token economies?
- The ethical issues raised
- This is because it gives professionals considerable power to control behaviour of other people in role of patient
- Involves imposing one persons norms onto others, which can be problematic if target behaviours are not identified sensitively
- e.g. someone who likes to look scruffy & get up late may have these personal freedoms curtailed
- Legal action taken by families who see their relative in this position has been major factor in the declining use of token economies
Means that benefits of token economies may be outweighed by their impact on personal freedodom & short-term reduction in quality of life
What are other limitations to consider with token economies?
- Dehumanising- treats people like animals- ignores free will & makes behaviours deterministic
- Makes clients dependent, not independent
- Requires patients to be deprived of basic rights in order to then earn them back
- Ethical issues including issues of informed consent- therapeutic goal not set by client
- Only works w patients in long-term institutional care, not in the community
- Wide range of symptoms- treatment might be effective for some but not others
Give a further limitation of token economies.
- The existence of more pleasant & ethical alternatives
- Even if token economies can be helpful for managing schiz there are other approaches w a comparable evidence base that do not raise the same ethical issues
- e.g. Review by Mathew Chiang et al (2019) concluded that art therapy might be a good alternative
- The evidence base is regularly small & has some methodological limitations, but it shows that art therapy is a high gain low risk approach to managing schizophrenia
- Art therapy is pleasant experience without major risk of side effects/ethical abuses
This perhaps suggests that art therapy may be a good alternative to token economies
