Management of schizophrenia - Token economy

Question 1

Token economy - overview

Answer 1

• Form of behavioural therapy
• Clinicians set target behaviours
• Tokens are given whenever a patient engages in one of their target behaviours
• Tokens can be exchanged for various rewards
• Desirable behaviours become associated with rewards

Question 2

How token economies work

Answer 2

• Operant conditioning - Positive reinforcement (2 types)
  1) Primary reinforcer - anything that gives pleasure e.g food
  2) Secondary reinforcer - initially have no value but gain reinforcing properties as a result of being paired with a primary reinforcer
• To maximise effect, reinforcer has to be delivered immediately after target behaviour

Question 3

Token values

Answer 3

• Needs to be repeatedly presented alongside or immediately before reinforcing stimulus
• Reinforcing stimulus - e.g movie, food
• By pairing token with reinforcing stimulus, the token eventually has the same reinforcing properties

Question 4

Reinforcement and trade

Answer 4

• Clinician rewards patients token in exchange for privileges - generalised reinforcer

Question 5

Link to SZ

Answer 5

• Doesn’t cure SZ but has 2 major benefits
  1) Improves person’s quality of life within the hospital setting
  2) Normalises behaviour and this makes it easier for people who have spent a time in hospital to adapt back into life in the community

Question 6

Token economies - evaluation - strength

Answer 6

• Evidence for its effectiveness
• Many studies into the effectiveness of token economies have found a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
• Supports the value of token economies

Question 7

Token economies - evaluation - limitation

Answer 7

• Ethical issues
• Gives professionals power to control the behaviour of the patient
• Restricting the availability of pleasures 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 whose relative has been badly affected by token economies has been a major factor in the decline of use of token economies