Management of Schizophrenia: Token Economies

Question 1

What is a token economy?

Answer 1

Reward systems used to manage the behaviour of people with SZ, especially those who’ve developed maladaptive behaviour through spending long period is psychiatric hospitals (institutionalisation)

Question 2

Describe the theoretical understanding of token economies

Answer 2

• Token economies is a behavioural therapy based on operant conditioning.
• Tokens are secondary reinforcers as they only have value once the person receiving them has learned that they can be used to get meaningful rewards
• The meaningful rewards, a walk outside or sweets, is the primary reinforcer as it’s innately rewarding

Question 3

Give an example of token economies being used

Answer 3

• Allyon and Azrin trailed a token economy system, where every time the patients did a task like make their bed, they were given a plastic token. (It’s important that tokens are given immediately as they’re less effective when given later)
• These token could then be swapped for ward privileges, e.g. watch a film. The number of tasked done increased significantly.

Question 4

What are the two major benefits of token economies?

Answer 4

• Improves the person’s quality of life in the hospital setting, e.g. social interaction for a usually sociable person
• ‘Normalises’ behaviour making it easier for those who have spent a time in hospital to adapt back into life in the community e.g. making their bed

Question 5

Give evaluation for token economies (research support for the effectiveness)

Answer 5

• Dickerson et al reviewed 13 studies of the use of token economies in treating SZ. 11 of the studies reported beneficial effect that were directly linked to the use token economies
• This means that these studies provide evidence of the token economy’s effectiveness in increasing the adaptive behaviours of patients with SZ, which is the aim.

Question 6

Give evaluation for token economies (less useful for patients living in the community)

Answer 6

• Corrigan argues there are problems administrating the token economy with outpatients who live in the community
• In the hospital, patients have 24 hour care, so there’s better control for staff to monitor and reward patients immediately. But as outpatients only receive treatment for a few hour, the token method could only used for part of the day which isn’t effective
• This means that while the token economy did produce positive result in the ward setting, it can’t be replicated beyond that environment.

Question 7

Give evaluation for token economies (ethical issues raised)

Answer 7

• Token economies gives professionals power to control the behaviour of patients, which inevitably involves imposing their norms of good behaviour onto them.
• And, restricting the availability of pleasure of those who don’t act as ‘desired’ means that very ill people may have an even worse time and be more stressed
• This means that the benefits of token economies may be outweighed by their impact on personal freedom and short-term reduction in quality of life.

Question 8

Give evaluation for token economies (there are alternative approaches that don’t raise ethical issues)

Answer 8

• Chiang et al noted that art therapy might be a good alternative. While the evidence base is small, it appears to show that art therapy is a high-gain low-risk approach to managing SZ
• Even if the benefits of art therapy are modest, unlike alternatives art therapy is a pleasant experiences with no major risks of side effect or ethical issues, and even the NICE guidelines recommended art therapy for SZ
• This means that art therapy might be a good alternative to token economies