Management of SZ Flashcards
What is used to manage SZ?
A token economy
What is a token economy?
A form of behaviour modification, where desirable behaviour are encouraged by the use of selective reinforcement. People are given rewards (tokens) when they engage in socially desirable behaviours. The tokens are secondary reinforcers and can be exchanged for primary reinforces- food or privileges.
Who demonstrated token economies?
Ayllon and Azrin (1968)- they trialled a token economy in a ward of schizophrenic women. Every time a p carried out a task such as making their bed they’d receive a token which could be exchanged for ward privileges like watching a film. The number tasks increased signigantly.
Has use of token economy increased or decreased and why?
Decreased from their height in 60s and 70s, due to growth of community-based care and closure of many psychiatric hospitals.
When does institutionalisation develop?
Under circumstances of prolonged hospitalisation, can create bad habits like poor socialisation and hygiene.
What are three institutionalised behaviours tackled by token economies?
Matson et al (2016)
1. Personal care
2. Condition- related behaviours (apathy)
3. Social Behaviour
This can improve life quality of someone in a hospital setting and normalises behaviour to make it easier to adapt back into life in the community (getting dressed)
What is involved in a token economy?
The idea that tokens are immediately given to individuals when they have carried out a desirable behaviour, act as a immediate reward- delayed rewards are less effective.
What is the theoretical understanding of token economies?
They’re an example of behaviour modification- a behavioural therapy based on operant conditioning. The tokens are secondary reinforcers they only have value once traded for meaningful rewards which are primary reinforcers. Such secondary reinforcers are generalised reinforcers.
What are the AO3 points for management?
- Evidence of effectiveness BUT small samples
- Ethical issues raised when using token economies
- Alternative approaches: existence of more pleasant and ethical alternatives
What are the strengths for management?
Token economies have evidence for their effectiveness, Glowacki et al identified seven high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health settings, all studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
HOWEVER,
Seven studies is small evidence to base the effectiveness of a technique, file drawer problem is a phenomenon where bias towards positive published findings because undesirable results have been filed away. Question over evidence
What are the limitations for management?
- Ethical implications, gives professionals considerable power to control the behaviour of people in the role of patient. Involves imposing an institutions norms onto others. Restricting ability to experience pleasure of already ill people may result in legal actions by a family. TE outweighed by impact on personal freedom and short-term reduction in quality of life.
- Chiang et al (2019) found art therapy may be a good alternative. High gain low risk approach to SZ no major risks of side effects or ethical issues. Good alternative
