management- token economies

Question 1

what are token economies?

Answer 1

reward systems used to manage the behaviour of participants, particularly those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals.

Question 2

ayllon and azrin (1968)

Answer 2

trialled a token economy system in ward of women with schizophrenia.
each time carried out task e.g. making bed given a plastic token that could be swapped for ward privileges like being able to watch a film.
found that tasks carried out e.g. making bed and cleaning up increased significantly.

Question 3

institutionalisation

Answer 3

institutionalisation develops under circumstances of prolonged hospitalisation. people often develop bad habits e.g. not maintaining good hygeine or socialising with others.

Question 4

matson (2016)- 3 categories of insitutional behaviour commonly tackled by TE

Answer 4

personal care, condition-related behaviours (e.g. apathy) and social behaviour.

Question 5

benefits of modifying these behaviours:

Answer 5

doesn’t cure but 2 major benefits

1. improves qol within hospital setting. e.g. social interaction for usually sociable person.
2. ‘normalises’ behaviour. makes it easier for people to adapt back into community. e.g. getting dressed in morning.

Question 6

how do token economies work?

Answer 6

• based on operant conditioning.
• tokens given immediately to patients when they carry out desirable behaviour that has been targeted for reinforcement. immediacy important as prevents ‘delay discounting.’
• tokens can be swapped for practical and tangible rewards like items, services or priveleges. these are primary reinforcers.
• tokens secondary reinforcers/generalised reinforcers.

Question 7

strength

evidence of effectiveness

Answer 7

glowacki (2016)- 7 high quality studies 1999-2013 examining effectiveness of TEs for patients in hospital settings/schiz etc. reduction in neg symptoms and ecline in frequency of unwanted behaviours.

supports value of TEs

Question 8

counter

small evidence base

Answer 8

7 studies- small evidence base to support effectiveness of technique.
file drawer problem- bias towards positive published findings because undesirable results ‘filed away’.

can question evidence for effectiveness of token economies.

Question 9

ethical issues

Answer 9

gives professionals considerable power to control behaviour of patients.
involves imposing one person’s (or institutions) norms onto others. problematic esp if target behaviours not identified sensitively.
e.g. someone who likes to get up late may have personal freedoms removed.

restricting ability of pleasures (e.g. having sweets) to those who don’t behave as desired means that seriously ill people (already experiencing distressing symptoms) have even worse time. legal action from families major factor in decline of TE’s use.

benefits may be outweighed by impact on personal freedom and reduction in qol.

Question 10

limitation

alt approaches

Answer 10

other approaches with comparable evidence base that don’t raise same ethical issues
review by chiang- art therapy. evidence base relativelty small and some methodological limitations, but art therapy high-gain low-risk approach to managing schiz. NICE reccommends