managment of schizophrenia: token economies Flashcards
how do token economies help manage the behaviour of patients with schizophrenia
uses systems of secondary reinforcement to improve the behaviour of patients by systematically rewarding desired behaviour.
when would token economies most likely be used with patients with SZ
used in institutions with those who have developed patterns of maladaptive behaviour through spending long periods of time in psychiatric hospitals.
what is the secondary reinforcer
the token - isn’t rewarding in iteself but can be swapped for a primary reinforcer
what is the primary reinforcer
the meaningful reward - what the token is exchanged for eg. food or a film
what may be some of the effects of institutionlisation
bad habits - eg. ceasing to maintain good hygeine, stop socialising
what symptoms of schizophrenia does token economies help with
negative symptoms for example - avolition is the loss of goal orientated behaviour.
what is the theory that token economies are based upon
operant conditioning - positive reinforcement of desirable behaivour and learning through consequences.
what are the two major benefits of token economies identified by Matsone et al
- improves the quality of life within the hospital setting
- ‘normalises’ behaviour making it easier for a person who has become institutionalised return to life in the community
how are target behaviours developed
Target behaviours are tailored to the individual and usually agreed with the patient on the most appropriate target behaviours.
what research is there to support the efficacy of token economies (AO3)
Glowacki et al identified seven high quality studies published that examined the effectiveness of token economies. All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviour. This supports the value of token economies in an institutional setting.
What does Glowacki et al’s study not tell us about token economies (AO3)
does not tell us anything about the long term impact. It is likely token economies have a minimal long term impact as when patients leave the hospital, behaviour stops being reinforced by reward, therefore any likely impact will end.
What is a limitation of token economies (AO3)
token economies are not a treatment for schizophrenia as do not treat the symptoms, therefore only a managment technique. As a result token economies have minimal theraputic value.
What is a limitation of Glowacki’s study which may hinder the validity of the results
glowacki’s study only involved published studies, therefore there is likely a publication bias towards studies that show a significant result. Studies that show negative, non significant results are less likely to be published and therefore findings may be due to a bias rather than token economies.
What are the ethical issues surrounding token economies (AO3)
Use of token economies could be seen as unethical for several reasons. Firstly, some argue that token economies are dehumanising as they take away the patient’s rights to make their own choices. For example for some people it is there preference to look scruffy, however in a token economy this may be deemed an undesirable behaviour.
Secondly, some argue that token economies are discriminatory: Severely ill patients will have greater difficulty complying with behavioural demands and thus get fewer privileges than patients who are less severely ill. Token economies may thus discriminate against the most severely ill patients.
