Managment Of SZ

Question 1

What are token economies?

Answer 1

Reward systems used to manage the behaviour of people with SZ in particular those who developed patterns of maladaptive behaviour through spending long periods of time in psychiatric hospitals.

Question 2

Who carried out a classic demonstration of a token economy system?

Answer 2

Ayllon and Azrin.

Question 3

What did Ayllon and Azrin do?

Answer 3

Trialled a token economy system in a ward of women with a diagnosis of SZ.

Question 4

When participants carried out tasks such as making their bed what happened?

Answer 4

They were given a plastic token embossed with the words ‘one gift.’ These tokens could be swapped for ward privileges e.g. being able to watch a film.

Question 5

What happened to the number of tasks after introducing the token economy system?

Answer 5

They increased significantly.

Question 6

When were token economy systems extensively used?

Answer 6

In the 1960s and 70s when the norm for treating SZ was long-term hospitalisation.

Question 7

Why has the use of token economy systems declined?

Answer 7

The growth of community-based care and the closure of many psychiatric hospitals but also because of the complex ethical issues raised by restricting rewards to people with mental disorders.

Question 8

What does institutionalisation develop under?

Answer 8

Under circumstances of prolonged hospitalisation.

Question 9

What is one outcome of insitutionalisation?

Answer 9

People often develop bad habits e.g. they might cease to maintain good hygiene or stop socialising with others.

Question 10

What did Matson et al identify?

Answer 10

3 categories of institutional behaviour commonly tackled by means of token economies.

Question 11

What were the 3 categories identified by Matson et al?

Answer 11

Personal care
Condition-related behaviours e.g. apathy
Social behaviour

Question 12

What are the two major benefits of modifying institutional behaviour?

Answer 12

1. Improves persons quality of life within the hospital setting.
2. Normalises behaviour and makes it easier for people who have spent time in hospital to adapt back into life in the community.

Question 13

How do token economy systems work?

Answer 13

• Tokens (coloured discs) are given to individuals when they carry out a desirable behaviour.
• Target behaviours are identified on an individual basis.
• Although the tokens have no value they are swapped later for ore tangible rewards.
• Having an immediate reward for target behaviour is important because delayed rewards are less effective.

Question 14

What are token economies an example of?

Answer 14

Behaviour modification.

Question 15

What is behaviour modification?

Answer 15

A behavioural therapy based on operant conditioning.

Question 16

What are tokens in terms of conditioning?

Answer 16

Secondary reinforces as they only have high value once the person receiving them has learned that they can be used to obtain meaningful rewards.

Question 17

What are meaningful rewards in terms of conditioning?

Answer 17

Primary reinforcers.

Question 18

What are secondary reinforcers called?

Answer 18

Generalised reinforcers

Question 19

How do tokens become secondary reinforcers?

Answer 19

They are paired with primary reinforcers so at the start of a token economy programme tokens and primary reinforcers are administered together.

Question 20

Evaluation:
Management for SZ is evidence for effectiveness

Answer 20

Glowacki et al identified 7 high quality studies published between 1999-2013 that examined the effectiveness of token economies for people with chronic mental health issues such as SZ and involved patients living in a hospital setting.
All the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.
This supports token economy systems.

Question 21

Counterpoint for management of SZ

Answer 21

7 studies is a small sample base to support the effectiveness of a technique.
One problem with a small sample size is the file drawer problem.
This leads to a bias towards positive published findings because undesirable results have been ‘filed away.’
This is a particular problem in reviews that only include a small number of studies.
This means that there is a question about the evidence for the effectiveness for token economy systems.

Question 22

Evaluation of family studies:
Ethical issues

Answer 22

The use of token economy systems raised ethical issues because it gives professionals considerable power to control the behaviour of people in the role of patient.
This involves imposing one persons norms on to others which is especially problematic if target behaviours are not identified sensitively.