mangement of schizophrenia Flashcards
what are token economies
-rewards systems to manage the behvaiour of people with sp with maladaptive behvaiours dpending a long time in psychiatric hosp
what study did azrin and ayllon carry out
-trialled it in ward of women w sp
-when they carried out desirbale behaviours .eg make their bed or clean they were given a plastic token labelled as ‘one gift’
-tokens swapped for privedlge e.g watch a film
-number of tasks increased signifciantly
why were tokens sued so much in the 1960s and 70s
-the norm was long hospitalisaiton
-but now has declined due to the community based approach of care given out
whats the ethical concern w the token system
-your restricitng rewards to those with emntal health
what is institutionalisaiton
-develops under prolonged hosp stay for exmaple you cease good hygiene and dont soicalise as mcuh with others due to the small routine and pleasures you used to have
what 3 catgeories did matson et al discover that the token ecomony tries to tackle with insituitnal behaviour
-personal care, conditon related apathy and social behvaiour
what is the importance in modifying the 3 categories
-improves their quality of life in hosp e.g makeup for someone who takea lot of pride in their appearance
-normalises behaviour - allows for people to adapt to community e.g get dressed and make bed
whats involved in the token eco
-token given if desirbale behaviour shown
-tagregt beh decided on idnvidual basis so important to get to know the prsn to identify most appropriate target beh
-token swapped later for tnagible rewards
what are some tangible rewards
-sweets, magazines, walk outside
does the reward have to be immediate
-yes delayed reward is less effective
theory behind token systems
-operant conditoning
-type of behvaiour modification
-secondary reinforcer only has value when indiviudal learns they can obtain menaingful rewards
what are meaningful rewards?
-primary reinforcers
which reinforcer are tokens exhanged for
-primary reinforcers which are a particualrly powerful secondary reinforcer
-such secondary reinforcers are called generalised reinforcers
how do tokens become secondary reinforcers
-paired with primary R , so at the start tokens and primary R are adminstered tg
strenghts of token eco
(evidence)
-Glowacki et al- exmained 7 high quality studies for effectiveness of token system and found for those with chronic Mh and sp and living in hosp setting
-it reduced negative symptoms and declined unwanted behaviours
(benefits)
-some ppl w SP only get the chance to live outside hosp if personal care and social interaction improves
-token eco may be the best way to provide the opporutnity
weakness of token eco
(counterpoint evidence)
-small smaple
-file drawer issue= leads to bias to psoitive findings but undesirbale reuslts can be ‘filed away’
-serious quetsions over the evidence
(ethical issues)
-professionals given control over peoples behvaiour
-impose their norms and values on others
-problem if target beh isnt idnetiifed sensitively
-people who dont do target beh may be restricted availablity
-if they have servere MH or distress they can get worse
-token sysrem outweighs freedom
(alternative approaches)
-CHIANG et al= art therapy a high gain but low risk strategy to manage sp
-pleasant exp and less risk of major side effects pr ethical abuse
-NICE guidelines recommend it
