PAPER 3 - SCHIZOPHRENIA - token economies: managements of schizophrenia

Question 1

what is a token enconomy?

Answer 1

• a form of therapy where desirable behaviours are selectively reinforced to encourage them
• rewards in the form of tokens are given when individual engages in socially desirable behaviours

Question 2

what do the tokens act as? and what can they be exchanged for?

Answer 2

secondary reinforcers exchanged for primary reinforcers e.g. food/privileges

Question 3

what are target behaviours?

Answer 3

baheviours set up by clinicians e.g. getting dressed, that they think will improve the patients daily life quality
- they are unique to each individual

Question 4

what is behavioural modification?

Answer 4

based on operant conditioning , when clients will set target behaviours to improve life of patient

Question 5

what are token values?

Answer 5

value of token is the reward, certain behaviours could earn you more valuable tokens?

Question 6

what are the 2 main purposes of running a token economy?

Answer 6

1. improve patients quality of life within the hospital
2. to assist transition back into society by ‘normalising’ behaviour

Question 7

how does a token economy work?

Answer 7

• patients are given tokens immediately after carrying out a desirable behaviour
• target behaviours are decided on an individual basis to recognise individual characteristics that are appropriate

Question 8

why is immediate reward important?

Answer 8

less effective if delayed, dont associate reward with completing the target behaviour
- tokens quickly swapped for privileges

Question 9

what is the rationale behind a token economy? (separate from aims?

Answer 9

1. personal care
2. condition-related behaviour e.g. therapy
3. social behaviour

Question 10

evaluation - why is “evidence for effectiveness” a strength of token economies?

Answer 10

• Krista Glowacki identifies 7 high quality studies published between 1999-2013 that examined effectiveness for token economies on mental health problems
• all studies showed a reduction in negative symptoms and decline in frequency of unwanted behaviours

Question 11

evaluation - why is “evidence for effectiveness” a limitation of token economies?

Answer 11

• token economies are only effective in hospitals & there have been problems using them in communities (patients only recieve care for a few hours so giving rewards would be harder)
• 7 studies (Glowacki) is a small evidence base
• issue with small number of studies is the file-drawer problem

Question 12

evaluation - what is the file drawer problem?

Answer 12

bias towards positive published findings because undesirable results have been ‘filed away’
- questions evidence for effectiveness

Question 13

evaluation - what are the ethical issues of token economies and why?

Answer 13

• gives professionals power to control behaviour of patients, involved imposing a persons/institutions norms to other which is problematic target behaviours arent identified sensitively
• e.g. restricting availability of pleasures, makes experience even worse

Question 14

evaluation - what are the alternatives to a token economy?

Answer 14

• more pleasant alternatives
• review by Chiang concluded art therapy might be a good alternative
• shows art therapy as high-gain low-risk approach to manage SZ (not many risks/ethical issues & recommended by NICE)

Question 15

what is the cost-benefit analysis to a token economy for someone who may stand a chance of leaving hospital setting?

Answer 15

• not effective in communities - patients don’t receive as much care so difficult to associate with reward behaviour (low effectiveness)
• Dickerson - 13 studies (small sample, methodological problems - different ways of studying each, rarely control groups etc.), 11 showed beneficial effects

Question 16

what are the differences between token economies and family therapy as a way of treating schizophrenia?

Answer 16

token economies
- based on rewarding individual
- setting (usually) in institution
- evidence for effectiveness but lots of criticising evidence

family therapy
- based on psychoeducation
- setting (usually)at home
- lots of evidence for effectiveness