Psychological Therapy. Token Enconomy

Question 1

Based on the behavioural principles of operant conditioning

Answer 1

The idea thsg positive reinforcement (a pleasant consequence of behaviour) increases the frequency of that behaviour

Question 2

A token economy is a system used in psychiatric hospitals with in patients who may have developed patterns of

Answer 2

Maladaptive behaviour through spending a long time in this institutionalised setting

Question 3

Clinicians will set target behaviours that they believe will improve the schizophrenia patients functioning and engagements with everyday life

Answer 3

Eg washing/grooming, doing chores and sociability

Question 4

Tokens (coloured discs) are given to patients immediately after they perform one of the target behaviours
It is important that this is immediate because

Answer 4

Patient may perform other undesirable behaviours before getting the reward
It would be unclear which behaviour was reinforced

Question 5

Tokens are secondary reinforces because they have

Answer 5

No value in themselves but acquire reinforcing properties through becoming associated with genuine rewards

Question 6

Tokens can then be exchanged for rewards and privileges which are

Answer 6

Primary reinforces as they directly give pleasure to the patient 
Eg entertainment 
Trips out 
Cigarettes 
Extra/special food
Extra visitation time

Question 7

Important that the exchange periods are frequent and not too much time passes between token presentation and exchange for reward

Answer 7

This is because the token may lose its association with the primary reinforcer, the token loses its rewarding properties

Question 8

Some tokens are generalised reinforces because they can be exchanged for a variety of different privileges and rewards

Answer 8

The more things the token can be exchanged for, the more powerful that token becomes and the more target behaviours are likely to be repeated by patients

Question 9

This is not a cure for schizophrenia but should provide the benefit of

Answer 9

Increasing desirable and reducing undesirable behaviour

Thereby improving independent living skills and therefore quality of life

Question 10

Social reinforcement

Answer 10

Althiught tokens strengthen behavior and make reinforcement explicit and immediate

Attention and praise from others (hospital staff and later family/friends) will ultimstrlyy maintain new desirable behaviours

Question 11

Shaping

Answer 11

To begin with patients are reinforced for behaviours that approach the target behaviours eg getting up at 9:15 when the target is 9AM
These are gradually built up until perfect

Question 12

Immediacy

Answer 12

Reinforcement has a greater effect if given as soon as the desired behaviour is displayed
The longer the patients have to wait, the less they learn

Question 13

Group contingencies

Answer 13

Although sometimes designed for a specific individual token economy are most often run with an entire ward of patients
Individual goals can still be incorporated in the system

Question 14

Consistent application

Answer 14

It is important that staff are fully trained so that they follow all the rules in the system regarding when to give a token and not simply use their own judgment

Families should be educated so that they do not undermine the system by giving rewards differently

Question 15

Consistent application

Answer 15

It is important that staff are fully trained so that they follow all the rules in the system regarding when to give a token and not simply use their own judgment

Families should be educated so that they do not undermine the system by giving rewards differently

Question 16

Levelled system

Answer 16

Token economy systems can be set up so there are several levels that patients have to pass before they move onto the next

At high levels, more complex patterns of desirable behaviour are required but more desirable and expensive rewards are available for these

Question 17

Supporting evidence for it’s effectiveness by Dickerson meta analysis of 13 studies

Answer 17

Investing the use of token economy in s psychiatric setting
11/13 reported beneficial effects in terms of increasing thr amount of adaptive behaviours shown by patients and reported that token economy was directly responsible for these effects

Supports effectiveness of token economy at helping patients improve their functioning and engsgment with society

Question 18

Difficult to measure effectiveness

Answer 18

Most studies including Dickerson are not controlled
No control over EV that could explain improvements
Some patients getting more attention from staff
No control group to compare
Supportive family outside of hospital

Questions the effectiveness, may not be solely attributed to this alone

Question 19

Less usefull for patients living in the community

Answer 19

TE only been shown to work in s hospital setting. Problems attempting to administer this system with outpatients because

Behaviour cant be monitored as closely (difficult to identify when a target behaviour has been produced as no constant supervision)

Patients only in treatment for a few hours each day, only get tokens for a small % of behaviour.

Beneficial effects of token economy likely not to be maintained once a patient is out of hospital

Question 20

Ethical concerns

Answer 20

Staff control the patients; food privacy and entertainment so patients are made to earn these as privileges
Witholding such things in order to train patients is controversial

Token economy id considered by some to be a violation of s patients basic human rights