Psychological Therapy. Token Enconomy Flashcards
Based on the behavioural principles of operant conditioning
The idea thsg positive reinforcement (a pleasant consequence of behaviour) increases the frequency of that behaviour
A token economy is a system used in psychiatric hospitals with in patients who may have developed patterns of
Maladaptive behaviour through spending a long time in this institutionalised setting
Clinicians will set target behaviours that they believe will improve the schizophrenia patients functioning and engagements with everyday life
Eg washing/grooming, doing chores and sociability
Tokens (coloured discs) are given to patients immediately after they perform one of the target behaviours
It is important that this is immediate because
Patient may perform other undesirable behaviours before getting the reward
It would be unclear which behaviour was reinforced
Tokens are secondary reinforces because they have
No value in themselves but acquire reinforcing properties through becoming associated with genuine rewards
Tokens can then be exchanged for rewards and privileges which are
Primary reinforces as they directly give pleasure to the patient Eg entertainment Trips out Cigarettes Extra/special food Extra visitation time
Important that the exchange periods are frequent and not too much time passes between token presentation and exchange for reward
This is because the token may lose its association with the primary reinforcer, the token loses its rewarding properties
Some tokens are generalised reinforces because they can be exchanged for a variety of different privileges and rewards
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
This is not a cure for schizophrenia but should provide the benefit of
Increasing desirable and reducing undesirable behaviour
Thereby improving independent living skills and therefore quality of life
Social reinforcement
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
Shaping
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
Immediacy
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
Group contingencies
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
Consistent application
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
Consistent application
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
Levelled system
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
Supporting evidence for it’s effectiveness by Dickerson meta analysis of 13 studies
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
Difficult to measure effectiveness
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
Less usefull for patients living in the community
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
Ethical concerns
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
