Schizophrenia: Management

Question 1

Explain how token economies were first developed to treat SZ:

Answer 1

• Ayllon and Azrin trialled a token economy system in a ward of women diagnosed with SZ.
• Each time the participants carried out a positive task e.g. making bed, they were given a plastic token that could be exchanged for something desirable e.g. being able to watch a film.
• The number of positive tasks completed by SZ individuals increased significantly.
• Token economies are less used in current psychiatric wards due to potential ethical issues - e.g. restricting rewards to those with mental disorders.

Question 2

Explain how token economies can improve institutionalisation in those with SZ:

Answer 2

• Institutionalisation develops under circumstances of prolonged hospitalisation.
• Patients often develop bad habits e.g. do not maintain hygiene or socialise with others.
• Matson identified 3 categories of insitutional behaviour that can be managed by token economies: personal care, condition-related behaviours and social behaviour. Modifying these behaviours can:
• Improve the persons quality of life in the hospital setting e.g. tokens can be exchanged for makeup if a person favours their apperance.
• ‘Normalises’ behaviour, making it easier for individuals to live in the real world after being in the hospital e.g. making bed.

Question 3

Outline the basics of token economies overall:

Answer 3

• Form of behaviour modification based on operant conditioning.
• Tokens are secondary reinforcers- they have value because they can be used to obtain meaningful rewards.
• These meaningful rewards are primary reinforcers

Question 4

Name the 4 evaluation points for using token economies to manage SZ:

Answer 4

1) Evidence of effectiveness (S)
2) Unsustainable (S)
3) Ethical issues (L)
4) Alternative approaches (L)

Question 5

Explain ‘evidence of effectiveness (S)’ as an evaluation point for using token economies to manage SZ:

Answer 5

• A strength is that there is evidence for the effectiveness of token economies to manage SZ.
• Glowacki identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies when treating those with chronic mental disorders, including SZ, and lived in a hospital setting.
• All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours.
• This supports the value of token economies.

Question 6

Explain ‘unsustainable (L)’ as an evaluation point for using token economies to manage SZ:

Answer 6

• A limitation is that token economies are very difficult to sustain outside a hospital setting.
• This is because target behaviours cannot be monitored closely and tokens cannot be administered immediately.
• This means that it is likely that the benefit of the token economy will be lost and the frequency of undesired behaviours will increase again.
• Suggest that token economies are only sustainable in hospital settings and other methods to manage SZ may be more practical long-term.

Question 7

Explain ‘ethical issues (L)’ as an evaluation point for using token economies to manage SZ:

Answer 7

• A limitation is the ethical issues raised with using token economies to manage SZ.
• Ethical issues arise from token economy use because it gives professionals considerable power to control the behaviour of patients.
• This inevitably involves imposing a person’s/institutions norms on to others, which is problematic if behaviours are not appropriate.
• Restricting the availability of pleasures, e.g. sweets, to SZ individuals that are not performing a desired behaviour means that struggling individuals that are experiencing distressing symptoms will have an even worse time.
• Suggests that the benefits of using token economies may be outweighed by their impact on personal freedom and quality of life

Question 8

Explain ‘alternative approaches (L)’ as an evaluation point for using token economies to manage SZ:

Answer 8

• A limitation is that there are more pleasent and ethical alternatives to token economies.
• Even if token economies can help manage SZ there are other approaches with a comparable evidence base that do not raise the same ethical issues.
  -Chiang concluded that art therapy may be a good alternative. The evidence base for this is small and has some methodological limitations, but appears to show that art therapy is a high-gain low-risk approach to managing SZ.
• Even if the benefits of art therapy are modest, this is generally true for all approaches to managing SZ.
• NICE recommends art therapy for managing SZ- especially as art therapy not having any significant side effects and is relatively pleasant compared to other methods.
• Suggests that art therapy may be a better alternative to token economies.