Schizophrenia - Management of Schizophrenia, Token Economies Flashcards
What are token economies used for.
Managing behaviour of those with Sz. Those with maladaptive patterns of behaviour. Extended periods of time in psychiatric wards can cause this.
Discuss use of token economies for Schizophrenia
Used mostly in 60s and 70s when hospitalisation was main treatment for Schizophrenia.
Aylonn and Azrin
Female Sz ward. Awarded plastic tokens ‘gifts’ which could be exchanged for privilages if desired tasks were completed. Number of tasks increased significantly.
Less used today. Increase in community based care. Some ethical issues with restricting and giving rewards to the mentally unwell.
What is institutionalisation
Develops due to prolonged hospitalisation. Bad habits such as poor hygiene and social skills develop.
Matson’s 3 types of behaviour tackled by TE:
1) Personal care
2) Condition related behaviours
3) Social behaviour
How does modifying behaviour through TE help patients
Improves quality of life in hospital. Helps normalise behaviours needed to readjust into the world after discharge.
Describe how TE works in the ward
Cooper
Target behaviours identified for patient. If desired behaviour is observed token is given immediately. Token is later exchanged for tangible reward. Token provides instant reward as delayed reward is less effective. GIVE EXAMPLES OF REWARDS. WATCH A MOVIE, WALK, SWEETS, VISITATIONS.
Explain TE in terms of behaviourism and operant conditioning
Behaviour modification - behavioural therapy. Token is the secondary reinforcer. Only have value after patient sees that they can be exchanged for tangible reward. Tangible rewards are primary reinforcers. These include walks, sweets, movies, visitations. As tokens can be exchanged for a range of rewards they are generalised reinforcers.
Evidence for Effectiveness of TE
+ COUNTERPOINT
Glowacki et al
Found 7 high quality studies about use of TE on patients with chronic mental health disorders like Sz in hospital settings. All showed reduction in negative symptoms and less frequent unwanted behaviours.
COUNTERPOINT
only 7 studies. Fie drawer problem. Undesired results filed away and only positive findings published. Mostly affects reviews of small number of studies like Glowacki’s. questions qulity of the review despite studies being of a high quality.
Ethical Issues
Gives power to professionals over the patients. Imposing of norms onto others. There can be issues identifying target behaviours. Restricting rewards that bring pleasure to those who could be suffering from the worst symptoms and therefore collecting least tokens can make their mental health worse. Families sometimes take legal action against professionals which lead o a decrease in TE use. Cots outweigh benefits. Costs include lack of personal freedom.
Better alternative approaches
Chiang
Review of studies showing that art therapy is as useful. Similar evidence base to support for TE. High gain low risk approach to managing Sz. More pleasant than TE. No ethical abuse. Recommended by NICE.
Continuity outside of institution
Patients may struggle utised of ward as they are not rewarded for certain behaviours. Target behaviours cannot be monitored as closely. However TE may be needed to improve their hygiene and social skills to get a discharge in the first place.
