schizophrenia- management of schizophrenia Flashcards
how did token economies develop in sz treatment?
-Allen and Adrian (1968) used a token economy in a sz ward
-gift token was given for every tidying act
-tokens later swapped for privileges e.g. films
-token economies still standard approach to managing sz in many parts of world
who identified three categories of institutional behaviour that can be tackled using token economies? and what where they?
Matson et al. (2016)
-personal care
-condition-related behaviours (e.g. apathy)
-social behaviours
modifying these behaviours has two benefits:
1. quality of life
2. ‘normalises’ behaviour
what did Matson et al. (2016) do for token economies sz?
-identified three categories of institutional behaviour that can be tackled using token economies
-modifying these behaviours doesn’t cure sz but has two major benefits
how do token economies improve quality of life?
improve the quality of life within the hospital setting e.g. putting on makeup or becoming more sociable with other residents
how do token economies ‘normalise’ behaviour?
encourages return to more ‘normal’ behaviour, making it easier to adapt back into the community e.g. getting dressed or making your bed
what’s involved with a token economy?
-tokens (e.g. coloured disks) given immediately after desirable behaviour. target behaviours are decided individually based on knowledge of the person (Cooper et al. 2007)
-tokens have no value in themselves. ut are swapped for rewards e.g. sweets, magazines or activities like a film
who suggested target behaviours are decided individually based on knowledge of the person?
Cooper et al. 2007
why are tokens given immediately and not delayed?
tokens are given immediately following target behaviours bc delayed rewards are less effective
what theory is behind token economies?
operant conditioning
-tokens are secondary reinforcers- exchanged for rewards (primary reinforcers which are directly rewarding e.g. food)
-tokens can be exchanged for a range of primary reinforcers are called generalised reinforcers. these have a more powerful effect
ao3 of token economies: evidence of effectiveness
-Glowacki et al. (2016) identified seven high quality studies published by between 1999 and 2013 on the effectiveness of token economies in hospital setting
-all the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours
-supports value of token economies
ao3 of token economies: ethical issues raised
-professionals have the power to control peoples behaviour and this means imposing one person’s norms on to others (e.g. a patient may like to look scruffy)
-also restricting the availability of pleasures topple who don’t behave as desired means that very ill people already experiencing distressing symptoms have an even worse time
-means the benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life
ao3 of token economies: existence of more pleasant and ethical alternatives
-other approaches do not raise ethical issues, e.g. art therapy is a high-gain low-risk approach to managing sz (Chiang et al. 2019)
-even if the benefits of art therapy are modest, this is true for all approaches to treatment and management of sz and art therapy is a pleasant experience
-means art therapy might be a good alt to token economies- no side effects or ethical abuses
ao3 of token economies: benefits
-problem w token economies is that they are hard to continue outside a hospital setting. target behaviours cannot be monitored closely and tokens cannot be given immediately
-on the other hand, some people may only get the chance to live outside a hospital if their personal care and social interaction improves
-suggests that it is worth it despite the issues around using them in hospital to give people a chance outside the hospital
