Schizophrenia: Token economy and the management of schizophrenia Flashcards
What is token economy?
A form of therapy where desirable behaviours are encouraged by the use of selective reinforcements. Rewards (tokens) are given as secondary reinforcers when individuals engage in correct/socially desirable behaviours. The tokens can then be exchanged for primary reinforcers- food or privilege’s.
How does token economy work?
The behavioural principles employed in token systems are based mainly on the theory of operant conditioning to describe the relationship between a behaviour and environmental events. Key within this relationship is the idea of positive reinforcement. There are 2 types of positive reinforcers:
- Primary reinforcers are anything that gives pleasure or removes unpleasant states. Primary reinforcers do not depend on learning in order to acquire their reinforcing value.
- Secondary reinforcers initially have no value to the individual but acquire their reinforcing properties as a result of being paired with primary reinforcers. In token economy , the tokens given out when a patient engages in a target behaviour are secondary reinforcers.
What is a study to do with token economy?
Ayllon and Azrin (1968) used token economy on a ward of female schizophrenic patients, many of whom had been hospitalised for many years. They were given plastic tokens, each embossed with the words ‘one gift’ for behaviours such as making their bed or carrying out domestic chores. These tokens were then exchanged for privileges such as being able to watch a movie. These researchers found that the use of a token economy with these patients increased dramatically the number of desirable behaviours that the patients performed each day.
Assigning value to the tokens:
To give the neutral token some ‘value’, it needs to first be repeatedly presented alongside or immediately before the reinforcing stimulus. The reinforcing stimulus may take the form of food, privilege’s or other incentives. By paring the neutral tokens with the reinforcing stimulus , the neutral token eventually acquires the same reinforcing properties. As a result of this process of classical conditioning, these tokens become secondary reinforcers, and so can be used to modify behaviour.
Reinforcing target behaviours:
When patients perform the desirable target behaviours, the clinician awards them tokens. When a token can be exchanged for a variety of different privileges and rewards, it is referred to as a generalised reinforcer. The more items or rewards or tokens can be exchanged for, the more powerful those tokens become. Sran and Borrero (2010) compared behaviours reinforced by tokens that could be exchanged for a variety of preferred edible items. They found that all participants had higher rates of responding in those sessions where tokens could be exchanged for a variety of items.
The ‘trade’:
An important part of the token economy is the exchange of tokens for backup rewards chosen by the clinician. These rewards may include food, sweets or other privileges such as being able to watch a movie. During the early stages of token economy, frequent exchange periods mean that the patients can be quickly reinforced and target behaviours can then increase in frequency. The effectiveness of the token economy may decrease if more time passes between the presentation of the token and the exchange for the backup reinforcers.
A03:
+ Research support
- Difficulties assessing the success of a token economy
- Ethical concerns
- Less useful for patients living in the community
A03: Research support
Dickerson (2005) has provided research support for the effectiveness of token economies in a psychiatric setting. They reviewed 13 studies of the use of token economy systems in the treatment of schizophrenia. 11 of these studies had reported beneficial effects that were directly attributable to the use of token economies. Dickinson et al concluded that, overall, these studies provide evidence of token economies’ effectiveness and increasing the adaptive behaviours of patients with schizophrenia. However, they did caution that many of the studies reviewed had significant methodological shortcomings that limited the impact of the overall assessment of token economies in this context.
A03: Difficulties assessing the success of a token economy
Comer (2013) suggests that a major problem in assessing the effectiveness of token economies is that studies of their use tend to be uncontrolled. When a token economy system is introduced into a psychiatric ward, typically all patients are brought into the program rather than having an experimental group that goes through the token economy program and a control group that does not. As a result, patient improvements can only be compared with their past behaviours rather than a control group. This comparison, claims Comer, may be misleading, as other factors could be causing patience improvement rather than the token economy.
A03: Ethical concerns
There are a number of ethical concerns concerning the use of token economy programs in psychiatric settings. For example, in order to make reinforcement effective, clinicians may exercise control over important primary reinforces such as food, privacy or access to activities that alleviate boredom. Patients may then exchange tokens if they display the target behaviour. However, it is generally accepted that all human beings have certain basic rights that cannot be violated regardless of positive consequences that might be achieved by manipulating them with a token economy Program
A03: Less useful for patients living in the community
Although token economy has shown to be effective in reducing negative symptoms for people with schizophrenia, it’s only really shown to work went in a hospital setting. Corrigan (1991) argues that there are problems administering the token economy method with outpatients who live in the community. Within a psychiatric ward setting, patients receive 24-hour care and there is better control for staff to monitor and reward patients appropriately. However, our patients living in the community only received treatment for a few hours a day, so therefore the token method could only be used for part of the day. As a result, even if the token economy did produce positive results within the ward setting, these results may not be maintained be on the environment.
