TEP in AN Flashcards
Tolken Economy Programe in AN
Token Economy Requires Hospitalisation
• Hospitalization of anybody for a mental disorder can often be a confusing and emotional decision.
• Family members or significant others may need to intervene in the patient’s life to ensure they do not starve themselves to a point where they are at risk of death.
• Family members should be aware that individuals who experience anorexia nervosa will often resist treatment of any sort, especially hospitalization.
• It is important, therefore, to come to an agreement about the need for such a step and not be swayed by the patient’s pleas for seeking alternative treatment options.
Often these have already been tried to no success.
Tolken Economy Programe in AN
in and out patient
In patinet = live in facility (e.g. hospital)
Out patient = live at home, only go to facility for therapy and drugs ect.
Being an Out-patient is an Reward on a TEP
Tolken Economy Programe in AN
life as an In patient
❖ A behaviourally-oriented token economy often exists in
psychiatric inpatient units specialising in eating disorders.
❖ This program rewards patients for eating regular meals and ensuring they do not purge afterwards
OR for gaining weight towards their target goal.
❖ As the patient gains weight, additional privileges may be granted.
❖ A specific target weight should be set as the treatment goal, upon which time the patient (ideally),
– should graduate from the hospital into an outpatient program
– consisting of individual therapy, group therapy, or simply a support group.
Often this is not possible because of financial limitations.
❖ If such a behavioural program is not implemented in the inpatient treatment facility the individual is in,
treatment progress will likely be much slower and less steady
Tolken Economy Programe in AN
how Operant conditioning principles and TEP work in Institutions
❖ Daily fluid intake and weight should be tracked.
❖ If the person vomits after meals, they should be watched for a few hours after each meal
to ensure no vomiting occurs.
❖ The individual’s diet should begin between 1,500 and 2,000 calories per day.
– This calorie intake can increase gradually as the patient makes treatment gains.
❖ The patient should have six equal feedings throughout the day, although this may not always be possible.
❖ Severely anorexic patients can be started on a liquid food supplement (e.g., Sustagen) or an IV, if necessary.
❖ Inpatient programs (especially) should be careful not to overemphasize the importance of a person’s weight,
– however. Weight is only the symptom in this disorder of poor body image and self-esteem problems.
– These primary difficulties should be the focus of any
treatment approach for an eating disorder.
❖ Weight gain can be used as an objective measure as to treatment progress. (construct validity)
Tolken Economy Programe in AN
why are sertain factors important for TEP
Token
• patience and carers decide on how many tokens a patient should get for accomplishing something
target behaviour
• targets must be achievable and realistic
– for example gain x amount of weight in a month
contingency and contiguity
• reward patients often so they do not lose their trust and stop the EaTing behaviour
– so reward all of the water behavior
primary reinforcers
• must be significant and rewarding to patients tailored to them such as food and drinks
exchange system
• needs clear rules of when where and how to tokens can be exchanged
– for example on Fridays at the desk with tokens and the form must be signed
scheduals or reinforcment
• changed between variable fixed and ratio and intervals so you keep the patient motivated to achieve
types of reinforcment
• positive only as the the whole program is based around rewards so no negative reinforcement as if this may be counterproductive
recording process
• review and feedback to patients so they reflect and receive on positive feedback on their progress
– so they need praise which is a good motivated to continue the design behavior of eating
Tolken Economy Programe in AN
Sonoda et al 1974 +/-
Sonoda et al (1974)
Report the case of a 10-yr-old girl treated for anorexia nervosa on an outpatient basis with behavioural therapy (operant conditioning)
The patient was one of monozygotic twins who started to lose weight after an appendectomy operation
At the time of treatment, she weighed 20.4 kg, about 30% below normal
She was treated for 2 months with appetite stimulants without result
The successful behavioural therapy included the following techniques:
(a) praise and encouragement, more eating and therapy
(b) a token economy system.
After acquiring 4 tokens she would be rewarded with a coveted bicycle.
A token was rewarded for each kilo gained
At first her weight increase was very slow.
Only after the introduction of the token system did she begin to gain weight at the approximate rate of 1 kg/month [+]
. She reached her target of 25 kg in 9 mo.
A follow-up study 10 months after treatment shows good home and school adjustment and continued normal weight gain
+ study showed the 10-year-old girl only improved after the introduction of the token economy program therefore this is a testament to its effectiveness and treating anorexia
.–
This is a case study
only one person and there could be independent variables and other effects that could have made the treatment work as well as it did
therefore meaning that it could be invalid
Tolken Economy Programe in AN
Ayllon and Arzin 1968 +/-
Ayllon & Azrin (1968)
were instrumental in developing a “very influential token economy program”
in a a ward of over 40 psychiatric patients.
The studies conducted in that token economy,
Patients earned special metal tokens for performing a variety of jobs on and off the ward as well as for self-care activities.
They could exchange their tokens for privileges that included such things as
– choice of living arrangements, special activities on and off the ward, social interaction with staff, and items at a commissary (eg. candy and cigarettes).
This procedure was effective in maintaining the patients’ adaptive behaviors
– as long as the token economy remained in effect, regardless of their individual traits (eg.. age, IQ, diagnosis, and length of hospitalization)
+
It supports the token economy as rewards for jobs done were given to the psychiatric patients
to get lots of rewards with the secondary enforcer that being the token
Search Awards include social interactions with staff and items
.–
It could be considered to be unethical as getting psychiatric patients to do jobs for them in exchange for privileges of which some appear to be basic rights such as social interaction with the staff or certain food
– shouldn’t really be a reward and should be more part of the treatment itself anyway
so unethical
Tolken Economy Programe in AN
field et al 2004 +/-
• treated young people with behavioral problems in a token economy system found it was overall effective
but there were 3 young people who didn’t respond
so a special program is put in place these people where the rewards were more immediate and frequent and found that this led them to be more successful in treating their behavioral problems
suggesting the program must be carefully designed to rewarded suits individual
+
In the end of the token economy worked and it could be moulded and individualized to be more effective for those people
.–
3 patient required heavy individualization of the treatment before it was effective this could be expensive and time consuming
– especially if you utilizing this on a wider scale for a larger amount of people in a TEP
Tolken Economy Programe in AN
parker et al 1977 +/-
parker et al 1977
10 anorexic females
TEP
variable number of chips gained by a patient for both cooperating with staff and weight gain
One chip was given for coming to the wheigh in, one for maintaining weight and 10 for each half lb gained
This could be used to get passes to social activities and over rewards the patient selected
Would get novelty gift at 1 lb weight gain intervals
All patients gained weight
The authors emphasise we need to educate staff that the behavioral approach the therapy doesn’t imply totalitarian ideology
and any comment on the patients eating behaviour as opposed to weight was unproductive
+
Find the fixed ratio reward system worked for 10 anorexic females to all gained weight during hospitalization
.–
The fact that it suggests that eating behaviour was unproductive compared to weight seems unlikely as weight is only a symptom of anorexia whereas it is in fact and eating disorder
therefore the encouragement of eating is more important than the encouragement of the weight itself
Therefore educating the staff against this technically opposes token economy as an treatment of anorexia
Tolken Economy Programe in AN
Bhanji and Thompson 1974 +/-
Bhanji and Thompson 1974
Token economy program 11 anorexic patients
Patients could create their own hierarchy of reinforces
The goals of this was initially to eat a full meal but later modified to account for actual weight gain
10/11 gainefd sig wheight at discharge
– a long-term 2 to 27 month follow-up was attempted using mailed questionnaires but only 7 were Returned and only 3 contained a weight update
so the authors concluded but based on this limited follow-up
tep was useful for initial weight gain
but were inadequate in terms of long-term maintenance of normal eating and weight
It is unclear whether the technique was adequately maintained after discharge
+
all but one gain significant weight after discharge therefore meaning that TEP is effective short term while on treatment
.–
It may not be long-term effective as the follow-up feedback was inadequate
and can’t be certain if the overall operant techniques of tech was maintained with normal eating and weight after the study was over
therefore more research is needed
As for now it must be concluded that it is not effective long term
Tolken Economy Programe in AN
deal with life threatning symptoms +
If too much weight loss occurs in anorexia somebody will die
so be token ecoprogram encourages weight gain and maintenance to decrease the death chance
Tolken Economy Programe in AN
flexable with other treatments +
Can be used alongside drug treatment while on the program
so it’s a holistic method as you treat the symptoms (drug) and help the person themselfs (TEP) to maintain that weight reducing anorexia
so good
Tolken Economy Programe in AN
ez measure progress +
Due to quantitative measuring in kilograms when you weigh the patient it is easy to do with scales
and objective and can’t be misinterpreted therefore it is bad as cause and effect can be established between the program and reduction of anorexia making the measure valid so it has construct validity
good for maintain wheight and gain wheight measurements
Tolken Economy Programe in AN
less side effects +
Drug therapy as it is a psychological treatment and have little to no side effects except possibly distress
whereas drug treatments have many side effects such as blurry vision, motor movement dysfunctions and serotonin syndrome
making the program more ethical than them
Tolken Economy Programe in AN
Flexible to individual +/-
+
The treatment can be individualised on how quickly they gain tokens from progress meaning it will be more likely to be effective for that person
if it was not it may be a slower treatment
.–
However if this is the case then it would be more difficult to do the program larger scale
more expensive and time-consuming to individually accommodate for every person’s needs
