THE PSYCHOLOGICAL TREATMENT: TOKEN ECONOMY

Question 1

What is token economies aim

Answer 1

Manage schizophrenia rather than treat it

Question 2

What type of approach is token economy and why

Answer 2

Form of behavioural therapy

where desirable behaviors are encouraged by the use of selective reinforcement and is based on operant conditioning.

Question 3

Describe token economy (2)

Answer 3

• where desirable behaviours are encouraged by the use of selective reinforcement. For example, patients are given rewards (tokens) as secondary reinforcers when they engage in correct/socially desirable behaviours
  
  • The tokens can then be exchanged for primary reinforcers Eg favourite foods or privileges

Question 4

How are tokens used (2)

Answer 4

When desired behavior is displayed eg. Getting dressed, tokens (in the form of coloured discs) are given immediately as secondary reinforcers which can be exchanged for rewards eg. Sweets and cigarettes.

immediacy of reward is important because It prevents 'delay discounting’⇒the reduced effect of a delayed reward.

Question 5

How does TE manage schizo (3)

Answer 5

it maintains desirable behavior and no longer reinforces undesirable behavior.

in particular those who have developed patterns of maladaptive behaviour through
spending long periods in psychiatric hospitals (referred to as 'institutionalised'). Under these circumstances it is common for patients to develop bad hygiene or perhaps to remain in pyjamas all day. 

Modifying these bad habits does not cure schizophrenia but it improves the patient's quality of life and makes it more likely that they can live outside a hospital setting

Question 6

What is the focus of token economy

Answer 6

on shaping and positively reinforcing desired behaviors and NOT on punishing undesirable behaviors.

Question 7

How does TE help negative symptoms

Answer 7

The technique alleviates negative symptoms such as poor motivation, and nurses subsequently view patients more positively, which raises staff morale(confidence) and has beneficial outcomes for patients

Question 8

How can TE reduce positive symptoms

Answer 8

by not rewarding them, but rewarding desirable behavior instead. Desirable behavior includes self-care, taking medication, work skills, and treatment participation.

Question 9

What did sultana et al find when reviewing token economy regimes

Answer 9

over a 15-year period, finding that they did reduce negative symptoms

though it was unclear if behavioral changes were maintained beyond the treatment programme.

Question 10

Evaluate -ve of token economy (3+ study)

Answer 10

• Effective when treating but does not cure: It is difficult to keep this treatment going once the patients are back at home in the communityKazdin et al. Found that changes in behavior achieved through token economies do not remain when tokens are with¬drawn, suggesting that such treatments address effects of schizophrenia rather than causes. It is not a cure.
  • ethical concerns: as such a process is seen to be dehumanising, subjecting the patient to a regime which takes away their right to make choices. In the 1950s and 60s nurses often “rewarded” patients with cigarettes. Due to the pivotal role of dopamine in schizophrenia this led to a culture of heavy smoking an nicotine addiction in psychiatric hospitals of the era.
  • Ethical issues:Severely ill patients can’t get privileges because they are less able to comply with desirable behaviors than moderately ill patients – They may suffer from discrimination