token economies Flashcards
What is a token economy
- Form of behavioural modification
- Desirable behaviours encouraged through operant conditioning
Reinforcers
Tokens are secondary reinforcers and exchanged for primary reinforcers such as food or privileges
Development of token economies
Ayllon and Azrin
- Women on ward with schizophrenia
- Plastic tokens for tasks eg making bed
- Exchanged for privileges eg watching film
- Found tasks increased significantly
- Popular in 1960s and 1970s - declining now
Why is it now declining in UK?
Growth of community based care and closure of psychiatric hospitals
- Ethical issues raised by restricting rewards to people with mental disorders
Rationale for token economies
Matson et al - three categories - personal care, condition-related behaviours and social behaviours
- Improves quality of life and normalises behaviour - adapt back into community
What is involved in a token economy
Cooper et al - target behaviours decided on individual basis and token swapped for tangible items
Theoretical understanding of token economies
Operant conditioning - tokens are secondary reinforcers, gain value through link with primary reinforcers (meaningful rewards)
EVAL - evidence of effectiveness
P - strength is evidence that it’s effective
E - Glowacki et al - seven high quality studied published between 1999 and 2013 - examined effectiveness of token economics for chronic mental health issues in hospital living
E - all studies showed reduction in negative symptoms and a decline in the frequency of unwanted behaviours
L - supports the value
P - small evidence base to support the effectiveness of a technique
E - issue with a small number of studies is the file drawer problem
E - this phenomenon leads to a bias towards positive published findings because undesirable results have been filed away - only included small numbers of studies
L - serious question over evidence for the effectiveness of token economies
EVAL - ethical issues
P - limited as ethical issues have been raised
E - power control and professionals have considerably more power to control behaviour - problematic if target behaviours not identified sensitively
E - restricting availability of pleasures - seriously ill people have a worse time - legal action by families who see their relative in this position has been major factor in decline of use
L - benefits of token economies may outweigh impact on personal freedom and short-term reduction in quality of life
EVAL - alternative approaches
P - limited as existence of more pleasant and ethical alternatives
E - other approaches with a comparable evidence base that do not raise same ethical issues - Chiang et al - art therapy
E - art therapy - high-gain low-risk approach to managing schizophrenia - even if benefits are modest - generally true for all approaches to treatment and is a pleasant experience without major risks of side effects or ethical abuse - NICE guidelines recommend art therapy
L - art therapy might be a better alternative
EVAL - benefits
P - they are difficult to continue once the person has left a hospital setting
E - due to target behaviours being unable to be monitored closely so the tokens that they would have received cannot be administered immediately
E - however, some people with schizophrenia may only get the chance to live outside a hospital if their personal care and social interaction can improve
L - using token economy can grant these people with the freedom of being able to leave the hospital and may be the best way to achieve this during hospital care
