Token economies Flashcards
development of token economies
Ayllon and Azrin (1968) used a token economy in a schizophrenia ward. A gift token was given for every tidying act. Tokens were later swapped for privileges e.g. films. Token economies were extensively used in the 1960s and 70s. Decline in the UK due to a shift towards care in the community rather than hospitals and because of ethical concerns. Token economies still remain a standard approach to managing schizophrenia in many parts of the world.
rationale
Institutionalisation occurs in long term hospital treatment. Mason et al (2016) identified three categories of institutional behaviour that can be tackled using token economies: personal care, condition-related behaviours (e.g. apathy) and social behaviour. Modifying these behaviours does not cure schizophrenia but does have two major benefits.
quality of life
Token economies improve the quality of life within the hospital setting e.g. putting on make-up or becoming more sociable with other residents.
normalise behaviour
Encourages return to more normal behaviours, making it easier to adapt back into the community e.g. getting dressed or making your bed.
what’s involved
Tokens (e.g. coloured disks) given immediately after a desirable behaviour. Target behaviours are decided individually based on knowledge of the person (Cooper et al 2007). Tokens have no value themselves but are swapped for rewards e.g. sweets or magazines, or activities like a film or a walk outside. Tokens are given immediately after target behaviours because delayed rewards are less effective.
theory (operant conditioning)
Token economies are an example of behaviour modification based on operant conditioning. Tokens are secondary reinforcers - exchanged for rewards (primary reinforcers which are directly rewarding e.g. food). Tokens that can be exchanged for a range of different primary reinforcers are called generalised reinforcers. These have a more powerful effect.
A03:One limitation is the ethical issues raised.
Professionals have the power to control people’s behaviour and this means imposing one person’s norms on others (e.g. a patient may like to look scruffy). Also restricting the availability of pleasures to people who don’t behave as desired means that very ill people, already experiencing distressing symptoms, have an even worse time.
This means that benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life.
A03:Another limitation is the 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 schizophrenia (Chiang et al 2019). Even if the benefits of art therapy are modest, this is true for all approaches to treatment and management of schizophrenia and art therapy is a pleasant experience.
This means that art therapy might be a good alternative to token economies - no side effects or ethical abuses.
A03:One strength is evidence of effectiveness.
Glowacki et al (2016) identified seven high quality studies published between 1999 and 2013 on the effectiveness of token economies in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours.
This suggests the value of token economies.
A03 (counter):However, seven studies is quite a small evidence base.
One issue with such a small number of studies is the file drawer problem - a bias towards publishing positive findings.
This means that there is a serious question over the effectiveness of token economies.
