Token Economies

Question 1

What is a token economy?

Answer 1

• a form of behaviour modification where desirable behaviours are encouraged by the use of selective reinforcement.
• for example, people are given rewards (tokens) when they engage in socially desirable behaviours.
• the tokens are secondary reinforcers which can then be traded in for primary reinforcers.

Question 2

Who carried out the classic demonstration of a token economy and how?

Answer 2

Ayllon and Azrin
- trialled a token economy in a ward of women with a diagnosis of schizophrenia.
- each time the patients carried out a task such as making their bed or cleaning up, they were given a token, embossed with the words ‘one gift’.
- these tokens could then be swapped for ward privileges, for example being able to watch a film.
- the number of tasks carried out increased significantly.

Question 3

When were token economies extensively used?

Answer 3

In the 1960s-70s when the norm for treating schizophrenia was long-term hospitalisation.

Question 4

Why has the use of token economies now declined?

Answer 4

• partly because of the growth of community based care and the closure of many psychiatric hospitals but also because of the complex ethical issues raised by by restricting rewards to people with mental disorders.

Question 5

What are possible negative outcomes of institutionalisation?

Answer 5

• people develop bad habits for example, they may cease to maintain good hygiene or perhaps stop socialising with others.

Question 6

What did Manson et al identify?

Answer 6

• three categories of institutional behaviour commonly tackled by means of token economies: personal care, condition-related behaviours (e.g. apathy) and social behaviours.

Question 7

What are the two major benefits of modifying undesirable behaviours even though it doesn’t cure schizophrenia?

Answer 7

• improves the person’s quality of life within a hospital setting
• normalises behaviour and this makes it easier for people who have spent time in a hospital to adapt back into life in the community

Question 8

When are the coloured disks given and why?

Answer 8

• tokens (coloured disks) are given immediately to individuals when they have carried out desirable behaviour.

Question 9

How are target behaviours decided?

Answer 9

• they are decided on an individual basis and it is important to know the person in order to identify the most important target behaviours for them.

Question 10

What are the tokens later swapped for?

Answer 10

• rewards

Question 11

When are tokens administered and why?

Answer 11

• as soon as possible after a target behaviours because delayed rewards are less effective

Question 12

What is behavioural therapy in a token economy based on?

Answer 12

• operant conditioning

Question 13

What type of reinforcers are tokens and why?

Answer 13

• secondary because they only have value once the person receiving them has learnt that they can be used to obtain meaningful rewards.

Question 14

What type of reinforcer are rewards?

Answer 14

• primary reinforcers

Question 15

Evaluation - Evidence Of Effectiveness

Answer 15

• Strength= evidence of their effectiveness
• Glowacki et al: identified seven high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic health issues, such as schizophrenia and involved patients living in a hospital.
• All of the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.

Question 16

Evaluation - Counterpoint For Effectiveness

Answer 16

• Seven studies is a small evidence base to support the effectiveness of a technique.
• This leads to the file draw problem which leads to a bias towards positive published findings because the undesirable results have been ‘filed away’. This is a particular problem in reviews that only include a small number of studies.

Question 17

Evaluation - Ethical Issues

Answer 17

• Limitation = ethical issues raised
• This is because it gives professionals the power to control the behaviour of the people in the role of patient.
• This inevitably involves imposing one person’s or institution’s norms onto others, which is a particular problem if target behaviours have not been identified sensitively.
• Limits the patients rewards.
• Legal action by families who see their relative in this position has been a major factor in the decline in the use of token economies.
• The benefits of token economies may be outweighed by their impact on personal freedom and short-term reduction in quality of life.

Question 18

Evaluation - Alternative Approaches

Answer 18

• Limitation = existence of more pleasant and ethical alternatives.
• Chiang et al review concluded that art therapy may be a good alternative.
• The evidence base is relatively small and has some methodological issues, but it appears to show that art therapy is a high-gain low-risk approach to managing schizophrenia.
• Art therapy does not have major risks like side effects or ethical issues.
• NICE guidelines recommend art therapy for schizophrenia.