Token economies for AN

Question 1

What should be included for A01 for a treatment?

Answer 1

-Rationale of the therapy-How the therapy is conducted-What is the impact on symptoms?

Question 2

What is the rationale of token economies for AN? (3)

Answer 2

-Uses operant conditioning to reinforce target behaviours-Used in closed institutions eg hospital, ED clinics-Behaviour modification: change maladaptive and encourage positive

Question 3

What are the key concepts of operant conditioning to describe how TEP’s are used for AN? (9)

Answer 3

-Tokens-Target behaviours-Primary reinforcers-Secondary reinforcers-Consistency/exchange system-Schedules of reinforcement/shaping-Positive reinforcement-Negative reinforcement-Recording progress

Question 4

Tokens + AN example (5)

Answer 4

-Given immediately after behaviour-Exchanged for primary reinforcer-Secondary reinforcer themself-Could be counters, stamps.-Patient and carers decide tog what beh need to show, how often, when and where to exchange

Question 5

Target behaviours + AN example (3)

Answer 5

-Beh encouraged and rewarded with tokens and primary reinforcers-Eating full meal, cooking, food shopping, target weight, CBT or therapy. -Need to be achievable and realistic. Simplistic, inc confidence

Question 6

Primary reinforcers + AN example(5)

Answer 6

-What secondary reinforcers and tokens exchanged for-Need for survival (food, shelter)-Have value to patient-Eg mobile phone or access to internet as basic need. -start with phone calls, then allow social media

Question 7

Secondary reinforcers + AN example (4)

Answer 7

-tokens/counters/stamps given after desired behaviour -exchange for primary-given immediately after so know what beh is reinforced-eg give a token immediately after eating a full meal

Question 8

Consistency/exchange system + AN example (5)

Answer 8

-Tokens immediately after so know what is being reinforced-Reinforce all behaviours-eg every time food shop or eat whole meal-clear rules on exchange system, when where how. -Frail need faith.

Question 9

Schedules of reinforcement/Shaping + AN example (5)

Answer 9

-token easy to get first, harder as programme goes on-sitting at table for family meal initially get token, then may need to eat meal-Mirror outside world-Need to review to keep motivated. -Change schedules: start = cont, fixed/variable ratio

Question 10

Positive reinforcement + AN example (5)

Answer 10

-Given once target beh shown eg eating meal-Addition of smth pleasant -eg time on social media, visit family-Reward depends on patient-Work better as inc encouragement, feel in control

Question 11

Negative reinforcement + AN example (3)

Answer 11

-Removal of smth unpleasant to encourage target beh-eg once eaten meal, don’t have to wash dishes-can be counterproductive, vulnerable, less engaged, not in control

Question 12

Recording progress

Answer 12

Review and feedback good motivators

Question 13

Impact on symptoms (5)

Answer 13

-Increase participation in other therapies-Practical and behaviour sympt-Increase feeding behaviour-Weight gain-More positive and willing to eat

Question 14

Evaluation

Answer 14

EACH

Question 15

Evidence

Answer 15

+Stunkard+Garfinkel+Sonoda+/-Feild et al- Paul and Lentz

Question 16

Garfinkel

Answer 16

-5 AN-Rapid weight gain -no side effects-In initial phase-Treatment then individualised to meet needs

Question 17

Stunkard

Answer 17

-Rewards such as TV time acted as successful way to inc eating behaviour

Question 18

Sonoda

Answer 18

-Case study of 10 yr old girl-30% below normal weight-Rapid weight gain of 1kg a month-25kg in 9mths-Works in kids

Question 19

Feild et al

Answer 19

• Typical TEP did not work-More freq rewards work better-Continuous reinforcement

Question 20

Paul and Lentz

Answer 20

-11% Needed drugs with TEP-Weight gain is side effect-Need more psychological support to deal with this-Don’t work in isolation

Question 21

Applications (4)

Answer 21

-Practicality: continued as out-patient in family home-Practicality: Hard to be consistent, lose trust and dis-engage-Flexible: use alongside other treatment-Wider use: while on waiting list for other therapies, don’t need specialist

Question 22

Comparisons and credibility (4s 4w)

Answer 22

-Cure: deal with beh and not eating. Better as drugs only limit co-morbid-TE better as drug invasive - AN high risk-But if targets too high then lose motivation-Only ST as don’t get rewards in real world-Easy to measure prog: not self-report, objective to see if working-Drugs better as can be done out-patient, TE mainly hosp-TE better as targets phys sympt-ethics: neg social control. Therapist control

Question 23

How good is the research (1)

Answer 23

-Limited sample size. can’t evaluate effectiveness