Token economies for AN Flashcards
What should be included for A01 for a treatment?
-Rationale of the therapy-How the therapy is conducted-What is the impact on symptoms?
What is the rationale of token economies for AN? (3)
-Uses operant conditioning to reinforce target behaviours-Used in closed institutions eg hospital, ED clinics-Behaviour modification: change maladaptive and encourage positive
What are the key concepts of operant conditioning to describe how TEP’s are used for AN? (9)
-Tokens-Target behaviours-Primary reinforcers-Secondary reinforcers-Consistency/exchange system-Schedules of reinforcement/shaping-Positive reinforcement-Negative reinforcement-Recording progress
Tokens + AN example (5)
-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
Target behaviours + AN example (3)
-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
Primary reinforcers + AN example(5)
-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
Secondary reinforcers + AN example (4)
-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
Consistency/exchange system + AN example (5)
-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.
Schedules of reinforcement/Shaping + AN example (5)
-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
Positive reinforcement + AN example (5)
-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
Negative reinforcement + AN example (3)
-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
Recording progress
Review and feedback good motivators
Impact on symptoms (5)
-Increase participation in other therapies-Practical and behaviour sympt-Increase feeding behaviour-Weight gain-More positive and willing to eat
Evaluation
EACH
Evidence
+Stunkard+Garfinkel+Sonoda+/-Feild et al- Paul and Lentz
Garfinkel
-5 AN-Rapid weight gain -no side effects-In initial phase-Treatment then individualised to meet needs
Stunkard
-Rewards such as TV time acted as successful way to inc eating behaviour
Sonoda
-Case study of 10 yr old girl-30% below normal weight-Rapid weight gain of 1kg a month-25kg in 9mths-Works in kids
Feild et al
- Typical TEP did not work-More freq rewards work better-Continuous reinforcement
Paul and Lentz
-11% Needed drugs with TEP-Weight gain is side effect-Need more psychological support to deal with this-Don’t work in isolation
Applications (4)
-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
Comparisons and credibility (4s 4w)
-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
How good is the research (1)
-Limited sample size. can’t evaluate effectiveness
