token economies in managing schizophrenia

Question 1

When were token economies most commonly used?

Answer 1

1960s and 1970s when long-term hospitalization was the norm for schizophrenia treatment

Question 2

Why was there a decline in use of token economies?

Answer 2

-closure of psychiatric hospitals
-sue of community based care
-ethical issues

Question 3

What is instiutionalization?

Answer 3

-development of bad habits due to prolonged hospitalisation

Question 4

What are examples of institutionalized habits?

Answer 4

-poor hygiene
-lack of socialisation

Question 5

What was the aim of token economies?

Answer 5

reduce effects of institutionalization

Question 6

How many categories of institutionalized behaviour tackled by token economies did Matson identify?

Answer 6

3

Question 7

What 3 categories of institutionalized behaviour are tackled by token economies according to Matson?

Answer 7

personal-care
condition-related behaviours
social behaviour

Question 8

What are the benefits of token economies?

Answer 8

improves quality of life and normalizes behaviour, making it easier to reintegrate into society

Question 9

What type of conditioning are token economies primarily based on?

Answer 9

operant

Question 10

What is a token economy?

Answer 10

a form of behavioral therapy where clinicians set target behaviors that they believe will improve the patient’s engagement in daily activities.

Question 11

What is the first step of a token economy?

Answer 11

tokens are paired with rewarding stimuli (primary reinforcers) and so become secondary reinforcers, which can be used to modify behaviour
this is an example of classical conditioning

Question 12

True or false? The first step of a token economy uses operant conditioning

Answer 12

False
it uses classical conditioning

Question 13

In a token economy, what is the primary reinforcer?

Answer 13

rewarding stimuli

Question 14

In a token economy, what is the secondary reinforcer?

Answer 14

the token

Question 15

What is the second stage of a token economy?

Answer 15

Patient engages in ‘target’ behaviours or reduces inappropriate ones

Question 16

What is the third stage of a token economy?

Answer 16

patient is given tokens for engaging in these target behaviours

Question 17

What is the fourth stage of a token economy?

Answer 17

patient trades these tokens for access to desirable items or other privileges

Question 18

true or false? a token is more powerful and effective when it can be traded for a specific reward, rather than a range of them

Answer 18

false
the more items or rewards the token can be exchanged for, the more powerful the token becomes

Question 19

What did Borrero find about token economies?

Answer 19

all participants had higher rates of responding in sessions where tokens could be exchanged for a variety of items

Question 20

Who found that all participants had higher rates of responding in sessions where tokens could be exchanged for a variety of items?

Answer 20

Borrero

Question 21

What were the findings of the study where they compared behaviours reinforced by tokens that could be exchanged for one singly highly preferred edible item with tokens which could be exchanged for a variety of preferred edible items?

Answer 21

all participants had higher rates of responding in sessions where tokens could be exchanged for a variety of items

Question 22

What did Ayllon and Azlin find about token economies?

Answer 22

number of tasks increased significantly

Question 23

Who trialed a token economy system in a ward full of female schizophrenics, where each time a target behaviour was carried out, a plastic token with the words ‘one gift’ were engraved and could be swapped for privileges?

Answer 23

Ayllon and Azlin

Question 24

What was found in the study where a token economy system in a ward full of female schizophrenics, where each time a target behaviour was carried out, a plastic token with the words ‘one gift’ were engraved and could be swapped for privileges

Answer 24

number of tasks increased significantly

Question 25

What is the strength of the use of token economies in managing schizophrenia?

Answer 25

-research support

Question 26

What are the limitations of the use of token economies in managing schizophrenia?

Answer 26

-ethical issues -less useful for patients living in the community -better alternatives

Question 27

Explain the limitation of the use of token economies in managing schizophrenia that there are ethical issues?

Answer 27

-for example, in order to make reinforcement effective, clinicians may exercise control over important primary reinforcers such as food, privacy or access to activities that alleviate boredom so that patients may then exchange tokens if they display the target behaviours -however, this may breach the idea of protection from physical/ psychological harm, and it is generally accepted that all human beings have certain basic rights to food, privacy etc that cannot be violated regardless of positive consequences that may be achieved by manipulating them within a token economy program

Question 28

Explain the limitation of the use of token economies in managing schizophrenia that there are better alternatives?

Answer 28

-even if token economies can be helpful for managing sz, there are other approaches with a comparable evidence base that do no raise the same ethical issues -Chiang et al conduced that art therapy is a better alternative as it is a high gain low risk approach without major risks of side effects or ethical abuses -NICE guidelines recommend art therapy for sz -this means that art therapy night be a better/ more appropriate alternative to sz management than token economies

Question 29

Explain the limitation of the use of token economies in managing schizophrenia that they are less likely for patients living in the community?

Answer 29

-Corrigan argues there are problems administrating the token economy method with outpatients living in the community -within a psych ward setting, inpatients receive 24 hour care and so there is better control for staff to monitor and reward patient appropriately -however, outpatients living in the community only receive treatment for a few hours a day, therefore the token method could only be used for a few hours a day -this makes the system ineffective , as for operant conditioning to work you need immediate and continuous reinforcement, or the target behaviour goes extinct- no reward no incentive to do the behaviour

Question 30

Explain the strength of the use of token economies in managing schizophrenia that there is research support? (counterpoint included)

Answer 30

-Glowacki et al did a meta-analysis and identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as sz all living in a hospital setting -all studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours, supporting value of token economies -HOWEVER: -7 studies is a small evidence base -can create 'file drawer problem'- a bias towards positive publish findings because undesirable results have been 'filed away'