token economies - management of schizophrenia Flashcards
Token economies as used in the management of Schizophrenia
. are behaviourist approach to manage behaviour of patients with Sz
. mainly used with patients spent long time in hospital so have developed maladaptive behaviour
. e.g. bad hygiene or lack of communication with others
Token economies as used in the management of Schizophrenia: aim
. to change patient’s behaviour
. so they are easier to manage
. have better quality of life
. so enabling them to live outside of hospital setting
How does token economy work?
. uses Skinner’s operant conditioning principles
. where patient receive reinforcement (rewards0
. in form of tokens - coloured discs
. immediately after producing desired behaviour
. e.g. self-care or social interaction
. tokens later exchanged for goods/privileges e.g. watching tv or going for walk
Why are token secondary reinforcers?
. they are not rewarding by themselves
. patient learns to associate tokens with meaningful rewards e.g. watching a film or sweets
. in order for token to be secondary reinforcer they need to be paired with primary reinforcers (sweets)
. at start of token economy tokens and primary reinforcers administered together
AO3 for token economy as a management technique for Sz: RTS by Dickerson - meta analysis
P - RTS use token economy as management technique for Sz by Dickerson et al
E - meta-analysis 13 studies of token economies found technique useful in increasing adaptive behaviour of patients e.g. self-hygiene
E - also showed significant increases when CBT combined with drug therapies - severity of symptoms reduced with drug therapy - CBT challenged irrational thought processes L - so suggest token economies is effective management technique - increases credibility of use of token economies in management of Sz
AO3 for token economy as a management technique for Sz: RTS COUNTERARGUMENT - publication bias
P - issue using meta-analysis is risk of publication bias - researchers have control over studies they wish to report
E - meta-analysis review published research research that has significant results more likely to be published than studies with non-significant results
E - limits support meta-analysis research by Dickerson provides for effectiveness of token economies in management of Sz
L - as accurate view of its effectiveness is skewed by bias.
AO3 for token economy as a management technique for Sz: ethical issues
P - use of token economies raise ethical issues
E - major issue is privileges more available to patients with mild symptoms - less available to those more severe symptoms of Sz - prevent them from complying with desirable behaviours
E - token economies suggests symptoms of Sz be easily bypassed if they seek reward - but leads to most severely ill patients suffer discrimination as severity of their symptoms prevents them accessing this programme
L - so has reduced use of token economies in psychiatric system to manage Sz as may not be appropriate for all patients
AO3 for token economy as a management technique for Sz: not get to the root cause
P - issue token economies they not get to root cause of Sz
E - aim is make Sz more manageable/ improve patients quality of life - helps by making patients behaviour more socially acceptable so can better integrate into society - whilst is important therapy not treat Sz
E - also token economies mainly effective in institutionalised setting - when patients sent back home they lose structure they had to help manage behaviour e.g. don’t have someone give them a token for completing desired behaviour
L - so questions appropriateness and effectiveness of therapy in managing Sz is high chance of relapse when patients given independence
AO3 for token economy as a management technique for Sz: combining therapies
. token economies increase adaptive behaviours
. Sz patients more likely take medication (drug therapy) and attend CBT
. studies showed significant increases in reducing Sz symptoms
. when CBT combined with drug therapy
. as severity of symptoms reduced with drug
. CBT challenged irrational thought processes (delusions)
