token economies (management of schizophrenia)

Question 1

token economies

Answer 1

reward systems (operant conditioning) used to manage behaviour of patients who spend long periods in psychiatric hospitals

tokens given to patients who carry out desirable behaviours (e.g. getting out of bed)

given immediately after desirable behaviour that has been targeted for reinforcement

no value in themselves but can be swapped for tangible rewards (e.g. sweets, walk outside)

secondary reinforcers as they only have value once patient has learned they can be used to obtain rewards

Question 2

how do token economies work

Answer 2

1. token paired with rewarding stimuli e.g. sweets so becomes secondary reinforcer
2. patient engages in ‘target’ (desirable) behaviours or reduces inappropriate ones
3. patient is given tokens for engaging in target behaviours (e.g. dressing themselves)
4. patient trades these tokens for access to desirable items or other privileges

Question 3

strength

Answer 3

evidence from Paul & Lentz

found token economies led to considerable improvements in self-care and pro-social behaviour (e.g., spent more time participating in activities & less time in bed)

after 4 more years on the scheme, 98% patients had been released from institution, compared to 71% treated under other treatments

suggests token economies are effective in reducing negative symptoms & seem to be more successful than alternative programmes in reintegrating patients back into society

Question 4

strength 2

Answer 4

evidence from Allyon & Azrin

used sample of female schizophrenic patients (hospitalised for average of 16 years)

patients rewarded with tokens for demonstrating behaviours e.g., daily hygiene and taking medication, average number of daily chores completed from 5 to 42

suggests that token economies are effective in improving patients motivation and sense of responsibility

Question 5

token economies limit

Answer 5

number of ethical issues with their use in psychiatric settings

as token economies may violate some patients basic human rights, which they have the right not to experience

e.g., severely ill patients may be less able to comply with desirable behaviours meaning these patients may experience discrimination towards their basic human rights (e.g., restrictions to privacy & food consumption)

these ethical issues make psychological therapies controversial and cause us to question the appropriateness of such treatment