Token Economies treatment

Question 1

What are token economies?

Answer 1

• Reward systems used to manage behaviour of patients, in particular with negative symptom’s e.g. apathy, social withdrawal
• Many patients develop maladaptive behaviour in hospitals e.g. bad hygiene
• Modifying these habits does not cure the condition but improves their quality of life + more likely they an live outside hospital setting

Question 2

What are the basic assumptions of token economies?

Answer 2

• Based on behavioural psychology, in particular, concepts of operant conditioning
• Clinicians set target behaviours, and patients will be rewarded for these desirable behaviours with tokens to be exchanged for rewards
• May be targets as simple as brushing hair, dressing, more socially orientated

Question 3

What are tokens?

Answer 3

• e.g coloured plastic discs form
• Awarded when display target behaviour
• Idea is that the patient will engage more often with these behaviours as it will become associate with these rewards.
• Imp that reward is given immediately after target behaviour to avoid ‘delay discounting’; reduced effect of delayed reward.

Question 4

What are rewards?

Answer 4

• Tokens are swapped for rewards.
• Token economies are secondary reinforcers as only have value once patient has learned they can be used to obtain awards
• Rewards = primary reinforcers - might be in form of e.g. sweets, cigarettes, services like room cleaned.

Question 5

What are 2 strengths of token economies?

Answer 5

Dickerson’s review of 13 studies of token economies:
- Dickerson et al have provided research support for the effectiveness in a psychiatric setting
- Reviewed 13 studies in treatment in schizophrenia
- 11 had reported beneficial effects that were directly attributable to use of token economies
Concluded that, overall, these studies provide evidence of it increasing the adaptive behaviours of patients.

Patients experience increased motivation:
- Long term hospitalisation -> negative effect such as lack of motivation and apathy
- One unforeseen advantage is that patients become more independent and active
This has a knock-on effect of nurses’ increased regard for them, making the patients even more motivated to recover.

Question 6

What are 2 limitations of token economies?

Answer 6

Aren’t effective outside a hospital setting:
- Corrigan argues there are problems administrating this method with outpatients.
- On a ward, inpatients receive 24/7 care and so there is better control for staff to monitor and reward patients appropriately.
- Outpatients receive day treatment only, a few hours a day, so this method could only be used for part of the day.
As a result, even if this method does produce positive results in a ward, they may not be maintained beyond that environment.

Only treats symptom, not cause:
- Helps to make behaviours socially acceptable to better reintegrate with society.
- Worth doing, however, does not actually cure the condition
- Ofc biological treatments do not cure, but do reduce severity of symptoms.
Therefore this method is most effective when used alongside biological treatment e.g. antipsychotics in order to produce a more holistic treatment.