Token economy Flashcards
What is the aim of token economy?
Aims to manage schizophrenia rather than treat it. It is a form of behavioural therapy where desirable behaviours are encouraged by the use of selective reinforcement based upon the principles of operant conditioning.
What is the background of token economy?
Token economy is based on operant conditioning techniques such as positive reinforcement.
Normal behaviours that are desired are positively rewarded, which means that the behaviour will be repeated again in the future, including getting dressed, cleaning your teeth and feeding yourself.
The desirable behaviours are reinforced by the use of plastic tokens which are secondary reinforcers.
The tokens have no intrinsic value but can be exchanged for primary reinforcers.
This meets a basic need, as tokens can be swapped for TV time, cigarettes, phone cards, time out or chocolate.
Critically, the primary reinforcers must be relevant and viewed as highly desirable by the patient.
When used in psychiatric hospitals, the programmes may also involve negative reinforcement - where privileges are removed until the patient performs normal behaviour and punishment, where the patient is punished for abnormal behaviour by time out.
How does token economy address alogia?
Only replying to questions with one word responses, failing to answer at all when asked direct questions by staff, taking a long time to respond to questions from others or taking a long time to speak from one word to the next. Tokens given each time questions are responded to in more than one word responses. These tokens can be exchanged at the end of the week for treats that the patients enjoys eating
How does token economy address flat effect?
Not smiling, laughing, or having any joy in their response. Tokens given when spending time engaging in social skills training with staff each day to learn how to express feelings and have control over facial and body expressions . Tokens can be gathered if there is progress in each training session to be exchange for day trip out after a couple of weeks
How does token economy address avolition?
Not brushing your teeth, getting out of bed, getting showered & dressed, feeding yourself. Tokens given if they get out of bed by 9am, token given if they brush their teeth after getting dressed - collect 4 tokens a day for a week to get favourite meals at the weekend.
How does token economy address apathy?
Not leaving your room or joining in with any activities with others, being indifferent to any contact from staff or other patients. Token given to go to the communal area & take part in the group activities offered. Get a token each day so by the end of the week you can watch your favourite film.
TOKEN ECONOMY - Research evidence?
Allyon and Azrin found that token economies were successful with female SZ patients hospitalised for 16 years on average. Patients earned tokens for self care, such as making their bed and washing their hair. Tokens were exchanged for social staff interactions, special activities, sweets or cigarettes. Daily chores rose from 5 to 42 making patients more responsible for themselves.
TOKEN ECONOMY - Alternative treatments?
Upper found that the side effect of weight gain associated with the use of APs could be addressed with token economy regimes and patients were able to achieve a target of 3 pounds weight loss a week. This suggests a combination of medication and token economy strategies. Medications allow for the ability to engage in the requirements of the token economy system.
TOKEN ECONOMY - Reductionist?
Upper found that the side effect of weight gain associated with the use of APs could be addressed with token economy regimes and patients were able to achieve a target of 3 pounds weight loss a week. This suggests a combination of medication and token economy strategies. Medications allow for the ability to engage in the requirements of the token economy system.
TOKEN ECONOMY - Effective?
Strategy does little to actually treat the disorder. In institutions there is 24 hour care so the staff can keep tighter control to monitor and reward patients but outpatients living in the community only receive treatments for a few hours a day, so TE does not have constant impact. This implies benefits are institutionally bound and are only effective in the short term.
