Token economy Flashcards
AO1: Token economy
Token economies are a behaviourist approach to manage the behaviour of patients with schizophrenia. It is mainly used with patients who have spent a long time in hospital and therefore who have developed maladaptive behaviour (institutionalised) such as bad hygiene or lack of communication with others. Aim: The aim of token economies is to change a patient’s behaviour so that they are easier to manage, will have a better quality of life and thus enabling them to live outside of a hospital setting.
The technique uses Skinner’s operant conditioning principles of positive reinforcement, whereby patients receive reinforcements (rewards) in the form of tokens, such as coloured discs, immediately after producing a desired behaviour such as self-care or social interaction. The tokens can then be later exchanged for goods or privileges such as hours watching tv, magazines, a walk outside or sweets.
Think further
The tokens are secondary reinforcers, these are not rewarding by themselves (they don’t see the token as the reward). However, the patients learn to associate them with meaningful rewards such as going for a walk, sweets or watching a film (primary reinforcers). In order for the token to become secondary reinforcers, they need to be paired with the primary reinforcers, so at the start of a token economy programme the tokens and primary reinforcers (e.g. sweets) are administered together.
What are the evaluations for token economy?
1) Limited evidence
2) Ethical issues
3) Long term impact
AO3: Limited evidence
One limitation of token economies as a management technique for SZ is that there is limited evidence to support the effectiveness. A review of 3 studies investigating the use of token economies found that there was a limited impact on the management of patients with SZ as only one of the 3 studies showed any improvement in symptoms and no significant positive change in maladaptive behaviours. This shows that using operant conditioning may not be the most effective method at creating positive behaviour change in schizophrenics. Therefore, casting doubt on the effectiveness and lowering the validity of token economies as a management technique for schizophrenia.
AO3: Ethical issues
Moreover, the use of token economies can raise ethical issues. The major issue is that privileges become more available to patients with mild symptoms and less available to those with more severe symptoms of schizophrenia that prevent them from complying with desirable behaviours. Token economies suggests that symptoms of schizophrenia can easily be bypassed if they seek the reward. However, this leads to the most severely ill patients experiencing discrimination, as the severity of their symptoms prevents them from accessing this behaviour management technique. Therefore, this has reduced the use of token economies in the psychiatric system to manage schizophrenia as they may not be appropriate for all patients.
AO3: Long term impact
Another issue with token economies is that they may not have a long term impact on behaviour change. It is mainly effective in institutionalised settings and when patients are sent home they lose the structure they had to manage their behaviour i.e. no token for desired behaviour. This questions the appropriateness and effectiveness of the therapy of managing SZ as there is a high chance of relapse when given independence.
