Token Economy Flashcards
define the token economy
3
a form of therapy where desirable behaviours are encouraged by the use of selective reinforcements
tokens are given as secondary reinforcers when individuals engage in correct, socially desirable behaviours
the tokens can then be exchanged for primary reinforcers such as food or privileges
why was the token economy developed?
5
some people with schizophrenia suffer from negative symptoms such as apathy and social withdrawal
as a result, they lack interest in aspects of a normal healthy life such as washing, eating and maintaining their physical appearance
research has looked at ways of decreasing these negative symptoms and encouraging such individuals to take part in more positive and adaptive behaviours
the token economy system, based on the principles of operant conditioning, was developed as a way of dealing with the negative symptoms of schizophrenia and encouraging more positive behaviours
the token economy was widely used in the management of schizophrenia in the 1960s and 1970s, although it has now been replaced by other forms of intervention such as social and life skills training
what is the token economy?
5
a form of behavioural therapy where clinicians set target behaviours that they believe will improve the patient’s engagement in daily activities
these target behaviours might be something as simple as the patient brushing their hair or dressing themselves
or they may be more socially orientated behaviours such as persevering at a task or helping another patient
tokens are awarded whenever the patient engages in one of the target behaviours and these tokens can later be exchanged for various rewards and privileges
the idea behind this is that the patient will engage with desirable behaviours more often because such behaviours become associated with rewards and privileges
study into the token economy
4
Ayllon and Azrin (1968) used a token economy on a ward of female schizophrenic patients, many of whom had been hospitalised for many years
they were given plastic tokens that were embossed with the words “one gift” for behaviours such as making their bed or carrying out domestic chores
these tokens were then exchanged for privileges such as being able to watch a movie
the researchers found that the use of a token economy with these patients dramatically increased the number of desirable behaviours that they performed each day
assigning value to tokens
4
to give the neutral token some value, it needs to be repeatedly presented alongside or immediately before the reinforcing stimulus (e.g. watching a movie)
the reinforcing stimulus may take the form of food, privileges or other incentives
by pairing the neutral tokens with the reinforcing stimulus, the neutral token eventually acquires the same reinforcing properties
as a result of this classical conditioning, the neutral tokens become secondary reinforcers and so can be used to modify behaviour
reinforcing target behaviours
5
when patients perform the desirable target behaviours, the clinician awards them tokens
a token becomes a generalised reinforcer when it can be exchanged for a variety of different privileges and rewards
the more items or rewards that the token can be exchanged for, the more powerful that token becomes
Sran and Borrero (2010) compared behaviours reinforced by tokens that could be exchanged for one single highly preferred edible item with tokens that could be exchanged for a variety of preferred edible items
they found that all participants had higher rates of responding in sessions where tokens could be exchanged for a variety of items
the trade
4
an important part of the token economy is the exchange of tokens for backup rewards chosen by the clinician
these rewards may include food, sweets or other privileges such as being able to watch a movie
during the early stages of the token economy, frequent exchange periods mean that patients can be quickly reinforced and target behaviours can then increase in frequency
the effectiveness of the token economy may decrease if more time passes between presentation of the token and exchange for the backup reinforcers
how does the token economy work?
8
the behavioural principles employed in token systems are based mainly on operant conditioning, which describes the relationship between a behaviour and environmental events
positive reinforcement is key in this relationship, it refers to an increase in the frequency of a particular behaviour when it is followed by a desirable event
these are two types of positive reinforcer….
- primary reinforcers = anything that gives pleasure (e.g. food or comfort) or removes unpleasant states (e.g. alleviates boredom), their reinforcing value does not need to be learned
- secondary reinforcers = initially have no value to the individual but acquire their reinforcing properties as a result of being paired with primary reinforcers
in a token economy, the tokens given out when a patient engages in a target behaviour are secondary reinforcers
to be maximally effective, reinforcers (tokens) need to be delivered immediately after the performance of the target behaviour
if the token does not follow immediately, then another behaviour (e.g. arguing with a fellow patient) that may have been performed in the intervening period would be reinforced instead of the target behaviour
outline the token economy cycle
4
1) tokens are paired with rewarding stimuli and so become secondary reinforcers
2) patient engages in target behaviours (e.g. taking care over the personal appearance or helping tidy up after a meal) or reduces inappropriate ones
3) patient is given tokens for engaging in these target behaviours
4) patient trades these tokens for access to desirable items or other privileges
x4 evaluation points for the token economy
research support
less useful for patients living in the community
ethical concerns
difficulties assessing the success of a token economy
EVALUATION
research support
5
Dickerson et al (2015) have provided research support for the effectiveness of token economies in a psychiatric setting
they reviewed 13 studies of the use of token economy systems in the treatment of schizophrenia
11 of these studies had reported beneficial effects that were directly attributable to the use of token economies
they concluded that overall, these studies provide evidence of the token economy’s effectiveness in increasing the adaptive behaviours of patients with schizophrenia
however, they did caution that many of the studies reviewed had significant methodological shortcomings that limited their impact in the overall assessment of token economies in this context
EVALUATION
less useful for patients living in the community
7
although the token economy has been shown to be effective in reducing negative symptoms for people with schizophrenia, it has only really been shown to work when in a hospital setting
Corrigan (1991) argues that there are problems with administrating the token economy method with patients who live in the community
within a psychiatric ward setting, patients receive 24 hour care, meaning that staff have more control and are better able to monitor and reward patients appropriately
however, patients living in the community only receive treatment for a few hours a day
therefore, the token method could only be used for part of the day as staff cannot effectively monitor them outside these few hours
as a result, even if the token economy did produce positive results within the ward setting, these results may not be maintained beyond that environment
this reduces the effectiveness of the token economy as it cannot be used to treat all patients with schizophrenia
EVALUATION
ethical concerns
5
there are a number of ethical concerns surrounding the use of token economy programmes in psychiatric settings
for example, in order to make reinforcement effective, clinicians may exercise control over important primary reinforcers such as food, privacy or access to activities that alleviate boredom
patients may then exchange tokens if they display the target behaviours such as domestic duties or better personal hygiene
by manipulating what patients eat, do and have access to, the token economy may be violating basic human rights
it is generally accepted that all human beings have certain basic rights (to food, privacy and so on) that cannot and should not be violated regardless of the positive consequences that might be achieved by manipulating them within a token economy programme
EVALUATION
difficulties assessing the success of a token economy
6
Comer (2013) suggests that a major problem in assessing the effectiveness of token economies is that studies into token economies tend to be uncontrolled
when a token economy system is introduced into a psychiatric ward, typically all patients are brought into the programme
there is not usually an experimental group that participates in the token economy and a control group that does not
consequently, patients’ improvements can only be compared with their own past behaviours rather than a control group
this comparison may be misleading as other factors such as an increase in staff attention could be the actual cause behind a patient’s improvement rather than the token economy
but we cannot be sure that the token economy caused the improvements because we cannot compare an experimental group to a control group as these studies are uncontrolled
