Token economy and management of Sz Flashcards
What is a token economy
A form of behavioural therapy where clinitians set target behaviours that they believe will improve the patients engagement in daily activities. Tokens are awarded as a reward for target behaviours which can be exchanged for rewards and privileges
What is the idea behind the token economy
That patients will engage more often in desirable behaviours as the behaviours will be associated with rewards and privileges
What is an example of a study done on the token economy
Ayllon and Azrin used the token economy on a ward of female Sz patients and they were given tokens for behaviours like making the bed or domestic chores. The patients dramatically increased the number of desirable behaviours performed each day
Who introduced the token economy to a ward of ladies resulting in improved behaviour
Ayllon and Azrin
What is the primary and secondary enforcer in a token economy
The gift/privilige/incentive is a primary enforcer
The token is a secondary enforcer, originally neutral in value until associated with the primary reinforcer
What is the token
A generalised reinforcer, as it can be exchanged for a variety of different priviliges and rewards. The more things it can be exchanged for the more powerful it becomes.
When may the effectiveness of the token economy diminish
When more time passes between the presentation of the token and the exchange for primary enforcers
What is research support for the effectiveness of the token economy (eval)
Dickerson et al reviewed 13 studies of the token economy and 11 reported beneficial effects that were directly attributable to the use of token economies. Dickerson concluded that there was evidence of the toke economies effectiveness, however many of the studies used had methodological shortcomings which limited their impact in overall assessment of token economies
Who did a review of token studies and concluded that they’re alright
Dickerson et al
Why is the token economy less useful for those living in a community (eval)
The token economy has only been shown to work in a hospital setting. Corrigan argues that there a problems administering the token economy to those living in the community. In a ward patients have 24 hour care and there is better control for administering rewards, whereas outpatients only recieve treatment for a few hours a day, so the token economy could only be used for part of the day. This limits it’s utility
Who argued that the token economy cannot be applied outside of hospitals
Corrigan
What are the ethical concerns associated with the token economy (eval)
In order to make treatment effective, clinitians may have to exercise control over important primary enforcers such as food, privacy and access to activities which alleviate boredom. Patients may then exchange tokens for these, but basic human rights cannot be violated regardless of the positive consequences which might be achieved by manipulating them
How is there still a question over whether or not the system actually works (eval)
Very few randomised trials have been carried out to support the claims made for the token economy. In evidence based medicine this lack of support is not acceptable and so the token economy systems have fallen out of use. Some psychologists have suggested that it could be of use if randomised trials are done, but this is only likely possible in developing countries where the system is still in use.
