Token Economy And The Management Of Schizophrenia

Question 1

What is a way of dealing with negative symptoms of schizophrenia such as not washing, eating and maintaining physical appearance?

Answer 1

The token economy

Question 2

Briefly explain what is meant by the term ‘token economy’

Answer 2

A form of therapy where desirable behaviours are encouraged by the use of selective reinforcements. Rewards (tokens) are given as secondary reinforcers when individuals engage in correct/socially desirable behaviours. The tokens can then be exchanged for primary reinforcers - food or privileges.

Question 3

What are the two types of positive reinforcer?

Answer 3

Primary reinforcers

Secondary reinforcers

Question 4

What are primary reinforcers?

Answer 4

Are anything that gives pleasure (e.g food or comfort) or remove unpleasant states (e.g that alleviate boredom)
- They don’t depend on learning in order to acquire their reinforcing value

Question 5

What are secondary reinforcers?

Answer 5

• Initially have no value to the individual, but get value through the process of classical conditioning- pairing it with food.
• The tokens given out when a patient engages in a target behaviour are secondary reinforcers

Question 6

How can token economy be maximally effective?

Answer 6

• By delivering a reinforcer immediately after the target behaviour has been performed

Question 7

Briefly describe the 4 stages of the token economy

Answer 7

1) Tokens are paired with rewarding stimuli and so become secondary reinforcers
2) Patients engage in ‘target’ (I.e desirable) behaviours or reduces inappropriate ones
3) Patient is giving tokens for engaging in these target behaviours (e.g. dressing themselves)
4) Patient trades these tokens for access to desirable items or privileges

Question 8

What are examples of target behaviours?

Answer 8

Washing hair
Brushing teeth
Socially oriented behaviour like persevering in a task or helping another patient

Question 9

What did Ayllon and Azrin (1968) find when they used the token economy?

Answer 9

There were increased desirable behaviours on ward of female schizophrenics

Question 10

How do neural tokens get value ?

Answer 10

• Through classical conditioning - by pairing the neutral tokens with the reinforcing stimulus.
• The neural tokens then become secondary reinforcers, and so can be used to modify behaviour

Question 11

What is a generalised reinforcer?

Answer 11

A token that has a variety of rewards

Question 12

What did Sran and Borrero (2010) when they compared ‘single reward tokens’ to ‘generalised reinforcers’?

Answer 12

• All participants had higher rates of responding in those sessions where tokens could be exchanged for a variety of items

Question 13

When might the effectiveness of the token economy decrease?

Answer 13

• If time passes between presentation of the token and exchange for the backup reinforcers (Kazdin, 1977)

Question 14

AO3

Is there research support for the use of token economy?

Answer 14

P: Dickerson et ap (2005) = research support
E: 13 studies using token economy. 11/13 = beneficial effects directly due to the use of token economy. Dickerson - evidence that token economy improves adaptive behaviours of patients
E: 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

Question 15

AO3

Why is it difficult to assess the success of token economies?

Answer 15

P: Comer (2013) - most studies are uncontrolled
E: When token economies are used, there’s no experimental group that goes through the token economy programme and a control group that does - Everyone is involved. Patients improvements can only be compared with their last behaviours rather than with those of a control group.
E: Comer - comparison may be misleading, as other factors (e.g increased staff attention) could be causing patients’ improvement rather than the token economy

Question 16

AO3

Is token economy as effective outside a psychiatric hospital?

Answer 16

P: Can reduce negative symptoms - shown to work only in hospital
E: Corrigan (1991) - token economy = problems with outpatients who live in community. No 24 hour care outside, can’t be monitored.
Outpatients receive treatment for a few hours
E: 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

Question 17

AO3

Why is token economy linked to ethical issues?

Answer 17

P: Token economy = ethical concerns
E: To make reinforcement effective, clinicians may exercise control over important primary reinforcers such as food, privacy etc.
E: Humans have basic human rights to food, privacy etc and that cannot he violated regardless of the positive consequences that might be achieved by manipulating them within a token economy programme

Question 18

AO3

Does token economy actually work?

Answer 18

P: Not sure - few randomised trials have been carried out to support the claims made for the effectiveness of token economies in the management of schizophrenia
E: Lack of evidence = unacceptable = so not used in developed world.
McMonagle and Sultana (2000) - token economy could be useful for treatment if such randomised trials could be carried out
E: Suggest this is only likely in developing countries where some form of token economy is still practised. This would provide an opportunity to finally answer questions about the effects of the token economy in the management of people with schizophrenia