token economy for anorexia Flashcards
1
Q
what is a token economy programme?
A
- a behavioural treatment based on the principle of operant conditioning and is a form of behaviour modification
- used only in closed institutions e.g. hospitals and eating disorder clinics
2
Q
what are some target behaviours that may be used for anorexia?
A
- eating a full meal
- achieving a target of weight
- attending CBT sessions
3
Q
how does the process of reinforcement work?
A
- target behaviour shown so positive reinforcement is given e.g. time on social media (dependant on the patient)
- may use negative reinforcement by removing something unpleasant e.g. washing the dishes
4
Q
how do the tokens work?
A
- when desired behaviour is shown then the staff will give out tokens e.g. stamps on a card which can be exchanged for primary reinforcers
- should be given immediately to create a clear link
- social media as a reward may need to be monitored to make sure it’s not a pro-anorexic site
5
Q
how is shaping used?
A
- tokens initially easy to get but become harder as they progress through the programme
- e.g. sitting at the dinner table may be an initial desired behaviour but then may progress to having to eat an entire meal
- this is to help mirror the patterns of reinforcement that will occur in the real world
6
Q
what target should be set and what other therapies are often used in conjunction?
A
- a specific target weight should be set as a goal upon which time the person would graduate from the hospital programme
- group therapy/family therapy may be used at the same time
7
Q
what is important about the tokens?
A
- patients and staff decide the reward together e.g. how they will be collected and what the reward is
8
Q
what is important about the target behaviours?
A
- achievable and realistic so that the patient can stick to it
- increases patient confidence and causes higher engagement in the programme
9
Q
what is important about the consistency of the rewards?
A
- the reward must be given every time that the desired behaviour is shown as the patient already has a low trust in the system so failure of consistency may lead to withdrawal
10
Q
what can be done with schedules of reinforcement?
A
- periodic reviews that the patient is aware of (may be changed regarding progress)
- may initially use continuous reinforcement but then change to variable ratio to maintain motivation and keep the programme unpredictable
11
Q
what is the supporting study of field et al?
A
- looked at the treatment of young people with behavioural problems
- effective as a whole but some didnt respond until rewards were made more frequent and immediate
- programme works if carefully designed
12
Q
what is the supporting study of stunkard?
A
- successfully used positive reinforcement with anorexics to encourage them to eat normally
- withhold the reward until behaviour is shown, making behaviour more likely to happen again
13
Q
what is the supporting study of sonoda et al?
A
- looked at the case of a 10 year old girl treated with anorexia on an outpatient basis
- at first weight gain was slow but after the intro of token system she began to gain weight at around 1kgmonth-1
14
Q
what is an issue with long term effectiveness?
A
- there is little evidence to show long term effectiveness of TEP’s as once reinforcement is discontinued when leaving the institution reinforced behaviours tend to disappear
15
Q
what is an issue with social control and a CA?
A
- staff are in control of the target behaviours and when tokens are administered so there is a power imbalance, could lead to a feeling of helplessness
- CA = patients do have some involvement e.g. choosing their reward which may make them feel empowered
