token economy system Flashcards
intro
• Reward systems used to manage maladaptive behaviour patterns(behaviours which stop you adapting to new or difficult circumstances) due to extended periods of time in hospital.
• Used a lot during the 60s and 70s
- long term hospitalization was the norm.
how does it work?
• Tokens are given to patients immediately after they have carried out a desirable behaviour.
• Delays reduce the effectiveness
• Target behaviours are individual (each person has own)
• Tokens have no value in themselves, but they can be swapped for tangible rewards.
• Sweets
• Magazines
• Films
• Walks outside
Theory
• Behaviour Modification
• Operant conditioning
• Tokens are secondary reinforcers
• They have no value in themselves.
• They gain their power through being paired with a primary reinforcer (reward)
• This generally happens at the start of the programme.
• Administered together at first
The rationale behind it
• Institutionalisation → Bad habits
• Matson et al. (2016) identify three categories of institutional behaviour tackled by token economies.
• Personal care
• Condition related behaviour
• Social behaviour
• Behaviour modification is not a cure.
• Improves life within the hospital setting
• Makes it easier to adapt back to life in the community after a stay in hospital
research
• Ayllon & Nazrin (1968) - Ward of women with schizophrenia.
• Carrying out a task e.g. making bed → token
• Swap for a gift / privilege
• Resulted in the number of tasks increasing
• Use has decreased more recently due to a change of care routines, but also due to ethical issues.
strength
Glowacki et al., (2016)
• Meta-analysis of of 7 high quality studies conducted between 1999 and 2003 on the effectiveness of TES for people with chronic mental health issues.
• In a hospital setting
• All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
• This supports the value of token economies.
limitation-ethical issues
It gives professionals considerable power to control the behaviour of the patient.
• Imposition of norms on an individual → problematic if issues aren’t approached sensitively.
• Restriction of personal freedoms
• Patients who have the most distressing symptoms, could have an even worse time due to the removal of small pleasures.
-This has lead to legal action taken by relatives of patients and the ultimately the decline of the use of TES.
Impact on personal freedom and short-term quality of life may outweigh the benefits.
6 marker
Token economies are a form of behaviour modification used with people who have schizophrenia, based on operant conditioning principles.
It involves tokens being issued to individuals when they carry out a desirable behaviour. Whilst the tokens themselves have no value, they can be exchanged for a reward e.g. extra privileges.
They are a secondary reinforcer and gain their value due to their link with the reward, the primary reinforcer. The use of token economies was brought about to combat the issue of institutionalisation, which is a consequence of long term hospitalisation, which sees patients develop bad habits, such as ceasing to maintain good personal hygiene or socialise with others.
According to Matson et al., Token economies can target 3 types of undesirable behaviour. Personal care, condition related behaviour and social behaviour. Finally, Whilst token economies do not cure schizophrenia, they do have two major benefits. They improve a persons life within a hospital setting and they encourage
“normalised” behaviour and routines, which makes it easier for people who have been in hospital long-term to adapt back into life in the community.
L-quality of evidence
Seven studies is quite a small evidence base to support the effectiveness of the technique.
• Small numbers of studies → file drawer problem
• Bias towards positive published findings → undesirable results have been filed away
This means that there is a serious question over the evidence for the effectiveness of token economies.
