Token Economy Systems Flashcards
What is the purpose of a token economy system?
To encourage target behaviours, such as good personal hygiene
What are token economy systems and where are they used?
in psychiatric hospitals, when patients carry out good behaviour or show signs of improvement, they are rewarded with tokens. These tokens can be exchanged for rewards, such as sweets, going for walks etc.
What psychological theory is token economy based on?
Operant conditioning
What is a secondary reinforcer?
The token
Initially has no value to the patient but once associated with the reward, they become valuable and have reinforcing properties
What are primary reinforcers?
The reward that tokens can be exchanged for that typically motivates the patient the most. Do not depend on learning to hold value.
Can token economies cure schizophrenia?
No
What is the rationale behind token economy systems for schizophrenia patients?
Aims to encourage and build good habits that the patient will continue outside of hospital
How can token economy systems benefit patients once they begin to live outside hospital?
Helps to normalise target behaviours so it becomes easier for them to adapt to life outside.
Explain the strength that token economies are effective.
What did a researcher find about a reduction in symptoms after examining 7 studies focusing on token economies?
Explain the issues of publication bias within this persons research.
A researcher identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with schizophrenia and other mental health problems who had lived as an inpatient. All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours. This shows the value of token economies. However, 7 studies is small evidence base, leading to publication bias. This means that studies may only have been selected because they support the researchers claim that token economies are good. Therefore, we cannot be sure about the true effectiveness of token economies.
Explain the limitation of there being ethical alternatives for token economies.
Use the example of art therapies.
Compare the use of art therapies to other schizophrenia treatments.
Do NICE guidelines recommend art therapy?
Even if token economies are helpful for managing schizophrenia, there are other approaches that have fewer ethical issues. For example, art therapies have shown to be a good alternative. The evidence base is relatively small and has some methodological implications, but appears to show that art therapy is a high gain, low risk approach to managing schizophrenia. Even if the benefits of art therapy are modest, this is generally true for all approaches to treatment and management of schizophrenia and unlike alternatives, art therapy is pleasant and low risk. NICE guidelines recommend art therapies, showing that it is a good alternative to token economies.
Explain the limitation of token economy systems being less useful for patients living in the community.
Where only have token economies proven to be useful?
Why is use of token economies helpful in these places compared to in the outside world once the patient is released?
Token economies have only really shown to work in hospital settings. Cottigan argues that there are problems with implementing the token economy system outside of hospital settings. Within a hospital setting, inpatients receive 24-hour care so there is better control for staff to monitor behaviour and reward patients. However, outpatients do not receive 24-hour care so behaviour cannot be continuously monitored and rewarded. Therefore, while token economies are beneficial within the ward setting, they may be less valuable outside.
Explain the limitation of there being ethical issues surrounding the use of token economy systems.
What do clinicians have to do to ensure that reinforcement is effective?
For example, for reinforcement to be effective, clinicians must exercise control over what patients have access to, such as privacy, food and access to hobbies. Patients may then exchange tokens if they display target behaviours, such as good personal hygiene. However, it is accepted that humans have certain basic rights (to food, privacy etc) that cannot be violated, regardless of positive consequences that may be achieved by implementing a token economy.
