Management of schizophrenia Flashcards
(15 cards)
What are token economies?
Form of behavioural modification
Desirable behaviours are encouraged by use of selective reinforcement
Tokens are secondary reinforcers and can be exchanged for primary reinforces
Who demonstrated token economy?
Ayllon and Azrin
How did Ayllon and Azrin demonstrate token economy?
Ward of women with schizophrenia diagnosis
Every time participants carried out a task - making their bed or cleanig up
Were given a plastic token embossed with the words one gift
Tokens could be swapped for ward privileges - Being able to watch a film
Number of tasks carried out increased significantly
When and why were token economies often used?
1960s and 70s
Norm for treating schizophrenia was long term hospitalisation
Now declined in the uk - growth of community based care and closure of many psychiatric hospitals
Complex ethical issues - restring rewards to people with mental disorders
What is institutionalisation?
Develops under circumstances of prolonged hospitalisation
Develop bad habits - cease to maintain good hygiene, stop socialising with others
What did Matson et al identify?
Three categories of insitutional behaviour commonly tackled by means of token economies
What were Matson et als three categories?
Personal care
Condition related behaviours
Social behaviours
What are the two major benefits of modifying these behaviours?
Improves person quality of life within hospital setting
Normalises behaviour and makes it easier for people have spent a time in hospital to adapt back into life in the community
What is involved in a token economy?
Target behaviours are decided on individual basis and is important to know the person in order to identify the most appropriate target behaviours for them
No values themselves - swapped for tangible rewards
Having immediate reward for traget behaviour is important - delayed rewards are less effective
Tokens are administered as soon as possible after target behaviour
What are rewards in a hospital setting?
Sweets, magazines
Access to activities - film, walk outside
Appointment with a social worker for life after hospitalisation
What is behavioural modification?
Behavioural therapy based on operant conditioning
Tokens secondary reinforces - only have value once person receiving them has learned that they can be used to obtain meaningful rewards
Meaningful rewards are primary reinforcers
In order for tokens to become secondary reinforcers they are paired with primary reinforces
So at start of token economy programme tokens and primary reinforcers are administered together
What is a strength of token economies?
Evidence of effectiveness
Glowacki et al
Identified seven high quality studies
Examined effectiveness of token economies
All studies showed reduction in negative symptoms and decline in frequency of unwanted behaviours
Supporting token economies
What is a counterpoint to evidence of effectiveness?
Seven studies i quite small evidence base
File drawer problem
Phenomenon leads to a bias towards positive published findings because undesirable results have been filed away
Problem in reviews that only include a small number of studies
Meaning there is a serious question over the evidence for the effectiveness of token economies
What is a limitation of token economies?
Ethical issues
Gives professionals considerable power to control the behaviour of people in the role of the patient
Imposing one persons norms onto others
Problematic if target behaviours are not identified sensitively
Legal action by families who see their relatives in this position has been a major factor in the decline in the use of token economies
Meaning benefits of token economies may be outweighed by their impacts on personal freedom and short term reduction in quality life
What is a limitation of token economies?
Existence of more pleasant and ethical alternatives
Chiang et al
Art therapy might be good alternative
Evidence base is regularly small and has some methodological limitations
High gain low risk approach
Benefits may be modest. but generally true for all approaches to treatment and management
Pleasant experience without major risks of side effects or ethical abuses
NICE guidelines recommend art therapy
Meaning art therapy may be a good alternative to token economies
