Management of SZ Flashcards
(14 cards)
token economies
a form of behavioural modification, where desirable behaviours are encouraged by the use of selective reinforcement
Ayllon and Azrin
- Trialed token economy system on a ward of female schizophrenics
- Everytime they completed a task such as cleaning up, they received a plastic token reading ‘one gift’
- Tokens could be swapped for ward privileges such as being able to watch a film
- Number of tasks carried out increased significantly
Why has the use of token economies delined?
- Growth of community-based care
- Closure of many psychiatric hospitals
- Complex ethical issues raised
rationale for token economies
Institutionalisation develops under prolonged hospitalisation. People may develop bad habits like not brushing their teeth or stopping to socialise with others
Matson et al identified 3 categories of institutional behaviour combated by token economies:
personal care, condition-related behaviours and social behaviour
Modifying Matson’s behaviours can have 2 benefits:
- Improving quality of life within the hospital
- Normalises behaviour and makes the transition from hospital back into life as smooth as possible
What is involved in a token economy?
Tokens are immediately given out after a desirable behaviour. Cooper et al found that target behaviours are decided on an individual basis so the person and doctor must develop rapport to identify the most appropriate ones
Why is immediate rewad fot target behaviour important?
delayed rewards are less effective
examples of tokens in hospital settings
Tradeable rewards in a hospital setting may include objects like sweets, or access to activities like a film, or an appointment with a social worker to discuss life after hospitalisation
Theoretical understanding of token economies
Example of behaviour modification and is based on operant conditioning. Tokens are secondary reinforcers as they only have value once the person receiving them has learned that they can be used to get meaningful rewards, which are the primary reinforcers. The powerful secondary reinforcers are called generalised reinforcers.
Evidence of effectiveness
strength
- Glowacki et al identified 7 high quality studies that examined the effectiveness of token economies
- All showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
Supports value of token economies
Counterpoint
limitation
- Small evidence base
- File drawer problem
- Leads to bias towards positive published findings because undesirable results have been ‘filed away’
Serious question over the evidence for the effectiveness of token economies
Ethical issues
limitation
- Gives professionals considerable power to control the behaviour of patients
- Thus imposing one’s norms onto others
- Especially problematic if target behaviours are not identified sensitively
- Someone who looks scruffy and gets up late may have this freedom removed
- May restrict availability of pleasures like sweets to people who don’t behave as desired eg seriously ill people
Benefit outweighed by their impact on personal freedom and short-term reduction in quality of life
Alternative approaches
- Chiang et al concluded that art therapy may be a good alternative
- Evidence base is small and some methodological limitations
- Art therapy appears as high-gain low-risk approach
- Pleasant experience without major risks or ethical abuse
- NICE guidelines for SZ recommend this
Art therapy may be good alternative
