Management of SZPN

Question 1

what are token economies

Answer 1

form of behavioural modification
(behavioural therapy based on operant conditioning)
- desirable behaviours = encouraged through selective reinforcement

e.g., people given rewards when engage in socially desirable behaviours

Question 2

what are the ‘tokens’ used for
(theoretical understanding)

Answer 2

secondary reinforcers, AKA generalised reinforcers, can be exchanged for primary reinforcers, e.g., food, privileges like TV time

• provide immediate reward as delayed rewards are less effective, may be associated with other non-target behaviour
• in order to become secondary reinforcer, initially administered together with primary

Question 3

rationale behind token economies

Answer 3

prolonged hospitalisations develops institutionalisation
= bad habits

e.g. cease maintaining good hygiene, stop socialising

token economies tackle this

Question 4

what 3 categories of institutional behaviour does token economies commonly tackle, according to Mateson et al (2016) identify

Answer 4

• personal care
• condition-related behaviours
  e.g., apathy
• social behaviour

Question 5

benefits of modifying these behaviour

Answer 5

does not cure SZPN

1. improves the person quality of life within hospital setting
   e.g. social interaction for usually sociable person
2. ‘normalises’ behaviours
   = makes it easier to adapt back into life in community

Question 6

secondary vs primary reinforcer

Answer 6

primary = gives pleasure, does not depend upon learning in order to acquire reinforcing value

secondary = initially have no value, but acquire reinforcing value by being paired with primary reinforcer

Question 7

Strength of token economies

Answer 7

Evidence for effectiveness
- Glowacki et al = identified 7 high quality studies between 1999-2013, examined token economy effectiveness for people with chronic mental health illnesses, incl SZPN, patients lived in hospital setting

• all studies showed reduction in negative symptoms, + decline in unwanted behaviours frequency

= support value of token economies

• only 7 studies = low population validity, may be misleading

Question 8

Weakness of token economies

Answer 8

Ethical issues
- give professionals considerable power to control behaviour of patient
= require imposing of ones’ norms on another person, especially problematic if target behaviour not identified sensitively
- cause greater distress
= legal action taken by families

= benefits of TE outweigh impact on personal freedom and ST reduction in life quality

Question 9

Example of how target behaviour can be insensitively identified

Answer 9

• improving appearance and and making individual get up early, when they like to look scruffy and get up late
• restricting of pleasures if not behaving desirably = worsen experience of SZPN

Question 10

Further limitation of token economies

Answer 10

TES = way to alleviate symptoms, but not a cure

• Kazdin = changes that were developed during patient’s time in hospital using TES did not remain once discharged

= suggesting issues with maintenance, which TES suggests it excels at