Psychological therapies- Token economies

Question 1

What is a token economy?

Answer 1

A form of therapy where desirable behaviours are encouraged by the use of selective reinforcement.

Question 2

How do token economy systems work?

Answer 2

Rewards (tokens) are given as secondary reinforcers when socially desirable behaviours are carried out.
The tokens can then be exchanged for primary reinforcers- food or privileges.

Question 3

Which type of symptoms do token economies aim to alleviate?

Answer 3

Negative symptoms

Question 4

Which principle are token economies based on?

Answer 4

Operant conditioning

Question 5

Are tokens a primary or secondary reinforcer?

Answer 5

Secondary reinforcer

Question 6

What is the strength of token economies?

Answer 6

Research Support:
Dickerson et al. (2005)- reviewed 13 studies of the use of token economy systems in the treatment of schizophrenia. 11 reported beneficial effects that were directly attributable to use of token economies and so supporting the idea that token economies are effective in increasing the adaptive behaviours of patients with schizophrenia.
COUNTER-ARGUMENT: Methodological limitation=very few of these studies used a control group. If there is no comparison with a control group then the patients’ improvements can only be compared with their past behaviours. This comparison may be misleading, as other factors (e.g. an increase in staff attention) could be causing the patients’ improvement rather than the token economy.

Question 7

What are the three limitations of token economies?

Answer 7

Less useful for patients living in the community:
Research has shown that token economies only really work well in a hospital setting.
Within a psychiatric ward setting, inpatients receive 24-hour care and so there is better control for staff to monitor and reward patients appropriately. However, outpatients living in the community only receive treatment for a few hours a day so the token method could only be used for part of the day.
As a result, even if the token economy did produce positive results within the ward setting, these results may not be maintained beyond that environment.

Ethical concerns:
In order to make reinforcement effective clinicians may exercise control over important primary reinforcers such as food, privacy or access to activities. Patients may then exchange tokens if they display the target behaviours.
It is accepted that all human beings have certain basic rights that cannot be violated. These basic rights become more available to patients with mild symptoms and less so for those with more severe symptoms and thus depriving them from these basic rights. Some families of patients have challenged the legality of this. This has in turn reduced the use of token economies in the psychiatric system.

Alternative psychological treatments:
There are other psychological therapies that can be helpful for some people with schizophrenia. That are less well-known but have less ethical issues.
Chiang et al. (2019) concluded art therapy is a good alternative. Evidence suggests it is a high-gain low-risk approach to managing schizophrenia. Unlike alternatives art therapy is a pleasant experience without major risks of side effects or ethical abuses.
NICE recommends art therapy with a qualified art therapist with experience of working with schizophrenia sufferers.