schizophrenia: management through token economys Flashcards
(9 cards)
what are token economies
Token economies are reward systems used to manage the behaviour of people with SZ, in particular those who have developed patterns of maladaptive behaviour through spending long periods **in psychiatric hospitals. **
how do token economies differ from CBT and family therpay
CBT and family therapy are methods of treatment whereas token economy is a **method of managing schizophrenia **
what is the aim of token economies
Based on operant conditiongin > Token economies are a form behaviour therapy where desirable behaviours are encouraged by the use of selective reinforcement.
* In psychiatric hospitals, it is common patients develop bad hygiene habits.
* Although modifying these habits does not cure schizophrenia, it **helps improve the patients quality of life. **
how do token economies work
- Tokens, for example in the shape of coloured discs, are given out immediately to patients when they have carried out a desirable behaviour that has been targeted for reinforcement
- EG: getting dressed in the morning, or making their bed
- The tokens can be swapped later for tangible rewards such as sweets, cigarettes, magazines etc.
- The immediacy of the reward is important because it prevents delay discounting, the reduced effect of a delayed reward
what are the primary and secondary reinforcers
Primary reinforcement involves a reward that fulfils a biological need. Secondary reinforcers are learned and
work via association with primary reinforcers.
Tokens are secondary reinforcers because they only have value once the person receiving them has learned that they can be used to obtain a reward.
The reward is the primary reinforcer.
In order for the tokens to become secondary reinforcers they are paired with primary reinforcer, so at the start of the programme tokens and primary reinforcers are administered together
AO3: research to support
One strength of token economies for the management of schizophrenia is evidence for their effectiveness
Glowacki et al identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for schizophrenia and involved patients living in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours. This demonstrates that token economy is effective in replacing maladaptive behaviours with more desirable ones.
COUNTER: However, an issue with a small number of studies is the file drawer problem. This leads to a bias towards positive published findings because undesirable results have been hidden (‘filed away’). This means we **cannot rely on such studies to demonstrate the effectiveness of token economy. **
AO3: ethical issues
P: One limitation with the use of token economy to manage schizophrenia is the ethical issues raised.
The use of token economies gives professionals considerable power to control the behaviour of patients. This involves imposing one person’s or institution’s norms on to others which is especially problematic if target behaviours are not identified sensitively. For example, someone who likes to look scruffy and get up late might have their personal freedom limited. Also restricting the availability of pleasures, such as sweets, to those who do not behave as desired may mean people who are
already experiencing distress symptoms, struggle even more
WEAKNESS as this means the benefits of token economy have been **outweighed by their impact on personal freedom and shortterm reduction in quality of life. **
AO3: no long-term impact
One problem with token economies is that they are not effective long term
Token economy is very difficult to continue once a person is outside a hospital setting. This is because target behaviours cannot be monitored closely and tokens cannot be delivered immediately. Additionally, token economy does not target the root cause nor does it treat symptoms such as hallucinations and delusions.
WEAKNESS as this limits the usefulness of token economy
AO3: alternative approaches
A further limitation of token economy is the existence of more pleasant and ethical alternatives
Art therapy has been proposed as a good alternative to token economy. Evidence suggests that even though there are some methodological issues, it is a high-gain low-cost approach to managing SZ.
Art therapy involves using art as a medium of expression, under the guidance of a therapist. Using paint, clay or various other types of art, a person with mental illness can express their inner thoughts without using words. The goal of art therapy is not to learn to paint or hone artistic skills, but to give voice to your thoughts and understand your feelings and emotions better. NICE has also recommended art therapy as a form of management for schizophrenia.
WEAKNESS as this suggests that art therapy might be a better method than token economy
