SCHIZOPHRENIA ( Token economy )

Question 1

Define a token economy

Answer 1

A token economy is a behavioural therapy based on operant conditioning , used primarily in institutional settings eg. hospitals to manage the symptoms of schizophrenia , especially negative symptoms like apathy , social withdrawal and poor hygiene

Question 2

Outline ais and the key components of token economy ( tokens , reinforcement , shaping , target behaviours )

Answer 2

AIMS : increase adaptive behaviours , improve motivation and functioning in patients , facilitate reintegration into society or improve quality of life in institutional care.

Tokens - secondary reinforcers ( plastic chips , stickers ) given immediately after a desired behaviour ( eg. getting dressed , engaging in conversation)

Reinforcement - tokens are later exchanged for primary reinforcers , such as extra food , privileges , or time outside

Shaping - complex behaviours are taught gradually through successive approximations , starting with small achievable goals

Target Behaviours -These are clearly defined and measurable , such as brushing teeth or making eye contact

Question 3

Evaluate the role of token economies in Schizophrenia

Answer 3

STRENGTHS :

Effective at managing negative symptoms : Allyon and Azrin found that token economies significantly improved behaviours in female schizophrenic patients in a psychiatric hospital. Especially useful for institutionalised patients who have become withdrawn or dependent

Improves quality of life : Encourages independence , self-care and social participation . Increases patients’ sense of agency and self worth

Ethical when used properly : Provides positive reinforcement rather than punishment . Can promote dignity and a sense of reward for effort.

LIMITATIONS :

Does not treat the underlying cause : Only addresses surface behaviours , not core cognitive or neurochemical abnormalities. Considered a management tool , not a treatment or cure

Short term effects : Behaviour may not generalise to the outside world or be maintained after leaving the institution .
Patients may relapse if reinforcement is removed.

Ethical issues : Some argue it can be manipulative or coercive especially if basic needs ( eg. food or privacy) are used as rewards.
Can lead to inequality if certain patients are unable to participate due to severity of symptoms

Question 4

Outline an interactionist approach

Answer 4

The interactionist approach to schizophrenia recognises that both biological and psychological factors contribute to the development and maintenance of the disorder.

Question 5

Outline the diathesis stress model as an explanation for schizophrenia

Answer 5

The diathesis - stress model suggests schizophrenia is a result of an interaction between a genetic vulnerability ( diathesis) & environmental stressors ( stress )

1. Diathesis ( vulnerability ) often refers to genetic predisposition ( eg. inherited from parents ) . Also includes a wider range of vulnerabilities like neurodevelopmental issues , early brain damage , or early trauma ( abuse)
2. Stress ( Trigger ) Environmental factors that trigger the onset of schizophrenia in someone already vulnerable. May include family dysfunction , substance abuse , or life events

Question 6

What treatment is favoured according to the interactionist approach

Answer 6

Combined treatments :
Biological : antipsychotic medication
Psychological : CBT , family therapy

Question 7

Evaluate the interactionist approach

Answer 7

STRENGTHS :

Strong supporting evidence for Diathesis - stress model : Tienari : Finnish adoption study showed that children with a genetic risk ( biological mothers with schizophrenia) only developed the disorder when raised in dysfunctional families , not when raised in healthy ones.
Demonstrates interaction between genes and environments

Supports a holistic treatment approach : Encourages personalised care that includes both medication and therapy. Research shows combined treatment is often more effective than either alone : Tarrier et al - patients receiving bot medication and CBT had better symptom management and lower relapse rates than those on medication alone

LIMITATIONS

Unclear on what the stress component is : Earlier models focused too heavily on family dysfunction or poor parenting , which can be socially sensitive and blame - inducing . The definition of stress is not very broad - lacks precision , making it difficult to test

Not all patients benefit from combined treatments : Some individually may respond well to medication alone .
Combined treatments may not always be cost-effective or accessible