Schizophrenia: topic 8 ‘token economies used in management of SZ’

Question 1

what is a token economy?

Answer 1

• A form of behavioural therapy where clinicians set target behaviours that they believe will improve the patients engagement in daily activities

Question 2

what do token economies aim do?

Answer 2

• Token Economies are used to manage the behaviour of patients with schizophrenia, in particular those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals

Question 3

what are behavioural theories based on in the use of token economies?

Answer 3

• all behavioural theories are based on the assumption that all behaviour is learned through the principles of conditioning and therefore can also be unlearned (known as counter conditioning)

Question 4

How do token economies use operating conditioning?

Answer 4

• token economy uses operating conditioning (learning through reinforcement) and aim to use selective positive reinforcement (or reward) to encourage appropriate behaviour
• Patients are given tokens such as coloured counters for behaving inappropriate ways
• For example tokens might be given to patients for getting out of bed by certain times, making their beds or combing their hair
• These tokens could then be used to obtain various privileges such as exchanging them for cigarettes or time watching TV

Question 5

How are token economies beneficial in managing schizophrenia?

Answer 5

• during the early stages of the token economy, frequent exchange periods of tokens for rewards means that patients can be quickly reinforced, and target behaviours can then increase in frequency
• Overtime to encourage further improvement, more may be expected of patients to achieve token rewards
• For example, they may only be rewarded for helping others or completing chores
• In this way, their behaviour can be developed and shaped overtime, working towards being more and more able to function and look after themselves and become less reliant on staff, carers, and medication too

Question 6

strengths of token economies

Answer 6

P - support for the effectiveness of token economies from dickerson
E/E - conducted a meta analysis of 13 studies, and found that 11 of these studies had reported beneficial effects
L - this suggest token economies are effective and increasing the adaptive behaviours of SZ patients in institutional care

Question 7

limitations of token economies

Answer 7

P - critics have argued that token economy is only effective in treating the negative symptoms which involve evolution, yet not effective in treating the positive symptoms such as hallucinations
E - it has been argued that token economies produce only token (minimal) learning
E - for example, it is possible that what patients learn in token economies is merely to imitate behaviour without any deeper changes in their thoughts and beliefs
L - this suggests the therapy may be limited in terms of its effectiveness in that it may be very superficial and temporary

P - token economies may only be useful in institutions
E - it could be argued that they work because the environment in an institution is carefully structured so that good behaviour can consistently be rewarded
E - as the outside world is very different, patients may find it hard to transfer what they have learned to everyday life when they have been released
L - this suggests although token economies may be effective institutions, they may not be effective preparation for life in the outside world

P - critics have argued to an economy fails to acknowledge individuality in each patient
E - although a standardised system may help them maintain a controlled structured institution, it might not be acceptable to the patient if they have a free choice
E - in other words, the rewarded behaviours may not be the way the patient would normally choose to behave
L - this raises questions over the appropriateness of token economy as it may be seen as inappropriate to expect individuals to behave in a standard way all of the time

P - there are also ethical concerns with the token economy approach to therapy
E - it is viewed as taken all the power away from the individual and given too much power to others - it therefore has the potential for abuse
E - corrigan claimed that token economy can be abusive and humiliating
L - this suggests token economy therapies may not always be appropriate when they are used for reasons other than the treatment of the patient