Token Economies And The Management Of Schizophrenia Flashcards Preview

3. Schizophrenia - Psychological Therapies > Token Economies And The Management Of Schizophrenia > Flashcards

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What are token economies?

Token economies are a form of behaviour therapy where desirable behaviour is encouraged trough the use of selective reinforcement.


Why are token economies used?

They are used to manage the behaviour of patient who may have developed maladaptive behaviour through spending long periods of time in psychiatric hospitals.

Modifying these behaviours does not cure schizophrenia, but is designed to make it more likely they can live outside a hospital setting.


What are the behavioural principles employed in a token economy system based on?

Operant conditioning


How do token economies work?

• Clinicians set target behaviours that they believe will improve the patient's engagement in daily activities.
• The patient is given a token (coloured disc or similar) immediately for engaging in the target behaviours. (Immediacy is important as a delay may reduce the effectiveness of the reward)
• Tokens are secondary reinforcers because they only have value once the patient has learned that they can be used to obtain rewards
• The token are then exchanged for primary reinforcers (what the person actually wants) which be in food, sweets or other privileges such as having a walk outside or watching tv

The idea behind token economy is that the patient will engage more often with desirable behaviours because the behaviours become associated with these reward and privileges.



Is there any evidence to support token economies?

Dickerson et al have provided research support for the effectiveness of TE in a psychiatric setting. They reviewed 13 studies of the use of TE in the treatment of schizophrenia. 11 out of 13 studies reported beneficial effects that were directly attributable to the use of token economies.

They concluded that these studies provide evidence evidence of the token economies effectiveness in increasing adaptive behaviours of patients with schizophrenia.

However, they did caution that many of the studies reviewed had significant methodological shortcomings that limited their impact in the overall assessment of TE in this context.



Are there an difficulties in assessing the success of a token economy?

A major problem in assessing the effectiveness of TE is that studies of their use tend to be uncontrolled.

When a TE system is introduced into a psychiatric ward, typically all patients are brought into the programme rather than having an experimental group and a control group.

This means that patient's improvements can only be compared to their past behaviours rather than the behaviours of a control group.

This comparison may be misleading as other factors (such as increase in staff attention) may be causing the patients improvement rather than the token economy.



Can token economies be generalised beyond a hospital setting?

A weakness is that token economies may not generalise beyond the hospital setting.

Within a psychiatric setting there is better control for staff to monitor and reward patients appropriately. However, with outpatients, it becomes impossible to reward them every time they perform a desirable act as they only receive a few hours of care each day. This results in a situation whereby the desired behaviour becomes dependent on the reinforcer - if the reinforcers stop, so does the desired behaviour - this makes relapse likely.

This is a weakness of token economies as they may only be useful to change unwanted behaviour of hospitalised patients and be less useful for patients living in the community.



Are there any ethical concerns?

There are a number of ethical concerns concerning the use of token economies in psychiatric settings.

Firstly, in order to make reinforcement effect, clinicians need to exercise control over important primary reinforcers such as food or access to activities. But it is argued that human beings have a certain right to these things that cannot be violated.

Moreover, the privileges become more available to patients with mild symptoms and less for those with sever that prevents them from complying with desirable behaviours. This means that the most severely ill suffer discrimination.

This is a weakness of token economies because they could be said to be discriminatory and violate basic human rights.



Do token economies cure schizophrenia?

Token economies are useful in terms of modifying problem behaviours to make it more likely that the schizophrenic can live outside a hospital setting. They also makes schizophrenic's behaviour more socially acceptable so they can better interstate into society but they do not cure it.

This means that token economies do not provide a complete treatment method and need to be combined with drugs or some other form of psychological therapy to treat the underlying disorder.