Token Economy and the Management of SZ

Question 1

outline token economy for managing SZ
- token economy/aim

Answer 1

token economy = form of behavioural therapy where clinicians set target behaviours they believe will improve the patient’s engagement in daily activities.

Used to manage the behaviour of patients with SZ, especially those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals.

Question 2

outline token economy for managing SZ
- behaviourism

Answer 2

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).

token economy uses operant conditioning.

Question 3

outline token economy for managing SZ
- operant conditioning

Answer 3

Token economy uses operant conditioning (learning through reinforcement)

aims to use selective positive reinforcement (or reward) to encourage appropriate behaviour.

Patients are given tokens eg. coloured counters for behaving in appropriate ways.

Eg. getting out of bed by certain times, making their beds, combing their hair

Tokens then used to obtain various privileges (rewards) eg. exchanging them for cigarettes or time watching TV

Question 4

outline token economy for managing SZ
- process/effect

Answer 4

Early stages: frequent exchange periods mean that patients can be quickly reinforced and target behaviours can increase in frequency

Over time, to encourage further improvements, more is expected of patients to achieve token rewards.

Eg, only rewarded helping others or completing ‘chores’.

Behaviour can be developed and shaped over time -> work towards being more able to function and look after themselves -> less reliant on staff, carers, medication

real world improvement in quality of life

Question 5

evaluate token economy for managing SZ:
STRENGTHS

Answer 5

P) Support for effectiveness from Dickerson et al (2005)
E) meta-analysis of 13 studies
E) 11 reported beneficial effects
L) effective in increasing the adaptive behaviours of SZ patients in institutional care

Question 6

evaluate token economy for managing SZ:
LIMITATIONS

Answer 6

P) only effective in treating negative symptoms (eg avolition) not positive symptoms (eg hallucinations)
E) also, produce only token (minimal) learning
E) Eg. patients merely learn to imitate normal behaviour without any deeper changes in their thoughts and beliefs.
L) limited effectiveness; superficial and temporary

P) only useful in institutions
E) they work bc the env in an institution is carefully structured so that good behaviour can consistently be rewarded.
E) outside world is very different, patients may find it hard to transfer what they have learned to everyday life once released.
L) not effective preparation for life; low external validity (benefits can’t generalise), lack practical applications

P) ignores patient individualty (nomothetic)
E) standardised system may help maintain a controlled and structured institution, but not acceptable to the patient if they had a free choice.
E) rewarded behaviours may not be the way the patient would
normally choose to behave.
L) not ‘appropriate’: expect individuals to behave in a standard way all the time
E) need more idiographic approach

P) ethical concerns
E) takes power away from the individual, gives too much power to others -> potential for abuse.
E) Corrigan (1995): TE can be abusive and humiliating.
L) removes autonomy; not appropriate when used for reasons other than the treatment of patient