management of schzoprenia

• based on operant conditioning. tokens secondary reinforcers, rewards are the primary reinforcers
• te is used to improve the quality of life and allow patients to take more pride in appearance and social interaction. it normalises their behaviour when entering back into the community such as making their bed
• tokens are giving for performing desirable behaviour and each of these desired behaviours depends on the individual (cooper 2007), and the token is giving immediately so the management is effective. these tokens can then be exchanged for rewards such as watching a film or seeing family members
• Ayllch and Azrin 1968 first trialled the te system in a womens hospital anf they were extensively used in the 60/70s
• A strength of TE as management for sz comes from Krista Glowacki et al. (2016) identified seven high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as 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.
• However, seven studies is quite a small evidence base to support the effectiveness of a technique. One issue with a small number of studies is the file drawer problem. This phenomenon leads to a bias towards positive published findings because undesirable results have been 'filed’ away. This is a particular problem in reviews that only include a small numbers of studies. This means that there is a serious question over the evidence for the effectiveness of token economies.
• One problem with token economies is that they are 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 administered immediately. Without accurate tracking of desired behaviours and immediate reward in the form of a token it is likely that the benefit of the token economy will be lost and the frequency of undesired behaviours will increase again.
• But some people with schizophrenia may only get the chance to live outside a hospital if their personal care and social interaction can be improved. And perhaps the best way to achieve this is using a token economy during hospital care. So even though there is a risk of the token economy losing its effect outside hospital this is probably a risk worth taking for individuals who might otherwise remain institutionalised.This suggests that it is worth the issues around using token economies in hospital to give people a chance outside the hospital.
• Other approaches may be more helpful. review by Mathew Chiang 2019 concluded that art therapy might be a good alternative. The evidence base is regularly small and has some methodological limitations, but it appears to show that art therapy is a high-gain low-risk approach to managing schizophrenia. Art therapy recommed by NICE. it can hekp reduce anxiety by providing relaxation techniques . therefore more effective than te
• A solution to some of these issues is to ensure that TE systems are carefully tailored to the individual. Mental health workers must take into account each patient’s current level of functioning and create achievable goals based on this. As a result, even small changes in behaviour for severely affected patients is rewarded and makes the system fair.
• Token economies give professionals considerable power to control the behaviour of people in the role of patient. involves imposing one person's norms on to others, which is especially problematic if target behaviours are not identified sensitively. e.g someone who likes to look scruffy and get up late might freedoms curtailed. Perhaps more seriously, restricting the availability of pleasures to people who don't behave as desired means that seriously ill people, who are already experiencing distressing symptoms. Therefore may carry out more unsociable behaviours