Token Economies Schizophrenia

• Token economy programmes (TEPs) are based on the principle of operant conditioning which suggests that behaviour can be shaped by positive and negative reinforcers.
• Token economy programmes are behaviourist programmes that work best with institutionalised patients in long-term psychiatric care.
• Token economy programmes proposed by behaviourist psychologists assume that dysfunctional behaviour is learned and can be unlearned.
• Token economies are reward systems used to manage the behaviour of people with schizophrenia, in particular those who have developed patterns of maladaptive behaviour.
• Token economy is a system of behaviour management based on the systematic reinforcement of target behaviour. The reinforces are rewards which can be exchanged for other reinforces.
• Primary reinforcers are things that motivate behaviour because they satisfy an individual's basic survival needs. Primary reinforcers are distinguished from other types of reinforcers because they have innate biological value.
• Secondary reinforcers are stimuli, objects, or events that become reinforcing based on their association with a primary reinforcer.
• In token economy programmes (TEPs) secondary reinforces such as tokens are exchanged for primary reinforces, which are rewards that people want to receive.
• Token economy programmes are used in hospitals to help patients with schizophrenia gain more control over their daily lives and increase positive behaviours.
• Token economy programmes provide structured point systems which emphasise and reinforce positive behaviour.
• In a token economy programme patients would be rewarded with tokens or points which can later be exchanged for genuine rewards.
• Token economies usually involve schedules of reinforcement and are used to modify the behaviour of those suffering from schizophrenia.
• McMonagle & Sultana (2000) conducted a meta-analysis of token economy programmes and found some evidence for progress with the negative symptoms of schizophrenia.
• Dickerson et al (2005) offer support for token economies in helping patients to become more independent when they are used with other treatments such as drug therapy.
• Paul & Lentz (1977) compared the effectiveness of token economy against other forms of therapy. They studied 84 chronic and hospitalised psychiatric patients all receiving drug treatment and followed them for a period a 4.5 years.
• Paul & Lentz (1977) found that patients receiving token economy were more likely to reduce their antipsychotic drugs and more than 10% were able to leave the hospital
• Glowacki et al (2016) reviewed seven high-quality studies examining the effectiveness of token economies for schizophrenia. All the studies showed a reduction in negative symptoms and a decline in unwanted behaviours.
• Token economy programmes provide a positive means for motivating and at times controlling behaviour.
• Token economy programmes do not require specialist training as all staff can award tokens to patients in hospital.
• Token economy programmes can provide psychiatrists with a way of monitoring the progress of the patient. The patient may also get some indirect intrinsic satisfaction with their progress.
• Behavioural models such as token economy can help people change their behaviour.
• Some psychologists argue that people with schizophrenia may only get the chance to live outside hospital if their personal care and social interaction is improved. In some cases this is achieved using token economy.
• Token economy programmes can be very staff intensive and demand resources and time to fully establish their use.
• One problem with token economy programmes is that patients may become dependent upon receiving points or tokens to perform daily tasks. This will not change their behaviour in the long-term.
• Token economy programmes require consistency and cooperation at all times. This may be difficult to achieve within the hospital setting.
• Token economy programmes have issues with generalisation as they do not work effectively outside of the hospital setting.
• One problem with token economies is they are very difficult to continue once a person is outside the hospital setting. This is because target behaviours cannot be monitored closely and tokens cannot be administered immediately.
• Token economy programmes work more successfully when used in combination with other treatment programmes.
• There are issues of social sensitivity when carrying out token economy programmes with patients suffering from schizophrenia. As vulnerable individuals there is an element of free will which is removed.
• There are ethical issues in token economies raised by restricting rewards to vulnerable people with mental disorders.
• Token economy programmes can also be seen as a form of social control. The power to control and withhold rewards lies with those who are administering the points or tokens.
• Token economies involving reinforces that withhold a basic human right such as food, clothing or privacy are unethical and have been ruled illegal in the USA.
• One criticism of token economies is that the principle of conditioning does not cure schizophrenia, it only helps manage behaviour.
• Alternative therapies such as art therapy do not raise ethical issues and according to Chiang et al (2019) are just as effective as token economies.
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