Token Economy

• A behavioural therapy used in the management of schizophrenia

  • shapes behaviour (negative symptoms) so that patients in long stay hospitals are easier to manage

  Desirable behaviours are encouraged through selective reinforcement (principles of operant conditioning) - increasing frequency of desired behaviours with reward
• Primary reinforcers 


  Gives you pleasure, eg food, or removes unpleasant state, eg hunger

  Do not depend on learning in order to acquire their reinforcing value
• Secondary reinforcers 


  No value, but acquire their reinforcing properties as a result of being paired with primary reinforcers
• Tokens are given immediately, as secondary reinforcers, when patients engage in desirable behaviours (eg showering)

  These are swapped later for rewards (primary reinforcers), eg, privileges like chocolate or a walk

  • Effectiveness may decrease if too much time passes between token and exchange (Kazdin 1977)
  • Doesn't cure schizophrenia but improves quality of life and increases likelihood of living outside a hospital setting
• Weakness - Evidence of Effectiveness

  McMonagle and Sultana (2009) - Found only three studies where people with SCZ had been randomly allocated to conditions with a total of 110 patients

  • Random allocation is important in controlling extraneous variables
  • Only one in three studies showed improvement in symptoms and none yielded useful information about behaviour change
• Eval - Improve QOL but doesn’t cure

  Token economies help by making the individuals behaviours more socially acceptable so they can better reintegrate with society

  However, biological treatments are more effective at reducing severity of some symptoms
• Weakness - Ethical issues

  Token economies is controversial as theres an issue with privileges, services, etc, becoming more available to patients with milder symptoms and less for those with more severe symptoms that prevent them from complying with desirable behaviours

  • This meant that most severely ill patients suffer discrimination in addition to other symptoms and some family members have challenged the legality of this
  • Therefore, reducing the use of token economies in psychiatric systems

  Arguably infringes on human rights - possibly taking away food or comfort