token economies

• Token economies


  A reward system used to manage the behaviour of

  people with schizophrenia
• Token economies targets those who have developed patterns of maladaptive behaviour due to spending prolonged periods in psychiatric hospitals
• Token economies are based on B.F Skinner theory of operant conditioning and is a form of behaviour modification
• When were token economies used exstensively?

  In the 1960s and 1970s
• What was the norm for treating schizophrenia in 60/70s?

  Long-term hospitalisation
• Why has the use of token economies has declined in the UK?

  • Growth of community-based care
  • Closure of many psychiatric hospitals
• What happens if the patient has no tokens in a token economy system?

  They have no access to desirable items or activities
• What is the first step in implementing a token economy system?

  A list of desired behaviours is drawn up, and target behaviours are decided on an individual basis.
• Why is it important to know the person when deciding target behaviours in a token economy system?

  Knowing the person helps identify the most appropriate target behaviours for them (Cooper et al, 2007)
• What happens when a patient carries out a desirable task in a token economy system?

  They are given a token immediately thereafter, which acts as a secondary reinforcer.
• Why is it important to give the token immediately after a desirable task?

  Immediate rewards are more effective than delayed rewards
• What are tokens in a token economy system later swapped for?

  Tokens are swapped for tangible rewards such as food, drink, or experiences
• What are the tangible rewards in a token economy system examples of?

  Primary reinforcers
• Who trialed a token economy system in a ward of women with schizophrenia?

  Ayllon and Azrin (1968)
• What was given to participants every time they carried out a task in Ayllon & Azrin’s study?

  A plastic token embossed with the word ‘one gift'
• What could tokens be exchanged for in Ayllon & Azrin’s study?

  Tokens could be exchanged for ward privileges, such as watching a film or purchasing certain items of food
• What was the result of Ayllon & Azrin’s token economy system trial?

  The number of tasks carried out by patients increased significantly
• Why do people in prolonged hospitalisation often develop bad habits?

  It is a response to living without the routine of everyday life and the lack of small pleasures.
• What are the three categories of institutional behavior that Matson et al. (2016) identified can be tackled by a token economy?


  1. Personal care
  2. Condition-related behaviors (such as apathy)
  3. Social behavior
• What are two major benefits of token economies for individuals with schizophrenia?

  1. They improve the person's quality of life within the hospital setting.
  2. They normalise behaviour, making it easier for individuals to reintegrate into the community after being released
• What alternative to token economies did Chiang et al. (2019) suggest for managing schizophrenia?


  Art therapy
• What did Chiang et al. (2019) conclude about art therapy?

  • It's a high gain/low risk approach to managing schizophrenia
  • Evidence base is small and has some methodological limitation
• Why is art therapy considered a pleasant alternative to token economies?

  No major risk of side effects or ethical abuses
• What do NICE guidelines recommend for managing schizophrenia?

  Art therapy