Token economies

• Token economies

  Reward system used to manage behaviour of people with SZ using selective reinforcement.

  Challenges institutionalisation -> personal care, condition-related behaviour, social behaviour
• Benefits of token economies

  Improves the person's quality of life within the hospital setting.

  'normalises' behaviour for people who have spent time in hospital to help them adapt back into the community
• Research evidence for effectiveness

  Glowacki et al

  Meta review of 7 studies on token economies

  All studies showed reduction in negative symptoms and a decrease in unwanted behaviours
• Counterpoint for research evidence

  7 studies is small evidence base

  Bias towards positive published studies because undesirable results have been filed away.
• Limitation - ethical issues

  Gives the professionals power to control behaviour of patient.

  Reduces personal freedom.

  Withholding tokens from patients could cause negative emotions - anger
• Strengths - appropriateness

  • no side effects
  • appropriate to use while in hospitalisation - no extra cost