A01: Management of SZ

• Development of token economies

  Ayllon & Azrin (1968) used a token economy in a SZ war. A gift token was given for every tidying act. Tokens were later swapped for priveledges like films

  • Token economies were extensively used in the 1960s and 70s. Decline in the UK due to a shift towards care in the community rather than hospitals and because of ethical concerns.
  • Token economies still remain a standard approach to managing SZ in many parts of the world.
• Rationale for token economies

  Institutionalisation occurs in long-term hospital treatment.

  • Matson et al (2016) identified 3 categories of institutional behaviour that can be tackled using token economies: person care, condition-related behaviour (e.g. apathy) and social behaviour.
  • Modifying these behaviours does not cure SZ but has 2 major benefits.
• 1. Quality of life

  Token econmies improve the quality of life within the hospital setting e.g putting on make-up or becoming more sociable with other residents.
• 2. 'Normalises' behaviour

  Encourages return to more 'normal' behaviour, making it easier to adapt back into the community e.g. getting dressed or making your bed.
• What is involved in a token economy?

  Tokens (e.g coloured discs) given immediately after a desirable behaviour. Target behaviours are decided individually based on knowledge of the person (Cooper et al 2007).

  • Tokens have no vale themselves but are swapped for rewards e.g sweets of magazines, or actives like a film or a walk outside.
  • Tokens are given immediately following target behaviours because delayed rewards are less effective.
• The theory behind token economies - operant conditioning

  Token economies are an example of behaviour modification based on operant conditioning

  • Token are secondary reinforcers - exchanged for rewards (primary reinforcers which are directly rewarding e.g food)
  • Tokens that can be exchanged for a range of different primary reinforcers are generalised reinforcers. There have a more powerful effect.
• Psychological Therapy for SZ - MANAGEMENT OF SZ:

  • Token Economies
• Token Economies: Booklet

  • These reward systems used to manage behaviour of patients with Sz.
  • They are useful for patients who been institutionalised; leading to development of maladaptive behaviours like staying in pyjamas all day or not maintaining a good level of self care.
  • Although this not address symptoms of Sz, does increase likelihood of recovery outside of institutional care.
• Tokens, desirable behaviour, rewards?: Booklet

  • Tokens - physical tokens (e.g coloured discs) given after desirable behaviour. This positive reinforcement must occur immediately or it reduces the impact as it leads to 'delay discounting'.
  • Desirable Behaviour:
  • Brushing teeth
  • Getting out of bed
  • Taking medication
  • Rewards - operant conditioning occurs where the tokens can then be exchanged for rewards which leads to the token becoming the secondary reinforcer & the reward becoming the primary reinforcer:
  • Sweets
  • Cigarettes
  • TV/Books