management of schizophrenia

• Token economy systems:

  • A reward system to manage behaviour 
  • Especially when behaviour is maladaptive due to institutionalisation 
  • The aim of a token economy systems is to improve quality of life. - this is not a cure or treatment to schizophrenia
  • Only work if a person is motivated to receive the reward  
• token economy systems are behavioural modifiers where participants earn tokens when they display desired behaviours, the tokens can be exchanged later for rewards and privileges
• • Rewards = primary reinforcer  token = secondary reinforcer - they must be paired together (token is meaningless without reward) 
• • token economy systems were trailed in the 60's by Aylion & Azrin trialled token economies in 1968 in a ward of schizophrenic women.
  • Each time a participant carried out a task they received a token that could be swapped for a reward - this increased the number of tasks participants carried out 
  • This helps especially for negative symptoms 
• Steps involved:

  1. Identify undesirable behaviour patient is displaying (target symptoms)
  2. Agree with patient what rewards will be (primary reinforcer) for good behaviours 
  3. Introduce token at the same time or just before the reinforcing stimulus 
  4. Reward with token for each desired behaviour - this needs to be immediate
  5. Exchange tokens (secondary reinforcer) for reward 

  • Kazdin (1977) found the effectiveness of token economy may decrease if more time passes between presentation of the token and exchange for rewards - which is why token must be given immediately
• token economy systems can also be effective for punishing undesirable behaviours by taking away tokens
• • 2 major benefits of Token economy
  • Improved quality of life in hospital settings 
  • Normalises behaviours - making it easier to adapt back to life in a community  

   
• supportive evidence:

  • Dickerson et al - reviewed 13 studies of token economy systems in treating schizophrenia - 11 reported beneficial effects 
  • Glowacki et al - 7 high quality studies published between 92 and 13 examined token economy system and chronic mental health disorders including schizophrenia, living in hospital settings - found reduction in negative symptoms, decline in frequency of unwanted behaviour 
  • However - both are meta-analysis studies so involve secondary data, low control over extraneous variables 
• • Opposing evidence - token economy system is comparable to other less unethical management techniques - Chiang et al - art therapy could be a good alternative - evidence is small with method issues but initially seems high gain and low risk - also a more pleasant experience 
• Limitations-

  • Ethical issues - professionals given power to control behaviour, imposing ones norms on another - problematic if behaviours not identified sensitively - restricting rewards has been met with family legal action - costs are higher than benefits