A03

• What are the strengths of token economies?

  1. Research support
• What are the limitations of token economies?

  1. Less useful for patients living in the community
  2. Ethical concerns
  3. Alternative psychological treatments
• Strength = research support

  • Dickerson et al. (2005) reviewed 13 studies of the use of token economy systems in the treatment of schizophrenia
  • 11 reported beneficial effects that were directly attributable to use of token economies and so supporting idea that token economies are effective in increasing the adaptive behaviours of patients with schizophrenia
  • HOWEVER - Methodological limitations as very few studies used a control group
• Limitation = less useful for patients living in the community

  • Research has shown that token economies only work well in a hospital setting
  • Within a psychiatric ward setting, inpatients receive 24-hour care and so there is better control for staff to monitor and reward patients appropriately
  • However, outpatients living in the community only receive treatment for a few hours a day so the token method could only be used for part of the day
  • Positive results may not be maintained beyond ward environment
• Limitation = ethical concerns

  • In order to make reinforcement effective clinicians may exercise control over important primary reinforcers such as food, privacy or access to activities
  • It is accepted that all human beings have certain basic rights that cannot be violated
  • These basic rights become more available to patients with mild symptoms and less so for those with more severe symptoms and this depriving them from these basic rights
  • Some families of patients have challenged the legality of this
  • Reduced use of token economies in psychiatric system
• Limitation = alternative psychological treatments

  • There are other psychological therapies that can be helpful for some people with schizophrenia
  • They are less well-known but have less ethical issues
  • Chiang et al. (2019) concluded art therapy is a good alternative
  • Evidence suggests it is a high gain low risk approach to managing schizophrenia
  • Unlike alternatives art therapy is a pleasant experience without major risks of side effects or ethical issues
  • NICE recommends art therapy with a qualified art therapist with experience working with schizophrenic sufferers