Token economies

• A type of behaviour modification based on the principles of operant conditioning. It is a reward system for "appropriate behaviour."

  People are given tokens when they engage in socially desirable behaviour. The token is a secondary reinforcer. The token/s can then be exchanged for a primary reinforcer (food/other privileges)
• Allyon and Azrin.

  • conducted research in a ward of female schizophrenia patients
  • every time the patient did a socially desirable behaviour such as make the bed or clean up they were given a token.
  • tokens were then exchanged for a privilege such as watching a film.
  • this led to an increase in tasks.
• Token economies were used extensively in hospitals during the 60s and 70s as the common way to treat patients was hospitalisation.

  Today in the UK, we have care in the community schemes, however it is still widely used in some places in the world.
• Matson identified 3 common categories of behaviour commonly treated:

  • personal care
  • apathy
  • social behaviour
• A03 - Limitation

  • it does not cure schizophrenia but just helps its management
  • doesn't address the positive symptoms such as hallucinations and delusions
  • however it can be argued that it does improve quality of life within the hospital and helps the patient get ready for society again
• A03 - Strength

  Supporting evidence

  • Glowacki et al
  • reviewed 7 high quality studies from 1999-2013 involving patients in institutions including schizophrenics
  • was found that all studies that were included showed a reduction in negative symptoms and a decline in the frequency of unwanted activities.
  • however a problem of this research is that it used a relatively small sample of studies for a meta analysis type reiew and may be subject to selection bias
• A03 - Problem

  • using token economies to manage schizophrenia is that it raises ethical issues as a person is imposing their behavioural standard on others and withholding privileges
  • could be distressing to someone who is already suffering
  • as a result of withholding privileges, some families have undertaken legal action against institutions which has led to a decline in its overall yse
• A03 -

  Other approaches do not raise the same ethical issues.

  • Chiang et al
  • showed that art therapy was a high gain, low cost alternative to token economies and the national institute of clinical excellence have included this in its recommendations as an alternative way for helping patients in institutions manage their schizophrenia.