A03

• Point: One strength of token economies for the management of schizophrenia is evidence for their effectiveness.

  Evidence: For example, Glowacki (2016) reviewed seven high-quality studies that investigated the effectiveness of token economies for people with chronic mental health issues like schizophrenia in a hospital setting.

  Explain: The results showed a reduction in negative symptoms and unwanted behaviours in patients.

  Link: Therefore, this suggests that token economies have demonstrated value in reducing symptoms and managing behaviours associated with schizophrenia.
• Point: However, a limitation is the small evidence base supporting the effectiveness of token economies.

  Evidence: The limited number of studies raises concerns about the file drawer problem, where positive findings may be overrepresented due to publication bias.

  Explain: This means that there is uncertainty regarding the overall effectiveness of token economies due to the potential bias in the available evidence.

  Link: Therefore, this raises questions about the reliability of the evidence supporting the use of token economies for managing schizophrenia.
• Point: One limitation with the use of token economies is the ethical issues raised.

  Evidence: Imposing norms and restricting personal freedoms can raise ethical concerns, particularly when considering the impact on the quality of life for individuals with schizophrenia.

  Explain: For instance, restricting the availability of rewards (e.g. seeing films) to those who don’t behave as desired could be even worse for someone already experiencing severe symptoms.

  Therefore, this means that the benefits of token economies may be outweighed by their negative impact on personal freedom and well-being.
• Point: A further limitation of token economies is the existence of more pleasant and ethical alternatives.

  Evidence: Research by Chiang (2019) suggests that art therapy may be a viable alternative with comparable effectiveness and fewer ethical concerns.

  Explain: This means that art therapy offers a high-gain, low-risk approach to managing schizophrenia without the ethical issues associated with token economies.

  Link: Therefore, this highlights the need to consider alternative interventions that prioritise patient well-being and autonomy.