Management of Schizophrenia - Token Economies

• Ayllon and Azrin used a token economy in a schizophrenia ward. A gift token was given for every tidying act. Tokens were later swapped for privileges e. g. 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 schizophrenia in many parts of the world.
• Institutionalisation occurs in long-term hospital treatment. Matson identified three categories of institutional behaviour that can be tackled using token economies: personal care, condition-related behaviours (e.g. apathy) and social behaviour. Modifying these behaviours does not cure schizophrenia but has two major benefits.
• Token economies improve the quality of life within the hospital setting, e.g. putting on make-up or becoming more sociable with other residents.
• Encourages return to more normal behaviour, making it easier to adapt back into the community e.g. getting dressed or making your bed.
• Tokens (e.g. coloured discs) given immediately after a desirable behaviour. Target behaviours are decided individually based on knowledge of the person (Cooper). Tokens have no value themselves but are swapped for rewards eg. sweets or magazines, or activities like a film or a walk outside. Tokens are given immediately following target behaviours because delayed rewards are less effective.
• Token economies are an example of behaviour modification, based on operant conditioning. Tokens 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 called generalised reinforcers. These have a more powerful effect.