Management of Schizophrenia AO3

• +Evidence of effectiveness. Glowacki identified seven high quality studies published between 1999 and 2013 on the effectiveness of token economies in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours. This supports the value of token economies.
• +-Seven studies is quite a small evidence base. One issue with such a small number of studies is the file drawer problem - a bias towards publishing positive findings. This means that there is a serious question over the effectiveness of token economies.
• -Ethical Issues. Professionals have the power to control people's behaviour and this means imposing one person's norms on to others (e.g. a patient may like to look scruffy). Also restricting the availability of pleasures to people who don't behave as desired means that very ill people, already experiencing distressing symptoms, have an even worse time. This means that benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life.
• -More pleasurable / ethical alternatives. Other approaches do not raise ethical issues, e.g. art therapy is a high-gain low-risk approach to managing schizophrenia (Chiang). Even if the benefits of art therapy are modest, this is true for all approaches to treatment and management of schizophrenia and art therapy is a pleasant experience. This means that art therapy might be a good alternative to token economies - no side effects or ethical abuses.
• Benefits

  A problem with token economies is that they are hard to continue outside a hospital setting. Target behaviours cannot be monitored closely and tokens cannot be given immediately. On the other hand, some people may only get the chance to live outside a hospital if their personal care and social interaction improves. This suggests that it is worth it, despite the issues around using the in hospital to give peopl a chance outside the hospital.