Token Economies

• aim and background

  a way of managing the behaviour of institutionalised patients, based on operant conditioning
• key strategies

  • staff agree on target behaviours to reward
  • patient engages in target behaviours
  • tokens awarded ASAP - to prevent delay discounting - by staff in order to shape behaviour
  • tokens (secondary reinforcer) traded for reward (primary reinforcer)
• McMonagle and Sultana (2009) - evidence for effectiveness

  • only three studies where people with SCZ had been randomly allocated to conditions, with a total of 110 patients - random allocation is important in controlling extraneous variables
  • only one of three studies showed improvement in symptoms and none yielded useful information about behaviour change
• Allyon and Azrin (1968)

  • token economy was successful on a ward of female schizophrenic patients in Illinois
  • they were given plastic tokens for target behaviours including dressing properly and carrying out domestic chores
  • these could be exchanged for privileges
  • the frequency of desirable behaviours significantly increased with use of the token economy
  • e.g. average number of daily chores increased from 5 to 42
• evaluation - ethics

  • manipulation when using tokens - clinicians also control primary reinforcers (food, privacy and meaningful activity)
  • privileges become more available with patients with mild symptoms and less so for those with more sever symptoms and less so for those with desirable behaviours
  • this means that the most severely ill patients suffer discrimination in addition to other symptoms, and some families of patients have challenged to legality of this