Management of Schizophrenia

• Development: Token Economies are an example of operant conditioning.
• Allyon and Azrin (1968) used a token economy in a schizophrenia ward.

  • Target desirable acts were detected by staff - every time a patient displayed one of these behaviours they were rewarded with a token (secondary reinforcer) which could be exchanged for a reward (primary reinforcer).
• Tokens act as primary reinforcers to motivate patients to carry out desired behaviours ad their frequency of doing so since they are positively reinforced.
• Reason for Token Economies:

  • Institutionalisation - bad habits formed during long periods in institutions
  • Can be treated with Token Economies if the behaviour falls into 3 categories, as proposed by Matson et al (2016)
  • Personal care
  • Condition-related behaviours
  • Social Behaviours
• Quality of Life: Token economies remain as a standard approach as they improve quality of life within a hospital setting.
• 'Normalises' Behaviour: Token Economies encourages patients' return to more 'normal' behaviour, making it easier to adapt back into the community.
• Target Behaviour: Token Economies are decided individually based on the knowledge of the individual, as proposed by Cooper at al (2007), such as encouraging a patient with avolition to have a daily shower.
• STRENGTH:

  P) There is evidence for the effectiveness of Token Economies.

  E) Glowacki et al (2016) identified 7 high quality studies between 1999 and 2013 on the effectiveness of token economies in hospital settings.

  E) All of the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours.

  L) This supports the value of token economies.
• COUNTERPOINT: This argument encounters the 'file drawer' problem - 7 studies in 14 years is not enough evidence to make this claim as it is mostly negative.
• LIMITATION:

  P) Ethical issues have been raised.

  E) Professionals have the power to control patient's behaviour, meaning imposing one's norms onto others (e.g. patient may like to look 'scruffy')

  E) Restricting the availability of pleasures to those who do not behave will cause patients who are already very ill and distressed more displeasure.

  L) Meaning the benefits of token economies may be outweighed by the impact on freedom and short-term reduction in quality of life.
• LIMITATION:

  P) Existence of more pleasant, ethical alternatives.

  E) Other approaches do not raise ethical issues e.g. art therapy is high-gain, low-risk approach to managing schizophrenia (Chiang et al 2019)

  E) 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 pleasant.

  L) Art Therapy may be a more beneficial approach.