Management of schizophrenia

• What are token economies?

  • Methods of behaviour modification involving rewards that are desired by the individual and desired behaviours to achieve these agreed before the programme
  • Looks to change behaviour by extinguishing undesirable behaviours and reinforcing desirable behaviours using rewards
  • Generally used in institutions and based on operant conditioning
• How were token economies developed to manage schizophrenia?

  • Carried out by Ayllon & Azrin (1968) who trialled a token economy system in a ward of women diagnosed with schizophrenia
  • Every time they made their beds or cleaned up they were rewarded with a plastic token that could be swapped for ward privileges like watching films
  • Found that the number of tasks increased significantly
• What is the rationale for token economy programmes?



  • An outcome of institutionalisation is bad habits, such as bad hygiene or reduced socialisation. Matson et al. (2016) said token economies tackle 3 things: personal care, condition-related behaviours (like apathy) and social behaviours
  • Benefits include improving the person's quality of life within the hospital setting and 'normalises' behaviours, which makes it easier for them to adapt back into life in the community
• What is one strength of token economies?

  • Research support for effectiveness: Dickerson et al. (2005) reviewed 13 studies using token economy programmes and 11 reported beneficial effects that were directly attributable to the use of these programmes
  • Glowaki et al. (2016) identified 7 high quality studies that examined the effectiveness of TEPs for patients with chronic mental health issues -> all showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours
  • Studies show support for the function and value of token economies
• What is one limitation of token economies?

  • Ethical issues: gives professionals considerable power to control patients' behaviours, inevitably involving imposing one's norms onto others that could lead to personal freedoms curtailed
  • Restricting the availability of pleasures to seriously ill and already distressed patients may make things worse for them. Families who have taken legal action because of this has been a major factor in the decline in use of token economies
  • Shows the benefits of TEPs may be outweighed by restriction of personal freedom and short-term reduction in quality of life
• What is another limitation of token economies?

  • Alternative approaches: there are other approaches with a comparable evidence base that do not raise the same ethical issues
  • Chiang et al. (2019)'s review concluded that art therapy may be a better alternative due to high gain and low risk despite modest benefits
  • Offers a pleasant experience without major side effects and is also recommended by NICE, weakening the value of TEPs as there are safer alternatives that are more preferrable
• What is another limitation of token economies?

  • Difficulty with outpatients: Corrigan (1991) argues that there are problems administrating the token economy method with outpatients who live in the community - within a psychiatric ward setting, inpatients receive 24-hour care and so there is better control for staff to monitor and reward patients appropriately
  • However, outpatients living in the community only receive treatment for a few hours a day, meaning the token method could only be used for part of the day
  • As a result, even if the token economy did produce positive results within the ward setting, these results may not be maintained beyond that environment, weakening its' effectiveness