Token economies + AO3

• How is it used?

  • a reward system
  • for those with maladaptive behaviour e.g. bad hygiene
  • primarily used with institutionalisd individuals
  • based on operant conditioning
• Not a cure for SZ (doesn't treat SZ) but an attempt to manage the behaviour of the patient and modify it so they can continue living 'normally'

  By using positive reinforcement, maladaptive behaviour can be reduced

  • awarded tokens for good/appropriate behaviour e.g. having a shower
  • tokens are accumalated
  • tokens can be exchanged to obtain priviledges e.g. a pack of cigarettes
• Strength

  • Dickerson - meta-analysis of 13 studies
  • token economies were found to be beneficial in 11/13 studies
  • effective in institutions with patients who are resistant to other forms of therapy
  • especially effective when used in combination with psychosocial and/or drug therapy
  • use of token eoncomies can help improve day to day funtioning of those with SZ, particularly in improving negative symptoms like social withdrawal or avolition
• Limitations

  • Token economies are only really appropriate for patients who are in a highly structured environment/institution
  • although the concept token economies are intended to transfer to other environments, rewards are no longer given in an unstructured environment e.g. in a normal community
  • = symptoms may reappear or become more of a problem again
  • questions whether this is a useful form of therapy (most patients are treated within the communisty now)
  • Ethical concerns
  • the patients are essentially being controlled by the institutional therapists, so they only recieve a token when showing the 'desired' behaviour
  • limits the free will of the patients, they cannot choose how to behave
  • the patient's rights are being limited, this can be viewed as demeaning and unethical