management of sz

• Token economies

  A form of behaviour modification reward system used to stimulate socially acceptable behaviours
• Desirable behaviours encouraged by token economies

  • Daily showers for someone suffering with avolition
• Token economies

  • Desirable behaviours are encouraged by selective reinforcement
• Token economies are used less now due to it being unethical to restriciting rewards to ill people
• Institutionalisation

  Bad habits formed during long periods in hospital
• Treating institutionalisation with token economies

  Behaviours must fall into 3 categories: personal care, social behaviour and condition-related care
• how and why do token economies work?

  • for behaviour modification to occur using operant conditioning, target behaviours for tokens are agreed upon first. Cooper (2007) argues target behaviours need to be individually personalised e.g. daily showers for avolition 
  • When the behaviour is performed, a plastic disc, a secondary reinforcer is given to the person immediately as a delayed reward isn't effective The token can then be exchanged for a primary ‘meaningful reinforcer’   
• Token economies work - Glowacki (2016) identified 7 studies over 17 years and all found a reduction in negative symptoms
• 7 studies over 17 years is a small sample size
• The 'file drawer problem' means there may be bias towards publishing positive results when negative results have been filed away
• Chiang (2019) found art therapy to be more ethical and effective than token economies, and NICE recommends art therapy
• Token economies are not effective outside of institutions


  There are no rewards to be given for target behaviours
• A counterpoint is that token economies still have value as they may get a person out of hospital and back home