Token economies

• What are token economies

  Token economies are based on the principles of operant conditioning and are an example of behaviour modification.
• What are the three main steps of token economies

  Firstly, the therapist needs to identify the undesirable or maladaptive behaviour and thus what the desirable behaviours would be. Secondly, they would identify the reinforcers that maintain the undesirable behaviour and then they would restructure the environment so that the undesirable behaviour is no longer reinforced. Additionally, they would give a reward for desirable behaviours, also known as tokens. This would act as a secondary reinforcer. This can later be exchanged for a more tangible reward e.g., sweets or an activity, such as watching TV (primary reinforcers).
• Who are toke economies aimed at?

  This technique is useful for patients who have become institutionalised and have developed bad habits, like struggling to get dressed in the morning. It helps improve their quality of life whilst preparing them for their life outside of the hospital when they are released. It is not frequently used in the U.K. anymore, as many patients are cared for in the community, but it is still widely used in other areas of the world.
• For token economies to work what needs to happen?

  Each patient is treated on an individual basis and target behaviours identified. The tokens should be given immediately after the target behaviour as if they are delayed this can reduce the effectiveness of the therapy. At the start of the programme both token and reward are given together so that the patient can associate the two and the token can become a secondary reinforcer.
• What are the strengths of token economies

  In support of token economies, there has been research to support its effectiveness. Glowacki et al. (2016) found that, in all 7 studies he examined, there was a reduction in negative symptoms and a decline in undesirable behaviours as a result of using token economies. However, this is one of very few studies that demonstrate the effectiveness of token economies and so tis could be a result of publication bias. This is when only positive/significant results are published and studies that have undesirable findings are not. Therefore, it is questionable as to just how effective token economies are in treating schizophrenia.
• What are the weaknesses of token economies

  Doesn't cure SZ

  
  

  Unethical
• Elaborate on not a cure as a weakness for token economies

  The therapy does not address the symptoms of Schizophrenia and so can not be used as a standalone treatment. Also, once patients leave the hospital it is difficult to continue its use as there is no way to administer tokens when they are at home. Therefore, the therapy only really helps patients in the short term, whilst they are under the care of mental health professionals. However, it could be argued that token economies enable a patient to make enough of a recovery to be discharged from hospital and then undertake other longer term treatments, such as CBT.
• Elaborate on unethical as a weakness for token economies


  there is concern over the ethics of using such a treatment. For instance, those with severe symptoms or unresponsive negative symptoms will not attain as many rewards. This can lead to accusations of discrimination and enables clinicians to effectively have power over their patients lives. Also, by limiting rewards to those who are already seriously ill can add to their distress and even worsen their symptoms. Therefore, it could be the benefits of using token economies to treat patients is outweighed by the ethical costs.