Token economies

• Token economies

  A form of behavioural modification, where desirable behaviours are encouraged by the use of selective reinforcement e.g. people are given rewards (tokens) when they engage in socially desirable behaviours. The tokens are secondary reinforcers and can then be exchanged for primary reinforcers – food or privileges
• Token economies

  • Developed for use with people with schizophrenia
  • Trialled by Ayllon and Azrin in 1968 in a ward of women with diagnosed schizophrenia
  • Participants given plastic tokens embossed with 'one gift' for carrying out tasks like making their bed or cleaning up
  • Tokens could then be swapped for ward privileges like watching a film
  • Extensively used in the 1960s and 70s when the norm for treating schizophrenia was long term hospitalisation
  • Use in the UK has now declined due to growth of community-based care, closure of psychiatric hospitals, and ethical issues raised by restricting rewards to people with mental disorders
  • However, token economies remain a standard approach to managing schizophrenia in many parts of the world
• Rationale for token economies

  • Commonly used to tackle 3 categories of institutional behaviour: personal care, condition-related behaviours (e.g. apathy) and social behaviour
  • Modifying these behaviours doesn't cure schizophrenia but improves the person's quality of life within the hospital setting and 'normalises' behaviour to make it easier for people to adapt back into life in the community
• Why token economies work


  • Tokens have no value in themselves, they are swapped later for more tangible rewards
  • Having some form of immediate reward for target behaviour is important because delayed rewards are less effective
  • Rewards in a hospital setting acquired through token economies must be administered straight away
• Rewards in token economies

  • Sweets
  • Magazines
  • Access to activities like a film or a walk outside
  • An appointment with a social worker to plan for life after hospitalisation
• Theoretical understanding of token economies

  • Token economies are an example of behaviour modification - a behavioural therapy based on operant conditioning
  • Tokens are secondary reinforcers because they only have value once the person receiving them has learned they can be used to obtain meaningful rewards
  • The meaningful rewards are primary reinforcers
  • In order for the tokens to become secondary reinforcers, they are paired with primary reinforcers, so at the start of a token economy programme, tokens and primary reinforcers are administered together
• Glowacki et al. (2016) identified 7 high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as schizophrenia and involved patients living in a hospital setting
• All the studies showed a reduction in in negative symptoms and a decline in the frequency of unwanted behaviours, supporting the value of token economies
• 7 studies is quite a small evidence base to support the effectiveness of a technique
• The file drawer problem leads to a bias towards positive published findings because undesirable results have been 'filed away', meaning there is a serious question over the evidence for the effectiveness of token economies
• The use of token economies raises ethical issues because it gives professionals considerable power to control the behaviour of people in the role of patient, which is especially problematic if target behaviours are not identified sensitively
• Legal action by families who see their relative in this position has been a major factor in the decline in the use of token economies, meaning the benefits may be outweighed by their impact on personal freedom and short-term reduction in quality of life
• There are other approaches to managing schizophrenia with a comparable evidence base that do not raise the same ethical issues, such as art therapy which is recommended by NICE guidelines