management of schizophrenia

• Ayllon and Azim used a token economy in a SZ ward. A gift token was given for every tidying act which were later swapped for privileges like films. Mason et al. identified 3 categories of institutional behaviour which occurs in long-term hospital treatment that could be tackled using token economies. The 3 categories were:

  • personal care
  • social behaviour
  • condition related behaviour

  Modifying these had major benefits such as quality of life and to 'normalises' behaviour
• Token economies improve the quality of life within in the hospital setting like putting on make up or becoming more social with other residents
• Token economies normalise behaviour as they encourage the return to more 'normal' behaviour, making it easier to adapt back into the community like getting dresses or making your bed
• Token economies are an example of operant conditioning as they are an example of behaviour modification based on operant conditions. Tokens are secondary reinforcers as they are exchanged for rewards. Tokens that can be exchanged for a range of different primary reinforcers are called generalised reinforcers and these have a more powerful effect.
• One strength of token economies is evidence of effectiveness. Glowacki et al. identified 7 high quality studies published between 1999 and 2013 on the effectiveness of token economies in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours. This supports the value of token economies
• one limitation of token economies is the ethical issues raised. Professionals have the power to control peoples behaviour and this means imposing one persons norms onto others. Also, restricting the availability of pleasures to people who dont behave as desired means that very ill people, already experiencing distressing symptoms, have an even worse time. This means that benefits of token economies may be outweighed by the impact on freedom and short term reduction in quality of life