token economies

• Token economies

  Behaviourist therapy
• Rationale (reasoning)

  • Institutionalisation can lead people to develop bad habits and maladaptive behaviours that are typically associated with negative symptoms
  • Rewards system based on operant conditioning - used to manage maladaptive behaviours often developed through long periods of time in psychiatric hospitals
• Maladaptive behaviours

  • bad hygiene
  • poor ability to socialise
• Token economies don't cure schizophrenia but improves quality of life and makes it easier for hospitals to manage patients and for patients to adapt to life in the community
• How do token economies work?


  Target behaviours are identified. Token = secondary reinforcer, token then swapped for a tangible reward (primary reinforcer) e.g. watching a film. Token = coloured disk administered immediately following target behaviour (positive reinforcement).
• What are token economies used for?

  The management of schizophrenia.
• Matson et al (2016)


  Identified three categories of institutional behaviour that can be tackled using token economies: Personal care, Condition-related behaviours, Social behaviour.

  Modifying these behaviours benefit the patients' quality of life, they become more sociable and motivated to carry out tasks & normalise behaviours. Tokens can be exchanged for ‘privileges’.
• Ayllon and Azrin (1968) - strength of token economies


  Found token economies a successful technique when used with females schizophrenic patients hospitalised for an average of 16 years -> Average number of daily tasks rose from 5 to 42. Token economies help patients take more responsibility for themselves and prevents institutionalisation.
• Upper and Newton (1971) - strength of token economies

   

  Found chronic schizophrenics achieved 3lbs of weight loss a week using a token economy system. Token economies can be helpful for managing the weight gain associated with antipsychotic use.
• Short term effect - limitation of token economies

  Token economies provide only a short-term benefit to patients with schizophrenia and are best used in conjunction with other treatments. Token economies have only been shown to be effective in an institutionalised setting with low transference to the community. Unclear long-term effectiveness.
• Silverstein et al (2009) - limitation of token economies


  Schizophrenics living in communities often struggle with jobs when pay is on a long-term basis (e.g. monthly). Schizophrenics have difficulty engaging in events that obtain distant rewards but engage rapidly when rewarded hourly/daily (they need to be paid more frequently).
• Ethic issues - limitation of token economies

  Restricting the availability of pleasures to those that have the most severe symptoms makes a bad time even worse and those with more severe symptoms might not be able to comply with desired behaviours -> The most severely ill may suffer from discrimination and humiliation -> Dehumanising to take away their right to make choices. Legal action has been a major factor in the decline of token economies in psychiatric hospitals