Token Economies - AO3

• Strength of token economies

  • There's research support - an effective method of management of symptoms - Dickerson et al - reviewed 13 studies of the use of token economies - 11 reported beneficial effects directly attributable to the use of token economies to increase adaptive behaviour
  • Suggests token economies is an effective way of managing negative symptoms -patients who received token economies can improve behaviour and make it more socially acceptable and less maladaptive
  • Can be tailored specifically to individual target behaviour - flexible - nurses can identify individual maladaptive behaviours and modify rewards to each individual specific needs - e.g. one patient may be influenced to carry out adaptive behaviours, such as washing themselves, by being rewarded with chocolate, however, another patients incentive may be watching a movie - this isn't problem because nurses can give specific rewards to different individuals and therefore is more effective in managing patients behaviour
• Weakness of token economies

  • There are some ethical issues in which Token economies are not favoured by all clinicians as they feel that the therapy can be humiliating and do not empower the patient
  • There are a number of ethical concerns concerning the appropriateness of token economy programmes in psychiatric settings with schizophrenic patients - Clinicians may exercise control over important primary reinforcers such as food, privacy or access to activities that alleviate boredom - Patients may then exchange tokens if they display the target behaviours - However, all human beings have certain basic rights that cannot be violated
  • It could be argued that using token economies doesn't really help the patient, it just makes the behaviour more acceptable to other people and its very aim is to encourage more 'desirable behaviour
• Further limitation of token economies

  • Existence of more pleasant and ethical alternatives - Even if token economies can be helpful for managing schizophrenia there are other approaches with a comparable evidence base that do not raise the same ethical issues
  • Art therapy might be a good alternative - The evidence base is regularly small and has some methodological limitations, but it appears to show that art therapy is a high-gain low-risk approach to managing schizophrenia - Even if the benefits of art therapy are modest, this is generally true for all approaches to treatment and management of schizophrenia and, unlike alternatives, art therapy is a pleasant experience without major risks of side effects or ethical abuses - NICE guidelines recommend art therapy for schizophrenia