Managamenet (token)

• STRENGTH:

  • Evidence for their effectiveness
  • Glowacki et al identified seven high quality studies published 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 negative symptoms and a decline in the frequency of unwanted behaviours

  This supports the value of token economies.
• COUNTERPOINT:

  • However seven studies is quite a small evidence base to support the effectiveness of a technique
  • One issue with a small number of studies is the file drawer problem
  • This phenomenon leads to a bias towards positive published findings because undesirable results have been 'filed away'. This is a particular problem in reviews that only include a small numbers of studies

  This means that there is a serious question over the evidence for the effectiveness of token economies.
• X

  • Existence of more pleasant + ethical alternatives
  • Token economies are helpful for managing schizo there're approaches with a comparable evidence base that do not raise same ethical issue
  • Review Chiang et al concluded that art therapy may be a good alternative
  • Evidence base is small and has methodological limitations but shows that it's a high-gain low-risk approach to managing
  • Even if the benefits are modest this is true for all approaches to treatment unlike alternatives, art therapy is a pleasant experience without major ethical abuses

  may be a good alternative to token economy