Token Economy

• Dickerson meta-analysis


  • 13 studies using token economy systems
  • 11 with beneficial effects directly attributed to them
  • Effective at increasing the adaptive behaviours of patients with Sz
• Lack of control


  • All patients on psychiatric ward brought into program
  • No random allocation
• McMonagle and Sultana findings

  • Only 3 studies where patients had been randomly allocated to treatment and control conditions
  • Total of only 110 patients being studied
  • Only 1 of the 3 studies showed improvement in symptoms
  • None yielded useful information about behaviour change
• If not randomly allocated

  The ones who have more room for improvement in symptoms will be put on it so improve regardless of the treatment - researcher bias
• Token economy method


  • Only works in hospital setting
  • Problems administering with outpatients who live in the community
  • Inpatients receive 24-hour care so better control for staff to monitor and reward patients appropriately
  • Outpatients only receive day treatment for a few hours so can only be used for part of the day
• Ethics of token economy method

  • Privileges and services become more available to patients with mild symptoms than those with more severe symptoms that prevent them from complying with desirable behaviours
  • Most severely ill patients suffer from discrimination as they don't receive the token economy treatment
  • Same rewards regardless of amount of effort required to do the activity