management of schizophrenia

• Token economies

  A form of behavioural modification, where desirable behaviours are encouraged by the use of selective reinforcement
• Token economies

  • People are given rewards (tokens) when they engage in socially desirable behaviours
• Tokens

  Secondary reinforcers that can then be exchanged for primary reinforcers - food or privileges
• developing token economies - schizophrenia

  • Ayllon and Azrin
  • trialled a token economy system in a ward of women with a diagnosis of schizophrenia
  • making bed or cleaning up - plastic token with 'one gift'
  • swapped for ward privileges
  • number of tasks carried out increased significantly
  • Their use has declined in the UK - growth of community-based care and the closure of psychiatric hospitals and ethical issues of restricting rewards to people with mental disorders
• rationale for token economies - schizophrenia

  • institutionalisation - prolonged hospitalisation
  • develop bad habits
  • Matson - token economies tackle personal care, condition-related behaviours and social behaviour
  • this improves persons quality of life within hospital setting
  • normalises behaviour which makes it easier for people who have spent time in hospital to adapt back into community
• what is involved in token economy - schizophrenia

  • token given to individuals immediately when they have carried out desirable behaviour
  • target behaviours decided on an individual basis
  • swapped for rewards
• theoretical understanding of token economies - schizophrenia

  • behaviour modification - operant conditioning
  • tokens = secondary reinforcers - only have value once person learns they are used to obtain meaningful rewards
  • meaningful rewards - primary reinforcers
  • secondary reinforces need to be paired with primary reinforcers
• AO3 - token economies - strength

  P: evidence for their effectiveness

  E: Glowacki - 7 high quality studies published examined the effectiveness of token economies for people with chronic mental health issues in a hospital setting - showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours

  L: supports the value of token economies
• AO3 - token economies - limitation

  P: ethical issues raised

  E: gives professionals power to control behaviour of patient - imposes their norms on others

  resticting the availability of pleasures to people who don't behave how desired - means ill people experience more distress

  L: benefits outweighed by the impact on personal freedom and short-term reduction in quality of life
• AO3 - token economies - limitation

  P: existence of more pleasant and ethical alternatives

  E: Chiang - art therapy might be a good alternative - high-gain low-risk approach to managing schizophrenia - pleasant experience without side effects or ethical abuse

  NICE guidelines recommend art therapy for schizophrenia

  L: art therapy might be a good alternative to token economies