token economy

• Token economies are reward systems used to manage the behaviour of people with schizophrenia, particularly those who have developed maladaptive behaviour through prolonged periods of institutionalisation. Mateson et al identified 3 categories of institutionalised behaviour: personal care, condition related behaviours and social care. Modifying these behaviours can increase quality of life and help transitioning into the normal world easier. 
• Token economies aim to modify behaviour through the basis of operant conditioning. This happens through gaining tokens for carrying out a desirable behaviour e.g making the bed every day. The tokens are secondary reinforcers, used to get rewards which are primary reinforcers. Rewards can be watching a film or going on a walk etc. Tokens must be given out as soon as a desirable behaviour is shown to show participants that they get rewarded for carrying out good actions, meaning they will be more likely to repeat behaviour (positive reinforcement).
• Allyon and azrin demonstrated the use of token economies on female schizophrenics in a ward. Everytime they carried out a desirable behaviour e.g making the bed they were given a token which could be swapped for rewards.
• A03

  +One strength of token economies is evidence for effectiveness by Glowacki et al. He identified 7 high quality studies on the use of token economies to treat people with chronic mental health disorders. In all studies, he found a decrease in symptoms of institutionalisation and a decline in unwanted behaviour. However, as only 7 studies were used the file drawer problem becomes apparent as there may be a bias towards reviewing positive studies. Therefore, this means it lacks generalisability to populations as you cannot reliably quantify effectiveness.
• A03

  -However, a major issue regarding token economies is ethical issues raised. Token economies give professionals power to control the behaviour of patients. This results in one person’s norms being forced on another, which can restrict their freedom. Additionally, if a mentally ill patients’ pleasures are being restricted, this can lead to distressing symptoms which can further worsen their condition. These ethical issues raised have resulted in legal action being taken by families which has resulted in a reduction in token economies used as a treatment.
• A03

  -Moreover, there are other additional treatments for treating schizophrenia that do not have ethical issues associated with them. Chiang et al concluded that art therapy is a suitable alternative therapy to treating schizophrenia, as it has a high gain low risk approach. While benefits are modest, it provides a pleasant experience for individuals, while being provided appropriate support. Therefore, this means there is better practicality for alternative treatments compared to token economies, as there is no risk of ethical issues or side effects.