AO3 - Token Economies

• One limitation of token economies as a management technique for schizophrenia is that there is limited evidence to support the effectiveness. A review of 3 studies investigating the use of token economies found that there was a limited impact on the management of patients with schizophrenia as only one of the 3 studies showed any improvement in symptoms and no significant positive change in maladaptive behaviours. Therefore casting doubt on the effectiveness of token economies as a management technique for schizophrenia.
• The use of token economies can raise ethical issues. The major issue is that privileges become more available to patients with mild symptoms and less available to those with more severe symptoms that prevent them from complying with desirable behaviours. Token economies suggests that symptoms of sz can easily be bypassed if they seek the reward. However, this leads to the most severely ill patients suffer discrimination, as the severity of their symptoms prevents them from accessing this programme. Therefore, reducing the use of token economies to manage sz as they may not be appropriate.
• Another issue with token economies is that they do not get to the root cause of sz. The aim is to make sz more manageable and improve patients' quality of life. Whilst this is important, the therapy does not treat sz. Also, token economies is mainly effective in an institutionalised setting and when patients are sent back home, they lose the structure they had to help manage their behaviour. (For example...) This questions the appropriateness/effectiveness of the therapy in managing sz, as there is high chance of relapse when patients are given independence.