6) Token Economy Systems

Briefly define token economy systems in regards to schizophrenia?

Reward systems used to manage maladaptive behaviour patterns due to extended periods of time in hospital.

• Used a lot during the 60s and 70s when long term hospitalisation was the norm.

Outline the process of token economy systems?

Tokens are given to patients immediately after they have carried out a desirable behaviour.

• Delays reduce the effectiveness.

• Target behaviours are individual to the person.

Tokens have no value in themselves, but they can be swapped for tangible rewards such as:

• Sweets

• magasines

• films

• walks outside

Outline the rationale behind token economy systems with reference to a researcher?

Institutionalisation - Bad Habits

MATSON ET AL:
Identified three categories of institutional behaviour tackled by token economies.

• Personal care

• Condition related behaviour

• Social behaviour

Behaviour modification is not a cure.

• It improves life within the hospital setting.

• Makes it easier to adapt back to life in the community after a stay in hospital.

Outline the theory behind token economy systems?

BEHAVIOUR MODIFICATION:
Operant conditioning is used.

However it is not a cure, but is used to improve life within the hospital setting.

• Makes it easier to adapt back to life in the community after a stay in the hospital.

TOKENS ARE SECONDARY REINFORCERS:
They have no value in themselves but gain their power through their pairing with a primary reinforcer (reward).

This generally happens at the start of the programme.

• They are administered together at first.

Name two researchers who studied the token economy system in regards to schizophrenia?

Ayllon and Nazrin

Outline the study by Ayllon and Nazrin?

AYLLON AND NAZRIN:
Studied a ward of women with schizophrenia.

• They carried out a task (e.g: making bed) in exchange for a token.

• This token could be swapped for a gift or privilege.

• This resulted in the number of tasks done increasing.

The use of token economy systems has decreased recently in the UK due to a change of care routines, but also due to ethical issues.

Evaluate one strength of token economy systems?

STRENGTH: EVDIDENCE FOR EFFECTIVENESS

GLOWACKI ET AL:
Meta-analysis of 7 high quality studies conducted between 1999 and 2003, on the effectiveness of Token economy systems for people with chronic mental health issues.

• This was done in a hospital setting

All studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours.

This supports the value of token economies.

Evaluate three limitations of token economy systems?

LIMITATION: QUALITY OF EVIDENCE IN RESEARCH SUPPORT

The seven studies used by Glowacki et al is quite a small evidence base to support the effectiveness of the technique.

• Small numbers of studies leads to the file drawer problem.

  • This creates a bias towards positive published findings and undesirable results are filed away.

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

LIMITATION: ETHICAL ISSUES

It gives professionals considerable power to control the behaviour of the patient.

• The imposition of norms on an individual is problematic if issues are not approached sensitively.

  • Could lead to a restriction of personal freedoms.

• Furthermore, patients with the most distressing symptoms could have an even worse experience due to the remove of small pleasures, an dit being much harder for them to earn any back due to their condition being so severe.

These have led to legal action being taken by relatives of patients, which has led to the ultimate decline of the use of token economy systems.

The negative impact on personal freedom and short term quality of life may outweigh the benefits.

LIMITATION: AN ALTERNATIVE APPROACH IN ART THERAPY

CHIANG ET AL:
Concluded that art therapy may be a better alternative to token economy.

• Although the research size is still small, it presents art therapy as low risk and potentially high gain.

The overall effects of art therapy may be modest but unlike other approaches, it is less confrontational, has a lower risk of side effects, and ethical abuse, and is an overall, more pleasant experience for the patients.

• It is recommended by NICE.

Therefore, it may be more appropriate for the management of schizophrenia.