token economy for schizophrenia

what is token economy?

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

For example, people are given rewards (tokens) when they

engage in socially desirable behaviours.

token economy is based of operant conditioning

learning from the consequences of our behaviour

positive reinforcement- behaviour is rewarded gets repeated/strengthened

negative reinforcement- behaviour is strengthened when something unpleasant is removed.

punishment- behaviour is extinguished by punishment consequence.

which symptoms does token economy target?

negative symptoms such as avolition

how does token economy work in the context of schizophrenia?

Patients are set targets. Tokens (secondary reinforcers) are awarded whenever patient achieves targets. Token are later exchanged for meaningful rewards (primary reinforcers).

institutionalisation

develops under circumstances of prolonged hospitalisation.

People often develop bad habits, for example they might cease to maintain good hygiene or perhaps stop socialising with others. Johnny Matson et al. (2016) identify three categories of institutional behaviour commonly tackled by means of token economies: personal care, condition-related behaviours (e.g. apathy) and social behaviour

token economy doesn't cure schizophrenia, but what are the two major benefits?

1. Improves the person's quality of life within the hospital setting, for example make-up for someone who usually takes a lot of pride in their appearance or social interaction for a usually sociable person.

2. 'Normalises' behaviour and this makes it easier for people who have spent a time in hospital to adapt back into life in the community, for example getting dressed in the morning or making their bed.

AO3- evidence for effectivness

Krista Glowacki et al. (2016) identified seven high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues such as schizophrenia and involved patients living in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours. However, seven studies is quite a small evidence base to support the effectiveness of a technique.

AO3- ethical issues

The use of token economies raises ethical issues because it gives professionals considerable power to control the behaviour of people in the role of patient. This inevitably involves imposing one person's (or institution's) norms on to others, which is especially problematic if target behaviours are not identified sensitively. For example, someone who likes to look scruffy and get up late might have these personal freedoms curtailed. Perhaps more seriously, restricting the

availability of pleasures (e.g. having sweets or seeing films) to people who don't behave as desired means that seriously ill people, who are already experiencing distressing symptoms, have an even worse time.

AO3- benefits outside of intuitions

Token economies are very difficult to continue once a person is outside a hospital setting. This is because target behaviours cannot be monitored closely and tokens cannot be administered immediately. On the other hand, some people with schizophrenia may only get the chance to live outside a hospital if their personal care and social interaction can be improved. And perhaps the best way to achieve this is using a token economy during hospital care. This means that token economies may be more beneficial to some patients than others.