Psych treatments 3- token economy

What are token economies?

A behaviourist approach to the management of schizophrenia where tokens are rewarded for demonstrations of desired behavioural change. Behavioural therapy

Where are token economies used?

Long stay hospitals

How do token economies work?

• the technique uses operant conditioning.

• Patients receive tokens immediately after desired behaviour (I.e. brushing teeth, taking medication etc.)

• The tokens can then be exchanged for goods or privileges e.g. gym, sweets, watching TV etc.

• Primary reinforcers - treats

• Secondary reinforcers- tokens

Aims of token economies

• Reduce negative symptoms such as avolition, social withdrawal in those hospitalised long term

• enable patients to leave hospital and live independently

• Reduce negative symptoms in the long term

AO3- effectiveness

P- some evidence to support the effectiveness of token economy within a care setting

E- ✅McMonagle and Sultana- small study found this therapy improved negative symptoms over 3 months when used in psychiatric hospitals - partially supports token economy as a way of managing schizophrenia and reducing symptoms

E- ❌ effects may not be maintained beyond the care setting. If desirable behaviour becomes dependent on being reinforced, when the rewards stop when individuals with schizophrenia are no longer in the long term hospitalised setting the individual may no longer display the desired behaviour- negative symptoms will return - could lead to relapse and high re-admittance rates

L- overall there is limited evidence to support the effectiveness of token economies in the long term

AO3- appropriateness

P- using token economies in psychiatric institutions raises ethical concerns

E- critics argue than token economies are dehumanising. As they rely on rewarding vulnerable patients with everyday pleasures, such as watching TV for behaviour deemed appropriate/easier to manage using operant conditioning this could be seen as unethical. They are denying people with schizophrenia these pleasurable activities until they behave in a way that the institution deems desirable, whilst these activities are freely available outside of the institution- punishing people for having schizophrenia

E- also not appropriate outside of the hospital, not really a therapy because not really addressing symptoms more managing them

L- raises serious moral and ethical questions as to whether token economies should be used as a way of managing symptoms of schizophrenia within a hospital setting, as well as the appropriateness outside of a hospital

AO3- applications

P- positive applications of schizophrenia can be questioned

E- does not reduce distress or allow people to carry out daily tasks in the real world, such as having a job

E- however can motivate people to carry out daily tasks in hospital and reduce negative symptoms so that sufferers can be discharged from hospital

L- can have useful applications

AO3- interactionism

P- better to consider token economies as a combination treatment

E- e.g. Drug therapy p+ token economies are often used in combination

E- drug therapy (biologically- treat and reduce symptoms) + token economies (motivate patients within a hospital environment- reduce negative symptoms)

L - taking an interactionist approach could be a better way to treat and manage schizophrenia for patients in a long term hospital environment