Token Ecconmies can be used to manage Schizophrenia

What are the features of token economies?

1. Behavioural treatments for schizophrenia are based on operant conditioning - learning through reinforcement.

2. Token economies can help encourage people in psychiatric institutions to perform socially desirable behaviours, e.g. getting dressed and making their beds. Patients are given tokens that reinforce these behaviours. They can then exchange them for something they want, like sweets or cigarettes.

What are token economies?

• Token Economies are reward systems used to manage the behaviour of patients with schizophrenia, in particular, those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals (referred to as institutionalised)

• Under these circumstances, it is common for patients to develop bad hygiene or perhaps remain in pyjamas all day.

• Modifying these bad habits does not cure schizophrenia but it improves the patient’s quality of life and makes it more likely that they can live outside a hospital setting

What are the rewards?

• Although the tokens have no value in themselves they can be swapped later for more tangible rewards

• Tokens economies are a form of behavioural therapy based on operant conditioning

• Tokens are secondary reinforces because they only have value once the patient has learnt they can be used to obtain rewards

• These rewards might be in the form of materials such as sweets or cigarettes or services such as having a room cleaned or privileges such as a walk outside the hospital

What method did Ayllon and Arzin use when studying the use of token economies?

• 45 female patients with schizophrenia received tokens for 'good' behaviours (e.g. making their beds).

• These could later be exchanged for rewards. Tokens were taken away for bizarre behaviour.

• Naturalistic observation was used to assess the effectiveness of this procedure in changing behaviour in the hospital ward.

What are the results of Ayllon and Arzin's use when studying the use of token economies?

The women, who had been institutionalised for an average of 16 years and displayed bouts of screaming, incontinence, aggression and low social skills (eg. eating by shoving their faces into the food), showed a massive improvement through the incentive of receiving privileges

What is the conclusion of Ayllon and Arzin use when studying the use of token economies?

Token economies can exert control over behaviour to give patients back a sense of dignity

What is the evaluation of Ayllon and Arzin use when studying the use of token economies?

The participants were all women, so the results can't be generalised to the real world

What are the advantages if token economies?

• Token economy programmes can produce significant improvements in self-care and desirable behaviour, even with chronically institutionalised people with schizophrenia.

• This means they work best within institutions - people who stay in institutions often lose the motivation to care for themselves, something token economies directly address.

• For example, Paul and Lentz (1977) compared the use of a token economy system with standard hospitalisation. They found that the people with schizophrenia whose disorder was managed using token economies showed the greatest improvement in behaviour.

What are the disadvantages of token economies?

• Token economies don't have high ecological validity - they don't transfer into the real world. Once people are away from institutions they often don't continue showing desirable behaviour, because there's nothing to reinforce it.

• The patients' behaviour might be superficial - they might only produce desirable behaviour if they're going to receive a token.

• There are ethical issues surrounding the use of behavioural therapy. It could be argued that it doesn't really help the patient, it just makes their behaviour more acceptable to other people. Depriving patients of rewards may be seen as infringing on their human rights. However, it may be justified if the outcome is that the patients get back their independence.

What are ethical issues with token economies?

• Although psychological treatments do not have serious side effects like drug treatments, they can raise ethical issues

• The major issue is that privileges, services etc. become more available to patients with mild symptoms

• This means that the most severely ill patients suffer discrimination

What is the quality of evidence of token economies?

• Many small-scale studies in which mental health professionals have compared patients before and after psychological treatments have found positive results.

• However, these studies have problems; there is often no control group, and patients are not randomly assigned but outcomes are usually more optimistic