token economies - dealing with schizophrenia

what is a token economy in the context of schizophrenia

a formal behavioural therapy based on the principles of operant conditioning/reinforcement, used for long-stay patients to manage symptoms of sz that make independent living difficult

what is institutionalisation in the context of schizophrenia

psychological state where patient becomes desensitised to the outside world due to long-term hospitalisation, patient may develop avolition (lack of motivation), TEs aim to counter this apathy

target behaviour in the context of schizophrenia

specific, observable, and measurable action identified for change, objectives broken down into small steps e.g. maintaining hygiene, socialising for 15 minutes

primary reinforcer in the context of schizophrenia

stimulus that is naturally rewarding because it meets a biological or basic need, actual goods or services the patient wants e.g. magazine, snack, walk in the hospital grounds

secondary reinforcer in the context of schizophrenia

stimulus that has no intrinsic value but becomes rewarding through association with a primary reinforcer, tokens associated with primary reinforcers they can be exchanged for

process of token economy in institution setting

1-patient has no access to tokens and so no rewards, 2-patient performs target behaviour which has been designed on an individual basis, 3-patient is given a token (secondary reinforcer), 4-patient exchanges tokens for tangible rewards (primary reinforcer) e.g. sweets, watching a film so specific target behaviour is learned and repeated

aims of token economies

reduce the impact of institutionalisation, support patient transition to non-clinical settings by reinforcing necessary, desirable behaviours - promotes good hygiene and nutrition, rewards and encourages pro-social behaviour, reduces apathy/increases motivation and self-efficacy

research support from aylon and azrin 1968

trialled token economy system in ward of sz women, number of tasks carried out increased significantly, increased reliability with empirical evidence

research support from dickerson 2005

reviewed 13 studies of the use of TE in the treatment of schizophrenia. 11/13 studies reported beneficial effects that were directly attributable to the use of token economies, increased reliability with empirical evidence

sran and borrero’s research 2010

found that all patients in the study preferred exchanging tokens for a variety of edible items rather than one highly preferred edible item, indicates importance of personalised reward system

research support from matson

identified 3 categories of institutional behaviour tackled by te: personal care, condition-related behaviours, social behaviour

idiographic approach research support from cooper et al

target behaviours are decided on an individual basis and it is important to know the person in order to identify the most appropriate target behaviours for them however also nomothetic as principle of tokens same across all prisons

refuting research from chiang 2019

review - found art therapy may be good alternative despite modest benefits, less risk of side effects + ethical abuse

refuting research from comer 2013

biological explanation received most research support to date, sz is nature not nurture, tes are environmentally reductionist and oversimplify a complex condition by not taking into account biological precursors

research support from glowacki 2016

identified 7 high qual studies between 1999-2013 examining te effectiveness - reduced neg symptoms + unwanted behaviours, increased reliability

ethical issues of token economies

power dynamic, infantilisation, social control/social norm imposition