token economies treatment for AN

what is token economies?

structured systems of positive reinforcement to discourage behaviours

what theory is this based on?

operant conditioning

how does token economies work?

an individual earns tokens for exhibiting specific target behaviours. The tokens can then be exchanged for backup reinforcers of behaviour such as rewards or privileges

why is hospitilisation necessary for it to work?

necessary at first to make sure the patient adheres to it. makes it easier to carry out when they are under 24/7 supervision and care

what sort of behaviours are rewarded for AN?

not purging, reaching a target weight, eating regular meals

what about the patient is observed closely?

daily fluid intake, daily calorie intake (should start between 1500-2000), daily feeds (6 equals feeds throughout the day)

what is important to consider with the target behaviours

need to be measurable, achievable and relevant

what is important to consider with consistency

you need to be consistent with reinforcing behaviour to avoid the patient giving up

what is important to consider with primary reinforcers

use good motivators that are significant to the patient

what is the primary reinforcer and secondary reinforcer

primary reinforcer- reward/privilege

secondary reinforcer- token

what is shaping

making tokens harder to obtain throughout the recovery process. It encourages bigger, necessary steps for recovery and prepares the individual for outpatient life

sonoda et al 1974 evidence (strength)

a 10 year old girl was 20kg, treated for 2 months with appetite stimulants with no result, but then used token economies and gained 5kg in 9 months. A follow up study showed continued weight gain

ayllon and azrin 1968 evidence (strength)

40 patients all found token economies to be effective, regardless of individual traits (age, iq, diagnosis, and length of hospitilisation)

field et al 2004 evidence (strength)

3 young people didnt respond to treatment until rewards were more immediate and frequent, showing reinforcement schedules to be important

bhanji and thompson 1974 evidence (weakness)

10/11 patients gained weight, but on 3 reported a consistent weight gain months after hospitalisations. Shows long term maintenance to not be effective

other treatments (strength)

can be used alongside other treatments like drugs or CBT, allowing for a tailored flexible approach

objective measures (strength)

not reliant on self report measures, but rather objective weight measures

root cause (weakness)

only deals with the symptoms, does not help the root cause