SZ 14 Token economy

Explain the general aims / logic of using token economy for managing schizophrenia (3)

* Behavioural therapy, involving operant conditioning

* Positive reinforcement for positive behaviour for institutionalised patients

* To manage (not treat) behaviour in hospital and transition to community

Explain the processes used in using token economy for managing schizophrenia (5)

* Tokens = secondary reinforcers

* 'Saved' to pay for primary reinforcers

* e.g., outside visits

* Tokens given for positive behaviours

* (e.g.) hygiene, sociability, punctuality

Explain what research shows about the effectiveness of using token economy for managing schizophrenia (4)

* TE reduces negative symptoms + 'target behaviours' e.g., aggression (Glowacki- review of trials)

* Fewer studies than of therapies for SZ

* Benefits less certain

* No evidence available on effects on transition to community

(*McMonagle & Sultana's meta- analysis is less confident of the benefits due to lack of clinical trials)

Explain the challenges of designing a token economy system for managing schizophrenia in a psychiatric hospital (5)

* Needs to be personalised / appropriate to patient ...

* ....by severity of illness, target behaviours and primary reinforcers

* But this can lead to perception of unfairness

* But so will making it the same for everyone!

* Could be used manipulatively by staff

Explain an argument against and for the idea that benefits from the use of token economy with schizophrenic patients would transfer to life outside (2x2)

* Lapse into bad habits outside structured reinforcement...

*...i.e., when behaviours are no longer reinforced

* Habits may be reinforced in interactions with others,

* e.g., punctuality leading to getting a job