token economy and the management of schizophrenia

what is a token economy?

a form of therapy where desirable behaviours are encouraged by the use of selective reinforcements. rewards are given as secondary reinforcers when individuals engage in socially desirable behaviours and these tokens can then be exchanged for primary reinforcers e.g., food/privileges

why is token economy used to treat SZ?

to treat negative symptoms

what are token systems based on?

operant conditioning

what are the two types of positive reinforcers?

• primary

• secondary

what are primary reinforcers?

anything that gives pleasure or remove unpleasant states and does not depend on learning to acquire value

what are secondary reinforcers?

initially have no value but acquire reinforcing properties as a result of being paired with primary reinforcers e.g., the tokens

how is a reinforcer maximally effective?

it is delivered immediately after the performance of the target behaviour

how does token economy work?

1. tokens are paired with rewarding stimuli and become secondary reinforcers

2. patient engages in target behaviours or reduces undesirable ones

3. patient is given tokens for engaging in these target behaviours

4. patient trades these tokens for access to desirable items or privileges

what are examples of target behaviours for schizophrenics?

• getting dressed

• washing

• eating

what is an example of a token economy being used?

Ayllon & Azrin

what did Ayllon & Azrun do?

• used a token economy on a ward of female SZ patients

• many had been hospitalised for years

• given plastic tokens with ‘one gift’ embossed for good behaviour e.g., making bed

• exchanged for privileges e.g., watching a movie

what did Ayllon & Azrun find?

use of a token economy dramatically increased the number of desirable behaviours that patients performed each day

what does the token become when it can be exchanged for a variety of different privileges and rewards?

generalised reinforcer

what did Sran & Borrero do?

compared behaviours reinforced by tokens which could be exchanged for a variety of preferred edible items

what did Sran & Borrero find?

all pps had higher rates of responding in those sessions where tokens could be exchanged for a variety of items

why might the effectiveness of a token economy decrease?

if more time passes between the presentation of the token and exchange for the backup reinforcers

what are the strengths of the token economy?

• RS: Dickerson et al - reviewed 13 studies using token economy systems for SZ - 11 had reported beneficial effects that were directly attributable to the use of token economies - concluded that token economies increase adaptive behaviours of schizophrenics - did caution that many studies had significant methodological shortcomings that limited their impact in the overall assessment of token economies

what are the weaknesses of token economy?

• difficulties assessing success - Comer: studies of TE tend to be uncontrolled - when they are introduced to wards, all patients are brought into the programme rather than having an experimental and control group - patient’s improvement can only be compared to pasty behaviour - comparison might be misleading as other factors may cause an improvement e.g., increase in staff attention

• less useful for patients living in community - only shown to work in hospital settings - Corrigan: problems administering the token economy with outpatients - 24 hour care means there is better control for staff to monitor and reward patients - outpatients only receive treatment for a few hours a day - results may not be maintained past the hospital environment

• ethical concerns - clinicians may exercise control over primary reinforcers e.g., food, privacy or access to activities that alleviate boredom - humans have basic rights that cannot be violated - psychological harm & manipulation