psychological treatments for schizophrenia: token economy

What is token economy

It is a behavioural approach to managing schizophrenia, in particular with those who have developed patterns of maladaptive behaviour as a result of spending long periods in psychiatric hospitals.

There are 3 categories of institutionalised behaviour tackled by token economies: Personal care, condition- related behaviours (eg; empathy) and social behaviour.

There are 2 major benefits:

1. Improves quality of life

2. Normalises behaviour, helping to adapt back into the community

How is token economy implicated?

• Patients are reinforced for behaving desirably by being given immediately to individuals when they have carried out a desirable behaviour

• These target behaviours must be decided on an individual basis and it is impotent to know the erosion in order to identify the most appropriate target bvrs for them

• Although the tokens have no value in themselves they are swapped for later more tangible rewards. Having some form of immediate reward for target behaviours is important because delayed rewards are less effective

• Token economy is therefore an example of bvr modification

• And is based on the principles of operant conditioning

• The tokens act as secondary reinforcers And the meaningful rewards are called primary reinforcers

Evidence for the effectiveness

There is evidence for the effectiveness of token economy

Gershone et al found token economy treated sufferers spent more time doing activities less time in bed and made fewer disturbing comments to other patients on the ward

Token economies do help in terms of making patients behaviour more socially acceptable so that they can reintegrate better into society. It can also make facilities safer and more stable in hospitals

However it is probably most effective when combined with other treatments and should therefore not be seen as a treatment in itself

Ethical issues

There are ethical issues. Token economy is not favoured by all clinicians some see it as humiliating and not beneficial in real life settings

The major issue is that those with the most severe symptoms are unlikely to earn the tokens as their symptoms prevent them complying with desirable behaviours

Treatment is patronising. This is becasye it is giving the impression that schizophrenics can be moulded in the same way as children

This reduces the value of treatment because we may create a social stigma is people with SZ are being treated in this way as it impacts their personal freedom

Too simplistic

It is too simplistic - a treatment should aim to ‘cure’ but this is not the case

The approach is to manage schizophrenia rather than treat it

It is token learning, rather than a form of treatment

Token economy in lives learning to imitate normal behaviours which a therapist believes are desirable