You may have come across a token economy system before. Teachers may have used them in schools to incentivise good behaviours, and parents may have used them at home to encourage children to do chores. But what are token economy systems? How do we treat schizophrenia using token economy systems?
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Jetzt kostenlos anmeldenYou may have come across a token economy system before. Teachers may have used them in schools to incentivise good behaviours, and parents may have used them at home to encourage children to do chores. But what are token economy systems? How do we treat schizophrenia using token economy systems?
Research into schizophrenia and psychosis has explored various aspects of addressing symptoms, from cognitive behavioural therapy to therapy focused on families. Token economy systems (TES) are based on operant conditioning and are an old favourite of hospitals treating schizophrenia. Let’s explore TES further.
Token economy systems (TES) are a form of psychological therapy based on operant conditioning, which uses a reward system to manage maladaptive behaviours. Good behaviours earn tokens (secondary reinforcers) that can be exchanged for a reward (primary reinforcers), such as magazines or favourite foods.
Maladaptive behaviours prevent the patient from adapting to new or difficult situations, often resulting in avoidance and withdrawal from social settings. Maladaptive behaviours are often viewed as negative and potentially harmful.
TES can be used as a means of changing the behaviour of a patient with schizophrenia, and they are not a new concept in the world of psychology.
Maladaptive behaviours tend to develop during prolonged hospital stays.
Today, families are more likely to care for patients with schizophrenia at home, with increased access to education and help for patients. TES has declined in popularity in recent decades for several reasons discussed below.
Token economy systems have been used since the 1960s to help treat patients with schizophrenia. Token economies encourage ‘correct’ behaviours in the patient and discourage ‘incorrect’ behaviours. These actions are usually related to a patient’s positive and particularly negative symptoms, such as depression, social withdrawal and poor motivation.
For example, if a patient suffers from despair and depression and refuses to get dressed, he receives a token when he does get dressed.
Despite being placed in an institution primarily to treat their illness, institutionalisation can exacerbate a patient’s symptoms. Bad habits and maladaptive behaviours may develop, such as problems with hygiene, disruptive behaviour, and decreased socialisation with other patients/staff.
This can be further exasperated by the fact that these behaviours impact the caregivers’ treatment of the patient, as constant aggression and acts of violence can cause caregivers and physicians to dislike the patient despite their best intentions. Through operant conditioning, TES can address these problems, in which desired behaviours are repeated and learned.
When a patient enters a hospital for treatment and a TES is used, the first step is for the patient to begin associating the token with the reward. The targeted behaviours are identified and should be observable and measurable for fairness.
Primary reinforcer: the reward serves as the primary reinforcer. It is intended to show the patient what they can achieve by engaging in desirable behaviours. Examples of token economies include sweets, magazines, films, and day trips.
Secondary reinforcer: tokens act as secondary reinforcers. The patient can tangibly earn what they can then be exchanged for a reward.
Matson et al. (2016) identified three categories of problematic behaviours that develop in a hospital and can be addressed through the use of token economies:
Personal hygiene issues (problems with hygiene such as showering, changing clothes, and brushing teeth).
Illness-related behaviours (problems with positive and negative symptoms).
Social behaviours (problems in dealing with other people).
It is important to note that TES effectively reduces symptoms and addresses the above problems. However, it is not a cure (Matson et al., 2016).
The secondary enforcer (token) gains power by being associated with a desirable reward. Patients then work toward earning these rewards with a certain number of tokens that are predetermined, exhibiting ‘better’ or more desirable behaviours, ultimately combating their symptoms.
According to the theory behind TES, the behaviours should be maintained and become routine.
Patients have to want to perform certain behaviours. They may be encouraged, but factors such as the person’s current level of motivation may influence the impact of the token economy on their behaviour.
Thus, in the case of schizophrenia, TES addresses symptoms by:
Encouraging patients to perform a desirable behaviour, such as getting dressed for the day and taking a shower (if they suffer from negative symptoms, such as avolition, this can be a significant problem affecting their day).
Immediately after performing this behaviour, they receive a token.
After earning a certain number of tokens, they can exchange them for rewards, such as a day trip or a walk in the garden.
The programme must be tailored to the patient and address their motivation and personal goals to be effective.
The use of TES has both strengths and weaknesses. For an exam, it is essential to understand what these are and how studies highlight these problems.
Let’s discuss some of the advantages and disadvantages of token economy systems. First, the advantages:
Now, let’s explore the disadvantages of token economy systems:
An example of a reward used in token economy systems is sweets or magazines. Any reward that can reinforce ‘good behaviour’ can be used in a token economy system.
Token economy systems (TES) are a form of psychological therapy, based on operant conditioning, which uses a reward system to manage maladaptive behaviours.
Token economy systems (TES) help treat patients with maladaptive behaviours. TES encourage desirable behaviours in patients and discourages undesirable or maladaptive behaviours. It associates good behaviours with rewards, as good behaviours earn tokens which can be exchanged for rewards.
In a token economy, tokens are used to encourage desirable behaviours. It involves assessing a patient and identifying their reinforcers (primary and secondary) and then basing the token system around this.
Token economy systems (TES) are a form of psychological therapy that utilises a reward system to manage maladaptive behaviours. TES is based on operant conditioning.
What three categories did Matson et al. (2016) establish of institutional behaviour affected by token economies?
Personal care, condition related behaviour, and social behaviour.
What did Allyon and Azrin (1968) find in their study?
Patients have to want to do certain behaviours for TES to be applicable.
Give an example of a negative symptom of schizophrenia that TES affects.
Avolition.
Describe the Glowacki et al. (2016) study.
Glowacki et al. (2016), in a meta-analysis of seven high-quality studies of the effectiveness of TES in hospitals, found that all studies showed decreased negative symptoms and a decrease in the frequency of undesirable behaviours (violence and aggression).
What did Kazdin (1982) say about TES?
Kazdin (1982) found that changes that were developed during a patient’s time in hospital using TES did not remain once they were discharged. Although TES is a way to alleviate symptoms, it is not a cure.
Early research, as seen in Wolfe (1936), investigated the effectiveness of token rewards for _______.
chimpanzees.
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