1. Token Economy Treatment for Schizophrenia

2. What is Token Economy? Token economy is a method used from the learning approach to improve behaviour, it is commonly used in prisons and young offender institutions. A set of rules (desired behaviours) are set up by staff. When these are followed the prisoners/patients are rewarded with a token, this is a secondary reinforcer. Tokens can be saved up and then exchanged for something of value to the prisoner, for example extra TV time or chocolate, these are primary reinforcers. The tokens then become reinforcers for good behaviour.

3. Token Economy- The Learning Approach Token economy is a treatment method based on operant conditioning. It teaches the participants to unlearn abnormal behaviours and learn normal ones.

4. Token Economy- to treat schizophrenia Token Economy has been widely used to treat schizophrenia, particularly on treatment-resistant patients. It is carried out in conjunction with a variety of other treatments. It is often used to help patients with schizophrenia with the process of resocialisation after a long hospital stay. It is mainly used to reduce negative symptoms, such as social withdrawal. Patients are rewarded for performing socially desirable behaviour.

5. Example Jim is a patient with schizophrenia. On Day One of the token economy programme Jim brushes his teeth. This is a socially desirable behaviour. Jim is rewarded with one token. On Day Two Jim has a shower. This is a socially desirable behaviour, Jim is rewarded with another token. On Day Three Jim makes his bed. This is socially desirable behaviour, Jim is rewarded with a token. On Day Four Jim plays a board game with other patients, this is a socially desirable behaviour. Jim receives another token. Jim has now collected four tokens. He is allowed to exchange the four tokens in return for either extra TV time, chocolate or sweets. Jim chooses chocolate. Jim now knows that he is rewarded for socially desirable behaviour, he will repeat these behaviours in order to gain more rewards.

6. Studies Allyon and Azrin (1968) Psychiatric hospital ward 45 female chronic schizophrenia sufferers with an average of 16 years hospitalisation. Patients behaviour included screaming for hours, being mute, not using cutlery when eating and assaulting others. Token economy was introduced. Tokens were given to patients for carrying out self care, such as brushing teeth and ward work. The tokens could then be added up and exchanged for a reward such as listening to music. Significant improvement in the patients self care behaviours, in 20 days patients had shown on average 40 desired behaviours.

7. Strengths of token economy as treatment for Schizophrenia Token economy can effectively reduce negative symptoms. It is a good way to ‘manage’ patients while they are in hospital as it encourages good behaviour. Gives more freedom and independence in institutions as the patients can make choices about their rewards.

8. Weaknesses for token economy as treatment for schizophrenia Results are difficult to maintain after the treatment programme. Doesn’t reduce positive symptoms. May not be ethical as patients are not given a choice as to whether or not they want to participate in the programme. Doesn’t deal with the cause of schizophrenia.