SCHIZOPHRENIA - Behavioural approach to treating schizophrenia (token economy)

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  • Token economy and the management of schizophrenia
    • Token economy
      • a form of therapy where desirable behavs are encouraged by the use of selective reinforcements. Rewards (tokens) are given as 2ndry.reins when individs engagein correct / socially desirable behaviours. Tokens can be exchanged for prim.reins (eg. food or privileges)
      • to be effective, the reinforcer needs to be given immediately after performance of the target behaviour
        • if token is given too late, another behaviour may been reinforced instead of target one (eg. arguing with another patient)
      • form of behavioural therapy
      • modification of patients behaviour to engage with target behaviours - associated with rewards
        • target behaviours = social interaction, reducing aggression
        • sch symptoms = speech poverty, lack of social interact, affective flattening
      • more items / rewards that the token can be exchanged for, the more valuable it becomes
        • rewards (the prim reins) could be: food, day out, internet
        • 2ndrary reins - tokens become valuable and as exchange for a reward. Associate token with reward
        • generalised reinforcers - rather than 1 reward, with tokens there are options
    • Research
      • SRAN - PPs had higher rates of responding in sessions where they were allowed to trade tokens in for choice between variety of edible items rather than a choice of one
    • How does it work?
      • 1. tokens are associated with rewarding stimuli (2ndry reins)
        • 2. patient engages in desirable (target) behavs or reduces inappropriate ones
          • 3. patient given tokens for engaging in target behavs (eg. tidying up after meal)
            • 4. patient trades these tokens for desirable items or privileges
    • Evaluation (A03)
      • research support
        • DICKERSON - meta 13 studies - 11 studies showed beneficial effects BUT many studies showed methodological shortcomings
      • difficulties assessing the success of T.E
        • COMER - uncontrolled studies - no control group. Improvements can only be compared with prev behavs.
        • other factors may be involved in improvement eg. increased staff attention
      • less useful for patients in community
        • effects only shown to work in hospital setting
        • difficult to administer tokens in community
        • in wards, patients get 24 hr care, so easier to monitor rewards etc
      • ethics
        • argued that all humans have a right to some rewards (food, privacy etc)
      • does it work?
        • very few trials carried out to support claims
        • SULTANA - t.e may still be a good treatment if trials are carried out
    • Conditioning
      • operant conditioning most important
        • learning through reinforcements
        • patient rewarded if behaviour is shown
        • positive rein = food, behav will be repeated
        • neg rein = avoid bad feelings, getting rewards taken away
      • classical
        • tokens become associated with the rewards

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