Token economies are derived from the behavioural approach, that suggests that schizophrenia is acquired through a learning process and can therefore be replaced by other behaviours in the same way.
Token economies provide instant reinforcement for desirable behaviours that can be later exchanged for goods or privalleges by patients. The technique is most appropriate for long term institutional patients, as the therapy does not work as effectively with social reinforcers.
Ayllon found that special attention paid to resistant patients at mealtimes was acting as a reinforcer for the behaviour, and that locking late patients out of the hall and making thme pay one penny to regain entry caused an increased motivation among patients and staff. To earn pennies, the patients had to display desired behaviours.
Sultana et al conducted a review of token economy regimes and found that they reduced negative sympotoms in schizophrenic patients, although it was unclear whether these changes were maintained beyond treatment programmes.
The major issue with the use of token economies is that they undermine patients and treat them as simple simulus-response machines with no free will, meaning the system is deterministic.
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