Psychological Treatment: Token Economy

Token Economy

Token economies are a behavioral therapy technique based on Skinners operant conditioning. This is learning through reinforcement of desired behaviours.

Psychiatric institutions: Treatment is designed to produce easier to manage behaviour within the hospital, or to prepare long stay patients for transfer into the community. This treatment should only be used with individuals who have mild negative symptoms.

Watch the first 5 minutes of this video to gain a full understanding of primary and secondary reinforcers. It is very crucial to highlight that tokens are secondary reinforcers and as such, they are not enjoyable in themselves but acquire reinforcing properties because they can be exchanged for a primary reinforcer that is intrinsically enjoyable. This was a major mistake that students made in exams in 2022, so be careful!

Evaluation of Token Economies

• Research to support the Usefulness of Token Economies – Dickerson et al (2005) reviewed 13 studies of the use of token economy systems in the treatment of schizophrenia. 11 of these studies had reported beneficial effects that were directly attributable to the use of token economies.
• Research to oppose the effectiveness – Dickerson et al (2005) showed that 2 of the 13 studies did not show evidence that the token economies were effective, 
• Individual differences –  Token economies can be used to cater to each individual. Sran & Borrero (2010) compared behaviours reinforced by tokens that could be exchanged for one single highly preferred edible item with tokens that could be exchanged for a variety of preferred edible items. They found that all ppts had higher rates of responding in those sessions where tokens could be exchanged for a variety of items. This could be because it increased the likelihood that the item acted as a reward. Everyone is different, what some people find rewarding others do not. This makes token economy more useful because it can target individual needs, increasing its effectiveness in reducing negative symptoms.
• Practical Issues – However in relation to the research by Sran & Borrero (2010) not all institutions have the time or the funding to individualize their reward programmes. In addition, it may be difficult for nurses to notice and reward the behaviours immediately after presentation. We know from Rosenhan’s research (sane in insane places) that mental health nurses spent little time with the patients. This means that the nurses may not be able to consistently provide the reward when a target behaviour is displayed. 
• Ethical concerns – Could reinforce the patients to withhold or hide their schizophrenic symptoms and it treats patients like lab rats. The fact that we learn about this in forensic psychology also highlights some issues with the image it portrays of schizophrenic patients. In addition, token economy is not a treatment, it addresses the symptoms rather than the cause. 
• Individual differences – Has mentioned earlier, token economy can only be used on individuals with mild symptoms and therefore this treatment not only has poor success but also poor generalisability.