Token Economies – schizophrenia (psychological therapies)
Token economies
Token economies are reward systems used to manage the behaviour of patients with
schizophrenia, in particular those who have developed patterns of maladaptive behaviour
through spending long periods in psychiatric hospitals (referred to as "institutionalised'*).
Under these circumstances it is common for patients to develop bad hygiene or perhaps to
remain in pyjamas all day. Modifying these bad habits does not cure schizophrenia but it
improves the patients quality of life and makes it more likely that they can live outside a
hospital setting.
Tokens The idea is that tokens - for example, in the form of coloured discs - are given
immediately to patients when they have carried out a desirable behaviour that has been
targeted for reinforcement. This may be getting dressed in the morning, making a bed, etc.,
according to the patient's individual behaviour issues. This immediacy of reward is
important because it prevents 'delay discounting', the reduced effect of a delayed reward.
Rewards Although the tokens have no value in themselves, they can be swapped later for
more tangible rewards. Token economies are a kind of behavioural therapy based on
operant conditioning. Tokens are secondary reinforcers because they only have value once
the patient has learned that they can be used to obtain rewards. These rewards might be in
the form of materials such as sweets, cigarettes, or magazines or rather in the form of
services such as having a room cleaned or privileges such as a walk outside the hospital.
Token economies
Token economies are reward systems used to manage the behaviour of patients with
schizophrenia, in particular those who have developed patterns of maladaptive behaviour
through spending long periods in psychiatric hospitals (referred to as "institutionalised'*).
Under these circumstances it is common for patients to develop bad hygiene or perhaps to
remain in pyjamas all day. Modifying these bad habits does not cure schizophrenia but it
improves the patients quality of life and makes it more likely that they can live outside a
hospital setting.
Tokens The idea is that tokens - for example, in the form of coloured discs - are given
immediately to patients when they have carried out a desirable behaviour that has been
targeted for reinforcement. This may be getting dressed in the morning, making a bed, etc.,
according to the patient's individual behaviour issues. This immediacy of reward is
important because it prevents 'delay discounting', the reduced effect of a delayed reward.
Rewards Although the tokens have no value in themselves, they can be swapped later for
more tangible rewards. Token economies are a kind of behavioural therapy based on
operant conditioning. Tokens are secondary reinforcers because they only have value once
the patient has learned that they can be used to obtain rewards. These rewards might be in
the form of materials such as sweets, cigarettes, or magazines or rather in the form of
services such as having a room cleaned or privileges such as a walk outside the hospital.
