Evaluation of token economies as a rehabilitation plan for
schizophrenia
McMonagle and Sultana: Found only three studies where patients were randomly allocated to
conditions. Total of 110 patients across the three studies. Only one of three studies showed
improvement.
S Paul and Lentz (1977): Found token economies improved behaviour of patients
Upper and Newton (1971): Found that token economies helped to reduce weight gain associated with
taking antipsychotics. People lost 3lbs a week via the use of token economies. This shows that token
economies can also be used to counteract the side effects of medications.
P N/A
Controversial/unethical: The system that’s used is a reward system, so patients are rewarded every
time they do a positive thing. This is slightly coercive and quite patronising. Also, this is similar to the
treatment prisoners (as in they get rewards for doing good behaviours), which can be seen as
controversial and dehumanising. It also strips them of their free will as patients may not want to take
medication if it helps them feel less lonely or helps them get things done. Doctors should instead be
having conversations with patients, adjusting medicines, explaining why they need them instead of just
I forcing them to take it. Some doctors could take advantage of this and abuse their position to control a
patient, which is bad for patient safety.
Privileges are more accessible to those with milder symptoms: Patients with more severe symptoms
may not be motivated enough to use the reward system, which can increase feelings of guilt,
uselessness or worthlessness. This discriminates against patients with more severe symptoms.
Links to behaviourism approach: Uses conditioning to change the behaviour of patients.
Links to cognitive approach: Changes patients’ schema about taking medication (from negative to
positive).
A
Kazdin et al: Found that good behaviour discontinues after token economies stops. Suggests that
patients don’t want to keep it up in the long term without receiving rewards. This means that we are
teaching patients to become reliant on external rewards as opposed to seeking motivation from within.
C
✘ Most studies lack random allocation, so they have no control group. This lowers validity as we cannot
know if the results are due to using token economies as a management therapy.
✘ Corrigan: Argues there are problems administering token economies with outpatients who live in the
E community as they are only cared for a few hours a day at home.
D N/A
schizophrenia
McMonagle and Sultana: Found only three studies where patients were randomly allocated to
conditions. Total of 110 patients across the three studies. Only one of three studies showed
improvement.
S Paul and Lentz (1977): Found token economies improved behaviour of patients
Upper and Newton (1971): Found that token economies helped to reduce weight gain associated with
taking antipsychotics. People lost 3lbs a week via the use of token economies. This shows that token
economies can also be used to counteract the side effects of medications.
P N/A
Controversial/unethical: The system that’s used is a reward system, so patients are rewarded every
time they do a positive thing. This is slightly coercive and quite patronising. Also, this is similar to the
treatment prisoners (as in they get rewards for doing good behaviours), which can be seen as
controversial and dehumanising. It also strips them of their free will as patients may not want to take
medication if it helps them feel less lonely or helps them get things done. Doctors should instead be
having conversations with patients, adjusting medicines, explaining why they need them instead of just
I forcing them to take it. Some doctors could take advantage of this and abuse their position to control a
patient, which is bad for patient safety.
Privileges are more accessible to those with milder symptoms: Patients with more severe symptoms
may not be motivated enough to use the reward system, which can increase feelings of guilt,
uselessness or worthlessness. This discriminates against patients with more severe symptoms.
Links to behaviourism approach: Uses conditioning to change the behaviour of patients.
Links to cognitive approach: Changes patients’ schema about taking medication (from negative to
positive).
A
Kazdin et al: Found that good behaviour discontinues after token economies stops. Suggests that
patients don’t want to keep it up in the long term without receiving rewards. This means that we are
teaching patients to become reliant on external rewards as opposed to seeking motivation from within.
C
✘ Most studies lack random allocation, so they have no control group. This lowers validity as we cannot
know if the results are due to using token economies as a management therapy.
✘ Corrigan: Argues there are problems administering token economies with outpatients who live in the
E community as they are only cared for a few hours a day at home.
D N/A
