Token Economies for Schizophrenia (AQA A Level Psychology): Revision Note

Token economies in the management of schizophrenia

• A token economy is one in which positive behaviours are rewarded and negative behaviours are discouraged

• Token economies are a feature of offender behaviour management as well as being used in health settings such as mental hospitals or care facilities

• The aim of a token economy is incentivise schizophrenia patients to behave in ways which are socially acceptable (e.g. showering and getting dressed daily; interacting with others) and which will help them to manage their illness (ultimately without the need for external incentive such as tokens)

• Tokens are in themselves value-less but they can be exchanged for desirable ‘treats’ or privileges e.g. chocolates, more outdoor exercise time, an extra hour’s TV viewing etc.

• Tokens act as secondary reinforcers i.e. it is not the tokens themselves that provide the reward, it is what they can be exchanged for (e.g. the primary reinforcement of sweeties, extra visits from family etc)

• Token economies were popular in the treatment of schizophrenia in the 1960s and 70s but they have since lost some traction since then and have largely been replaced by social and life skills training and CBT

Research which investigates token economies

• Monagle & Sultana (2000) - A review article which concluded that token economies are effective in treating the negative symptoms of schizophrenia e.g. avolition

• Baker et al. (2018) - A longitudinal (18 months) experiment in which the independent variable was tokens awarded for either positive behaviour or tokens were awarded regardless of the patients’ behaviour: both groups improved in terms of social withdrawal but overall symptoms did not change for either group i.e. a token economy has limited power in symptom management

Evaluation of token economies

Strengths

• Token economies may be useful for patients whose symptoms are mild and who need some motivation to enable them to cope with everyday challenges such as social interaction and personal hygiene

• A programme of token economy behaviour management is less potentially harmful than drug therapy so it may be more ethically valid to some extent

Weaknesses

• Monagle & Sultana (2000) also concluded that research on token economies is unclear as to the extent to which token economies have a long-term effect i.e.  are they maintained beyond the treatment programme? 

• A token economy could be viewed as being patronising (i.e. treating patients like children; deciding when/how/if to give rewards) which means that there are ethical concerns about the protection of patients who are enrolled in such a system

Issues & Debates

• Token economies operate on operant conditioning, encouraging specific behaviours through reinforcement, which reflects environmental determinism

  • This raises the question of whether patients are truly choosing their behaviour or simply responding to rewards, limiting their autonomy and free will

• Token economies are reductionist, focusing only on external behaviour change without addressing underlying cognitive, emotional, or biological causes of schizophrenia

  • This limits their long-term effectiveness, as behaviour may not generalise outside of the institutional setting once reinforcement is removed