Token Economy
Treatment for Schizophrenia
What is Token Economy?
• Token economy is a method used from the learning
approach to improve behaviour, it is commonly used
in prisons and young offender institutions.
• A set of rules (desired behaviours) are set up by staff.
When these are followed the prisoners/patients are
rewarded with a token, this is a secondary reinforcer.
• Tokens can be saved up and then exchanged for
something of value to the prisoner, for example extra
TV time or chocolate, these are primary reinforcers.
The tokens then become reinforcers for good
behaviour.
Token Economy- The Learning Approach
• Token economy is a treatment method based
on operant conditioning.
• It teaches the participants to unlearn
abnormal behaviours and learn normal ones.
Token Economy- to treat schizophrenia
• Token Economy has been widely used to treat
schizophrenia, particularly on treatment-resistant
patients.
• It is carried out in conjunction with a variety of
other treatments.
• It is often used to help patients with
schizophrenia with the process of resocialisation
after a long hospital stay.
• It is mainly used to reduce negative symptoms,
such as social withdrawal. Patients are rewarded
for performing socially desirable behaviour.
Example
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Jim is a patient with schizophrenia.
On Day One of the token economy programme Jim brushes his teeth. This is a socially
desirable behaviour. Jim is rewarded with one token.
On Day Two Jim has a shower. This is a socially desirable behaviour, Jim is rewarded with
another token.
On Day Three Jim makes his bed. This is socially desirable behaviour, Jim is rewarded with a
token.
On Day Four Jim plays a board game with other patients, this is a socially desirable behaviour.
Jim receives another token.
Jim has now collected four tokens.
He is allowed to exchange the four tokens in return for either extra TV time, chocolate or
sweets.
Jim chooses chocolate.
Jim now knows that he is rewarded for socially desirable behaviour, he will repeat these
behaviours in order to gain more rewards.
Studies
• Allyon and Azrin (1968)
• Psychiatric hospital ward
• 45 female chronic schizophrenia sufferers with an average of 16 years
hospitalisation.
• Patients behaviour included screaming for hours, being mute, not
using cutlery when eating and assaulting others.
• Token economy was introduced. Tokens were given to patients for
carrying out self care, such as brushing teeth and ward work.
• The tokens could then be added up and exchanged for a reward such
as listening to music.
• Significant improvement in the patients self care behaviours, in 20 days
patients had shown on average 40 desired behaviours.
Strengths of token economy as
treatment for Schizophrenia
• Token economy can effectively reduce
negative symptoms.
• It is a good way to ‘manage’ patients while
they are in hospital as it encourages good
behaviour.
• Gives more freedom and independence in
institutions as the patients can make choices
about their rewards.
Weaknesses for token economy as
treatment for schizophrenia
• Results are difficult to maintain after the
treatment programme.
• Doesn’t reduce positive symptoms.
• May not be ethical as patients are not given a
choice as to whether or not they want to
participate in the programme.
• Doesn’t deal with the cause of schizophrenia.