Token Economy- Paul & Lentz 1977

This is the behavioural approach to schizophrenia, it believes that symptoms of this disorder are learned response, this treatment gets patients to "unlearn" undesirable behaviours. The study by Paul & Lentz 1977 investigated how effective operant conditioning was to reinforce appropriate behaviours. He has 84 patients with chronic schizophrenia. The study split these patients into 3 groups and used individual measures design to compare the effectiveness of each treatment.

The first treatment was called Milieu therapy which involves he use of therapeutic community , patients live collectively in a clinic and are encouraged to look after each other, this promotes social building skills.

Another group was a traditional existing hospital management of schizophrenia

The last group was a token economy group where desirable behaviours (such as self-care, engaging socially and attending therapy) were reinforced by rewards (tokens) These token rewards could be traded for luxury items such as clothing, tv time, sweets or cigarettes

The behaviour of the patient groups was monitored though time-sampled observation, questionnaires and individual interviews. There was an overall reduction of positive and negative symptoms. The system was most effective at removing catatonic behaviour and social withdrawal, however it made little effect on hallucinations and delusional thinking. 97% of the token economy group were able too live independently for between 1.5 and 5 years compared to the 71%in the milieu group and 45% in the hospital group.

Strengths- The rewards were administered reliably because staff were getting intensively trained, staff were also monitored ad issued a Manuel to ensure procedures were standardised. After this study only 11% needed drug treatment compared to the 100% of the control group.

Weaknesses- Does not work long term at all, 100% of patients relapsed and had to return to the ward. A lack of "reward" in real life for things like taking a shower slowly made participants return to their old habits as there was no longer a reward. The study lacks ecological validity as they were in a controlled environment. There are also obvious ethical issues with this as it ignores the hallucinations they are having and punishes them for showing symptoms.

	Created by Millie O almost 3 years ago

Covers all the treatments of schizophrenia