Token economy

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Token economy
ICD-9-CM 94.33

A token economy is a system of contingency management based on the systematic reinforcement of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. [1] A token economy is based on the principles of operant conditioning and behavioral economics and can be situated within applied behavior analysis. In applied settings token economies are used with children and adults; however, they have been successfully modeled with pigeons in lab settings. [2]

Contents

Basic requirements

Three requirements are basic for a token economy: tokens, back-up reinforcers, and specified target behaviours. [3]

Tokens

Tokens must be used as reinforcers to be effective. A token is an object or symbol that can be exchanged for material reinforcers, services, or privileges (back-up reinforcers). In applied settings, a wide range of tokens have been used: coins, checkmarks, images of small suns or stars, points on a counter, and checkmarks on a poster. These symbols and objects are comparably worthless outside of the patient–clinician or teacher–student relationship, but their value lies in the fact that they can be exchanged for other things. Technically speaking, tokens are not primary reinforcers, but secondary or learned reinforcers. Much research has been conducted on token reinforcement, including animal studies. [4]

Back-up reinforcers

Tokens have no intrinsic value, but can be exchanged for other valued reinforcing events: back-up reinforcers, which act as rewards. Most token economies offer a choice of differing back-up reinforcers that can be virtually anything. Some possible reinforcers might be:

Back-up reinforcers are chosen in function of the individual or group for which the token economy is set up, or depending upon the possibilities available to the staff. Prior to starting the staff decides how many tokens have to be paid for each back-up reinforcer. Often, price lists are exposed or given to the clients. Some back-up reinforcers can be bought anytime, for other exchange times are limited (e.g. opening times of a token shop). [ citation needed ]

Specified target behaviors

There is a broad range of possible target behaviors: doing self-care such as washing, attending scheduled activities, having good academic behavior, or avoiding disruptive behavior. A token economy is more than just using exchangeable tokens. [3] For a token economy to work, criteria have to be specified and clear. A staff member giving tokens to a client just because they judge them to be behaving positively is not part of a token economy because it is not done in a systematic way. Sometimes client manuals have specifications how many tokens can be earned by each target behavior. For instance, if making the bed is a target behavior, staff and clients have to know how a well-made bed looks like. However, often these specifications are hard to make: behavior such as eating politely and positive cooperation are hard to specify. While planning how many tokens can be earned by each target behavior some factors have to be considered: on the one hand clients should be able to earn a minimal amount of tokens for a minimal effort, and on the other hand clients should not earn too much too soon, making more effort useless.

Sometimes the possibility of punishment by token loss is included, technically called response cost: [5] disruptive behavior can be fined with the loss of tokens. This is also clearly specified before the application starts. Clients can be involved in the specifying of the contingencies.

Other features

Besides the three basic requirements, other features are often present: social reinforcement, shaping, immediacy of reinforcement, forward planning, and consistency. [6]

Social reinforcement

Token reinforcement is always accompanied by social reinforcement. Tokens are intended to make reinforcement explicit and immediate, and to strengthen behavior, but in the end social reinforcement should be sufficient to maintain what's been learned. [ citation needed ]

Shaping

Shaping implies clients aren't expected to do everything perfectly at once; behavior can be acquired in steps. Initially clients can be reinforced for behavior that approaches the target. If the target behavior is keeping attention during a 30 minutes session, clients can initially already get (perhaps smaller) reinforcement for 5 minutes of attention. [ citation needed ]

Immediacy of reinforcement

Reinforcement is more likely to influence behavior if given shortly after the response is emitted. The longer people have to wait for a reward, the less effect and the less they will learn. This is the principle of delay discounting. Immediate token reinforcement can bridge later reinforcement. [7]

Saving

Sometimes clients can earn larger rewards like the permission to spend a weekend at home, going to a movie, or having a class excursion. When such rewards would be given at once for one instance of a target behavior, the scarce resources would soon be depleted and consequently the incentives would be lost. One advantage of tokens is they can be used to divide larger rewards into parts: clients can save tokens to buy more expensive rewards later. This implies they shouldn't immediately spend all earned tokens on attractive smaller rewards, and instead learn to plan ahead. This way they can acquire self-control. (See Delayed gratification.) [ citation needed ]

Individual and group contingencies

Many token economies are designed for groups. The system is running for a whole ward or class. Within this group contingency specific individual goals and reinforcers can be added, though sometimes a token economy is designed for only one specific individual. [ citation needed ]

Consistent application

The power of a token economy largely depends on the consistency of its application. To achieve this thorough staff training is essential. Some token economies failed exactly on this point. [6] Token economies imply rights and duties for clients as well as for staff. When, according to the system, a client deserves tokens, he or she should get them, even when a staff member judges he or she doesn't deserve them because he has been impolite the day before. Family education and involvement is also an aspect. They can support the system or they can undermine it, for instance by secretly giving undeserved rewards.

Leveled system

Often, token economies are leveled programs. Clients can pass through different levels until they reach the highest level. At that point, behaviors are performed without token reinforcement. Higher levels require more complex behaviors. The incentive to progress from one level to the next is the availability of increasingly desirable reinforcers.

History

In the early 19th century, long before there was any knowledge about operant learning, there were some precursors of token economies in schools and prisons. In those systems points could be earned and exchanged for many different items and privileges. Only in the 1960s the first real token economies arose in psychiatric hospitals. Teodoro Ayllon, Nathan Azrin and Leonard Krasner were important pioneers in these early years. [8] [9] The very first token economy bearing that name was founded by Ayllon and Azrin in 1961 at Anna State Hospital in Illinois. In the 1970s the token economies came to a peak and became widespread. In 1977 a major study (a randomized controlled trial), still considered a landmark, was published. [10] This study showed the superiority of a token economy compared to standard treatment and specialized milieu therapy. Despite this success token economies declined from the 1980s on.

Controversy

The application of token economies, especially with adults, became a matter of criticism. In addition some impediments and the evolution of mental health care caused troubles. [ citation needed ] Token economies have proven their effectiveness and utility for chronic psychiatric patients, despite requiring months or even years to achieve optimal results. This causes problems when insurance and government policies increasingly require the shortest possible hospital stays. Because emphasis has shifted to community-based treatment, outpatient and home-based care is often the preferred choice over institutionalization. This decentralization of patient care methods makes it difficult to further study and develop token economies in a scientific, research-oriented method. [ citation needed ]

Token economies can present issues with concern to patient rights. The right to have their personal properties, basic comfort and freedom of choice of treatment constrains the possibilities for token economies. In addition, ethical and personal concerns of staff members arose, such as the ethics of using certain reinforcers, the ethics of operant conditioning itself, a lack of sincerity, and an emphasis on material goods. [ citation needed ] Application of a token economy to adults sometimes triggers client resistance. [11]

Problems with maintaining what's been learned and the generalization toward new situations have also been signaled. When the token programs stops the acquired behavior might disappear again. [ citation needed ] Rewarding behavior could increase the extrinsic motivation and at the same time decrease the intrinsic motivation for activities. [ citation needed ]

Applications and findings

In the last 50 years much research has been conducted on token economy. Despite controversy and a lack of implementation token programs still exist in several settings. [ citation needed ]

Adults

In adult settings token economies are mostly applied in mental health care. When offered a choice, the vast majority of clients in past studies voluntarily chose to stay in the program. Research[ citation needed ] shows the effects of token economies can more or less be divided into three categories:

Schizophrenia

The first token economies were designed for chronic, treatment-resistant psychotic inpatients. Even now token economies are applied to clients with schizophrenia, who are often resistant to common behavioral treatment approaches. Sometimes the token economy is used as a lasting prosthesis. [12] Sometimes it's used to help such clients reach resocialization. A token economy, in combination with other interventions, succeeded in the community reintegration of 78% of the clients within an average period of 110 days, after more than seven years of uninterrupted hospital stay. [13] Research shows clients experience the token economy with positive reception. [14] Several recent reviews of psychosocial treatment for schizophrenia explicitly mention token economy as an effective, evidence-based treatment [15] [16] and one systematic review specifically examined token economy. The token economy approach may have effects on symptoms such as apathy and poverty of thought, but it is unclear if these results are reproducible, clinically meaningful and are maintained beyond the treatment programme. [17]

Acute units

The application of token economies has been extended from psychiatric rehabilitation services to acute psychiatric units. A token economy was successful in decreasing the aggression on a ward where clients on average stayed for less than three weeks. [18]

Substance abuse

As a result of ethical criticism, token economies developed a negative stigma and, as a result, systems were sometimes introduced with aliases. This was especially the case in substance abuse treatment settings (although some systems for smoking cessation continue to use the term token economy). [19] For some time, systems derived from token economies were used under the name contingency management; initially this was more broadly defined and referred to any direct coupling of consequences (reinforcements or punishments) with behavior (for example staying clean [20] [21] ); later it referred specifically to one kind of token economy.

The community reinforcement approach can be combined with contingency management; [22] tokens are used, whereas contingency management employs the term voucher (or related terms). Research shows this kind of token economy is easily applied outside of hospitals and is effective, allowing for less hospital-based treatment –although contingency management is used in the treatment of drug abuse in both inpatient and outpatient settings.

Developmental disorders

Token economy has also been applied in settings for adults with developmental disabilities. Target behaviors can vary in types of social behavior and self care, or the decreasing of inappropriate and/or disruptive behavior. [23]

Children and adolescents

Token economies have been applied to children and adolescents with developmental disabilities as well as in schools. [ citation needed ]

Developmental disabilities

A token economy has proven effective in increasing attentiveness and motivation in completion of tasks for children with developmental disabilities. Research shows it can help to diminish disruptive behavior and promote social behavior. [24]

Schools

Token economies have been applied in schools, particularly special education programs as well as in other programs. Positive results can imply increased attention and decreased disruptive behavior. [25] In educational settings token economy seems to raise the intrinsic motivation to complete assigned tasks. [26] [27]

See also

Related Research Articles

Operant conditioning, also called instrumental conditioning, is a learning process where voluntary behaviors are modified by association with the addition of reward or aversive stimuli. The frequency or duration of the behavior may increase through reinforcement or decrease through punishment or extinction.

<span class="mw-page-title-main">Operant conditioning chamber</span> Laboratory apparatus used to study animal behavior

An operant conditioning chamber is a laboratory apparatus used to study animal behavior. The operant conditioning chamber was created by B. F. Skinner while he was a graduate student at Harvard University. The chamber can be used to study both operant conditioning and classical conditioning.

<span class="mw-page-title-main">Reinforcement</span> Consequence affecting an organisms future behavior

In behavioral psychology, reinforcement refers to consequences that increase the likelihood of an organism's future behavior, typically in the presence of a particular antecedent stimulus. For example, a rat can be trained to push a lever to receive food whenever a light is turned on. In this example, the light is the antecedent stimulus, the lever pushing is the operant behavior, and the food is the reinforcer. Likewise, a student that receives attention and praise when answering a teacher's question will be more likely to answer future questions in class. The teacher's question is the antecedent, the student's response is the behavior, and the praise and attention are the reinforcements.

The experimental analysis of behavior is a science that studies the behavior of individuals across a variety of species. A key early scientist was B. F. Skinner who discovered operant behavior, reinforcers, secondary reinforcers, contingencies of reinforcement, stimulus control, shaping, intermittent schedules, discrimination, and generalization. A central method was the examination of functional relations between environment and behavior, as opposed to hypothetico-deductive learning theory that had grown up in the comparative psychology of the 1920–1950 period. Skinner's approach was characterized by observation of measurable behavior which could be predicted and controlled. It owed its early success to the effectiveness of Skinner's procedures of operant conditioning, both in the laboratory and in behavior therapy.

Behaviorism is a systematic approach to understand the behavior of humans and other animals. It assumes that behavior is either a reflex elicited by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual's history, including especially reinforcement and punishment contingencies, together with the individual's current motivational state and controlling stimuli. Although behaviorists generally accept the important role of heredity in determining behavior, they focus primarily on environmental events. The cognitive revolution of the late 20th century largely replaced behaviorism as an explanatory theory with cognitive psychology, which unlike behaviorism views internal mental states as explanations for observable behavior.

Motivational salience is a cognitive process and a form of attention that motivates or propels an individual's behavior towards or away from a particular object, perceived event or outcome. Motivational salience regulates the intensity of behaviors that facilitate the attainment of a particular goal, the amount of time and energy that an individual is willing to expend to attain a particular goal, and the amount of risk that an individual is willing to accept while working to attain a particular goal.

Applied behavior analysis (ABA) is a scientific discipline that utilizes the principles of learning based upon respondent and operant conditioning to make socially significant changes in a subject's behavior. ABA is the applied form of behavior analysis. The impact ABA has on meaningful behaviors is a defining feature, and what differentiates it from experimental analysis of behavior, which focuses on basic experimental research.

Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's mental states, influences those behaviours, and consists of techniques based on behaviorism's theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.

Shaping is a conditioning paradigm used primarily in the experimental analysis of behavior. The method used is differential reinforcement of successive approximations. It was introduced by B. F. Skinner with pigeons and extended to dogs, dolphins, humans and other species. In shaping, the form of an existing response is gradually changed across successive trials towards a desired target behavior by reinforcing exact segments of behavior. Skinner's explanation of shaping was this:

We first give the bird food when it turns slightly in the direction of the spot from any part of the cage. This increases the frequency of such behavior. We then withhold reinforcement until a slight movement is made toward the spot. This again alters the general distribution of behavior without producing a new unit. We continue by reinforcing positions successively closer to the spot, then by reinforcing only when the head is moved slightly forward, and finally only when the beak actually makes contact with the spot. ... The original probability of the response in its final form is very low; in some cases it may even be zero. In this way we can build complicated operants which would never appear in the repertoire of the organism otherwise. By reinforcing a series of successive approximations, we bring a rare response to a very high probability in a short time. ... The total act of turning toward the spot from any point in the box, walking toward it, raising the head, and striking the spot may seem to be a functionally coherent unit of behavior; but it is constructed by a continual process of differential reinforcement from undifferentiated behavior, just as the sculptor shapes his figure from a lump of clay.

Contingency management (CM) is the application of the three-term contingency, which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), but it is sometimes implemented from a cognitive-behavioral therapy (CBT) framework as well.

Punishment is any change in a human or animal's surroundings which, occurring after a given behavior or response, reduces the likelihood of that behavior occurring again in the future. Reinforcement, referring to any behavior that increases the likelihood that a response will occurs, plays a large role in punishment. Motivating operations (MO) can be categorized in abolishing operations, decrease the effectiveness of the stimuli and establishing, increase the effectiveness of the stimuli. For example, a painful stimulus which would act as a punisher for most people may actually reinforce some behaviors of masochistic individuals.

<span class="mw-page-title-main">Residential treatment center</span> Live-in healthcare facility

A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance use disorders, mental illness, or other behavioral problems. Residential treatment may be considered the "last-ditch" approach to treating abnormal psychology or psychopathology.

Behavioral momentum is a theory in quantitative analysis of behavior and is a behavioral metaphor based on physical momentum. It describes the general relation between resistance to change and the rate of reinforcement obtained in a given situation.

The professional practice of behavior analysis is a domain of behavior analysis, the others being radical behaviorism, experimental analysis of behavior and applied behavior analysis. The practice of behavior analysis is the delivery of interventions to consumers that are guided by the principles of radical behaviorism and the research of both experimental and applied behavior analysis. Professional practice seeks to change specific behavior through the implementation of these principles. In many states, practicing behavior analysts hold a license, certificate, or registration. In other states, there are no laws governing their practice and, as such, the practice may be prohibited as falling under the practice definition of other mental health professionals. This is rapidly changing as behavior analysts are becoming more and more common.

Behavior management, similar to behavior modification, is a less-intensive form of behavior therapy. Unlike behavior modification, which focuses on changing behavior, behavior management focuses on maintaining positive habits and behaviors and reducing negative ones. Behavior management skills are especially useful for teachers and educators, healthcare workers, and those working in supported living communities. This form of management aims to help professionals oversee and guide behavior management in individuals and groups toward fulfilling, productive, and socially acceptable behaviors. Behavior management can be accomplished through modeling, rewards, or punishment.

The behavioral analysis of child development originates from John B. Watson's behaviorism.

Aubrey C. Daniels is the founder and chairman of the board for Aubrey Daniels International or ADI, a Performance Management consulting company.

A licensed behavior analyst is a type of behavioral health professional in the United States. They have at least a master's degree, and sometimes a doctorate, in behavior analysis or a related field. Behavior analysts apply radical behaviorism, or applied behavior analysis, to people.

Nathan H. Azrin was a behavioral modification researcher, psychologist, and university professor. He taught at Southern Illinois University and was the research director of Anna State Hospital between 1958 and 1980. In 1980 he became a professor at Nova Southeastern University, and entered emeritus status at the university in 2010. Azrin was the founder of several research methodologies, including Token Economics, the Community Reinforcement Approach (CRA) on which the CRAFT model was based, Family Behavior Therapy, and habit reversal training. According to fellow psychologist Brian Iwata “Few people have made research contributions equaling Nate’s in either basic or applied behaviour analysis, and none have matched his contributions to both endeavors.”

Community reinforcement approach and family training is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Meyers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning techniques to assist those with addictions live healthily. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to commence and continue treatment and provides them with defences against addiction's damaging effects on themselves.

References

  1. ↑ "The definition of token economy".
  2. ↑ K. Jackson and T.D. Hackenberg : Token reinforcement, choice, and self-control in pigeons. Journal of the Experimental Analysis of Behavior. 1996 July; 66(1): 29–49. doi : 10.1901/jeab.1996.66-29 PMC   1284552
  3. 1 2 A.E. Kazdin : The Token Economy. A review and evaluation. New York: Plenum Press, 1977. ISBN   0-306-30962-9
  4. ↑ T.D. Hackenberg: Token reinforcement: a review and analysis. Journal of the Experimental Analysis of Behavior, 2009, 91, 257–286.
  5. ↑ Ormrod, Jeanne Ellis (2009). Essentials of Educational Psychology (2nd ed.). Upper Saddle River, N.J.: Merrill. pp.  338. ISBN   978-0-13-501657-2.
  6. 1 2 S.M. Glynn: Token economy approaches for psychiatric patients. Progress and pitfalls over 25 years. Archived 2011-12-22 at the Wayback Machine Behavior Modification, 1990, 14, 383–407.
  7. ↑ TD, Hackenberg (March 2009). "Token reinforcement: a review and analysis". J Exp Anal Behav. 91 (2): 257–286. doi:10.1901/jeab.2009.91-257. PMC   2648534 . PMID   19794838.
  8. ↑ R.P. Liberman: The token economy. American Journal of Psychiatry, 2000, 157, 1398.
  9. ↑ T. Ayllon & N.H. Azrin : The Token Economy: a motivational system for therapy and rehabilitation. New York: Appleton-Century-Crofts, 1968. ISBN   0-390-04310-9
  10. ↑ G.L. Paul & R.J. Lentz : Psychosocial treatment of chronic mental patients: milieu versus social-learning programs. Cambridge, MA: Harvard University Press, 1977. ISBN   0-674-72112-8
  11. ↑ A.E. Kazdin: The token economy: a decade later. Journal of Applied Behavior Analysis, 1982, 15, 431–445.
  12. ↑ C.M. Coelho, e.a.: Rehabilitation programs for elderly women inpatients with schizophrenia. Journal of Woman & Aging, 2008, 3, 283–295.
  13. ↑ S.M. Silverstein, e.a.: Behavioral rehabilitation of the "treatment-refractory" schizophrenia patient: conceptual foundations, interventions, and outcome data. Psychological Services, 2006, 3, 145–169.
  14. ↑ M.F. Lin, e.a.: Significant experiences of token therapy from the perspective of psychotic patients. Journal of Nursing Research, 2006, 14, 315–323.
  15. ↑ G.D. Shean: Evidence-based psychosocial practices and recovery from schizophrenia. Psychiatry, 2009, 72, 307–320.
  16. ↑ L.B. Dixon, e.a.: The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophrenia Bulletin, 2010, 36, 48–70.
  17. ↑ Toit, D; Xia, J; Lovell, M (2000). "Token economy for schizophrenia". Cochrane Database of Systematic Reviews. 3 (3): CD001473. doi:10.1002/14651858.CD001473. PMID   10908499.
  18. ↑ J.P. LePage, e.a.: Reducing assault on an acute psychiatric unit using a token economy: a 2-year follow-up. Behavioral Interventions, 2003, 18, 179–190.
  19. ↑ V. McLeod: How to quit smoking by using a token economy method. EzineArticles, 2011.
  20. ↑ N.M. Higgins & N. Petry: Contingency Management Incentives for sobriety. Archived 2010-10-08 at the Wayback Machine Alcohol Research & Health, 1999, 23, 122–126.
  21. ↑ M.W. Lewis: Application of contingency management-prize reinforcement to community practice with alcohol and drug problems: a critical examination. Behavior and Social Issues, 2008, 17, 119–138.
  22. ↑ H.G. Roozen, e.a.: A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug and Alcohol Dependence, 2004, 74, 1–13.
  23. ↑ L.A. LeBlanc, L.P. Hagopian & K.A. Maglieri: Use of a token economy to eliminate excessive inappropriate social behavior in an adult with developmental disabilities. Behavioral Interventions, 2000, 15, 135–143.
  24. ↑ J.L. Matson & J.A. Boisjoli: The token economy for children with intellectual disability and/or autism: a review. Research in Developmental Disabilities, 2009, 30, 240–248.
  25. ↑ K. Zlomke & L. Zlomke: Token economy plus self-monitoring to reduce disruptive classroom behaviors. Archived 2010-12-29 at the Wayback Machine The Behavior Analyst Today, 2003, 4, 177–182.
  26. ↑ G. LeBlanc: Enhancing intrinsic motivation through the use of a token economy. Essays in Education, 2004, 11.
  27. ↑ H.A. Filcheck & C.B. McNeil: The use of token economies in preschool classrooms: practical and philosophical concerns. Archived 2011-12-15 at the Wayback Machine Journal of Early and Intensive Behavior Intervention, 2004, 1, 94–104.
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