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 he judges he is 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: do the sheets have to be put under the mattress, cushion on top? 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 also should be 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 essential, but 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

All principles of operant learning are applied within a token economy. 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 will greater 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. [ citation needed ]

Learning to plan ahead and save earnings

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

Mostly 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 very important. 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. [7] [8] 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. [9] 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. It became fairly quiet on that front due to a variety of problems and criticism.

Problems and controversy

Especially the application of token economies with adults became a matter of criticism. In addition some impediments and the evolution of mental health care caused troubles. [ citation needed ]

Changes in patient care

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 constrained the possibilities for token economies. In addition, ethical and personal concerns of staff members arose: is it ethically justified to use cigarettes as secondary reinforcers; is it human to rely on ‘reward and punishment’ as means for treatment; isn't sincere human contact much more valuable and effective; and do token economies reduce human interaction to trade, therefore centering patients' attention (and behavior) upon materials? [ citation needed ]

Client resistance

Application of a token economy to adults sometimes triggers client resistance. [10]

Response maintenance and generalization

Problems with maintaining what's been learned and the generalization toward new situations have been signaled. When the token programs stops the acquired behavior might disappear again. [ citation needed ]

Extrinsic versus intrinsic motivation

Rewarding behavior could increase the extrinsic motivation and at the same time decrease the intrinsic motivation for activities. (Note, these terms are not part of ABA literature). [ citation needed ]

Applications and findings

In the last 50 years much research has been conducted on token economy. The first 20 years were especially productive. Despite controversy and a lack of implementation token programs are alive and well in several settings. [ citation needed ]

Adults

In adult settings token economies are mostly applied in mental health care. The criticism that clients have no choice and are being forced, is countered by offering them the choice to enter the token program or not to enter, or to leave again once entered. 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. [11] Sometimes it's used to help such clients reach resocialization. A token economy (of course always 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. [12] Research shows clients experience the token economy with positive reception. [13] Several recent reviews of psychosocial treatment for schizophrenia explicitly mention token economy as an effective, evidence-based treatment [14] [15] and one systematic review specifically examined token economy:

Token economy compared to standard care [16]
Summary
The token economy approach may have effects on the 'negative 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. Token economy remains worthy of careful evaluation in modern well-designed, conducted and reported randomized trials. [16]

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. [17]

Substance abuse

As a result of heavy 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). [18] 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 [19] [20] ); later it referred specifically to one kind of token economy.

The community reinforcement approach can be combined with contingency management; [21] ‘tokens’ are used, whereas contingency management employs the term "vouchers" (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 is also being 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. [22]

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. [23]

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. [24] In educational settings token economy seems to raise the intrinsic motivation to complete assigned tasks. [25] But there's still need for more research. [26]

See also

Related Research Articles

Time-out (parenting)

Time-out is a form of behavioral modification that involves temporarily separating a person from an environment where an unacceptable behavior has occurred. The goal is to remove that person from an enriched, enjoyable environment, and therefore lead to extinction of the offending behavior. It is an educational and parenting technique recommended by most pediatricians and developmental psychologists as an effective form of discipline. Often a corner or a similar space where the person is to stand or sit during time-outs is designated. This form of discipline is especially popular in western cultures. In the UK, the punishment is often known as the naughty chair or naughty step. This term became popular in the US thanks to two reality TV series, Supernanny and Nanny 911.

Operant conditioning is a type of associative learning process through which the strength of a behavior is modified by reinforcement or punishment. It is also a procedure that is used to bring about such learning.

Reinforcement A consequence applied that will strengthen an organisms future behavior

In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher frequency of behavior, longer duration, greater magnitude, or shorter latency. There are two types of reinforcement, known as positive reinforcement and negative reinforcement; positive is whereby a reward is offered on expression of the wanted behaviour and negative is taking away an undesirable element in the persons environment whenever the desired behaviour is achieved. Rewarding stimuli, which are associated with "wanting" and "liking" and appetitive behavior, function as positive reinforcers; the converse statement is also true: positive reinforcers provide a desirable stimulus. Reinforcement does not require an individual to consciously perceive an effect elicited by the stimulus. Thus, reinforcement occurs only if there is an observable strengthening in behavior. However, there is also negative reinforcement, which is characterized by taking away an undesirable stimulus. Changing someone's job might serve as a negative reinforcer to someone who suffers from back problems, i.e. Changing from a labourers job to an office position for instance.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. The diagnosis is made when the person has symptoms of both schizophrenia and a mood disorder—either bipolar disorder or depression. The main criterion for the schizoaffective disorder diagnosis is the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, psychotic bipolar disorder, schizophreniform disorder, or schizophrenia. It is imperative for providers to accurately diagnose patients, as treatment and prognosis differs greatly for each of these diagnoses.

Behaviorism is a systematic approach to understanding the behavior of humans and other animals. It assumes that behavior is either a reflex evoked 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.

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.

Dog training Practice of teaching behaviors to dogs

Dog training is the application of behavior analysis which uses the environmental events of antecedents and consequences to modify the dog behavior, either for it to assist in specific activities or undertake particular tasks, or for it to participate effectively in contemporary domestic life. While training dogs for specific roles dates back to Roman times at least, the training of dogs to be compatible household pets developed with suburbanization in the 1950s.

Applied Behavior Analysis (ABA), also called behavioral engineering, is a scientific technique concerned with applying empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. It is the applied form of behavior analysis; the other two forms are radical behaviorism and the experimental analysis of behavior.

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 learning theory, such as 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.

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Reward system Group of neural structures responsible for motivation and desire

The reward system is a group of neural structures responsible for incentive salience, associative learning, and positively-valenced emotions, particularly ones involving pleasure as a core component. Reward is the attractive and motivational property of a stimulus that induces appetitive behavior, also known as approach behavior, and consummatory behavior. A rewarding stimulus has been described as "any stimulus, object, event, activity, or situation that has the potential to make us approach and consume it is by definition a reward". In operant conditioning, rewarding stimuli function as positive reinforcers; however, the converse statement also holds true: positive reinforcers are rewarding.

In operant conditioning, 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. As with reinforcement, it is the behavior, not the human/animal, that is punished. Whether a change is or is not punishing is determined by its effect on the rate that the behavior occurs, not by any "hostile" or aversive features of the change. For example, a painful stimulus which would act as a punisher for most people may actually reinforce some behaviors of masochistic individuals.

Residential treatment center

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 one domain of behavior analysis: the others being radical behaviorism, experimental analysis of behavior and applied behavior analysis. The professional 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 the experimental analysis of behavior and applied behavior analysis. Professional practice seeks maximum precision to change behavior most effectively in specific instances. Behavior analysts are mental health professionals and, in some states, may hold a license, certificate or registration as a behavior analyst. 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 version of behavior therapy. Unlike behavior modification, which focuses on changing behavior, behavior management focuses on maintaining order. In particular, behavior management skills are critical to teachers and people in the educational system. This form of management includes all of the actions and inactions to help people, both individually or in groups, to choose behaviors that are personally fulfilling, productive, and socially acceptable. Behavior management can be accomplished through modeling, rewards, or punishment.

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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 (CRAFT) 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 help people learn to reduce the power of their addictions and enjoy healthy living. 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 begin and continue treatment and provides them with defences against addiction's damaging effects on themselves.

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