The token economy program in the psychiatric hospital: a review and analysis

Reports of token economy programs with hospitalized psychiatric patients are reviewed with emphasis on three general aspects of function :(1) effectiveness. (2) factors influencing effectiveness, and (3) experimental methodology. Token economies are effective in modifying a wide variety and range of patient behavior, but it is still unclear which variable or combination of variables operating in the program are primarily responsible for the changes effected. The methodological aspects of program evaluation were found to be less than adequate in most cases because of failure to control probable operational variables. A systems analysis of the token economy program was offered in which influential aspects of the program including feedback effects were recognized and accounted for in conceptualizing function and evaluation.     

Overgeneral autobiographical memory and traumatic events: an evaluative review

Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology.     

The use of an escape contingency and a token economy to increase food acceptance

Escape (termination of a meal) and token-based differential reinforcement of alternative behavior were used as reinforcement to increase acceptance of food. Using a changing criterion design, the number of bites accepted and consumed was gradually increased to 15 bites per meal. These data suggest that, in some cases, escape may be a potent reinforcer for food acceptance.     

Social skill assessment and training for children: an evaluative review

Techniques employed in the behavioral assessment and treatment of socially deficient children are reviewed. General definitions and components of assertion and social skill in children are presented. While considerable data attest to the potential efficiency of behavioral approaches with this population, several methodological problems prevent any definitive conclusions from being drawn at this time. Some of these include: (1) lack of an accurate classification system of socially isolated children, (2) need for an empirical determination of skill components, and (3) the paucity of data concerning generalization and maintenance of treatment effects. The utility of incorporating developmental and social psychological methods into behavioral programs also is discussed. Suggestions for future directions of research are offered.     

Intrinsic reinforcers in a classroom token economy

An inexpensive, easily managed token economy was used in a normal classroom for one academic year, and data were collected for the entire academic performance in spelling, language, handwriting, and math for that year. During a baseline period, assignment completion was variable. The introduction of a token economy with a point exchange every five days increased assignment completion and decreased variability of performance. An application of a token economy that had a point exchange averaging four days was accompanied by an assignment completion rate that approximated 100%. A reinforcement contingency for which quiet behavior rather than for assignment completion was eased quiet behavior was accompanied by a marked diminution of assignment completion. A reintroduction of the token reinforcement for assignment completion system increased assignment completion again.     

Maintaining patients' improvements in a token economy.

Eighteen long stay male patients (diagnosis chronic schizophrenia) were involved in a six month token economy prior to random assignment to one of three experimental groups to investigate the importance of social reinforcement and other token-related variables in maintaining improvements brought about by the token system. Assessment included standardised psychiatric rating scales, nurse rating scales, and behavioural measures. Analysis of variance suggests the full token economy system produced significant improvements, but that the social factors involved in token exchanges were not demonstrably important sources of reinforcement. and that none of the variables studies at the experimental phase were critical factors. Once patients returned to a complete token system, results indicate that this may have more value in the promotion of work activities rather than social responding. It is argued that the token system provides a necessary clear structure within which nurses can encourage continuous improvements with long stay patients.     

A token economy program for chronic schizophrenic patients

Abstract.— A token economy program was applied on a ward for 12 chronic schizophrenic patients. An ABABC-design, i.e. a group reversal design with a noncontingent reinforcement phase at the end, was used to evaluate the treatment. The patients' activity-level increased from baseline to the treatment phase. During the reversal period the activity-level decreased but it increased again when the token economy was reintroduced. The non-contingent reinforcement resulted in the predicted decrease for two of the six behaviors recorded. Five of the twelve patients were discharged from the ward during the 8-month program period and none of them had been readmitted at the end of the one year follow-up. Individual treatment programs for two of the patients concerning aggressive acts, deficient eye-contact and lip-biting are described.     

Item preference in a token economy ward store

Token spending by 20 schizophrenic patients was monitored over a six-month period. It was found that: (1) token expenditures for cigarettes and "edibles" far surpassed other store item categories; and (2) percentage increases in token expenditures were greatest for categories of items relating to appearance and grooming, strongly suggesting that store purchasing patterns over time may provide an index of program effectiveness.