| Abstract: | Eighteen chronic schizophrenic patients were allocated to 3 matched groups, one group acting as an own-ward no-treatment control group. The two other groups moved to a token-economy ward, where the token group received contingent tokens, social reinforcement, and informational feedback as a consequence of appropriate behaviour, and where the control group received contingent social reinforcement and feedback with a matched amount of non-contingent tokens. After a 3 month baseline phase, this procedure was followed for a total of 15 months. A continuous assessment system was used with some weekly and monthly assessments, incorporating nursing checklists and ratings, psychiatric ratings, psychological tests, and time-sampling procedures, as well as continuous monitoring of the ward programme. The introduction of contingent tokens had an immediate positive effect in 3 areas of behaviour, but this advantage disappeared over the 15 months owing to the slower but sustained improvement in the control group. Significant improvement was limited to the areas of Social Withdrawal. Appearance and Routine. The patients who improved the most on any measure were those who were initially the most deteriorated. There were paradoxical changes in non-target behaviour, and in symptomatic behaviour. Suggestions and instructions to nurses may play a major part in influencing patient behaviour within and between experimental phases. |
