The Effect of Token Economy on Managing Aggression in Adults and Adolescents with Mental Disorders: A Recent Review

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Context: Individuals with mental illness may exhibit aggression due to psychological instability. The Token Economy is a behavioral approach that aims to achieve desired changes by using tokens as reinforcements. Objectives: This study investigates the effectiveness of token reinforcement in reducing aggressive behavior in mentally ill patients and identifies the factors that enhance the effectiveness of the Token Economy program. Evidence Acquisition: A search for studies was conducted in the databases of PubMed, Google Scholar, ProQuest, Scopus, and Web of Science using several keywords, including "Contingency Management," "Token Reinforcement," "Token Economy," "behavioral disorder," "mental disorder," "aggression," "violence," "disruptive behavior," and "challenging behavior." The search focused on articles published from 2003 to 2023 that included the implementation of token reinforcement in various settings for managing aggression. Results: A total of 12 studies met the inclusion criteria. After reviewing these studies, several factors were identified as responsible for the program's effectiveness. The Quality Assessment Tool for Quantitative Studies and the Oxford Centre for Evidence-Based Medicine (2011) were used to evaluate the studies. Of the 12 studies, two were rated as strong quality, one as moderate, and nine as weak quality. Additionally, three studies were classified as level 2, one as level 3, and eight as level 4, indicating significant methodological limitations. Conclusions: Generally, 9 studies supported the effectiveness of the Token Economy in managing aggression in adults and adolescents with mental illness. This approach can be useful in the modern rehabilitation and education of individuals with aggressive behavior. We recommend further studies with higher methodological quality to examine the generalizability and transferability of the results.