Token Economy Program Research Articles

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

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.

Intervention for Learner Engagement using Token Economy among National Language Classrooms in Tamil Primary Schools

This research is aimed to know the effect of the application of the token economy method on National Language learning motivation. The experiment was set as the research method. The variables in this study were the token economy method as an independent variable, learning motivation as the dependent variable, and learning achievement as the control variable. The subjects used in this study were Year Three students in four Tamil Primary Schools in the District of Larut Matang Selama, in the state of Perak. Based on the descriptive analysis, it is found that in general, before undergoing modification, the experimental variables had a low motivation in learning the National Language. After undergoing the modification, it was noted that the variables in the Token Economy program have higher learning motivation compared to the same variables before the Token Economy program.

Efectos de un programa basado en el Análisis Conductual Aplicado en la enseñanza de Conceptos Éticos y Morales religiosos

La educación es fundamental para el desarrollo pleno como seres humanos, puesto que es allí donde seaprenden conceptos básicos y parámetros de comportamiento para desenvolverse en el ámbito social. Alo largo de la historia han surgido diferentes modelos o paradigmas que buscan dar pautas, técnicas, herramientas y estrategias para cumplir los objetivos y metas propuestas en los procesos que se adelantandentro de la educación y el diseño de los currículos. Uno de estos paradigmas es el planteado por el análisis de la conducta, el cual por su incorrecta e incompleta aplicación se ha tergiversado en su interpretacióny ha recibido fuertes críticas en la práctica. Por lo anterior, esta investigación propone observar y establecer los efectos de la implementación de los principios del Análisis Conductual Aplicado en la enseñanza devalores éticos religiosos de 12 adolescentes de 11 a 13 años, pertenecientes al grupo de catequesis de laiglesia el Buen Pastor de Bucaramanga. Para esto se llevó a cabo una investigación con un diseño ABAB endonde se midieron las variables dependientes motivación y participación al aplicarse un programa de reforzadores sociales y economía de fichas. Los resultados evidenciaron que estas últimas estrategias del Aná-lisis Conductual fueron efectivas para aumentar la participación y la motivación y el nivel de aprendizaje

Quais são as técnicas comportamentalistas que os docentes consideram mais eficazes nas crianças com Perturbação de Hiperatividade com Défice de Atenção?

The Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral disorder characterized by persistent patterns and inadequate levels of inattention and/or hyperactivity-impulsivity. It is the most frequent disorder of school age, and, therefore, it is relevant that teachers know how to intervene appropriately, using educational and behavioral strategies in view of academic success and social integration. Currently, ADHD is probably the most studied disorder of childhood and with which 1st cycle teachers most are faced in their daily lives. In this study, in order to identify the behavioral techniques based in positive reinforcement and punition that teachers consider more efficient to change the behavior of children with ADHD and what’s the frequency of their use, a questionnaire was developed and applied to a sample of two hundred and fifty teachers. The results show, that teachers use more frequently the Contingency Contract and Response Cost and attribute to these techniques more efficacy than those related with Time Out and Token Economy program.

Classroom Reinforcement Schedules and Their Effectiveness in Selected Kenyan Primary Schools

The purpose of the study was to determine Classroom Reinforcement Schedules and Their Effectiveness in Selected Kenyan Primary Schools. The study employed a Mixed Methods design in which both quantitative and qualitative data were collected. The target population teachers and pupils from public primary schools. Data was collected by using questionnaires and interview schedules. Quantitative data was analyzed using inferential statistics while Qualitative data was analyzed by using the thematic and content analysis. The study reported on the use of praise, tangible items such as games and money were also moderately often used by the teachers. The participants also used both Continuous reinforcement and partial reinforcement schedules. The study recommends that, schools should enhance token economy programs which have long term effect. Moreover, teachers should deepen their knowledge on token economy programs for academic success. DOI: 10.5901/jesr.2015.v5n3p41

The Effect of a Token Economy System Program and Physical Activity on Improving Quality of Life of Patients with Schizophrenia: A Pilot Study

The aim of this pilot study was to examine the effect of an exercise and token economy system program on improving quality of life of patients with schizophrenia. Thirty (30) patients with schizophrenia separated in three groups (control group, an exercise observation with tokens group and an actual exercise with tokens group) of 10 individuals, took part in an eight weeks exercise program combining physical activity with token economy behavioral treatment. Data included the use of SF-36 Quality of Life Questionnaire (QLQ). Experiment group B participants as compared to those of the experiment group A and control group individuals found at the end of the exercise program as experiencing less problems with daily activities and felling more energetic and vigorous leading to an improved mental component score. Overall, findings are encouraging concerning the effect of a combined exercise and token economy program on improving quality of life of patients with schizophrenia.

Effect of a token economy behaviour therapy on drooling in children with cerebral palsy

Objective: To investigate the effect of token economy-a behaviour therapy technique for controlling drooling in children with cerebral palsy associated with mild intellectual disability. Methodology: A total number of 25 children with cerebral palsy associated with mild intellectual disability attending the occupational therapy department of Swami Vivekanand National Institute of Rehabilitation Training and Research (SVNIRTAR), Orissa, India, participated in a single blind randomized pre-and post-test control group training study. Subjects were randomly allocated to group A (experimental n=12) and group B (control n=13). Baseline frequency of drooling was observed by two independent raters for 20 minutes for both the groups. After the baseline data collection, subjects in group A received conventional therapy along with behaviour therapy (token economy) and group B received conventional therapy alone. Results: The result showed that there was a significant decrease in frequency of drooling after application of token economy as a behaviour modification technique in the experimental group (P=0.001) as compared to the control group (P=0.070). Conclusion: The result of the study demonstrated that the token economy program was effective in controlling drooling in children with cerebral palsy associated with mild intellectual disability.

Recent developments in psychosocial treatments for schizophrenic patients

Pessimistic views regarding the course and outcome of schizophrenia have been replaced by an emphasis on recovery. The concept of recovery emphasizes the need to provide access to treatments and services that are effective in both decreasing manifestations of the disorder and in assisting individuals to lead maximally productive and personally meaningful lives. To this end, the schizophrenia Patient Outcomes Research Team (PORT) published an updated consensus list of evidence-based practices that includes 14 recommendations, six of which describe psychosocial treatments (family interventions, supported employment, assertive community treatment, skills training, cognitive therapy and token economy programs). This paper reviews the schizophrenia PORT committee recommendations for psychosocial evidence-based practices, and discusses future needs and potential confounds that can have an impact on the effectiveness of these approaches. Among these potential confounds, the heterogeneity of individuals diagnosed with schizophrenia, variations in quality and integrity of implementation and the degree to which services listed are truly accessible and available as needed are paramount. The PORT psychosocial recommendations are an excellent foundation in the process of identifying evidence-based practices that can foster social recovery; they are not a comprehensive list. More innovation and research on psychosocial therapies remains to be accomplished in order to improve the chances for social recovery of patients diagnosed with schizophrenia.

Integration of a token economy program with psychosocial and psychopharmacological research on a treatment refractory schizophrenia unit

Integration of a token economy program with psychosocial and psychopharmacological research on a treatment refractory schizophrenia unit

Token economy plus self-monitoring to reduce disruptive classroom behaviors.

The current study examined the effectiveness of a combined token economy and self-monitoring package with a youth displaying a major mental illness and severe aggressive and persistent disruptive behaviors. The student received points for lower rates of aggressive/disruptive behavior and 'bonus' points for accurately self-monitoring and recording his own behaviors. The results indicate that the addition of the self-monitoring component decreased the number of targeted behaviors beyond the substantial reduction of the token economy alone. In the reversal, there was a slight rise in the emission of problem behaviors, yet the frequency was still significantly below baseline. Implications for clinical applications and future research are discussed. Youth diagnosed with Conduct Disorder, Attention Deficit-Hyperactivity Disorder, Oppositional Defiant Disorder or those who have emotional or behavioral problems often experience academic deficits or problems meeting the expectations of schools. These difficulties are often apparent in many other aspects of their lives; including home, social, and recreation. The difficulties experienced by youth with emotional or behavioral disorders include inattention, disruptive behaviors like calling out and out of seat behavior, social skills deficits, aggression and other maladaptive behaviors. Many different interventions have been implemented to decrease the occurrence of these behaviors to acceptable and appropriate levels. For example, behavioral interventions that are typically implemented to manage inappropriate and disruptive behaviors are variations of differential reinforcement of incompatible or appropriate alternative behaviors where the frequency of appropriate behaviors increase and a natural consequence of the increase is a decrease in disruptive inappropriate behaviors (Gaughan & Axelrod, 1989). Additionally, Fontenell and Holloman (1983) investigated the effects of differentially reinforcing hand-raising in a classroom on the rate of disruptive behavior of calling-out for teacher attention. Token economies have also been implemented to decrease disruptive behaviors and increase appropriate behaviors. A token economy is an intervention that includes contingencies in which tokens or points are given following the emission of targeted behaviors. Tokens can then be redeemed for reinforcing objects or activities at a later point in time. Many studies have produced data that affirmed the effectiveness of token economies and contingency plans with behaviorally and /or emotionally-disordered youth for a variety of target behaviors, including aggression, on-task behavior, and social skills (Phillips, 1968). Subsequent studies have investigated token economy procedures to reinforce on-task behavior, reduce disruptive classroom behavior, and improve social skills of youth with weak reinforcement histories and emotional problems. (Ferritor, Buckholdt, Hamblin, & Smith, 1972; Ayllon & Roberts,1974, & Gaughan & Axelrod, 1989). Self-monitoring and self-recording have been examined as a technique to influence behavior change in multiple human populations but few have specifically targeted youth with emotional or behavioral disorders. McLaughlin et al. (1985) found that self-monitoring can improve social behavior and attending behavior in school settings. Few studies have examined the combined effects of token-economies with self-monitoring on disruptive behaviors in a classroom setting. Champagne, et al. (1990) used a token economy to effectively decrease talk outs and inappropriate facial expressions in classroom and group therapy settings. The procedures included a self-monitoring component but the contribution of the self-monitoring to the treatment effect was not investigated. The purpose of the present study is to examine the effects of a combined intervention consisting of a token-economy program with self-monitoring of disruptive classroom behaviors in an adolescent with emotional and behavioral disorders. …

Analysis of outcome variables of a token economy system in a state psychiatric hospital: a program evaluation

This study describes the outcome of a token economy treatment applied to 2 distinct patient populations on the same unit of a state psychiatric hospital: individuals with a dual diagnosis of mental retardation and a DSM-IV Axis I diagnosis of either (a) a severe behavior disorder (BD) or (b) a serious and persistent psychiatric disorder (PD). Results showed that patients in the PD group were more likely to complete the treatment (17/20) than those in the BD group (17/31) who were more likely to be terminated from the program (14/31). Individuals who did not complete the program were distinguished early, within the first 3 weeks of treatment. These noncompleters received significantly more fines and earned significantly fewer tokens than those who completed the program. At an average of 2.7 years post-discharge, there was no difference in the proportion of PD (12/16) and BD completers (9/11) and BD noncompleters (3/7) remaining in the community. These data show that diverse populations of patients can be treated within the same token economy program, thereby improving cost effectiveness. Future research should be directed toward characterizing those patients (e.g., BD) less likely to succeed when they enter treatment, and determining if modifications in the program can improve that outcome.

Token economy for schizophrenia.

A token economy is a behavioural therapy technique in which the desired change is achieved by means of tokens administered for the performance of predefined behaviours according to a program. Though token economy programmes were widespread in the 1970s they became largely restricted to wards where long-stay patients from institutions are prepared for transfer into the community and were particularly aimed at changing negative symptoms of schizophrenia - poor motivation, poor attention and social withdrawal. To review the effects of token economies for people with schizophrenia, or other serious or chronic mental illnesses, compared with standard care. Electronic searches of Biological Abstracts (1985-1999), CINAHL (1982-1998), The Cochrane Library (Issue 1, 1999), The Cochrane Schizophrenia Group's Register of Trials (February 1999), EMBASE (1980-1999) and PsycLIT (1987-1998) were supplemented with reference searches, personal contact with trial authors and hand searches. Randomised studies comparing a token economy regime (one in which change is achieved by means of use of non-monetary, non-consumable tokens) to standard care for those with schizophrenia or any other similar chronic or serious mental illness. Studies were reliably selected, quality rated and data extracted. For dichotomous data relative risk (RR) with 95% confidence intervals (CI) was estimated. Where possible, the number needed to treat statistic (NNT) was also calculated. Analysis was by intention-to-treat. Normal continuous data were summated using the weighted mean difference (WMD). Scale data were presented only for those tools that had attained pre-specified levels of quality. Only three randomised controlled trials could be included in the analyses (total n=110). There were no usable data on target or non-target behaviour. One small study favoured the token economy approach for the outcome 'change in mental state' on the SANS-CV with improvement in negative symptoms at three months (n=40, WMD -12. 7, CI -21.44 to -3.96). The token economy approach may have effects on negative symptoms 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 well designed, conducted and reported randomised trials.

Effects of professional group membership, intervention type, and diagnostic label on treatment acceptability

Differences in ratings of treatment acceptability among groups of individuals who are often involved in the recommendation, selection, implementation, and evaluation of behavioral interventions in educational settings were examined. Teachers, school psychologists, and school social workers were presented with a vignette of a 3rd grade student exhibiting a pattern of disruptive problem behavior. The vignette was held constant but diagnostic labels (LD, BD, ADD) and interventions (verbal praise and token economy program versus time out from reinforcement program and verbal praise) for the child in the vignette were varied. After examining the vignette, participants rated the acceptability of the interventions. There was a significant interaction for professional group membership by intervention type on ratings of treatment acceptability. No significant effects of diagnostic label occurred. Implications of the present study and future research directions are discussed. © 1997 John Wiley & Sons, Inc.

Effects of professional group membership, intervention type, and diagnostic label on treatment acceptability

Differences in ratings of treatment acceptability among groups of individuals who are often involved in the recommendation, selection, implementation, and evaluation of behavioral interventions in educational settings were examined. Teachers, school psychologists, and school social workers were presented with a vignette of a 3rd grade student exhibiting a pattern of disruptive problem behavior. The vignette was held constant but diagnostic labels (LD, BD, ADD) and interventions (verbal praise and token economy program versus time out from reinforcement program and verbal praise) for the child in the vignette were varied. After examining the vignette, participants rated the acceptability of the interventions. There was a significant interaction for professional group membership by intervention type on ratings of treatment acceptability. No significant effects of diagnostic label occurred. Implications of the present study and future research directions are discussed. © 1997 John Wiley & Sons, Inc.

Predicting treatment outcome and recidivism among patients in a maximum security token economy

AbstractThe relationship between program performance and outcome for patients in maximum security token economy programs has not been previously studied. We examined variables related to success in a token economy program and to postrelease failure for 92 men in a maximum security psychiatric hospital. Point earnings later in the program were best predicted by earlier point earnings. Variables that best predicted postrelease failure, defined in various ways, were similar to those found in other studies; youthfulness, having spent more time in institutions, a diagnosis of personality disorder or retardation rather than psychosis, not having been found not guilty by reason of insanity or unfit to stand trial, and having been referred from another psychiatric hospital. That program variables were generally unrelated to later outcome suggests that treatment programs for patients in maximum security settings must emphasize skills that are relevant to postrelease success.

The relationship between neuroleptic drug dose and the performance of psychiatric patients in a maximum security token economy program

This study examined the relationship between neuroleptic medication dose and performance in a token economy program on two maximum security psychiatric wards. Patients receiving higher than average doses exhibited poorer than average program performance but there was a small but statistically significant positive relationship between neuroleptic drug dose (measured in CPZ units/kg) and program performance. However, this positive relationship existed only for the first few weeks of patients' hospital stays, and there was a delay (approximately 2 weeks) between the administration of the drug and the maximal positive effect on program performance. Only a very small minority of medication changes were ever followed by improvements in program performance. The results are discussed in terms of what is a rational strategy for the provision of psychiatric medication and other forms of treatment in institutional settings.

The effects of behavior modification vs lithium therapy on frontal lobe syndrome

An A-B-BC-C single-subject design was used to evaluate the effects of behavior modification (i.e. a token economy program) and lithium therapy on the behavioral symptoms associated with frontal lobe damage in a 21-year-old woman. The design consisted of a baseline, token economy, token economy plus lithium, lithium alone and a 4 month follow-up. There was a significant decrease in inappropriate behaviors after treatment with the token economy program, but no additional change was noted in subsequent phases involving lithium therapy. There was evidence of generalization and maintenance in the home environment, even after lithium therapy was discontinued. The results do not support the use of a combined treatment approach.

The role of meals as a reinforcing event in a token economy programme.

Items such as meals have frequently been used as back-up events in Token Economy Programmes (TEPs) because of their supposed reinforcing effectiveness. However, despite the dubious ethical questions that this raises, there is little research evidence to support the necessity for their use in TEP's with hospitalised chronic mentally ill patients. The effects of introducing meals as a 'free' item on patients' performance of a number of target behaviours were investigated in a TEP where they had previously been scheduled as a back-up event. While 'free' meals produced a slight increase in the actual number of meals eaten, there were no systematic effects on patients' performance of the target behaviours.

Elimination of response cost in a token economy program and improvement in behavior of emotionally disturbed youth

This paper evaluated the effects of eliminating the response cost procedure in a token economy program that had been developed for adolescents diagnosed as “emotionally disturbed” and/or “socially maladjusted.” It was hypothesized that this change would result in improvements in clients' behavior in addition to the improvements that resulted with the initial implementation of the token economy system. The research was carried out in a community-based treatment and special education program. The number of clients varied between 107 and 132 during the course of the study. Data consisted of official records of misbehavior incidents and use of the time-out room. The results showed that, as hypothesized, elimination of the response cost procedure was followed by declines in the frequency of misbehavior reports, use of the time-out room, and number of episodes involving violence. These results suggest that elimination of the response cost and the related shift to a more positive approach increased the effectiveness of a token economy program that originally had employed a combination of positive and negative contingencies.

Token-economy programmes with chronic psychotic patients: The importance of direct measurement and objective evaluation for long-term maintenance

Direct-observational data collected from 6 example patients over 5 yr on a token-economy ward are presented. Comparison of performance in baseline, contingent-token and non-contingent-token conditions revealed considerable variability within and between both patients and self-care behaviours. For 3 patients the Token-Economy Programme appeared to have a ‘therapeutic’ effect, producing behaviour change that was sustained after the termination of a contingent token regime. For the others, rates of behaviour change were exceptionally slow and the token economy functioned as an essential prosthetic environment. It is suggested that the longevity of the system was related to the conceptional framework and methodology employed. An example of behaviour becoming ‘token bound’ is included.