A Token Economy Project with Chronic Schizophrenic Patients

¹ Mental Health Research Fund Bates Fellow in Schizophrenia, Department of Psychiatry, University of Leeds
² Medical Research Council Research Fellow, Departments of Psychiatry and Psychology, University of Leeds

A group of 7 schizophrenic patients with varied symptoms were moved to a ward where different aspects of a token economy system were sequentially introduced. At first patients were just exposed to a smaller ward with a better standard of care (Baseline). Then a stimulating programme of daily events was started (Activity). Next free tokens were given (Non-contingent) and lastly the full scale token reinforcement procedure was instituted, where patients had to earn tokens for appropriate behaviour. The reason for this design was to try to understand more about the therapeutic ingredients at work in a token economy system. Theoretically the reinforcement by tokens is the key agent of therapy and so the last phase should have caused the most improvement.

Patients improved in several areas, notably on dressing and initiative, and on withdrawal and thought disorder, although most of the improvement occurred before the token reinforcement phase was instituted. Also, psychiatric deterioration was associated with the token reinforcement phase. In all, token reinforcement did not emerge as the critical therapeutic agent.

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