Token economy
Encyclopedia
A token economy is a system of behavior modification
based on the systematic positive reinforcement
of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. Token economy is based on the principles of operant conditioning
and can be situated within applied behavior analysis
(behaviorism
). Token economies are applied with children and adults.
There are plenty of possible back-up reinforcers. They’re chosen in function of the individual or group for which the token economy is set up, or depending on the possibilities available to the staff. Before starting they decide how many tokens have to be paid for each back-up reinforcer. Often price lists are exposed or given to the clients. Some back-up reinforcers can be bought anytime, for other exchange times are limited (e.g. opening times of a token shop).
While planning how many tokens can be earned by each target behavior some factors have to be considered: one has to assure that everyone can already earn a minimal amount of tokens for a minimal effort, and on the other hand one has to arrange that clients don’t earn too much too soon, making more effort useless.
Sometimes the possibility of punishment by token loss is included, technically called 'response cost': disruptive behavior can be fined with the loss of tokens. This also should be clearly specified before the application starts. Clients can be involved in the specifying of the contingencies.
implies clients aren’t expected to do everything perfectly at once; behavior can be acquired in steps. Initially clients can be reinforced for behavior that approaches the target. If the target behavior is keeping attention during a 30 minutes session, clients can initially already get (perhaps smaller) reinforcement for 5 minutes of attention.
Family education and involvement is very important. They can support the system or they can undermine it, for instance by secretly giving undeserved rewards.
s. Teodoro Ayllon, Nathan Azrin and Leonard Krasner were important pioneers in these early years. The very first token economy, bearing that name, was founded by Ayllon and Azrin in 1961 at Anna State Hospital in Illinois. In the 1970s the token economies came to a peak and got widespread. In 1977 a major study (a randomized controlled trial
), still considered a landmark, was published. This study successfully showed the superiority of a token economy compared to standard treatment and specialized milieu therapy. Despite this success token economies massively disappeared from the 1980s on. It became fairly quiet on that front, having to do with a variety of problems and criticism.
and at the same time decrease the intrinsic motivation for activities.
care. The criticism that clients have no choice and are being forced, is countered by offering them the choice to enter the token program or not to enter, or to leave again once entered. The vast majority of clients voluntarily chooses to stay in the program.
Research shows the effects of token economies can more or less be divided into three categories:
inpatients. Even now token economies are applied to clients with schizophrenia
. Sometimes the token economy is being used as a lasting prosthesis. Sometimes it’s used to help so-called treatment-resistant clients towards resocialization
. A token economy (of course always in combination with other interventions) succeeded in the community reintegration of 78% of the clients within an average period of 110 days, after more than 7 years of uninterrupted hospital stay. Research shows clients experience the token economy positively. Several recent reviews of psychosocial
treatment for schizophrenia explicitly mention token economy as an effective, evidence-based
treatment.
services to acute psychiatric units. A token economy was successful in decreasing the aggression on a ward where clients on average stayed for less than three weeks.
treatment settings. Since considerable time systems derived from token economies are being used under the name contingency management
. Initially contingency management was broader, referring to the direct coupling of consequences (reinforcers) to behavior like staying clean. But more and more it evolved to a kind of token economy. Also the community reinforcement approach is often combined with contingency management. Instead of using the name ‘tokens’, contingency management is speaking of voucher
s or related terms.
Research shows this kind of token economy is easily applicable outside of hospitals and clearly leads to less drug abuse. This way the problem of less hospital-based and more community-based treatment is solved. Contingency management is being used with inpatients and outpatients.
. Target behaviors can be all kinds of social behavior and self care, or the decreasing of inappropriate or disruptive behavior.
as well as in other schools. Positive results can imply increased attention and decreased disruptive behavior. In educational settings token economy seems to raise the intrinsic motivation. But there’s still need for more research.
Behavior modification
Behavior modification is the use of empirically demonstrated behavior change techniques to increase or decrease the frequency of behaviors, such as altering an individual's behaviors and reactions to stimuli through positive and negative reinforcement of adaptive behavior and/or the reduction of...
based on the systematic positive reinforcement
Reinforcement
Reinforcement is a term in operant conditioning and behavior analysis for the process of increasing the rate or probability of a behavior in the form of a "response" by the delivery or emergence of a stimulus Reinforcement is a term in operant conditioning and behavior analysis for the process of...
of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. Token economy is based on the principles of operant conditioning
Operant conditioning
Operant conditioning is a form of psychological learning during which an individual modifies the occurrence and form of its own behavior due to the association of the behavior with a stimulus...
and can be situated within applied behavior analysis
Applied Behavior Analysis
Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...
(behaviorism
Behaviorism
Behaviorism , also called the learning perspective , is a philosophy of psychology based on the proposition that all things that organisms do—including acting, thinking, and feeling—can and should be regarded as behaviors, and that psychological disorders are best treated by altering behavior...
). Token economies are applied with children and adults.
Tokens
Tokens have to be used as reinforcers. A token is an object or symbol that can be exchanged for material reinforcers, services or privileges (back-up reinforcers). In applied settings a wide range of tokens are being used: coins, checkmarks, images of small suns, points on a counter. These things are worthless. Their value lies in the fact that they can be exchanged for valued things. Technically speaking tokens aren’t primary reinforcers, but secondary or learned reinforcers. Lots of research has been done on token reinforcement, including animal studies.Back-up reinforcers
Tokens have no intrinsic value, but can be exchanged for other valued reinforcing events: back-up reinforcers. Most token economies offer a choice of differing back-up reinforcers:- Material reinforcers: sweets, cigarettes, journals, money
- Services: breakfast in bed, having your room cleaned, activities
- Privileges and other extras: passes for leaving the building or area, permission to stay in bed, phone calls, having your name or picture on the wall.
There are plenty of possible back-up reinforcers. They’re chosen in function of the individual or group for which the token economy is set up, or depending on the possibilities available to the staff. Before starting they decide how many tokens have to be paid for each back-up reinforcer. Often price lists are exposed or given to the clients. Some back-up reinforcers can be bought anytime, for other exchange times are limited (e.g. opening times of a token shop).
Specified target behaviors
Using exchangeable tokens isn’t sufficient for a token economy. The contingencies have to be specified before introducing the program. Sometimes client manuals are written to specify how many tokens can be earned by each target behavior (including the exact criteria being used). When a staff member gives tokens to a client just because he judges he’s behaving positively, isn’t part of a token economy. That’s just arbitrarily giving tokens. Criteria have to be clarified before starting the program. If making your bed is a target behavior, staff and clients have to know how a well-made bed looks like: do the sheets have to be put under the mattress, cushion on top? Often these specifications are hard to make: eating politely, positive cooperation … how to specify these? There’s a broad range of possible target behaviors: self-care, attending activities, academic behavior, disruptive behavior. Clearly specified behavioral criteria can facilitate the learning process. A token economy helps people experience the immediate consequences of their behavior and get a grip on their life. Their social environment becomes more predictable.While planning how many tokens can be earned by each target behavior some factors have to be considered: one has to assure that everyone can already earn a minimal amount of tokens for a minimal effort, and on the other hand one has to arrange that clients don’t earn too much too soon, making more effort useless.
Sometimes the possibility of punishment by token loss is included, technically called 'response cost': disruptive behavior can be fined with the loss of tokens. This also should be clearly specified before the application starts. Clients can be involved in the specifying of the contingencies.
Other features of a token economy
Besides the 3 basic requirements, other features often are present.Social reinforcement
Token reinforcement is essential, but is always accompanied by social reinforcement. Tokens are intended to make reinforcement explicit and immediate, and to strengthen behavior, but in the end social reinforcement should be sufficient to maintain what’s been learned.Shaping
All principles of operant learning are applied within a token economy. ShapingShaping
Shaping can refer to:* In electricity generation, maintaining reliable delivery, for example by use of pumped storage hydroelectricity* Shaping , the reinforcement of successive approximations to train a type of behavior...
implies clients aren’t expected to do everything perfectly at once; behavior can be acquired in steps. Initially clients can be reinforced for behavior that approaches the target. If the target behavior is keeping attention during a 30 minutes session, clients can initially already get (perhaps smaller) reinforcement for 5 minutes of attention.
Immediacy of reinforcement
Reinforcement will greater influence behavior if given shortly after the response is emitted. The longer people have to wait for a reward, the less effect and the less they will learn. This is the principle of delay discounting. Immediate token reinforcement can bridge later reinforcement.Learning to plan ahead and save earnings
Sometimes clients can earn larger rewards like the permission to spend a weekend at home, going to a movie, or having a class excursion. When such rewards would be given at once for one instance of a target behavior, the scarce resources would soon be depleted and consequently the incentives would be lost. One advantage of tokens is they can be used to divide larger rewards into parts: clients can save tokens to buy more expensive rewards later. This implies they shouldn’t immediately spend all earned tokens to attractive smaller rewards, and learn to plan ahead. This way they can acquire self-control.Individual and group contingencies
Mostly token economies are designed for groups. The system is running for a whole ward or class. Within this group contingency specific individual goals and reinforcers can be added. Though sometimes a token economy is being designed only for one specific individual.Consistent application
The power of a token economy largely depends on the consistency of its application. To achieve this thorough staff training is essential. Some token economies failed exactly on this point. Token economies imply rights and duties for clients as well as for staff. When according to the system a client deserved tokens, he should get them, even when a staff member judges he doesn’t deserve them because he has been impolite the day before.Family education and involvement is very important. They can support the system or they can undermine it, for instance by secretly giving undeserved rewards.
Leveled system
Often token economies are leveled programs. Clients can pass through different levels until they reach the highest level. At that point behaviors are performed without token reinforcement. Higher levels require more complex behaviors. The incentive to progress from one level to the next is the availability of increasingly desirable reinforcers.History of the token economy
In the early 19th century, long before there was any knowledge about operant learning, there were some precursors of token economies in schools and prisons. In those systems points could be earned and exchanged for all kinds of things and privileges. Only in the 1960s the first real token economies arose in psychiatric hospitalPsychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
s. Teodoro Ayllon, Nathan Azrin and Leonard Krasner were important pioneers in these early years. The very first token economy, bearing that name, was founded by Ayllon and Azrin in 1961 at Anna State Hospital in Illinois. In the 1970s the token economies came to a peak and got widespread. In 1977 a major study (a randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
), still considered a landmark, was published. This study successfully showed the superiority of a token economy compared to standard treatment and specialized milieu therapy. Despite this success token economies massively disappeared from the 1980s on. It became fairly quiet on that front, having to do with a variety of problems and criticism.
Problems and controversy
Especially the application of token economies with adults became a matter of criticism. In addition some impediments and the evolution of mental health care caused troubles.Dramatic changes in the mental health system
Token economies had proven their effectiveness and utility for chronic psychiatric patients. They can require months or even years to achieve optimal results. This causes problems when insurance and government policies increasingly require the shortest possible hospital stays. Emphasis was put on community-based treatment. Outpatient and home-based care were the future. It wasn’t easy for token economies to adapt to this evolution.Legal and ethical issues
At the same time there was a growing concern for patient rights. The right to have their personal properties, basic comfort and freedom of choice of treatment constrained the possibilities for token economies. In addition ethical and personal concerns of staff members arose: is it ethically justified to use cigarettes as back-up reinforcers, is it human to rely on ‘reward and punishment’ as means for treatment (behavior modification often is reduced to this by opponents), isn’t sincere human contact much more valuable and effective, isn’t human interaction reduced to trade, isn’t this manipulating people?Client resistance
Application of a token economy to adults sometimes triggers client resistance. People can feel to be forced. Badly designed token economies even can induce aggression.Response maintenance and generalization
Problems with maintaining what’s been learned and the generalization toward new situations have been signaled. When the token programs stops the acquired behavior might disappear again.Extrinsic versus intrinsic motivation
Rewarding behavior could increase the extrinsic motivationMotivation
Motivation is the driving force by which humans achieve their goals. Motivation is said to be intrinsic or extrinsic. The term is generally used for humans but it can also be used to describe the causes for animal behavior as well. This article refers to human motivation...
and at the same time decrease the intrinsic motivation for activities.
Recent applications and findings
In the last 50 years plenty of research has been done on token economy. The first 20 years were especially productive. Despite controversy and a lack of implementation token programs are alive and well in several settings.Adults
In adult settings token economies are mostly applied in mental healthMental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
care. The criticism that clients have no choice and are being forced, is countered by offering them the choice to enter the token program or not to enter, or to leave again once entered. The vast majority of clients voluntarily chooses to stay in the program.
Research shows the effects of token economies can more or less be divided into three categories:
- No effect: 5 to 20% of the clients does not (or only minimally) respond to the token economy;
- Only effect while the token economy is active and no effect once stopped: in this case the token economy is functioning as a prosthesisProsthesisIn medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
(like a wheelchairWheelchairA wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...
; it doesn’t cure but is necessary to keep functioning well; - Well established long-term effects (including community reintegration).
Schizophrenia
The first token economies were designed for chronic, treatment-resistant psychoticPsychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
inpatients. Even now token economies are applied to clients with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
. Sometimes the token economy is being used as a lasting prosthesis. Sometimes it’s used to help so-called treatment-resistant clients towards resocialization
Resocialization
Resocialization is defined as radically changing an inmate’s personality by carefully controlling the environmentKey examples include the process of resocializing new recruits into the military so that they can operate as soldiers and the reverse process, in which those who have become accustomed...
. A token economy (of course always in combination with other interventions) succeeded in the community reintegration of 78% of the clients within an average period of 110 days, after more than 7 years of uninterrupted hospital stay. Research shows clients experience the token economy positively. Several recent reviews of psychosocial
Psychosocial
For a concept to be psychosocial means it relates to one's psychological development in, and interaction with, a social environment. The individual needs not be fully aware of this relationship with his or her environment. It was first commonly used by psychologist Erik Erikson in his stages of...
treatment for schizophrenia explicitly mention token economy as an effective, evidence-based
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
treatment.
Acute units
The application of token economies has been extended from psychiatric rehabilitationPsychiatric rehabilitation
Psychiatric rehabilitation, also known as psychosocial rehabilitation, and usually simplified to psych rehab, is the process of restoration of community functioning and well-being of an individual who has a psychiatric disability...
services to acute psychiatric units. A token economy was successful in decreasing the aggression on a ward where clients on average stayed for less than three weeks.
Substance abuse
As a result of heavy ethical criticism token economy got negative connotations. That’s why sometimes the system is being introduced under other names. This is especially the case in substance abuseSubstance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
treatment settings. Since considerable time systems derived from token economies are being used under the name contingency management
Contingency Management
Contingency management is a type of treatment used in the mental health or substance abuse fields. Patients are rewarded for their behavior; generally, adherence to or failure to adhere to program rules and regulations or their treatment plan...
. Initially contingency management was broader, referring to the direct coupling of consequences (reinforcers) to behavior like staying clean. But more and more it evolved to a kind of token economy. Also the community reinforcement approach is often combined with contingency management. Instead of using the name ‘tokens’, contingency management is speaking of voucher
Voucher
A voucher is a bond which is worth a certain monetary value and which may be spent only for specific reasons or on specific goods. Examples include housing, travel, and food vouchers...
s or related terms.
Research shows this kind of token economy is easily applicable outside of hospitals and clearly leads to less drug abuse. This way the problem of less hospital-based and more community-based treatment is solved. Contingency management is being used with inpatients and outpatients.
Developmental disorders
Token economy is also being applied in settings for adults with developmental disabilitiesDevelopmental disability
Developmental disability is a term used in the United States and Canada to describe lifelong disabilities attributable to mental or physical impairments, manifested prior to age 18. It is not synonymous with "developmental delay" which is often a consequence of a temporary illness or trauma during...
. Target behaviors can be all kinds of social behavior and self care, or the decreasing of inappropriate or disruptive behavior.
Children and adolescents
For a long time token economies are applied with children and adolescents with developmental disabilities as well as in schools.Developmental disabilities
Token economy is effective for children with developmental disabilities. Research shows it can help to diminish disruptive behavior and promote social behavior.Schools
Token economy is applied in diverse schools, in special educationSpecial education
Special education is the education of students with special needs in a way that addresses the students' individual differences and needs. Ideally, this process involves the individually planned and systematically monitored arrangement of teaching procedures, adapted equipment and materials,...
as well as in other schools. Positive results can imply increased attention and decreased disruptive behavior. In educational settings token economy seems to raise the intrinsic motivation. But there’s still need for more research.