The token economy: a living-learning environment

A Systematic Review of Treatment Maintenance Strategies in Token Economies: Implications for Contingency Management

Contingency management (CM) interventions are based on operant principles and are effective in promoting health behaviors. Despite their success, a common criticism of CM is that its effects to not persist after the intervention is withdrawn. Many CM studies evaluate posttreatment effects, but few investigate procedures for promoting maintenance. Token economy interventions and CM interventions are procedurally and conceptually similar. The token economy literature includes many studies in which procedures for promoting postintervention maintenance are evaluated. A systematic literature review was conducted to synthesize the literature on treatment maintenance in token economies. Search procedures yielded 697 articles, and application of inclusion/exclusion criteria resulted in 37 articles for review. The most successful strategy is to combine procedures. In most cases, thinning or fading was combined with programmed transfer of control via social reinforcement or self-management. Social reinforcement and self-monitoring procedures appear to be especially important, and were included in 70% of studies involving combined approaches. Thus, our primary recommendation is to incorporate multiple maintenance strategies, at least one of which should facilitate transfer of control of the target behavior to other reinforcers. In addition, graded removal of the intervention, which has also been evaluated to a limited extent in CM, is a reasonable candidate for further development and evaluation. Direct comparisons of maintenance procedures are lacking, and should be considered a research priority in both domains. Researchers and clinicians interested in either type of intervention will likely benefit from ongoing attention to developments in both areas.

The home behaviour of schizophrenic patients living in the community and attending a day centre

With large numbers of psychotic patients now living in the community, there is growing appreciation of the influence of family life on the long-term social outcome of chronic schizophrenia. From the work of Brown, Birley and Wing (1972) it appears that to achieve and maintain optimum clinical stability in ‘typical’ chronic schizophrenia, it is desirable that face-to-face contact between patients and emotional relatives should be held to a minimum and that phenothiazine drugs should be used to soften the impact on the patient of sudden and stressful life changes. Reviewing the many social problems which accrue from this general treatment approach, Stevens (1973) noted a distinct lack of evaluative study of psychotic patients who actually live in the community.