(2026 Exams) Psychological Therapies 2

Q: Ayllon and Azrin (1968)

**Ayllon and Azrin (1968)** investigated the effectiveness of token economies in a psychiatric ward.

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Family Therapy

Family therapy involves both the patient and the patient’s family and aims to improve the quality of communication within the family.

Family therapy

Family therapists use a range of approaches.
Some might see the family as the root cause of the condition (consistent with the schizophrenogenic mother and the double-bind theory).
But contemporary therapists are more likely to be concerned with reducing stress within the family than locating the causes of the condition within the family, particularly through reducing levels of expressed emotion.

Pharoah et al. (2010)

Pharoah et al. (2010) identified a range of strategies that family therapists use to try to improve the functioning of the family with a member suffering from schizophrenia. These include:
- Forming a therapeutic alliance with all family members.
- Reducing the stress of caring for a relative with schizophrenia.
- Improving the ability of the family to anticipate unresolved problems.
- Reducing anger and guilt in family members.

Findings of Pharoah et al. (2010)

Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives is an important aspect of family therapy.
So is improving families’ beliefs about and behaviour towards schizophrenia.
According to Pharoah et al. (2010), these strategies work by reducing levels of stress and expressed emotion, while also increasing the chance of patients complying with medication.
This combination tends to result in reduced chance of relapse and hospital readmission.

Conclusions of Pharoah et al. (2010)

Pharoah et al. reviewed evidence on the effectiveness of family therapy for families of schizophrenia sufferers.
They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of the year and improves quality of life for patients and their families. -They also noted that results of different studies were inconsistent and that there were problems with the quality of some evidence.
Overall, the evidence base for family therapy remains weak.

Token economies use our reward system to manage the behaviour of patients with schizophrenia, particularly those patients who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals.

Principles of token economies

Token economies are based on the principle of operant conditioning.
They usually operate via the use of coloured discs (tokens) that are given to patients immediately after they have carried out some positive or desirable behaviour, such as getting dressed or making their bed.
Tokens can then be exchanged for some tangible reward, such as sweets or being allowed to go for walk beyond the hospital.

Aims of token economies

Tokens are seen as secondary reinforcers because they only have value once the patient has learned that they can be used to obtain rewards.
It is common for institutionalised individuals to develop certain behaviours, including poor personal hygiene or reluctance to change out of their pyjamas.
Token economies help to modify these habits and improve quality of life, rather than trying to cure schizophrenia.

McMonagle and Sultana (2009)

There is weak evidence supporting token economies.
McMonagle and Sultana (2009) carried out a review of the literature, finding only three studies where patients have been randomly allocated conditions, with a total of only 110 patients.
Only one of the three studies showed improvement in symptoms and none provided useful information about behaviour change.

Ayllon and Azrin (1968)

Ayllon and Azrin (1968) investigated the effectiveness of token economies in a psychiatric ward.

Procedure

Ayllon and Azrin (1968) used a token economy on a ward of female schizophrenic patients, many of whom had been hospitalised for many years.
They were given plastic tokens, each embossed with the words ‘one gift’ for behaviours such as making their bed or carrying out domestic chores. These tokens were then exchanged for privileges such as being able to watch a movie.

Results & conclusions

Results
- The researchers found that the use of a token economy with these patients dramatically increased the number of desirable behaviours that the patients performed each day.
Conclusion
- Token economy did increase the positive behaviour in patients. But there was no evidence that it alleviated their symptoms of schizophrenia; it simply made their social behaviours more acceptable.