Social Learning/Token Economy Programs for Schizophrenia

Status: Strong Research Support


Token economy programs are generally used in long-term care setting such as long-stay inpatient units and residential care settings, but can be adapted for shorter stay and less intensive treatment programs as well. They are comprehensive behavioral programs, based on social learning principles, in which participants receive reinforcers (such as tokens or points) for performing clearly defined target behaviors. These reinforcers are provided immediately after a desired behavior and then exchanged at a later time for tangible goods or desired privileges. The focus of a token economy is on shaping and positively reinforcing desired behaviors and NOT on punishing undesirable behaviors. Examples of typical target behaviors include self-care, medication adherence, work skills, and treatment participation. The primary goals of a token economy program are to increase the presence of adaptive behaviors and reduce the frequency of maladaptive or inappropriate behaviors, with the ultimate goal of preparing each participant for greater independence and improved functioning. Token economy programs appear to be most effective when implemented in the context of appropriate medication management, individualized treatment planning, and other evidence-based psychosocial treatments.

Key References (in reverse chronological order)

  • Glynn, S. Token economy approaches for psychiatric patients: Progress and pitfalls over 25 years. Behavior Modification, 17:383-407, 1990.
  • Corrigan, P.W. Strategies that overcome barriers to token economies in community programs for severe mentally ill adults. Community Mental Health Journal, 27: 17-30, 1991.
  • Corrigan, P.W. Use of a token economy with seriously mentally ill patients: Criticisms and misconceptions. Psychiatric Services, 46(12): 1258-1263, 1995.
  • Dickerson, F.D., Tenhula, W.N., & Green-Paden, L. (2005). The token economy for schizophrenia: Review of the literature and recommendations for future research.Schizophrenia Research. 75 (2-3): 405-416.

Clinical Resources

  • Ayllon, T., and Azrin, N.H. The Token Economy : A Motivational System for Therapy and Rehabilitation. Englewood Cliffs, NJ: Prentice Hall, 1968.
  • Paul, G.L., and Lentz, R.J. Psychosocial Treatment of Chronic Mental Patients: Milieu versus Social-learning Programs. Cambridge, MA: Harvard University Press, 1977.
  • Spaulding, W.D., Sullivan, M., Poland, J., 2002. Treatment and Rehabilitation of Severe Mental Illness: A Comprehensive Approach. Guildford Publications, New York.

Training Opportunities

Steven M. Silverstein, Ph.D.
Director, Division of Schizophrenia Research University of Medicine
and Dentistry of New Jersey University Behavioral Health Care, and
Dept. of Psychiatry, Robert Wood Johnson Medical School
151 Centennial Avenue
Piscataway, New Jersey, 08854
Phone: (732) 235-5149
Wendy Tenhula, Ph.D. VA Capitol Health Care Network Mental Illness Research,
Education and Clinical Center
10 N. Greene Street, BT/MIRECC
Baltimore, MD 21201