Context: Individuals with mental illness may exhibit aggression due to psychological instability. The Token Economy is a behavioral approach that aims to achieve desired changes by using tokens as reinforcements. Objectives: This study investigates the effectiveness of token reinforcement in reducing aggressive behavior in mentally ill patients and identifies the factors that enhance the effectiveness of the Token Economy program. Evidence Acquisition: A search for studies was conducted in the databases of PubMed, Google Scholar, ProQuest, Scopus, and Web of Science using several keywords, including "Contingency Management," "Token Reinforcement," "Token Economy," "behavioral disorder," "mental disorder," "aggression," "violence," "disruptive behavior," and "challenging behavior." The search focused on articles published from 2003 to 2023 that included the implementation of token reinforcement in various settings for managing aggression. Results: A total of 12 studies met the inclusion criteria. After reviewing these studies, several factors were identified as responsible for the program's effectiveness. The Quality Assessment Tool for Quantitative Studies and the Oxford Centre for Evidence-Based Medicine (2011) were used to evaluate the studies. Of the 12 studies, two were rated as strong quality, one as moderate, and nine as weak quality. Additionally, three studies were classified as level 2, one as level 3, and eight as level 4, indicating significant methodological limitations. Conclusions: Generally, 9 studies supported the effectiveness of the Token Economy in managing aggression in adults and adolescents with mental illness. This approach can be useful in the modern rehabilitation and education of individuals with aggressive behavior. We recommend further studies with higher methodological quality to examine the generalizability and transferability of the results.
Background: People with chronic mental illness have long been rejected from society and lost their self-identity and self-efficacy due to individual obstacles, such as continuous negative symptoms, lack of motivation, or social obstacles, like stigma, which reduce their self-confidence and prevent them from engaging in healthy activity patterns. One of the behavioral therapy methods used to increase the motivation of people with severe mental illness is token economy. Objectives: The purpose of this narrative review was to review and investigate the impact of the token economy on people with severe mental illness. Methods: A search for studies published from 2002 to 2022 in PubMed and Google Scholar databases was conducted using the keywords “token economy”, “token reinforcement”, “contingency management”, “severe mental disorder”, “serious mental illness”, “chronic psychiatric disorder”, and “participation”. Results: In the initial search, 92 articles were obtained, and after reviewing and rejecting duplicates, 44 articles related to severe mental illness and token economy remained. Finally, 15 articles met the inclusion criteria and were selected for review. token economy can be an effective method in improving the performance of daily life activities, reducing the symptoms of mental illnesses and avoiding drugs, reducing alcohol consumption, and quitting smoking Conclusion: token economy can be an effective method in improving the performance of daily life activities, reducing the symptoms of mental illnesses, drug abstinence, reducing alcohol use, and quitting smoking, but in reducing violence, the results of the studies were contradictory. It is recommended to carry out wider studies on the impact of the token economy method on the occupational performance and participation of chronic mental patients.
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