J Korean Acad Nurs.  2012 Dec;42(7):1062-1069. 10.4040/jkan.2012.42.7.1062.

Modification of Severe Violent and Aggressive Behavior among Psychiatric Inpatients through the Use of a Short-Term Token Economy

• Park JS
• Lee K

• KMID: 1739544
• DOI: http://doi.org/10.4040/jkan.2012.42.7.1062

Abstract

PURPOSE
Meager research has been carried out to determine the effectiveness of the token economy among patients behaving violently in mental hospitals. The purpose of this study was to examine the effectiveness of the Short-Term Token Economy (STTE) on violent behavior among chronic psychiatric in-patients.
METHODS
A nonequivalent control group design method was utilized. Participants in an experimental group (n=22) and control group (n=22) took part in this study from January to April, 2008. Observation on aggressive behavior among male in-patients in one hospital as a baseline was made during the week before the behavior modification program and measurement of aggressive behavior was done using the Overt Aggression Scale (OAS), which includes verbal attacks, property damage and physical attacks.
RESULTS
The aggressive behavior scores of the experimental group decreased, those of the control group, scores showed an increase after the eight-week behavior modification program utilizing STTE.
CONCLUSION
The results of the study indicate that STTE is effective in reducing the incidence of aggressive behavior among male in-patients in psychiatric hospitals. The outcome of this study should be helpful in reducing the use of coercive measures or psychoactive medication in controlling the violent behavior among in-patients in hospitals.

Keyword

Token economy; Behavior therapy; Aggression; Psychiatric

MeSH Terms

Adult
Aggression
*Behavior Therapy
Hospitals, Psychiatric
Humans
Male
Mental Disorders/psychology/*therapy
Middle Aged
Program Evaluation
*Token Economy
Violence

Figure

• 

  Figure 1 Changes in aggressive behavior scores.

Reference

1. Abramowitz JS, Baucom DH, Wheaton MG, Boeding S, Fabricant LE, Paprocki C, et al. Enhancing exposure and response prevention for OCD: A couple-based approach. Behav Modif. 2012. 08. 10. [Epub ahead of print] http://dx.doi.org/10.1177/0145445512444596.

2. Ayllon T, Azrin NH. The measurement and reinforcement of behavior of psychotics. J Exp Anal Behav. 1965. 8(6):357–383. http://dx.doi.org/10.1901/jeab.1965.8-357.

3. Bowers L, Carr-Walker P, Paton J, Nijman H, Callaghan P, Allan T, et al. Changes in attitudes to personality disorder on a DSPD unit. Crim Behav Ment Health. 2005. 15(3):171–183. http://dx.doi.org/10.1002/cbm.5.

4. Chukwujekwu DC, Stanley PC. Prevalence and correlates of aggression among psychiatric in-patients at Jos University Teaching Hospital. Niger J Clin Pract. 2011. 14(2):163–167. http://dx.doi.org/10.4103/1119-3077.84007.

5. Corrigan PW, Yudofsky SC, Silver JM. American Psychiatric Association. Pharmacological and behavioral treatments for aggressive psychiatric inpatients. Violent behavior & mental illness: A compendium of articles from psychiatric services and hospital and community psychiatry. N. W. Washington, DC: American Psychiatric Pub;46–54.

6. Gripp RF, Magaro PA. A token economy program evaluation with untreated control ward omparisons. Behav Res Ther. 1971. 9(2):137–149. http://dx.doi.org/10.1016/0005 -7967-(71)90071-4.

7. Ha GS. Clinical characteristics of violent behaviors among inpatients in large mental hospital. J Korean Neuropsychiatr Assoc. 1993. 32(5):660–668.

8. Han KC, Tsai YF, Chen MC, Chen YY. Violent schizophrenia patients: Caregiver burden and related factors. Hu Li Za Zhi. 2012. 59(2):29–39.

9. Hoffmeister F. Reinforcing properties of nicocodine in the rhesus monkey. Arzneimittelforschung. 1979. 29(5):811–814.

10. Jang SJ. Relationship between experience of patients' violent behaviors and burnout of psychiatric nurses. 2004. Seoul: Seoul National University;Unpublished master's thesis.

11. James DV, Fineberg NA, Shah AK, Priest RG. An increase in violence on an acute psychiatric ward. A study of associated factors. Br J Psychiatry. 1990. 156:846–852. http://dx.doi.org/10.1192/bjp.156.6.846.

12. Kazdin AE. Issues in behavior modification with mentally retarded persons. Am J Ment Defic. 1973. 78(2):134–140.

13. Kim YO. Analysis of nursing intervention according to type of aggressive behavior in psychiatric inpatients. 2010. Seoul: Ewha Womans University;Unpublished master's thesis.

14. Lippman MR, Motta RW. Effects of positive and negative reinforcement on daily living skills in chronic psychiatric patients in community residences. J Clin Psychol. 1993. 49(5):654–662. http://dx.doi.org/10.1002/1097-4679(199309)49:5<654::AID-JCLP2270490507>3.0.CO;2-B.

15. Noble P, Rodger S. Violence by psychiatric in-patients. Br J Psychiatry. 1989. 155:384–390.

16. Pearson M, Wilmot E, Padi M. A study of violent behaviour among in-patients in a psychiatric hospital. Br J Psychiatry. 1986. 149:232–235. http://dx.doi.org/10.1192/bjp.149.2.232.

17. Poulsen HD, Engberg M. Validation of psychiatric patients' statements on coercive measures. Acta Psychiatr Scand. 2001. 103(1):60–65. http://dx.doi.org/10.1111/j.1600-0447.2001.00146.x.

18. Steinert T, Wiebe C, Gebhardt RP. Aggressive behavior against self and others among first-admission patients with schizophrenia. Psychiatr Serv. 1999. 50(1):85–90.

19. Tedeschi JT, Felson RB. Violence, aggression, and coercive actions. 1994. Washington, DC: American Psychological Association.

20. Walker Z, Seifert R. Violent incidents in a psychiatric intensive care unit. Br J Psychiatry. 1994. 164:826–828. http://dx.doi.org/10.1192/bjp.164.6.826.

21. Yudofsky SC, Silver JM, Jackson W, Endicott J, Williams D. The overt aggression scale for the objective rating of verbal and physical aggression. Am J Psychiatry. 1986. 143(1):35–39.