Token Economy — MRCPsych Paper B MCQ

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EasyRehabilitationToken EconomyMRCPsych Paper B

A rehabilitation programme awards patients tokens contingent on completing specified adaptive behaviours. The tokens can later be exchanged for agreed rewards. Which behavioural principle most directly underlies this intervention?

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Correct answer: E — Operant conditioning

The correct answer is E, operant conditioning. A token is delivered contingently after a specified adaptive behaviour, positively reinforcing that behaviour and increasing the likelihood that it will recur. Tokens are conditioned or secondary reinforcers because they acquire value through exchange for backup rewards; those rewards are not necessarily primary reinforcers. Classical conditioning concerns associations between stimuli rather than consequences contingent on behaviour. Social learning involves learning through observation or modelling, which is not the defining mechanism here. Cognitive restructuring targets maladaptive thoughts and beliefs. Systematic desensitisation uses graded exposure with an incompatible response, classically relaxation, to reduce anxiety.

Reference: Fiske KE et al. Token Economy: A Systematic Review of Procedural Descriptions. Behavior Modification. 2017;41(5):708–737. https://pubmed.ncbi.nlm.nih.gov/28423911/