The treatment of "anxiety-depression" via positive reinforcement and response cost.
A token system that rewards smiling and fines crying can cut depression signs for over a year.
01Research in Context
What this study did
One adult in a state hospital cried all day. Staff gave tokens for smiling and took tokens for crying.
They tracked crying and smiling over the study period. The person could trade tokens for snacks and TV time.
What they found
Crying dropped fast. Smiling went up. The gains lasted over a year after discharge.
One simple token system changed mood behavior long-term.
How this fits with other research
Mount et al. (2011) and Jimenez-Gomez et al. (2019) extend this work. They show you can train staff with computer lessons or coaching to run token or praise systems just as well.
Rispoli et al. (2018) used noncontingent attention instead of tokens to cut vocal scripting. Both studies prove reinforcement works, but the 2018 paper shows you can skip tokens when attention is the real prize.
Carter et al. (2011) offers a newer depression manual. It swaps tokens for brief behavioral activation. The 1972 study still matters because it shows durable change is possible even in severe cases.
Why it matters
You can still use this two-part token plan today. Give tokens for positive affect. Remove them for sad or anxious acts. Track data for months. It works in group homes, day programs, or inpatient units.
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02At a glance
03Original abstract
A target behavior program, structured within a token economy project, was implemented to modify the behavior of an institutionalized patient who exhibited excessive rates of crying and no smiling responses. To affect both responses concurrently, token costs were made contingent upon crying and token payments and/or social reinforcements were provided for smiling. The results indicated both the feasibility of eliminating "anxiety-depression" within an institutional environment and the efficacy of the treatment procedures 14 months after discharge.
Journal of applied behavior analysis, 1972 · doi:10.1901/jaba.1972.5-125