NEW YORK — When Dr. Nathan Azrin was appointed director of treatment development at Anna State Hospital in Anna, Ill. in 1958, a majority of the patients he was expected to treat were schizophrenic, emotionally withdrawn, and, in many cases, mute after years in institutions. Few bothered getting dressed, spending their days in hospital gowns.
Getting his patients to dress, Dr. Azrin decided, would be his first treatment.
The system that he and a colleague developed for doing that — a bartering process that they described as ‘‘token economics’’ — not only persuaded Anna State’s residents to get dressed every day, but also changed the way psychologists approached behavior-changing techniques across a wide spectrum of human experience. It has been used in treatments for autism, couples therapy, military training, employee supervision, prisoner management, special education, athletic coaching, and consumer marketing.
Dr. Azrin — a Boston native who died on March 29 in Pompano Beach, Fla., at 82 — did not invent the principles that he and the colleague, Dr. Teodoro Ayllon, applied in their work at Anna State. The ideas were developed by Dr. Azrin’s mentor at Harvard, the behavioral pioneer B.F. Skinner, working mainly with rats. But Dr. Azrin was among the first psychologists to show that human behavior could be changed in much the same way as Skinner had changed that of rats.
Dr. Azrin and Ayllon laid out their evidence in 1968 in ‘‘The Token Economy,’’ which is considered one of behavior psychology’s foundational texts.
Dr. Azrin received far more attention for a book he wrote in 1974 with Dr. Richard M. Foxx, applying token economics to the behavior modification everybody knows. That book, ‘‘Toilet Training in Less Than a Day,’’ sold more than 3 million copies. Some of its advice about conditioning children was criticized as overly harsh.
In a review in The New York Times, the psychologist Eda LeShan wrote of the method: ‘‘Although one is supposed to be kind and patient, it’s all done by forcing fluids (with things like salty potato chips and orange soda) and conditioned reflexes, leaving out such minor considerations as fears and fantasies, love-hate feelings, dependency, and rebellion — the whole unconscious, which we have been struggling so hard to understand. It is an immoral book.’’
But the less controversial, and less known, ‘‘Token Economy,’’ written for a professional readership, had the more profound influence.
“It would be difficult to name a population that wasn’t affected by his work: the young, the old, the professional athlete, the developmentally disabled,’’ said Dr. Alan Kazdin, a former president of the American Psychological Association and a professor of psychology and child psychiatry at Yale.
In Dr. Azrin’s token economy, people barter for rewards, or tokens, by modifying their behavior in incremental steps. He and Ayllon introduced the system to female patients at Anna State, giving them plastic tokens, each embossed with the words ‘‘one gift.’’ The reward system included a token-operated television and a token-operated turnstile installed at the entrance to the television room. Patients earned one or more tokens for dressing themselves, the number depending on the level of care they showed in their dress.
Eventually most patients were dressing themselves, some were doing simple household chores, and a few were running a kind of token-exchange store on the ward, offering such special items as lipstick.
‘‘These patients had previously been regarded as deranged, incapable of learning,’’ Ayllon said in an interview last week. ‘‘Yet they learned the system rather quickly.’’
Dr. Azrin believed that any behavior could be modified once it was understood as a chain of component parts.
‘‘To get someone dressed, for example, requires putting on a shirt,’’ Dr. Azrin said in a recent interview. ‘‘But first, the person must reach for the shirt. And before that, the person must get up and go toward it. And even more basically, you need to say to the person, ‘Look at me,’ and get them to make eye contact.’’
Nathan Harold Azrin was born in Boston, the son of Harry Azrin, a grocer, and the former Esther Alper. He graduated from Boston University in 1951 and received a doctorate in psychology from Harvard in 1956.
After beginning his research in Boston, he was appointed a professor of psychology at Southern Illinois University and research director in the Illinois Department of Mental Health. From 1958 to 1980, he was the director of treatment at Anna State Hospital, now known as Choate Mental Health and Development Center.
He was a professor of psychology at Nova Southeastern University in Fort Lauderdale, Fla., from 1980 until 2010, when he was named a professor emeritus. He retired last month.