Overview of Social Skills Training:
What is it?:
It is a behavioral technique used to teach individuals social and interpersonal skills and behaviors that will improve their functioning in all areas of life.
Why it is Needed?:
Impairment in one or more of the major areas of life functioning is a requirement to have a diagnosis of schizophrenia. It is also one of the major problems to overcome in treating the person with the illness (Pratt and Mueser 2001). Medicine can reduce symptoms but it cannot overcome the lack of skills a person has (Sands 302 2001).
Some common skills people with Schizophrenia lack include social and interpersonal skills that cause poor relationships. Some of these characteristics include:
- Expressive or non-verbal skills- Tone, pitch, volume of voice, eye contact
- Receptive skills- verbal and nonverbal behaviors regarding listening, asking for clarification, understanding cues.
- Interactive skills- timing of responses, taking turns talking.
- Social perception skills- understanding others emotions or feelings.
Other skills that people with Schizophrenia lack include:
- Self Care skills- Can't groom oneself or dress appropriately, administer medication
- Problem solving skills- dealing with conflict or coping with stress
Impairments in psychosocial functioning can lead to anxiety, low self-esteem, frustration, depression and social isolation, which can intensify the primary symptoms of the disorder and lead to relapse(Pratt and Mueser 2001).
How does it work?:
There is no one set way to do social skills training. However, research has shown that the longer the amount of time spent in training the better the outcome is for the individual. Training can be done on an individual, family, or group basis within outpatient clinic programs, hospital settings and various other settings (Sands 303, 2001).
Social Skills Training is based on the assumption that social skills and behaviors are learned by 1) observing and modeling others, 2) having consequences for bad behavior by using positive reinforcement techniques, 3) "relearning" new material, 4) generalizing learned skills and behaviors to different situations and role playing (Pratt and Mueser 28, 2001& Bellack and Mueser, 1993).
The 5 common steps involved in SST include (Pratt and Mueser, 2001):
1) Explain the rationale for learning the new skill
2) Discuss the details of the skill
3) Use modeling and role-playing exercises to learn skill
4) Assign homework to practice skill
5) Generalize skill to new situations
Research:
Research has shown that while medication does help control symptoms it does not help with learning the skills needed to cope with stress or other life functions that can prevent relapse. It has been found that relapse in patients who had some form of social skills training was less than for people who had no social skills training or who only had been involved in supportive group therapy (Mojtabi et al, 1998& Bellack and Mueser,1993& Heinssen et al, 2000).
Cognitive-Behavioral Therapy
"Cognitive-Behavioral therapy includes the process by which information from the environment is translated, considered, integrated, stored, retrieved, and eventually produced as some form of personal activity (Thomlison and Thomlison 45, 1996)
The theory is based on the assumption that cognition plays the most important role in shaping behavior (Thomlison and Thomlison, 1996). It is also believed that cognitive activity can change therefore changing the behaviors displayed (Dobson, 2001).
There is alot of empirical evidence showing that individuals with Schizophrenia have many cognitive deficits including: impairments in attention, memory and concept formation. These cognitive difficulties are believed to restrict the individual from learning new skills (Heinssen et al, 2000).
Three major classes of CBT (Dobson, 2001):
Coping skills therapy- Used to assist clients to develop skills to cope varying stressful situations.
Problem-solving therapy-Used to develop general strategies for dealing with a broad range of personal problems
Cognitive restructuring methods- Used to establish more adaptive thought patterns.
Cognitive-behavioral therapy allows the deficits to be controlled by overlearning the skills by minimizing the amount of cognitive demands put on the individual.
Research:
Alone, CBT, is not a sufficient strategy to treat Schizophrenia. However, when combined with antipsychotic medication to control the symptoms, CBT can be used as a tool to change cognitive beliefs that will in turn alter the person's behavior. Applying the tradtional goals of CBT to the goals of treating Schizophrenia is a very effective method to change an individuals behavior (Bellack and Mueser,1993 & Hinssen et al, 2000).
