Efficacy of Social Skills Training among Persons with Schizophrenia
Praful P. Kapse
Mental Health Initiative
Sir Ratan Tata Trust
Dr. B. P. Nirmala
Department of Psychiatric Social Work
National Institute of Mental Health and Neuro Sciences
Kapse PP & Nirmala BP. (2015)
Efficacy of Social Skills Training among Persons with Schizophrenia.
International Journal of Psychosocial Rehabilitation. Vol 20 (1) 45-50
Person with schizophrenia have the deterioration of personal, family,
and social life. The illness leads to many disabilities in terms of
interpersonal skills, communication skills, coping skills, dealing with
emotions, self-care, self-control, occupational skills. Impairments in
social functioning are among the most debilitating and treatment
refractory aspects of schizophrenia (Bellack et al., 2007).
and Methods: The study aimed to know social skills deficits among
persons with schizophrenia and to check the efficacy of the social
skills training programme. A total number of 12 persons with
schizophrenia, who were availing day care rehabilitation services, were
selected randomly for the social skills training programme. The
researcher adopted quasi experimental design without control, and
interview and observer rating method used to collect data.
Finding: Significant amount of deficits were found in self care,
instrumental skills, communication skills, impulse control and social
functions of the participants. The post social skills training
programme there was significant improvement reported in social skills
of the participants, repeated measures shows (F1.65,18.15)=93.26, p=26
significant level of change in social skills in post1 and post2
Conclusion: The present study reported the
efficacy of social skills training in improving social skills among
persons with schizophrenia who are availing day care rehabilitation
facility. The model of social skills training programme were found to
be effective and can be applied for larger practice in rehabilitation
centres in India.
Key Words: Social Skills Training, Schizophrenia, Rehabilitation
is perhaps commonplace to state to human being as social animals,
nevertheless it is true. A substantial portion of human lives spent in
interactions with one another moreover, the nature quality, and
quantity of those interaction have a tremendous impact on behaviour,
mood, and the adequacy of adjustment. Faulty interpersonal relationship
patterns have unfailingly been associated with a wide variety of
behavioural- psychological dysfunction ranging from simple loneliness
Schizophrenia is a clinical syndrome of
variable, but severely disruptive, the psychopathology which involves
disturbance in cognition, emotion, perception, and other aspects of
behaviour. The expression of these manifestations varies across
patients and over time, however the effect of the illness is always
stark and is usually long lasting.
"Inexpressive faces, blank
looks, monotone and monosyllabic speech, few gestures, seeming lack of
interest in the world and other people, inability to feel pleasure or
An estimated 25% of people with
schizophrenia have "the deficit syndrome", marked by "severe and
persistent negative symptoms." These negative symptoms are related to
the individuals inability to socialize, and are connected to the
cognitive deficits seen in many patients. These negative symptoms are
also the markers for any schizophrenia spectrum disorder (such as
schizoptypal personality, and schizoid personality), as well as early
markers for full schizophrenia prior to the first psychotic break.
only are these negative symptoms common and detrimental, little is
available for treatment. Most antipsychotic medications work mainly on
positive symptoms, and patients with mostly negative symptoms are often
deemed "treatment resistant".
The term “skills”- in contrast to
the term “abilities” – implies that they are predominantly based on
learning experiences. Thus, social skills training utilizes behaviour
therapy principles and techniques for teaching individuals to
communicate their emotions and requests so that they are more likely to
achieve their goals and meet their needs for affiliative relationships
and roles required for independent living.
Social skills are
interpersonal behaviours that are normative and/or socially sanctioned.
They include such things as dress and behaviour codes, roles about what
to say and not to say, and stylistic guidelines about the expression of
affect, social reinforcement interpersonal distance and so on and so
forth. Whether they have never learned social skills or have lost them,
most people with schizophrenia have marked skill deficits. These
deficits make it difficult for many clients to establish and maintain
social relationship, to fulfil social roles or to have their needs met.
various studies social skills training has found moderately to strongly
effective in increasing skill acquisition and reducing psychiatric
symptoms. (Melody Nichols Dilk). Skills training are effective for
virtually every area of role functioning for persons with severe
psychiatric disabilities (Dion and Anthony 1987).
of social skills training, all of which involve role playing by the
patient and modelling, prompting, feedback, and reinforcement by the
therapist. Many patients can benefit from the basic training model. For
patients functioning at a higher level, the problem-solving model
provides general strategies for dealing with a variety of social
situations. (Robert P. Liberman et al.1985). Despite of these many
studies, there are very less number of studies found in Indian context.
Beliefs and understanding of mental illness is itself a taboo in India.
Persons with mental illness perceive as possessed by black magic and
other supernatural powers, so the Stigma, discrimination, hostility is
attached with person with mental illness. It often found that family
members and society is avoids the abilities of these population and
does not give chance to their abilities. In this context the purpose of
this study is to find out the effectiveness of social skills training
among persons with schizophrenia availing day care rehabilitation
Materials and Methods
aimed to know social skills deficits among persons with schizophrenia
and to check the efficacy of the social skills training programme. The
objective stated for study was to study the socio-demographic profile
of the participants. 1) To assess the social skills deficits among
participants. 2) To design social skills training program to address
social skills deficits. 3) To study the efficacy of social skills
training program. For present study researcher hypothesized that there
will be significant improvement in social skills of the participants
who undergo social skills training.
A total number of 12
persons with schizophrenia, who were availing day care rehabilitation
services, were selected randomly for the social skills training
programme. The researcher adopted quasi experimental design without
control. The interview and standardised instruments were used to
collect data. Semi-structured interview schedule used to collect
socio-demographic details of the participants, Social Adaptive
Functioning Evaluation (SAFE) by Harvey et.al 1997 an observer rated
scale used to measure social skills of the participants, Social Skills
Checklist were used to check social behaviour and functioning over past
results shows that majority of the participants (66.7%) belongs to age
group of 31 to 40 years. Majority of the participants (83.3%) were
male. Highest number of participants (33.3%) reported to studied up to
high school and very few (16.7%) studied up to graduation and above.
All the participants belong to Hindu religion. Majority of the
participants (91.7%) were never married. And equal number
of participants (41.7%) belongs to Nuclear and joint family.
Social Skills Deficits
of the participants reported deficits in instrumental skills. Many of
the respondents had difficulty in self care activities. 50% of the
participants had moderate level of impairment in impulse control.
Regarding conversation skills 66.7% participants had severe impairment.
Majority of the participants reported deficits in social functions.
Post Intervention Results
skills training in current study the mean total score of the
participants during pre, post1 and post2 were 38.33, 22, and 5.75
respectively pair wise comparison shows significant level change F =
93.26, p<0.01 and the social skills training reported effect size
0.895. The study adopted repeated measures of ANOVA were obtained to
see effects of intervention there was significant effect of social
skills training on social adaptive functioning, F (1.65, 18.15) =
93.26, p=.05 These results show that there was significant change in
social skills of participants after social skills training. The study
also finds the improvement in social skills is significant at linear
level (F=127.75,p<0.001) and quadratic trend found to be
non-significant (F=0.001, p>0.05), which indicates the improvement
in social skills at each post SST assessment. In the present study, the
social skills training analysis shows that various skills have improved
in the participants after social skills training. The efficacy can be
seen from the differences in the means score, significant level and
effect size. The social skills training effect on the various domain
namely instrumental skills, self care, impulse control and social
function shows significant improvement. There was a decreased mean
score in these domains. The effect size shows a large effect on the
above four domains.
present study regarding socio-demographic profile of the participants
following results were observed majority of the participants were in
age group 31 to 40 years, majority of them were male, all participants
belong to Hindu religion, majority of them were never married and equal
number of participants was in nuclear and joint family. The similar age
group were widely studied in other studies related to social skills.
This could be because of adulthood in which persons from this age group
are most expected to work and earn money so in this way majority of the
participants were from this age group the similar studies (William H.
et al, 2009) reported older adults with schizophrenia use more services
than any other diagnostic elderly group within community mental health
organizations (Bartels, Miles, Dain, & Smyer, 1996; Cuffel, Jeste,
& Halpain, 1996).and male member accessing the treatment and other
allied services is commonly seen in India, the cultural and
socio-cultural beliefs may influence accessibility of the services.
present study intends to help in understanding the social skills
deficits among persons with schizophrenia who are availing day care
rehabilitation services. The present study shows among persons who are
availing day care rehabilitation facility has significant level of
social skills deficits in pre-training (M=38.33, SD=16.38). These
deficits include instrumental and self care skills, impulse control,
and social function skills. The similar level of deficits had been
found widely (Harvey et al., 1997).
In another study the
prevalence of social skill deficits in schizophrenia was examined by
comparing patients assessed over a 1 year period with a group of
non-patient controls recruited from the community. Social skills were
assessed using a role play test and were considered deficient when they
were below the range of the control sample. Approximately 50% of the
patients were consistently unskilled over the one year, whereas 11%
were consistently skilled. Deficits in specific social skills were
relative rare. Consistent deficits were present for only one of six
specific skills 14% of the patients was consistently less appropriate
in their conversation. (Kim T. Mueser et al., 1991) This finding found
to be similar with current study, the deficits in conversational skills
found significant (M = 2.53, SD = .79) which is high among other
A large amount of research studies have done regarding
social skills training. Social skills training (SST) involves the use
of standard behavioural skills training procedures to develop social
competencies, and has been used for over three decades in an attempt to
remediate poor social skills in schizophrenia patients (Halford &
Hayes, 1991). Implicit in the use of SST is the assumption that poor
social skills inhibit the development of supportive social networks and
decrease patients coping with stressors, and consequently patient’s
quality of life & prognosis deteriorate (Anthony & Liberman,
1986; Trower, Brgent, & Argyle, 1978; Wallace, Boone, Donohue,
& Foy, 1985). Consistent with this assumption low levels of social
skills co vary with social isolation, and poor community functioning
(Bellack et al. Halford & Hayes, 1995).
literature dealing with social skills training of schizophrenia
patients indicates that topographical features and self-reports of
anxiety and discomfort can be changed for the better functioning by
social skills training. Unfortunately, these changes do not occur for
every patient and, when they do occur, often do not generalize to new
situations. Research must be directed to determining the interaction
between patient characteristics and training procedures as they affect
outcome. The scope of the procedures must also be expanded if
meaningful changes in patients' quality of life are to be effected.
(Charles J. Wallace, Connie J. Nelson, Robert Paul Liberman et al.,
In line of these finding current study adopts social
skills training for persons with schizophrenia. Social skills training
found to be effective in many previous studies, the efficacy of social
skills training and day hospital treatment for 20 chronic schizophrenia
patients in a 12-week day hospital program and 44 patients in the same
program supplemented by comprehensive social skills training. Patient
who completed treatment showed improvement immediately following
treatment, during the six month post treatment they maintained gains (
Alan S. Bellack, et al. 1984).
In present study social skills
training among schizophrenia patient found to be useful in improving
overall social skills. The mean difference in pre-SST and post SST
significantly shown improvement, pre SST overall (M = 38.33, SD =
16.38) which was considerably improved in post1 SST (M = 22, SD =
12.96) and further in post 2 SST shown significant improvement (M =
7.58, SD = 9.23). Similar significant improvement were reported in many
studies in a study of twenty-eight schizophrenic male patients,
diagnosed by the Present State Examination and Catego criteria, and
from families high on “expressed emotion,” were randomly assigned to
either intensive social skills training or holistic health therapy. A
multidimensional evaluation was conducted before and after 9 weeks of
inpatient treatment and for 24 months in the community. Patients
exposed to social skills training evidenced significantly greater
acquisition, generalization, and durability of social skills and their
social adjustment in the community was rated as better by
significant others; and they experienced fewer relapses and
rehospitalisation (Charles J Wallace et al., 2002).
Efficacy of Social Skills
line of the searching efficacy of social skills training in current
study the mean total score of the participants during pre, post1 and
post2 were 38.33, 22, and 5.75 respectively pair wise comparison shows
significant level change F = 93.26, p<0.01 and the social skills
training reported effect size 0.895. Which is large effect among
previous similar other studies. For between-group studies, the
overall effect size was medium at post test (d. = .40, n = 58, z =
9.18, p < .001) and large at follow-up (d = .56, n = 14, z = 5.34, p
< .01). For within-group studies, the overall effect size was also
medium at post test (d. = .48, n = 9, z = 7.59, p < .01), but small
at follow up (d. = .30, n = 4, z = 2.37, p < .05). Thus, the overall
post test effect size for the within-group studies was similar to that
for the between-group studies, whereas the overall follow-up effect
size was smaller for the within-group studies than the corresponding
statistic for the between-group studies. The study adopted repeated
measures of ANOVA were obtained to see effects of intervention there
was significant effect of social skills training on social adaptive
functioning, F (1.65, 18.15) = 93.26, p=.05 These results show that
there was significant change in social skills of participants after
social skills training. The study also finds the improvement in social
skills is significant at linear level (F=127.75,p<0.001) and
quadratic trend found to be non-significant (F=0.001, p>0.05). Which
indicates the improvement in social skills at each post SST assessment.
Efficacy of social skills
training among persons with schizophrenia was studied in present study.
The social skills deficits have been widely found to be obstacle in
recovery of persons with mental illness. Many individuals with
schizophrenia gradually develop isolated lives, punctuated by lengthy
periods in psychiatric hospitals or in community residence. Such events
remove clients from their normal peer group, provide few opportunities
to engage in appropriate social roles, and limit social contacts to
mental health staff and other severely ill clients. Under such
circumstances, clients do not have an opportunity to acquire and
practice appropriate adult roles. Moreover, skills mastered earlier in
life may be lost because of disuse or lack of reinforcement by the
Several studies have reported social skills
deficits interfere with the development of appropriate social
relationship and the acquisition of social skills. Schizophrenia often
strikes first in late adolescence or young adulthood, a critical period
for mastery of adult social roles and skills, such as dating and sexual
behaviours, work related skills, and the ability to form and maintain
adult relationships. (Bellack & Muser, 1993)
study was reported the efficacy of social skills training in improving
social skills among persons with schizophrenia who are availing day
care rehabilitation facility. Several similar studies also widely
reported the efficacy of social skills training (Benton et al.,
1990).The model of social skills training programme were found to be
effective and can be applied for larger practice in rehabilitation
centres in India.
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