Social Skills Training for Psychiatric Patients,II

In this second paper on social skills training for psychiatric patients the author critically reviews the controlled clinical outcome studies of social skills training in a number of psychiatric populations: mentally retarded persons, depressed patients, psychiatric outpatients, and psychiatric inpatients. He points out that more research is needed to determine the effectiveness of social skills training, especially for patients with debilitating chronic mental illness.     

Social skills training: The moderating influence of culture in the treatment of Latinos with schizophrenia

Providing effective psychiatric rehabilitation to ethnic minority patients with serious persistent mental illness (SPMI) requires an understanding of the role of cultural values and ethnicity-relevant factors on the course and outcome of severe mental disorders. In this paper, the author identifies some of the cultural factors that are relevant for Latinos with SPMI, and describes how these factors were incorporated into existing rehabilitation modalities. The results of a pilot study designed to test the efficacy of culturally-modified social skills training are presented. The results suggest that the cultural modifications improved Latino patients' ability to learn the material and enhanced their use of these skills in their natural environments. Future research will be aimed at identifying and incorporating these salutary cultural forces into the rehabilitation process of the severely mentally ill.     

Social skills training with hospitalized adolescents: an evaluative experiment

The effectiveness of social skills training on adolescent males admitted to a psychiatric hospital was evaluated through the use of empirically derived anger scenarios, blind raters, matched experimental and control treatment groups, and a repeated measures analysis. Results indicated that the social skills training effectively improved the dimension of verbal response and eye contact. Facial expression did not show measurable improvement. The use of specific skills components and scoring criteria in the social skills training was emphasized. Overall, support was found for the efficacy of social skills training for hospitalized adolescents.     

Clinical pastoral training in an emergency psychiatric service

Summary This paper reports the utilization of an emergency psychiatric service as a new factor in the clinical pastoral training experience. The usual pattern of clinical setting for these students is the hospital ward, where the patient has already been admitted and is making some adjustment to hospital routine and treatment. In such a setting the student misses the opportunity to see the patient at the crisis point of the illness and does not see the large numbers of individuals troubled enough to require psychiatric help but not sick enough to be hospitalized. The latter group constitute the largest portion seen by the parish minister even before psychiatric referral is arranged. During a twelve-week clinical pastoral training program, each student spent a major portion of his time for two of the weeks working on an emergency psychiatric service with a psychiatrist and social worker and seeing a large variety of patients, most of whom were not hospitalized. The experience provided an opportunity to develop evaluative skills and knowledge of appropriate community resources, and offered some experience in brief counseling under supervision. The clinical pastoral training student and the personnel of the emergency service all felt that this was an experience of mutual value and that it should be for a longer period. It is suggested that other clinical pastoral training programs would find it of value to utilize emergency psychiatric clinic settings where available.     

A controlled evaluation of systematic desensitisation and social skills training for socially inadequate psychiatric patients.

A controlled study of systematic desensitisation and social skills training was carried out on a sample of socially inadequate psychiatric patients. The results showed that both treatments led to significant improvements in the patients' social lives, which, in the case of social skills training were maintained at 6 months follow-up. Neither treatment, however, led to significantly greater anxiety reduction, improvements in social skills or clinical adjustment than the untreated control. Systematic desensitisation ran into a number of procedural difficulties and there was a substantial drop-out rate during treatment. Both treatments are discussed in the light of these mixed results and suggestions made for further research in this area.     

Success and failure in social skills training: individual differences

Four psychiatric out-patients with social dificulties were treated by social skills training and related treatments in a series of controlled within-subject designs. In all cases treatment produced predicted changes in social skills but these changes were not always sufficient to produce more general clinical change, which sometimes seemed to be more closely related to extra-therapeutic environmental changes. Several different treatment strategies were necessary in addition to social skills training including relaxation training, videotaped feedback and directive advice, and this emphasized important differences between patients which affected the choice of therapy. Three out of four cases improved; one reacted adversely to treatment and dropped out. Reasons for this failure are discussed. The study as a whole indicates the need to look more closely at individual patients, both in planning individual treatment and carrying out evaluative research.     

VR-based conversation training program for patients with schizophrenia: a preliminary clinical trial.

Schizophrenia is a devastating mental illness and is characterized by hallucinations and delusions as well as social skills deficits. Generally, social skills training designed to help patients develop social skills includes role-playing, but this form of training has typical shortcomings, which are largely due to a trainer's difficulties to project emotion. Virtual reality (VR)-based techniques have the potential to solve these difficulties, because they provide a computer-generated but realistic three-dimensional world and humanlike avatars that can provide emotional stimuli. In this paper, we report on a method of implementing virtual environments (VEs) in order to train people with schizophrenia to develop conversational skills in specific situations, which could overcome the shortcomings of or complement conventional role-playing techniques. The paper reports the efficacy of the proposed approach in a preliminary clinical trial with 10 patients with schizophrenia.     

Applying the Group Process to Psychiatric Occupational Therapy Part 1

The authors trace the current use of group activities in occupational therapy from an historical perspective. A pilot study of thirty-four psychiatric treatment programs located in Wisconsin, Quebec, and Alberta are described. The five most frequent groups used in these facilities include: social skills training, independent living skills, leisure time activities, stress management and exercise. The results are compared to a previous study by Duncornbe and Howe, 1985.     

Reply by Edward S. Casey

Stigma and discrimination against mental illness represent chronic social stressors that can inflame psychiatric symptoms and limit functional adjustment. The implication is that the prevalence and severity of mental illness is determined, at least to a certain extent, by aversive socio-cultural factors. In a hostile social environment, these factors may seriously limit the effectiveness of professional interventions; whereas, removing social barriers to functioning often results in a favorable clinical outcome. For example, studies show that inclusive settings with supportive employment decrease psychiatric symptoms and the use of mental health services. By extrapolation, these results point to the possibility that a society-wide reduction in the prevalence and severity of mental illness may come from benevolent changes in the social climate, not just from innovative treatments. Public health policies rarely take this possibility into consideration in resource allocation decisions.     

Individual response patterns and the effects of different behavioral methods in the treatment of social phobia

The importance of individual response patterns in the treatment of phobic patients was examined in the present study. Forty psychiatric outpatients with social phobia were assessed with a social interaction test which was videotaped. Heart rate was continuously monitored during the test. On the basis of their reactions in the test situation, the patients were divided into two groups showing different response patterns; behavioral and physiological reactors. Within each group half of the patients were randomly assigned to a behaviorally focused method (social skills training) while the other half received a physiologically focused method (applied relaxation). The patients were treated individually in 10 sessions. The within-group comparisons showed that both treatments yielded significant improvements on most measures. The between-group comparisons showed that for the behavioral reactors, social skills training was significantly better than applied relaxation on six out of ten measures, and for the physiological reactors applied relaxation was significantly better than social skills training on three of the measures. The results support the hypothesis that greater effects are achieved when the method used fits the patient's response pattern.     

Group Activities to Promote Early Rehabilitation in an Acute Psychiatric Ward: A Relationship-Based Approach Focusing on Movies

Our Psychiatry Institute has a long-standing tradition of providing training in the importance of relational and emotional skills and helping relationships. Here we describe techniques that are routinely used on our psychiatric ward (Maggiore della Carità Hospital, Novara, Italy) to promote early rehabilitation of acute psychiatric inpatients. We focus on the Cinema group, which is typical of our approach to informal, therapeutic group activity. Targeting social and relational issues as adjunct to treatment as usual is useful in acute settings and can begin at an early stage of hospitalization. Our intervention is designed to improve patients’ coping strategies, relational and communication skills, and overall quality of life.     

Predicting Successful Employment in the Community for People with a History of Chronic Mental Illness

Much work has been done to prepare people with a history of chronic mental illness for vocational placement. Evaluation tools can select some who are likely to be successful in competitive or sheltered work. Many whose psychiatric disability is so severe it interferes seriously with their capacity for work have need for more pre-vocational or vocational skills training. A literature survey shows many programs designed to help this population but little specific outcome data. Other articles state the need for empirical research. With limited funds and a large underserved population, further research is important.     

Family systems training in psychiatric residencies

Both extensive research and common sense dictate that attention to families is necessary for appropriate care of psychiatric patients. However, training in family skills has often been difficult to integrate into psychiatric residency programs because of conflicting paradigms, turf battles, constraints of time and money, and confusion over whether family-centered care or family therapy should be taught. Current changes in residency accreditation mandate that family skills (not necessarily family therapy in its sophisticated form) be part of all residency programs. This article reviews the history of systems training in residencies, current accreditation requirements, and the GAP proposal for family systems skills, knowledge, and attitudes that that are teachable within the limited time available to residents. The application of these core skills is described using a case example and formulation. Challenges in teaching and ways of overcoming programmatic constraints are outlined.     

EFFECTS OF SELF-MANAGEMENT TRAINING AND REINFORCEMENT ON THE TRANSFER OF IMPROVED CONDUCT IN THE ABSENCE OF SUPERVISION

The instruction, maintenance, and transfer of training of social skills of 3 seriously emotionally disturbed adolescents were accomplished by a self-management training and reinforcement package. During baseline sessions these students, who were covertly filmed in their classroom, averaged over 90% off-task or socially inappropriate behavior while their teacher was out of the room. They showed similar behaviors when walking between classes, unattended by their teacher. Treatment was introduced in the classroom and consisted of social skills and self-management training and reinforcement. Treatment procedures included instruction, modeling, and role playing of social skills, as well as self-assessment, self-recording, and self-reinforcement for correct approximations of these skills. After 5 weeks of training, all subjects demonstrated substantial improvements in the classroom during the teacher's absence and when distracted by other students; however, transfer of social skills did not occur to the between-class setting until students were given explicit instruction to initiate self-managing procedures in this setting.     

An evaluation of group therapy for adolescents using social skills training

The present study investigated the hypothesis that social skills training is more effective in increasing socially acceptable behaviour in adolescents than is a generalized or non-specific form of group therapy. Forty-two subjects were selected to participate in the study from among adolescents referred for group therapy at two youth guidance clinics in Brisbane, Australia. The 23 males and 19 females were randomly assigned to one of three treatment conditions: a social skills training group, a non-specific therapy group and a waiting-list-for-therapy (control) condition. All subjects were assessed before and after treatment on five measures of social skills. Subjects in the social skills training group showed significant improvements on three of these measures while the non-specific therapy and waiting-list control groups showed no specific changes on any of the measures.     

Problems with Danforth's Early Diagnosis and Observational Bias in Behavior Management

ABSTRACT

Many children diagnosed with Attention-Deficit/Hyper-activity Disorder (ADHD) experience difficulties in social relations. While psychosocial approaches based on a combination of skills training and contingency management approaches do appear to improve social behavior, evidence that these benefits generalize and persist following training has been limited. We describe a social skills training program designed to help parents promote the display of appropriate social behavior and better athletic performance in sports settings. The program consists of standard psychological assessment, behavioral parent training, functional assessment, parent-mediated social and sports skills coaching, and generalization and maintenance programming. The goals of this intervention are to promote retention of the child in team sports and facilitate friendship acquisition. Training parents to coach their children effectively in sports-related social skills may prove useful in promoting the maintenance and generalization of skills as well as preventing some of the negative effects of social isolation that frequently accompany an ADHD diagnosis.     

Social skills training with adolescent male offenders—II. Short-term,long-term and generalized effects

Seventy-six young, male offenders, attending a Community Home School, were randomly assigned to social skills training (SST) incorporating training in basic and more complex interpersonal skills, attention placebo (APC) and no treatment control (NTC) groups. Within subject changes in specific social skills were monitored in the SST group using a multiple baseline design. The results showed that SST led to definite improvements in some but not all the basic skills, and that these improvements were maintained at 3-month follow-up. In a between groups design SST was found to be significantly superior to APC and NTC groups on the performance of basic skills at posttest. Although the SST group reported significantly less social problems on a social problems questionnaire after training, a similar, though lesser reduction was found for the APC group and the NTC group. On a staff questionnaire of social problems, and independent ratings of social skills, friendliness, anxiety and employability. social workers' ratings of work, school and family relationships, self-reported offending and police convictions, there was no evidence that SST was differentially more effective than the comparison groups. The implications of these findings are discussed in terms both of current research into SST and the treatment of delinquency.     

Teaching social skills to emotionally disturbed adolescent inpatients

A social skills training program was evaluated with emotionally disturbed adolescent inpatients. The targeted social skills required an action or reaction within six skill areas. The program was adapted from a commercially available social skills training game that features the use of response specific feedback, self-monitoring, individualized reinforcers, and individualized performance criteria. A peer conducted the baseline and posttraining sessions while the training was conducted by an adult who had no previous interactive history with the subjects. A multiple baseline design across groups demonstrated that the program increased appropriate responding in all skill areas and that these effects generalized during the posttraining peer conducted sessions. A generalization test indicated that the subjects used their newly learned skills with a novel adult outside the training setting. The program appears quite applicable to emotionally disturbed adolescents since it targets skills in a variety of areas and employs standardized procedures to enhance replicability.     

Stories as Gift: Patient Narratives and the Development of Empathy

Critical thought and assessment of medical, emotional, and social problems faced by patients is central to genetic counselor training and development. However, primary emphasis on these critical problem-solving approaches can interfere with the development of empathic listening skills. Using a narrative medicine approach, I describe how learning to reframe one patient’s story of healing as a gift allowed me to become a more open and empathic listener. Ultimately, the empathy and understanding that I learned from this patient’s narrative added to what previous patients had taught me and helped me assist other patients (and myself) in identifying and nurturing healing narratives for people coping with illness and grief. The approach presented here emphasizes the importance of recognizing patients as valuable teachers in the development of higher-level empathy skills.     

Characteristics of social perception assessed in schizophrenia using virtual reality.

Impairment in social skills is one of the few criteria that all individuals diagnosed with schizophrenia must meet. Successful social skills require the coordination of many abilities, including social perception, which involves the decoding and interpretation of social cues from others. In this study, we examined the potential for virtual reality (VR) in social skill training. We attempted to determine if VR can be used to measure social skills and social perception, and to determine which VR parameters are related to schizophrenic symptoms. Some of these results have clear clinical relevance, while other observations need further study. The VR system appears to be useful in assessing the social perception of schizophrenics and normal people, and could be more widely used in the future for social training and in the assessment of social problem-solving abilities, assertiveness skills, and general social skills.