Symptomatology and the prediction of social skills acquisition in schizophrenia.

The relationship between patient symptomatology and the acquisition of social skills during an inpatient social skills training program, and the maintenance of skills at a one-month followup, were examined in a sample of recently hospitalized schizophrenic and schizoaffective disorder patients. Subtypes of patients with enduring Thought Disorder (vs. no enduring Thought Disorder) or enduring Anergia (vs. no enduring Anergia) on the BPRS during the treatment period were compared in their response to the social skills training intervention. Patients with enduring Thought Disorder acquired skills at the same rate as patients without Thought Disorder, but were unable to retain their skills at followup, in contrast to their counterparts. Enduring Anergia was not related to either the acquisition or maintenance of social skills. The results were unaffected when memory was statistically controlled. The findings suggest that patient symptomatology may be an important factor mediating the efficacy of social skills training interventions.     

Group therapy for adolescent depressive disorder: a comparison of social skills and therapeutic support

Two forms of short-term group therapy for depressed adolescents are compared. Adolescents were assigned to either a social skills training or therapeutic support group. Treatment outcome was based on self-report and semistructured clinical interviews for depression, measures of self-concept, and cognitive distortions. After treatment, adolescents in the therapeutic support groups showed significantly greater reductions in clinical depression and significant increases in self-concept compared with those in the social skills training group. These group differences were no longer evident at 9-month follow-up, as adolescents in the therapeutic support groups maintained their improvement, and adolescents in the social skills training groups caught up.     

Financial management and job social skills training components in a summer business institute: a controlled evaluation in high achieving predominantly ethnic minority youth

Ninety-two adolescents, predominantly ethnic minority high school students, participated in a structured Summer Business Institute (SBI). Participating youth were randomly assigned to receive either job social skills or financial management skills training components. Students who additionally received the job social skills training component were more likely to recommend their employment agency to others than were youth who received the financial management component, rated their overall on-the-job work experience more favorably, and demonstrated higher scores in areas that were relevant to the skills that were taught in the job social skills workshops. The financial management component also appeared to be relatively effective, as youth who received this intervention improved their knowledge of financial management issues more than youth who received job social skills, and rated their workshops as more helpful in financial management, as well as insurance management. Future directions are discussed in light of these results.     

An examination of the efficacy of social skills training for chronic schizophrenic patients

To study the efficacy of social skills training and day hospital treatment for schizophrenic patients, the authors treated 20 chronic schizophrenic patients in a 12-week day hospital program and 44 patients in the same program supplemented by comprehensive social skills training. While both groups of patients who completed treatment showed improvement immediately following treatment, during the six-month posttreatment period patients who had received social skills training either continued to improve or maintained their gains on most measures, while the patients receiving day hospital treatment alone either maintained gains or lost them. The authors discuss the implications of these findings as well as the finding that almost half of the patients in both groups were hospitalized at least once in the year following treatment.     

Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation

Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed-computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)-to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM-IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after 8 weeks. Analyses of covariance controlling for basis-level functioning demonstrated that patients receiving CAST plus vocational rehabilitation showed greater improvement on attention and verbal memory but not on planning ability. Patients receiving TSSN plus vocational rehabilitation failed to demonstrate improvement in negative symptoms. CAST plus vocational rehabilitation was found to be associated with a higher rate of successful job placement at the 12-month followup interval. Hierarchical logistic regression analyses demonstrated that improvement in short- and long-term verbal memory predicted a higher proportion of variance of successful job placement in the followup than pretreatment history of employment alone. Cognitive training as an adjunct to inpatient vocational rehabilitation demonstrated cognitive improvement, which was found to be associated with successful job placement in the followup. TSSN's efficacy was less clear; reasons for this uncertainty are provided.     

The effectiveness of skills training for improving outcomes in supported employment

OBJECTIVE: This study evaluated whether a supplementary skills training program improved work outcomes for clients enrolled in supported employment programs. METHODS: Thirty-five recently employed clients with severe mental illness who were receiving supported employment services at a free-standing agency were randomly assigned to participate in either the workplace fundamentals program, a skills training program designed to make work more "successful and satisfying," or treatment as usual. Knowledge of workplace fundamentals (for example, identifying workplace stressors, problem solving, and improving job performance) was assessed at baseline and at nine months; employment outcomes and use of additional vocational services were tracked for 18 months. RESULTS: Clients in the workplace fundamentals group (N=17) improved more in knowledge of workplace fundamentals than those in the control group (N=18) at the nine-month follow-up, but the two groups did not differ in the number of hours or days worked, salary earned, or receipt of additional vocational services over the 18-month period. In general, clients in this study had higher educational levels and better employment outcomes than clients in most previous studies of supported employment, making it difficult to detect possible effects of the skills training intervention on work. CONCLUSIONS: Supplementary skills training did not improve work outcomes for clients who were receiving supported employment.     

Use of Audio Cuing to Expand Employment Opportunities for Adolescents with Autism Spectrum Disorders and Intellectual Disabilities

We evaluated audio cuing to facilitate community employment of individuals with autism and intellectual disability. The job required promoting products in retail stores by wearing an air-inflated WalkAround^? costume of a popular commercial character. Three adolescents, ages 16–18, were initially trained with video modeling. Audio cuing was then used by an attendant who delivered prompts regarding when to perform job skills. The two interventions were evaluated in an interrupted time series withdrawal design during training and then again in an actual job setting. Results show video modeling was not effective. However, the audio cuing produced job performances well above the designated criteria during training and when on the job. These changes were replicated with each participant, demonstrating clear experimental control. The changes proved statistically significant as well. Participants and parents reported high job satisfaction. The challenges of competitive employment for individuals with autism and intellectual disabilities are discussed.     

Employment among young people with epilepsy.

The study reports the findings of a follow-up review of 38 trainees who had completed social skills training programmes run by BRAINWAVE The Irish Epilepsy Association and FAS, the state training and employment authority, during the period 1986 to 1990. The social skills programmes were aimed at young, unqualified school leavers. A total of 101 young people completed the programmes, 45 of whom had epilepsy. Of those with epilepsy, 38 were interviewed about their current employment position. On completion of the programmes 58% had found a job or gone on to further training. At the time of interview 39% were in work or training. Fifty-eight per cent were still experiencing seizures (a seizure in the last 12 months). Fifty per cent of those interviewed felt that they were being actively discriminated against because of their epilepsy. Fifty-eight per cent had made contact with the National Rehabilitation Board, the state placement service for people with a disability, but only 36% of these were in training or employment at the time of interview. Sixty-six per cent of those interviewed had found the programmes helpful in terms of increasing their self-confidence and social skills. The study points to the need for more specialized training and job placement programmes for young people with epilepsy.     

Social skills training for schizophrenic individuals at risk for relapse

Two studies were conducted to evaluate the clinical efficacy of intensive social skills training in medicated schizophrenic inpatients at risk for relapse. In study 1, three patients were treated; two showed reductions in psychopathology and rehospitalization and improved social functioning 9 months following discharge. In study 2, social skills training was compared with holistic health treatment in 28 patients. Both groups showed reduced psychopathology 2 years after discharge; patients treated with social skills training had better social functioning, spent less time hospitalized, and had fewer symptomatic relapses. The results support the utility of social skills training as a psychosocial treatment for schizophrenia.     

Psychosocial skills training on social functioning and quality of life in the treatment of schizophrenia: a controlled study in Turkey

OBJECTIVE This study assessed the impact of a psychosocial skills training program, consisting of psychoeducation, interpersonal group therapy and family education incorporated into social skills training, as an integrative approach on social functioning and quality of life of patients with schizophrenia, in comparison to standard care for an 8-month period.

METHOD Thirty patients with DSM-IV schizophrenia were included in the study. Patients were assessed using the Positive and Negative Syndrome Scale (PANSS), Quality of Life Scale (QLS), Social Functioning Scale (SFS), and Global Assessment of Function (GAF) at baseline. Fifteen patients underwent an 8-month psychosocial skills training group program and another fifteen patients (waiting list) continued in standard care. Both groups were reassessed and analyzed at the end of the study.

RESULTS Two groups were not statistically different in terms of total PANSS, QLS, SFS, GAF scores, and demographic characteristics at baseline. However, there was a significant improvement in the mean total QLS, SFS, GAF, and even in total PANSS scores (respectively from 64.46±19.58 to 89.67±24.10, P<0.001, from 93.20±22.85 to 132.60±33.85, P<0.002, from 57.40±8.78 to 63.86±7.57, P<0.012, and from 63.53±14.48 to 53.33±15.71, P<0.029) for those who underwent the PSST program, but there was no statistically significant change for those on standard care at the end of the study.

CONCLUSION This study highlights the ‘social functioning’ and ‘quality of life’ benefits of the psychosocial skills training program for patients with schizophrenia. It can be concluded that this comprehensive psychosocial skills training program might be an important contribution to the functioning of the patients.     

No Association of COMT Val158Met Polymorphism with Suicidal Behavior or CSF Monoamine Metabolites in Mood Disorders

The suicide rate has been paralleled by an upward trend of unemployment in Hong Kong since 1997. This study aims to explore the unknown suicide-related factors among the unemployed. This information is useful in developing culturally specific suicide prevention initiatives related to unemployment. Seventy-six suicide deceased and 15 life subjects who were unemployed were selected from a previous psychological autopsy study. Logistic regression models were employed to estimate the relative suicide risks among the unemployed people. Among the unemployed, the suicide deceased were more likely to be male, had suffered from psychiatric illness, and had attempted suicide before. They also had acquired less competent social problem solving skills. Comparison with a small control group creates a generalizability problem. Suicide prevention for the unemployed could be done through mental health awareness programs; problem-solving skills training for attempters and males; and vocational training and job opportunities for discharged psychiatric patients and rehabilitees.     

Math practice and its influence on math skills and executive functions in adolescents with mild to borderline intellectual disability

Adolescents with mild to borderline intellectual disability (MBID) often complete schooling without mastering basic math skills, even though basic math is essential for math-related challenges in everyday life. Limited attention to cognitive skills and low executive functioning (EF) may cause this delay. We aimed to improve math skills in an MBID-sample using computerized math training. Also, it was investigated whether EF and math performance were related and whether computerized math training had beneficial effects on EF. The sample consisted of a total of 58 adolescents (12–15 years) from special education. Participants were randomly assigned to either the experimental group or a treatment as usual (TAU) group. In the experimental condition, participants received 5 weeks of training. Math performance and EF were assessed before and after the training period. Math performance improved equally in both groups. However, frequently practicing participants improved more than participants in the control group. Visuo-spatial memory skills were positively related to addition and subtraction skills. Transfer effects from math training to EF were absent. It is concluded that math skills may increase if a reasonable effort in practicing math skills is made. The relation between visuo-spatial memory skills provides opportunities for improving math performance.     

Applying social skills training in the context of vocational rehabilitation for people with schizophrenia

This paper describes a model for the conceptualization of social skills necessary for the vocational success of people with schizophrenia. Based on this model, a two-part measure was developed and validated to assess social skills necessary for job search and tenure. The measure consists of a 10-item self-administered checklist and a role-play exercise. The self-administered checklist measures clients' perceived competence in handling work-related social situations. The role-play exercise assesses the social skills necessary for job acquisition and maintenance in two simulated situations (participating in a simulated job interview and requesting urgent leave from work). Furthermore, a social skills training module has been designed, which enhances vocational outcome and fills a gap in the existing, commonly used modules. A pilot study shows that the training module together with appropriate professional support afterward is effective in enhancing the social competence and vocational outcomes of persons with schizophrenia. Implications for cross-cultural applications are discussed.     

Suicide and unemployment: what are the missing links?

The suicide rate has been paralleled by an upward trend of unemployment in Hong Kong since 1997. This study aims to explore the unknown suicide-related factors among the unemployed. This information is useful in developing culturally specific suicide prevention initiatives related to unemployment. Seventy-six suicide deceased and 15 life subjects who were unemployed were selected from a previous psychological autopsy study. Logistic regression models were employed to estimate the relative suicide risks among the unemployed people. Among the unemployed, the suicide deceased were more likely to be male, had suffered from psychiatric illness, and had attempted suicide before. They also had acquired less competent social problem solving skills. Comparison with a small control group creates a generalizability problem. Suicide prevention for the unemployed could be done through mental health awareness programs; problem-solving skills training for attempters and males; and vocational training and job opportunities for discharged psychiatric patients and rehabilitees.     

Errorless learning for training individuals with schizophrenia at a community mental health setting providing work experience

The effects of errorless learning (EL) on work performance, tenure, and personal well-being were compared with conventional job training in a community mental health fellowship club offering 12-week time-limited work experience. Participants were 40 clinically stable schizophrenia and schizoaffective disorder outpatients randomly assigned to EL vs conventional instruction (CI) at a thrift-type clothing store. EL participants received training on how to perform their assigned job tasks based on principles of EL, such as error reduction and automation of task performance. CI participants received training common to other community-based entry-level jobs that included verbal instruction, a visual demonstration, independent practice, and corrective feedback. Participants were scheduled to work 2 hours per week for 12 weeks. For both groups, job training occurred during the first 2 weeks at the worksite. Work performance (assessed using the Work Behavior Inventory, WBI) and personal well-being (self-esteem, job satisfaction, and work stress) were assessed at weeks 2, 4, and 12. Job tenure was defined as the number of weeks on the job or total number of hours worked prior to quitting or study end. The EL group performed better than the CI group on the Work Quality Scale from the WBI, and the group differences were relatively consistent over time. Results from the survival analyses of job tenure revealed a non-significant trend favoring EL. There were no group differences on self-esteem, job satisfaction, or work stress. The findings provide modest support for the extensions of EL to community settings for enhancing work performance.     

Correlations between psychiatric disabilities and vocational outcome.

Eighty-nine subjects were recruited from inpatient and community psychiatric treatment programs in the Los Angeles area to participate in the Brentwood Job Finding Club. They were trained in job-seeking skills and were given logistical support during their job search. Thirty-six percent either obtained a job or entered a job training program. Persons with good work histories, good job interviewing skills, and nonpsychotic diagnoses were more likely to find employment. Persons with psychotic diagnoses and poor work histories and those receiving Supplemental Security Income were the least successful.     

Effects of event-specific memory training on autobiographical memory retrieval and depressive symptoms in schizophrenic patients

Background and objectivesThis report describes the effects of a specific event group-based training programme on autobiographical memory, self-consciousness of memory retrieval, and depression symptoms in a sample of 24 schizophrenic patients (experimental group).MethodsTwenty-six matched schizophrenic patients who participated in social skills and occupational therapy group sessions constituted the active control group. Participants in the experimental group were trained to complete a diary with specific daily memories, followed by patients’ ratings of the associated emotional arousal of those entries. During training, significant specific events from childhood, adolescence, adulthood and the previous year were also reviewed.ResultsAfter 10 weeks of group-based sessions, the experimental group demonstrated an increase in their degree of specificity for autobiographical retrievals, had a higher level of consciousness of their memories and showed a decrease in their depression scores. Significant changes in measurements of retrieval specificity and autonoetic awareness were maintained when changes in emotional symptomatology were statistically controlled.LimitationsThe present study did not assess the impact of autobiographical memory training on the positive and negative symptoms of schizophrenia.ConclusionsThese results suggest that cognitive training strategies based on event-specific autobiographical memory training should be considered for inclusion in intervention programs for schizophrenic patients.     

The ability of modifying cognitive deficits in the area of social functioning in chronic schizophrenic patients

The paper concerns the effectiveness of rehabilitation of chronically ill schizophrenic patients who participate in social skills training. The assumption was that the participation in a four-month training programme (as authored by R. P. Liberman) will improve emotional problem solving, ability to keep in norms and conflict solving as well as the ability of cause-effect thinking. 100 schizophrenic patients and their families participated in the study. Half of those studied participated in the social skills training programme and the half who did not, were the control group. The subjects were examined twice in the four months. The following tools were used: "Means Ends Problem Solving" by Platt and Spivack, "PANSS" by Kay and Fiszbein, "Social-demographic questionnaire". Before the study period the groups did not vary much in the aspect of interpersonal social skills solving. After the training, the participants benefited significantly in the effectiveness of their problem solving and other criteria improved as well. It was concluded that the study of a group of 100 chronic schizophrenic patients who participated in a four month social skills training programme has a significant effect on social skills problem solving. The improvement of those skills consisted of: interpersonal and emotional problem solving, prediction of the consequences of one's actions, cause-effect thinking and alternative thinking.     

Long-term retention of skilled visual search following severe traumatic brain injury.

We examined the long-term retention of a learned automatic cognitive process in 17 severe TBI participants and 10 controls. Participants had initially received extensive consistent-mapping (CM) training (i.e., 3600 trials) in a semantic category visual search task (Schmitter-Edgecombe & Beglinger, 2001). Following CM training, TBI and control groups demonstrated dramatic performance improvements and the development of an automatic attention response (AAR), indicating task-specific and stimulus-specific skill learning. After a 5- or 10-month retention interval, participants in this study performed a New CM task and the originally trained CM task to assess for retention of task-specific and stimulus-specific visual search skills, respectively. No significant group differences were found in the level of retention for either skill type, indicating that individuals with severe TBI were able to retain the learned skills over a long-term retention interval at a level comparable to controls. Exploratory analyses revealed that TBI participants who returned at the 5-month retention interval showed nearly complete skill retention, and greater skill retention than TBI participants who returned at the 10-month interval, suggesting that "booster" or retraining sessions may be needed when a skill is not continuously in use.