Social problem solving in schizophrenia

The recent literature on social skills training has placed an increasing emphasis on the role of cognitive factors in social failure, as opposed to deficits in motoric skills. It has been hypothesized that schizophrenic patients are markedly deficient in social problem-solving abilities, and several programs have been developed to teach problem-solving skills. Despite high face validity, there is little empirical support for these training programs or the problem-solving model on which they are based. Research on information processing and problem solving in nonpatient populations is discussed, and it is concluded that the model used in these treatment programs is not a good representation of the problem-solving process. In particular, means-ends analysis is not an appropriate strategy for dealing with most interpersonal problems and conflicts. The difficulties experienced by schizophrenic patients in social situations might be due to a number of factors other than deficits in problem-solving skill, including sensitivity to negative affect and disordered communication. It is concluded that further research on problem-solving training programs is clearly warranted but that the validity of the problem-solving model and the utility of the training is uncertain.     

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.     

Social Skills Training with Children and Young People: Theory, Evidence and Practice

Deficits in social skills and social competence play a significant role in the development and maintenance of many emotional and behavioural disorders of childhood and adolescence. Social skills training (SST) aims to increase the ability to perform key social behaviours that are important in achieving success in social situations. Behavioural SST methods include instructions, modelling, behaviour rehearsal, feedback and reinforcement, frequently used in association with interpersonal problem solving and social perception skills training. Effective change in social behaviour also requires interventions that reduce inhibiting and competing behaviours, such as cognitive restructuring, self- and emotional-regulation methods and contingency management. Research suggests that SST alone is unlikely to produce significant and lasting change in psychopathology or global indicators of social competence. Rather, SST has become a widely accepted component of multi-method approaches to the treatment of many emotional, behavioural and developmental disorders.     

The facilitation of social-emotional understanding and social interaction in high-functioning children with autism: intervention outcomes

This study evaluated the effectiveness of a 7-month cognitive behavioral intervention for the facilitation of the social-emotional understanding and social interaction of 15 high-functioning children (8 to 17 years old) with autism. Intervention focused on teaching interpersonal problem solving, affective knowledge, and social interaction. Preintervention and postintervention measures included observations of social interaction, measures of problem solving and of emotion understanding, and teacher-rated social skills. Results demonstrated progress in three areas of intervention. Children were more likely to initiate positive social interaction with peers after treatment; in particular, they improved eye contact and their ability to share experiences with peers and to show interest in peers. In problem solving after treatment, children provided more relevant solutions and fewer nonsocial solutions to different social situations. In emotional knowledge, after treatment, children provided more examples of complex emotions, supplied more specific rather then general examples, and included an audience more often in the different emotions. Children also obtained higher teacher-rated social skills scores in assertion and cooperation after treatment. The implications of these findings are discussed in terms of the effectiveness of the current model of intervention for high-functioning children with autism.     

Assessment of interpersonal problem-solving skills

A new instrument for assessing social skills of schizophrenic patients, Assessment of Interpersonal Problem-Solving Skills (AIPSS), is a videotaped-based test with an examiner's administration and scoring manual. The test measures an examinee's ability to describe an interpersonal social problem, to derive a solution to the problem, and to enact a solution in a role-played simulation test. In a study using a sample of schizophrenic outpatients and a comparison group of nonpatients, we found that the test had adequate psychometric properties, and the patients demonstrated deficits on all scales relative to the nonpatients. The results of the study also provided partial support for the validity of an information-processing model of social skills, which was used as a basis for constructing the AIPSS. Thus, the AIPSS represents a departure from previous methods of assessing social skills.     

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.     

Social cognition and social problem solving abilities in individuals with alcohol use disorder

Background: Up to now, little is known about higher order cognitive abilities like social cognition and social problem solving abilities in alcohol-dependent patients. However, impairments in these domains lead to an increased probability for relapse and are thus highly relevant in treatment contexts. Method: This cross-sectional study assessed distinct aspects of social cognition and social problem solving in 31 hospitalized patients with alcohol use disorder (AUD) and 30 matched healthy controls (HC). Three ecologically valid scenario-based tests were used to gauge the ability to infer the mental state of story characters in complicated interpersonal situations, the capacity to select the best problem solving strategy among other less optimal alternatives, and the ability to freely generate appropriate strategies to handle difficult interpersonal conflicts. Standardized tests were used to assess executive function, attention, trait empathy, and memory, and correlations were computed between measures of executive function, attention, trait empathy, and tests of social problem solving. Results: AUD patients generated significantly fewer socially sensitive and practically effective solutions for problematic interpersonal situations than the HC group. Furthermore, patients performed significantly worse when asked to select the best alternative among a list of presented alternatives for scenarios containing sarcastic remarks and had significantly more problems to interpret sarcastic remarks in difficult interpersonal situations.

Conclusions: These specific patterns of impairments should be considered in treatment programs addressing impaired social skills in individuals with AUD.     

Staying in the here‐and‐now: A pilot study on the use of dialectical behaviour therapy group skills training for forensic clients with intellectual disability

Background Dialectic behaviour therapy (DBT) has been widely used with individuals diagnosed with borderline personality disorder who exhibit severe emotional and behavioural dysregulation. There is a paucity of research in assessing the effectiveness of DBT with forensic clients with intellectual disability (ID). Methods This pilot study aims to evaluate the effectiveness of the DBT group skills training programme adapted particularly for offenders with ID. Six participants completed the 13‐week adapted DBT group skills training programme. All participants exhibited challenging behaviours and have a history of prior charges or convictions for violent crimes. The study conducted pre‐ and post‐tests using instruments that measured dynamic risks, relative strengths, coping skills and global functioning. Results The study result showed improvement across all measures. A decrease in the level of risks, increase in relative strengths and general improvement in overall functioning were found significant. The results were promising particularly as a stand‐alone adapted DBT group skills training programme for this client group.     

Cognitive predictors of skill acquisition on social problem solving in patients with schizophrenia

The aim of the study was to evaluate the relationship between social problem solving ability, clinical features and cognitive functions, and determine the predictors of benefit from social problem solving training in 63 patients with schizophrenia. We administered Brief Psychiatric Rating Scale (BPRS), Wisconsin Card Sorting Test (WCST), Digit Span Test, Continuous Performance Test (CPT) and the Assessment of Interpersonal Problem Solving Skills (AIPSS). Only BPRS-positive symptoms subscale was negatively related to AIPSS on linear regression analysis. After the completion of the pretest, the patients were randomized to either problem solving training (n = 32) or control groups (n = 31). Patients in training group received 6 weeks problem solving training in-group modality, and those in control group were treated as usual. We readministered AIPSS at the end of 6 weeks. There were significant changes from pretest to posttest on AIPSS-total, AIPSS-receiving skills, and AIPSS-processing skills score in training group but not in control group. The number of correct answers in WCST and CPT hit rate were the predictors of post-training AIPSS scores in training group. Our findings suggest that skill acquisition on social problem solving is related with cognitive flexibility and sustained attention.     

Technique for training schizophrenic patients in illness self-management: a controlled trial.

OBJECTIVE: To determine whether schizophrenic outpatients receiving low-dose neuroleptic therapy could learn and retain complex information and skills related to self-management of their illness, a novel technique of teaching, using cognitive and behavioral methods, was designed to compensate for the patients' learning disabilities. METHOD: The subjects were 41 patients with DSM-III-R schizophrenia who were receiving constant maintenance neuroleptic drug therapy. They were randomly assigned to structured, modularized skills training or to supportive group psychotherapy. RESULTS: The patients who received skills training made significant gains in each of the areas taught, while those participating in group therapy did not. The skills learned during training were retained without significant erosion over a 1-year follow-up period. CONCLUSIONS: The effectiveness of modularized teaching of illness self-management skills to schizophrenic patients appears to be largely independent of baseline psychology and symptom improvement. Such an approach is useful for overcoming or compensating for the enduring cognitive and information processing deficits commonly found in schizophrenia.     

Recent advances in social skills training for schizophrenia

Social skills training consists of learning activities utilizing behavioral techniques that enable persons with schizophrenia and other disabling mental disorders to acquire interpersonal disease management and independent living skills for improved functioning in their communities. A large and growing body of research supports the efficacy and effectiveness of social skills training for schizophrenia. When the type and frequency of training is linked to the phase of the disorder, patients can learn and retain a wide variety of social and independent living skills. Generalization of the skills for use in everyday life occurs when patients are provided with opportunities, encouragement, and reinforcement for practicing the skills in relevant situations. Recent advances in skills training include special adaptations and applications for improved generalization of training into the community, short-term stays in psychiatric inpatient units, dually diagnosed substance abusing mentally ill, minority groups, amplifying supported employment, treatment refractory schizophrenia, older adults, overcoming cognitive deficits, and negative symptoms as well as the inclusion of social skills training as part of multidimensional treatment and rehabilitation programs.     

Specific skills and social competence in schizophrenia.

Generalization of skills is a major problem in social skills training for schizophrenic patients. Assessment of skills is mostly not based on objective indices of specific skill deficits. The results of this study show that global competence of schizophrenics can be differentiated from specific competence. Global competence was found to be related to symptoms, whereas specific competence was not. No support was found for the assumption that social dysfunctions are caused by negative symptoms. Social perception and positive symptoms did explain a substantial part of the variance of global competence. It is therefore concluded that neither global incompetence nor negative symptoms should be used as an indication for social skills training.     

The Inclusion of Siblings in Social Skills Training Groups for Boys With Asperger Syndrome

This pilot investigation evaluated the effectiveness of siblings as generalisation agents in an 8-week social skills training (SST) program designed for boys with Asperger syndrome (AS). Twenty-one boys aged 8–12 participated in a SST group alone, with a sibling, or remained in a wait-list control group. After training, participants’ identification of non-verbal social cues significantly improved and was maintained at 3-month follow-up, irrespective of sibling involvement. Similar trends existed for participants’ ability to accurately interpret emotions relative to controls. Improvements did not extend to parent and teacher ratings on standardised social skills measures, suggesting poor generalisation, or questionable sensitivity of measures to taught skills. Results suggest some promise in improving social skills training for children with AS.     

Social skills training and negative symptoms.

Schizophrenic patients with severe negative symptoms may have an impaired capacity to benefit from social skills training (SST), and their negative symptoms may show little change as a result of SST. The present study, employing a multiple-baseline design across-behaviors with three patients who had prominent negative schizophrenic symptoms, combined nonverbal skills training with the Stacking the Deck social skills game. Further, the study examined changes in both social skills (assessed using role-play and conversation tests) and negative symptoms. Depression, extrapyramidal side effects, and positive symptoms were also monitored. Modest improvements in social skills and negative symptoms were achieved. There was little evidence of a training effect. The unstable baselines may have contributed to this finding. It is important for further research to employ comprehensive patient-assessment procedures.     

Social skills training for patients with schizophrenia: a controlled clinical trial

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; their social adjustment in the community was rated as better by significant others; and they experienced fewer relapses and rehospitalizations.     

家属参与的社会技能训练对社区精神分裂症患者康复的作用

目的:探讨家属参与的社会技能训练对社区精神分裂症患者康复的影响。方法:80例社区的精神分裂症患者随机分为试验组和对照组;在抗精神病药物治疗基础上所有患者在社区接受每周1次、每次60 min的社会技能训练,共训练16次。试验组每例患者均有1位家属参与训练,其接受治疗师单独指导及在家庭生活中帮助患者实践所学到的技能。两组在训练前、训练6及12个月时分别进行大体评定量表(GAS)、社会功能缺陷筛选量表(SDSS)、自知力和治疗态度问卷(ITAQ)及日常生活量表(ADLS)的评定。结果:训练后试验组SDSS(F=4.02,P0.05)、ADLS(F=12.73,P0.01)及工具性日常生活活动量表(IADL)(F=15.11,P0.01)减分值明显优于对照组。结论:有家属参与的社会技能训练能更好地帮助社区精神分裂症患者康复。     

Flat affect and social skills in schizophrenia: evidence for their independence

Although flat affect and social skills deficits are generally considered to be distinct impairments in schizophrenia, flat affect is typically assessed via an interview - an inherently social context. To the extent that emotional expressivity is an important component of socially appropriate interaction, it is possible that schizophrenic patients' diminished expressiveness in a social situation is largely a function of their concurrent social skills deficit. In the present study, we examined the relation between social skills and flat affect by measuring flat affect in two contexts: during an interview (high social demand) and while participants watched emotional film clips alone (low social demand). Results showed that social skills were not significantly correlated with flat affect in either context, suggesting that the two constructs represent independent domains of functioning in schizophrenic patients.     

Group treatment of problem‐solving deficits in outpatients with traumatic brain injury: A randomised outcome study

Sixty higher‐level outpatients with traumatic brain injury (TBI), all at least 1 year post‐injury, were randomly assigned to either conventional group neuropsychological rehabilitation or an innovative group treatment focused on the treatment of problem‐solving deficits. Incorporating strategies for addressing underlying emotional self‐regulation and logical thinking/reasoning deficits, the innovative treatment is unique in its attention to both motivational, attitudinal, and affective processes and problem‐solving skills in persons with TBI. Participants in the innovative group improved in problem solving as assessed using a variety of measures, including (1) executive function, (2) problem‐solving self‐appraisal, (3) self‐appraised emotional self‐regulation and clear thinking, and (4) objective observer ratings of roleplayed scenarios. These improvements were maintained at follow‐up. Baseline performance on timed attention tasks was related to improvement; individuals who processed the most slowly benefited the most. These participants did not show improvements on timed attention tasks, but did improve on problem‐solving measures. Such findings are consistent with successful compensatory strategy use—the person may still have deficits and symptoms, but now has effective strategies for reducing their impact on daily functioning.     

Entwicklung interpersoneller Problemlösekompetenz während psychotherapeutischer Ausbildung in Psychodrama

Psychotherapists’ skills regarding relationships are the key elements of successful psychotherapy for all psychotherapeutic schools. During psychotherapy training programs it is essential to train those skills. This survey aims of finding out if trainees learn relational and interpersonal problem solving competencies during their psychotherapy training and if these competencies are measurable and evaluable. For this reason, the psychodrama training program at the “Institute for Psychosocial Intervention and Communications Research” (University of Innsbruck) was subject of research over the past years. Besides other instruments, the IIP—Inventory of Interpersonal Problems—has been used to evaluate the training program. This pilot survey shows that the IIP is appropriate for therapist training studies. During the psychodrama training program main features of relational competencies have improved significantly. The trainees’ interpersonal problem solving competencies have clearly increased.