Treatment of socially anxious women by a skills training program

Investigation into the treatment of socially anxious college males has provided a framework for assessing and treating similar deficits in college females. The present study used both self-report and behavioral measures in the assessment of social anxiety and social skills in two undergraduate females who were selected on the basis of skills deficits and social discomfort. A within-subject baseline design was employed to assess the effects of direct training on each of three verbal target skills. The use of instructions, modeling, behavioral rehearsal, and audiotaped feedback in training these verbal skills resulted in significant changes on behavioral and self-report measures. Skill acquisition was also effective in reducing levels of discomfort while engaging in conversations with unfamiliar males.     

Poor peer interactions and social isolation: a case report of successful in vivo social skills training on a child psychiatric inpatient unit

The effects of social skills training comprising didactic instructions, coaching, modeling, feedback and reinforcement were examined in a child diagnosed Conduct Disorder and Attention Deficit Disorder in whom social isolation and poor peer interactions were prominent features. Treatment was implemented in the specific settings in which deficient social performance was noted using a multiple baseline design. Application of social skills training led to increased rates of appropriate interactions with peers and decreased rates of playing alone. In addition, pre- and posttreatment scores on the Child Behavior Checklist and School Behavior Checklist showed significantly decreased dysfunctional behaviors after training. Follow-up contact 1 and 12 months following discharge indicated that the child continued to socialize more with peers and to show improved adjustment.     

Teaching heterosocial conversational skills to male psychiatric inpatients

Two socially-deficient formerly hospitalized male psychiatric patients received conversational skills training to increase their ability to converse appropriately with females. Training consisted of a behavior rehearsal-modeling-self observation procedure designed to increase specific conversational skills, the skills being introduced sequentially in multiple baseline fashion. Effectiveness of treatment was demonstrated by means of (1) objective ratings of subject behavior during conversations with females following each training session; (2) objective ratings of pre- and post-treatment and follow-up conversations with different females; and (3) blind ratings of each subject's pre- and post-training conversations by naive female judges, who evaluated the more global aspects of conversational reinforcement value. Implications for the clinical use of heterosocial conversational skills training are discussed.     

The use of skills training procedures in the treatment of a child-abusive parent

Recent behavioral formulations suggest that child abuse can often be conceptualized in terms of skill deficits of the parent. In the present case study, training was used to improve an abusive parent's anger-assertion, child management, and personal problem-solving skills; deficits in all three areas were functionally related to prior episodes of violence. Treatment across these skill areas was introduced in multiple baseline fashion. The effectiveness of treatment was demonstrated by (1) assessments of assertion, child management, and problem-solving knowledge following each training session; (2) parent monitoring data on the frequency of child-related and anger problems at home throughout the intervention; (3) performance on skill generalization measures; and (4) objectively-rated parent-child interactions during pre- and post-training home observation probes.     

Sibling self-management: Programming for generalization to improve interactions between typically developing siblings and children with autism spectrum disorders

The present study taught typically developing (TD) siblings of children with autism spectrum disorders (ASD) social-communicative and self-management skills. The authors’ hypothesized that the acquisition of self-management skills would support generalization of targeted social-communicative responses. A multiple baseline probe design across sibling dyads was used to decrease exposure to unnecessary sessions in the absence of intervention. Four TD siblings were taught self-management of a social skills curriculum using behavioral skills training, which consisted of instructions, modeling, practice, and subsequent feedback. Results indicated that TD siblings learned to self-manage the social skills curriculum with some generalization across novel settings and over time. Comparisons of social-communicative responses to their typical peers provided some support for the social validity of the intervention outcomes. These results support the use of self-management, when explicitly programming for generalization, which continues to be a key consideration when including TD siblings in interventions with their siblings with ASD.     

Operant training of head control and beginning language for a severely developmentally disabled child

Contingent social reinforcement was applied differentially to aid the behavioral and educational development of a nine-year-old, severely retarded, non-verbal female with quadriplegic spastic cerebral palsy. Four behaviors prerequisite and collateral to beginning language development were defined and measured: eye contact, head control, imitative vocalization, and drooling. Treatment was administered in multiple baseline design, and improvements in all behaviors were observed over the 20 week program. The experimenters found the improvements maintained during follow-up periods one month and 12 months after the initial child training had ceased.     

Training and generalization of commendatory assertiveness: A controlled single subject experiment

Assertiveness involves the use of both effective oppositional and commendatory skills. The latter have received little research attention. In the current multiple baseline case study, a clinically social skills-deficient patient was first trained in commendatory and, later, refusal skills using a role-playing paradigm. Throughout training, both commendatory and refusal skills were continously evaluated to determine whether training one class of skills (commendatory) would generalize to another class of skills (refusal). Largely, the trained commendatory skills did not enhance refusal capabilities, which later had to be specifically trained themselves. Follow-up data is presented, and clinical implications of specificity in social skills training is discussed.     

Acquisition of generalized telephone use by students with moderate and severe mental retardation

This study examines the effects of one approach for selecting teaching examples on the development of generalized telephone skills with moderately and severely mentally retarded high school students. Four subjects were taught to make and receive telephone calls within a counterbalanced multiple baseline design. The primary dependent variable was generalization of telephone skills to nontrained telephone situations in home, school, and community settings. Results document the effectiveness and efficiency of the training approach. An eighteen-month validation assessment also shows that telephone use continued as a regular part of each student's lifestyle. The instructional implications of these results are discussed as well as methodological implications for applied research on generalization.     

The effects of contingent water mist on the stereotypic responding of a severely handicapped adolescent

The reductive effects of the water misting procedure on the stereotypic responding of a severely handicapped adolescent were investigated by using a variation of the multiple baseline design across settings, with sequential interventions across settings and simultaneous interventions across teachers. The results indicated that the intervention was related to reduced rates of stereotypic responding in each setting. The effects of the intervention were also maintained across multiple administrators of the procedure and during follow-up. Instructional implications are discussed. Further research is suggested.     

Prescriptive rehabilitation for severely disabled psychiatric patients

Several behavioral rehabilitation strategies have been empirically validated in the treatment of schizophrenia and are now the psychosocial treatments of choice for chronic mental disorders. The stress-vulnerability model and an empirically based decision tree offer clinicians' guidance in prescribing strategies that are particularly relevant for each patient. Hence, behavioral family therapy may be indicated for patients who experience disease exacerbation that results from stressful family interactions. Patients with insufficient social and coping skills may benefit from skills training. Supported employment and job-finding clubs may be indicated for patients with deficits in work skills. The form and programmatic matrix of these strategies differ, depending upon their locus in inpatient and outpatient settings.     

Promoting social skill use and generalization in children with autism spectrum disorder

Social skills training is a frequently utilized intervention for addressing social deficits of children with autism spectrum disorder (ASD). The current study investigated the effects of the Superheroes Social Skills program, a social skills training program consisting of multiple evidence-based practices, in promoting accurate demonstration of target social skills in both a training and generalized setting. Three children with ASD between the ages of 10 and 14 attended 10 social skills training sessions over five weeks, with social skills lessons targeting participation, conversation, perspective taking, and problem solving skills. A multiple probe design across behaviors and replicated across participants was utilized to evaluate accurate demonstration of target social skills. Results suggest improvement in skill accuracy in both the training and generalization settings. Indirect secondary measures of participant social functioning and parental stress were also collected and suggest improvements associated with social skills training.     

Social skills training to teach prosocial behaviors in an organically impaired and retarded patient

A social skills training program consisting of behavior rehearsal, modeling, instruction, feedback, and reinforcement was used to teach prosocial behaviors (e.g. number of words spoken, eye contact, smiles) in an organically impaired and intellectually deficient young adult. Six months following initial treatment, booster sessions were used to bolster the effects of initial training. All behaviors improved initially; decrements in skill performance seen over the six months of no treatment were reinstituted in booster sessions. The effects of treatment were evaluated in a multiple baseline design across behaviors.     

A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia

OBJECTIVE: The number of older patients with chronic schizophrenia is increasing. There is a need for empirically validated psychotherapy interventions for these patients. Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. The authors compared treatment as usual with the combination of treatment as usual plus cognitive behavioral social skills training. METHOD: The randomized, controlled trial included 76 middle-aged and older outpatients with chronic schizophrenia, who were assigned to either treatment as usual or combined treatment. Cognitive behavioral social skills training was administered over 24 weekly group sessions. Blind raters assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery. RESULTS: After treatment, the patients receiving combined treatment performed social functioning activities significantly more frequently than the patients in treatment as usual, although general skill at social functioning activities did not differ significantly. Patients receiving cognitive behavioral social skills training achieved significantly greater cognitive insight, indicating more objectivity in reappraising psychotic symptoms, and demonstrated greater skill mastery. The overall group effect was not significant for symptoms, but the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms. CONCLUSIONS: With cognitive behavioral social skills training, middle-aged and older outpatients with chronic schizophrenia learned coping skills, evaluated anomalous experiences with more objectivity (achieved greater cognitive insight), and improved social functioning. Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.     

Treatment of an assaultive, sensory-impaired adolescent through a multicomponent behavioral program

This project examined the effects of a multicomponent behavioral treatment program on assaultive behavior in a deaf, visually-impaired adolescent boy. Two types of assaultiveness were monitored: aggression towards adults and destruction of the physical environment. Intervention consisted of a token economy system, a response cost procedure, a "relaxation" technique, and skill training sessions. Through use of a multiple baseline across behaviors design, it was demonstrated that differentially reinforcing the absence of target behaviors on a weekly basis was the crucial ingredient in the treatment package. During a maintenance programming phase, the boy was gradually weaned off the token system. At 1- and 2-year follow-ups, no aggressive or destructive acts had occurred and the boy was showing improved communication and interpersonal skills.     

In vivo training of a fire emergency skill with a severely retarded adult

A behavioral training program of shaping, stimulus control and contingent reinforcement (primary and social) procedures was utilized to teach required survival skills to a 43-year-old severely retarded man. All training was conducted in vivo with his residential living unit, initially by a psychologist and subsequently by residential staff personnel. Using an AB design, effects of intervention were immediate, with skill acquisition achieved in 2 weeks and maintained at a 1-year follow-up.     

Teaching denial assertation to chronic hospitalized patients

Seventeen chronic hospitalized female participants in an intensive behavioral treatment program were trained by a semi-automated assertion training procedure aimed at producing greater refusal to unreasonable demands. The patients had not been screened for deficits in assertive skills. The training program utilized modeling, coaching, and either overt or covert behavioral rehearsal. Ten control subjects participated in the comprehensive behavioral treatment program but received no assertion training. A second control group of 8 subjects neither participated in the program nor received training. The trained subjects displayed greater refusal in the role-playing situations for which they had been trained than control subjects. Overt rehearsal led to greater refusal than covert rehearsal. The greater assertion was maintained on trained, but not untrained, subjects at 24-month follow-up.     

Intensive Cognitive Behavioral Therapy for Anxiety Disorders in School-aged Children with Autism: A Preliminary Comparison with Treatment-as-Usual

Children with autism spectrum disorders (ASDs) frequently present with a comorbid anxiety disorder that can cause significant functional impairment, particularly at school. An intensive modular cognitive behavioral treatment (CBT) program was delivered to address anxiety, self-regulation, and social engagement in school and in the community. A particular emphasis was placed on increasing generalizability of coping skills and positive social behavior by involving school personnel in the treatment process. Children (7–11 years old) were randomly assigned to an immediate treatment condition (IT) that included 32 sessions of CBT (n = 7) or a 16-week treatment-as-usual (TAU) condition (n = 5). The CBT sessions emphasized behavioral experimentation and emotion regulation training as well as social coaching on increasing positive peer interactions. School observations and consultations were included in the treatment model. Independent evaluators blind to treatment condition conducted structured diagnostic interviews at baseline and post-IT/post-TAU. Post-treatment analyses showed that 71.4 % of the IT group had remitted from their primary anxiety disorder diagnosis as compared with none of the TAU group. In addition, an ANCOVA analysis conducted with baseline anxiety scores included as a covariate revealed a statistically significant difference by treatment group in anxiety severity favoring the IT group at post-treatment. The 32-session CBT program is an intensive approach for children with ASD and moderate-to-severe anxiety disorders that appears to yield a clinically significant impact on anxiety symptoms. The generalizability of coping skills may be enhanced by the inclusion of school-based treatment components due to the consistency of supports this permits across the child’s daily settings.     

The application of multiple behavioral techniques to multiple problems of a complex case

A systematic approach to the behavioral treatment of complex cases with multiple problems is presented. The approach was applied to a client with problems of: uncertain vocational goals; inadequate social skills; unassertiveness; fear of crowded places; marital difficulty; and public-speaking phobia. Treatment was successful in all six problem areas. At a 14-month follow-up the client reported continued improvement in all areas.     

A parent training model for toilet training children with autism

Background Azrin & Foxx pioneered an intensive toilet training protocol for individuals with intellectual disability living in a residential setting. Since the development of the Rapid Toilet Training (RTT) protocol, many have replicated the efficacy, most notably in educational and outpatient treatment settings, but often training over longer periods of time. This study presents data from a parent training model that replicates Azrin and Foxx's results and training time. Method This multiple baseline across subjects design study employs an ABA design where two boys diagnosed with autism were toilet trained using a modified Azrin & Foxx intensive teaching protocol. The first subject, a 4‐year‐old boy, did not have a history of attempted toilet training. The second subject, a 6‐year‐old boy, demonstrated a history of failed toilet training attempts in both the home and school settings. The trainings were conducted in the home setting where a novel parent‐training approach was implemented. Results Participant 1 was continent at the end of the second day of training, and completely toilet trained (including initiation and communication) by day 10 of the intervention. Participant 2 was continent after day 1 and completely toilet trained by day 5 of the intervention. Conclusions Long‐term follow‐up demonstrates maintenance of skills 3 years post training. Social validity via parent satisfaction was assessed. Limitations to the current study and recommendations for future research were discussed.     

Social skills training and endogenous depression

The clinical response to social skills training was studied in four women with definite endogenous depression (melancholia) to ascertain if a behavioral intervention could be effective with more severe and pervasive affective syndromes. Three of four patients responded to social skills training, although both patients available for longitudinal follow-up relapsed within 24 months post-treatment. Implications for research and practice are discussed.