Indian Journal of Health and Wellbeing

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Efficacy of Social Skill Training in the Treatment of Stabilized Outpatients with Chronic Schizophrenia


Affiliations
1 PhD. Scholar, Department of Psychology Savitribai Phule Pune University, Pune, Maharashtra M.Phil in Clinical Psychology, RINPAS, Ranchi, Jharkhand, India
2 Professor and Head, Department of Psychology Savitribai Phule Pune University, Pune, Maharashtra, India
     

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Schizophrenia, a debilitating neuropsychiatric disorder, is considered by WHO to be one amongst the foremost ten illnesses which contribute to the global burden of disease (Murray & Lopez, 1996). Antipsychotic medicines, considered to be first-line treatment of Schizophrenia, do not meaningfully improve cognitive deficits, negative symptoms and concomitant poor social adaptive functioning. Inclusion of empirically validated psychosocial interventions can enhance the quality of life and independent life skills in persons with Schizophrenia. The study aimed at evaluating efficacy of a Social Skills Training (SST) intervention of six months duration, on adaptive behavior among stabilized outpatients of chronic schizophrenia availing day care rehabilitation services. 96 stabilized outpatients with chronic schizophrenia, diagnosed as per DSM-V criteria, availing day care rehabilitation services, were allotted either to a wait list control group receiving standard care of treatment with antipsychotic medication (n=48) or experimental (active treatment) group, receiving SST in addition to standard care (n=48), through simple random sampling. This was a centre based pretest-posttest control group study. Both the groups were assessed once at the baseline and thereafter 6 months of SST intervention, comprising of 75 sessions, using Social Adaptive Functioning Evaluation (SAFE). Statistical analysis was conducted through independent samples t test on gain score (pre-intervention or baseline assessment post-intervention assessment) of the two groups. The results revealed an overall significant effect of SST program in the form of enhancing adaptive behaviour. At post intervention, the experimental group's gain scores on SAFE were found to be significantly higher (t= 2.458, p<0.05) while compared to the wait list control group. Thus, the present study highlighted efficacy of SST intervention in improving adaptive behaviour in persons with chronic schizophrenia. Therefore, in view of these favourable effects, it can be concluded that, although not routinely recommended in treatment guidelines of schizophrenia, integration of SST can improve present standard services, and can be recommended for wider implementation in rehabilitation centres in India.

Keywords

social skills training, positive symptoms, negative symptoms, adaptive behaviour, schizophrenia
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  • AlHossainy, A. (2012). Effects of community based program, social competence and symptoms intensity among hospitalized psychiatric patients. Thesis Submitted in Partial Fulfillment of the Requirements for Doctoral Degree In Psychiatric Mental Health Nursing, Faculty of Nursing, Cairo University.

  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

  • American Psychiatric Association (2013). Diagnostic and statistical manual of mental health disorders (5th ed.). DSM-5; American Psychiatric Association.

  • Barzegar, S., Ahadi, M., Barzegar, Z., & Ghahar, S. (2016). The effectiveness of social skills training on reducing negative symptoms of chronic schizophrenia. International Journal of Medical Research and Health Sciences, 5(7S), 323-327.

  • Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta, J. (2004). Social skills training for schizophrenia: A step-by-step guide (2nd ed.). New York: Guilford Press.

  • Bowie, R., McGurk, R., Mausbach, B., Patterson, L., & Harvey, P. (2012). Combined cognitive remediation and functional skill straining for schizophrenia: Effects on cognition, functional competence, and real-world behavior. American Journal of Psychiatry, 169, 710-718.

  • Bustillo, J.R., Lauriello, J., Horan, W.P., & Keith, S.J. (2001) The psyhosocial treatment of schizophrenia: An update. American Journal of Psychiatry, 15(8), 163-175.

  • Delahunty, A., Morice, R., & Frost, B. (1993). Specific cognitive flexibility rehabilitation in Schizophrenia. Psychological Medicine, 23, 221-227.

  • Deveci, A., Danaci, A., & Yurtsever, F. (2008). The effect of psycho social skill straining on symptomatology, insight, quality of life and suicide probability in schizophrenia. Turkish Journal of Psychiatry, 19, 1-8.

  • Ghanem, M., Gadallah, M., Meky, F., & Elkholy, G. (2009). National survey of prevalence of mental disorders in Egypt: Preliminary survey. Eastern Mediterranean Health Journal, 15(1), 65-68.

  • Ghanem, M., Gadallah, M., Meky, F., & Elkholy, G. (2009). National survey of prevalence of mental disorders in Egypt: Preliminary survey. Eastern Mediterranean Health Journal, 15(1), 65-68.

  • Glynn, S.M., Marder, S.R., Liberman, R.P., Blair, K., Wirshing, W.C., Wirshing, D.A., Ross, D., & Mintz, J. (2002). Supplementing clinic-based skills training with manual-based community support sessions: Effects on social adjustment of patients with schizophrenia. American Journal of Psychiatry, 159, 829-837.

  • Gobal, Y., & Variend, R. (2005). 1st episode schizophrenia review of cognitive remediation. Advances in Psychiatric Treatments, 11, 38-44.

  • Granholm, E., Been-Zeev, D., & Link, P.C. (2009). Social disinterest attitudes and group cognitive behavioral social skills training for functional disability in schizophrenia. Schizophrenia Bulletin, 35(5), 874-883.

  • Granholm, E., McQuaid, J. R., Link, P. C., Fish, S., Patterson, T., & Jeste, D. V. (2008). Neuropsychological predictors of functional outcome in cognitive-behavioral social skills training for older people with schizophrenia. Schizophrenia Research, 100, 133-143.

  • Green, M. F., Kern, R., Braff, D., & Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the 'right stuff'? Schizophrenia Bulletin, 26, 119-136.

  • Harvey, P.D., Davidson, M., Mueser, K.T., Parrella, M., White, L., & Powchik, P. (1997). Social-adaptive functioning evaluation (SAFE): A rating scale for geriatric psychiatric patients. Schizophrenia Bulletin, 23(1), 131-145. doi:10.1093/schbul/23.1.131. PMID: 9050119.

  • Heaton, R., Paulsen, J.S., McAdams, L.A., Kuck, J., Zisook, S., Braff, D., Harris, J., & Jeste, D.V. (1994). Neuropsychological deficits in schizophrenics: Relationship to age, chronicity, and dementia. Archives of General Psychiatry, 51, 469-476.

  • Hegarty, J.D., Baldessanni, R.J., & Tohen, M. (1994). One hundred years of schizophrenia: A meta-analysis of the outcome literature. American Journal of Psychiatry, 151, 1409-1416.

  • Horan, W.P., Kern, R.S., Tripp, C., Hellemann, G., Wynn, J.K., Bell, M., Marder, S.R., & Green, M.F. (2011). Efficacy and specificity of social cognitive skills training for outpatients with psychotic disorders. Journal of Psychiatric Research, 45(8), 1113-1122.

  • Khalil, A. I. (2012). A community based treatment: Impact of social skills training program on improving social skills among schizophrenic patients. World Applied Sciences Journal, 18(3), 370-378.

  • Kopelowicz, A., & Liberman, R. P. (2004). Psychiatric rehabilitation for schizophrenia. International Journal of Psychology and Psychological Therapy, 3, 1-16.

  • Kopelowicz, A., Liberman, R.P., & Zarate, R. (2006). Recent advances in social skills training for schizophrenia. Schizophrenia Bulletin, 32(Suppl. 1), S12-S23.

  • Liberman, R.P., & Corrigan, P.W. (1993). Designing new psychosocial treatments for schizophrenia. Psychiatry, 56, 238-249.

  • Liberman, R.P., Mueser, K.T., Wallace, C.J., Jacobs, H.E., Eckman, T., & Massel, H.K. (1986). Training skills in the psychiatrically disabled: Learning coping and competence. Schizophrenia Bulletin, 12, 631-647.

  • Liberman, R.P., Wallace, C.J., Blackwell, G., Kopelowicz, A., Vaccaro, J.V., & Mintz, J. (1998). Skills training versus psychosocial occupational therapy for persons with per- sistent schizophrenia. American Journal of Psychiatry, 155, 1087-1091.

  • Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R., Perkins, D. O., Keefe, R. S. E., Davis, S. M., Davis, C. E., Lebowitz, B. D., Severe, J., & Hsiao, J. K. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209-1223.

  • Marder, S.R., Wirshing, W.C., Mintz, J., Mckenzie, J., Johnston, K., Eckman, T.A., Lebell, M.B., Zimmerman, K.E., & Liberman, R.P. (1996). Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia. The American Journal of Psychiatry, 153(12), 1585-1592.

  • McFall, R. (1982). A review and reformulation of the concept of social skill. Behavioural Assessment, 4, 13.

  • Meesters, P.D., Stek, M.L., Comijs, H.C., Haan, L., Patterson, T.L., Eikelenboom, P., & Beekman, A.T.F. (2010). Social functioning among older community-dwelling patients with schizophrenia: A review. American Journal of Geriatric Psychiatry, 18(10), 862-872.

  • Mousa, A., Imam, S., & Sharaf, A. (2011). The effect of an assertiveness training program on assertiveness skills and social interaction anxiety of individuals with schizophrenia. Journal of American Science, 7(12), 454-466.

  • Mueser, K.T., & Bellack, A.S. (1998). Social skills and social functioning. In K.T.

  • Mueser and N. Tarrier (Eds.), Handbook of social functioning in schizophrenia (pp. 79-96). Needham Heights, MA: Allyn and Bacon.

  • Murray, C.J.L., & Lopez, A.D. (1996). The global burden of disease. Harvard University Press, Cambridge, MA, p.21.

  • Olfson, M., Mechanic, D., Hansell, S., Boyer, C., Walkup, J., & Weiden, P. (2000). Predicting medication noncompliance after hospital discharge among patients with schizophrenia. Psychiatric Services, 51, 216-222. (Washington, D.C.). 10.1176/appi.ps.51.2.216.

  • Penades, R., Boget, T., Catalan, R., Bernardo, M., Gasto, C., & Salamero, M. (2003). Cognitive mechanisms, psychosocial functioning and neurocognitive in rehabilitation schizophrenia. Schizophrenia Research, 63, 219-227.

  • Perlick, P., Rosenheck, R., & Kaczynski, (2008). Association of symptomatology and cognitive deficitst functional capacity in Schizophrenia. Schizophrenia Research, 99(1-1). 192-199.

  • Pfammatter, M., Junghan, U.M., & Brenner, H.D. (2006). Efficacy of psychological therapy in schizophrenia: Conclusions from meta- analyses. Schizophrenia Bulletin, 32(S1), S64-S80.

  • Roberts, L., & Penn, L. (2009). Social cognition and interaction training (SCIT) for out patients with schizophrenia: A preliminary study. Psychiatry Research, 166, 141-147.

  • Rus-Calafell, M., Gutiérrez-Maldonado, J., Ortega-Bravo, M., Ribas-Sabaté, J., & Caqueo-Urizar, A. (2012). A brief cognitive-behavioural social skills training for stabilised outpatients with schizophrenia: A preliminary study. Schizophrenia Research, 143(2-3), 327-336. 10.1016/j.schres.2012.11.014.

  • Smith, T. E., Bellack, A. S., & Liberman, R. P. (1996). Social skills training for schizophrenia: Review and future directions. Clinical Psychology Review, 16, 599-617.

  • Tarrier, N., & Bobes, J. (2000). The importance of psychosocial interventions and patient involvement in the treatment of schizophrenia. International Journal of Psychiatry in Clinical Practice, 4(Suppl 1), S35 −S51.

  • Valencia, M., Rascon, M.L., Juarez, F., & Murow, E. (2007). A psychosocial skills training approach in Mexican out-patients with schizophrenia. Psychological Medicine, 37(10), 1393-1402.

  • Wallace, C.J., Liberman, R.P., MacKain, S.J., Blackwell, G., & Eckman, T.E. (1992). Effectiveness and replicability of modules for teaching social and instrumental skills to the severely mentally ill. American Journal of Psychiatry, 149, 654-658.

  • Weiss, K.A., Smith, T.E., Hull, J.W., Piper, A.C., & Hubbert, J.D. (2002). Predictors of risk of non-adherence in outpatients with schizophrenia and other psychotic disorders. Schizophrenia Bulletin, 28, 341-349.

  • World Health Organization (2014). Schizophrenia. Retrieved from http://www.who.int/mental_health/management/schizophrenia/en/

  • Yildiz, M., Veznedaroglu, B., Eryavuz, A., & Kayahan, B. (2004). Psychosocial skills training on social functioning and quality of life in the treatment of schizophrenia: A controlled study in Turkey. International Journal of Psychiatry in Clinical Practice, 8, 219-225.


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  • Efficacy of Social Skill Training in the Treatment of Stabilized Outpatients with Chronic Schizophrenia

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Authors

Sucharita Kundu
PhD. Scholar, Department of Psychology Savitribai Phule Pune University, Pune, Maharashtra M.Phil in Clinical Psychology, RINPAS, Ranchi, Jharkhand, India
V. R. Shinde
Professor and Head, Department of Psychology Savitribai Phule Pune University, Pune, Maharashtra, India

Abstract


Schizophrenia, a debilitating neuropsychiatric disorder, is considered by WHO to be one amongst the foremost ten illnesses which contribute to the global burden of disease (Murray & Lopez, 1996). Antipsychotic medicines, considered to be first-line treatment of Schizophrenia, do not meaningfully improve cognitive deficits, negative symptoms and concomitant poor social adaptive functioning. Inclusion of empirically validated psychosocial interventions can enhance the quality of life and independent life skills in persons with Schizophrenia. The study aimed at evaluating efficacy of a Social Skills Training (SST) intervention of six months duration, on adaptive behavior among stabilized outpatients of chronic schizophrenia availing day care rehabilitation services. 96 stabilized outpatients with chronic schizophrenia, diagnosed as per DSM-V criteria, availing day care rehabilitation services, were allotted either to a wait list control group receiving standard care of treatment with antipsychotic medication (n=48) or experimental (active treatment) group, receiving SST in addition to standard care (n=48), through simple random sampling. This was a centre based pretest-posttest control group study. Both the groups were assessed once at the baseline and thereafter 6 months of SST intervention, comprising of 75 sessions, using Social Adaptive Functioning Evaluation (SAFE). Statistical analysis was conducted through independent samples t test on gain score (pre-intervention or baseline assessment post-intervention assessment) of the two groups. The results revealed an overall significant effect of SST program in the form of enhancing adaptive behaviour. At post intervention, the experimental group's gain scores on SAFE were found to be significantly higher (t= 2.458, p<0.05) while compared to the wait list control group. Thus, the present study highlighted efficacy of SST intervention in improving adaptive behaviour in persons with chronic schizophrenia. Therefore, in view of these favourable effects, it can be concluded that, although not routinely recommended in treatment guidelines of schizophrenia, integration of SST can improve present standard services, and can be recommended for wider implementation in rehabilitation centres in India.

Keywords


social skills training, positive symptoms, negative symptoms, adaptive behaviour, schizophrenia

References