Social Skills Training

Cognitive Behavioral Social Skills Training May Be Helpful in Schizophrenia

http://www.medscape.com/viewarticle/500800

March 4, 2005 — Cognitive behavioral social skills training added to usual care improves social functioning for middle-aged and older outpatients with schizophrenia, according to the results of a randomized trial published in the March issue of the American Journal of Psychiatry.

\"Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments,\" write Eric Granholm, PhD, from the Department of Veterans Affairs San Diego Health Care System, and colleagues. \"Whereas cognitive behavior therapy focuses on how beliefs affect behavior and mood, social skills training focuses on practicing pragmatic skills of living.\"

In this controlled trial, 76 middle-aged and older outpatients with chronic schizophrenia were randomized to either treatment as usual or to combined treatment including cognitive behavioral social skills training administered for 24 weekly group sessions. Raters blinded to treatment assignment assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery.

After treatment, patients in the combined treatment group performed social functioning activities significantly more often than did the patients in the usual care group. However, general skill at social functioning activities was not significantly different between groups. The combined treatment group also fared better than the treatment as usual group in terms of greater cognitive insight, more objectivity in reappraising psychotic symptoms, and greater skill mastery. Although the overall group effect was not significant for symptoms, the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms.

\"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,\" the authors write. \"Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.\"

Study limitations include moderately small sample size; lack of a control for nonspecific therapist contact factors; exclusion of patients with current comorbid substance dependence, which may also limit generalizability of the findings; and lack of ratings of distress or dysfunction caused by symptoms.

\"To our knowledge this is the first published randomized trial to examine a psychosocial intervention designed for the unique needs of older patients with psychotic disorders,\" the authors conclude. \"Given the heterogeneity of schizophrenia, it is unlikely that a single cognitive behavior therapy intervention will work equally well for all types of patients (e.g., young and old, acutely and chronically ill, medication-resistant and -responsive, neurocognitively normal and impaired, insightful and unaware). Researchers should continue to develop and test group and individual cognitive behavior therapy interventions that are tailored to the unique needs of different subgroups of patients with schizophrenia and identify which treatments are most effective for which patients and in what circumstances.\"

The Department of Veterans Affairs, National Institutes of Mental Health, and the National Alliance for Research on Schizophrenia and Depression supported this study.

Am J Psych. 2005;162:520-529

Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Specify outcomes improved by social skills training in younger adults with schizophrenia.
Identify outcomes improved with a combination of cognitive behavioral and social skills training in a cohort of older adults with schizophrenia.
Clinical Context
As medications have helped patients with schizophrenia significantly with regard to the positive symptoms associated with the illness, more attention has focused on the negative symptoms of schizophrenia, including poor social functioning and social withdrawal. According to a meta-analysis of younger adults with schizophrenia by Benton and Schroeder, which appeared in the December 1990 issue of the Journal of Consulting and Clinical Psychology, social skills training can improve behavioral measures of social skill, self-rated assertiveness, and hospital discharge rates. However, social skills training is not as effective in reducing broad symptoms of schizophrenia.

The authors of the current study applied a unique combination of social skills training and cognitive behavioral therapy in a randomized trial of older adults with schizophrenia. The outcomes measured focused on social functioning.

Study Highlights
Study subjects were community-dwelling adults between the ages of 42 to 74 years old with a diagnosis of schizophrenia or schizoaffective disorder. Patients with disabling medical conditions or substance abuse were excluded from participation.
Participants were randomized to either usual care or cognitive behavioral skills training. Cognitive behavior skills training consisted of 24 weekly 2-hour group psychotherapy sessions plus \"homework\" sessions designed to hone social skills. The therapy sessions focused on challenging ageist beliefs regarding social adaptation and used age-sensitive scenarios.
The main study outcomes were the patient-subjective Independent Living Skills Survey and the University of California, San Diego, Performance-Based Skills Assessment, a practical and objective assessment of specific functional living skills. Secondary outcomes included measurements of positive and negative symptoms of schizophrenia, the Hamilton Depression Scale, and assessments of self-reflectiveness and self-certainty. Finally, knowledge of the specific elements taught in the cognitive behavior social skills was also measured.
Outcomes were assessed at baseline, 3 months, and 6 months. Assessors were blind to the subjects\' randomization group. Analysis was performed on an intent-to-treat basis.
72% of eligible patients consented to study participation, yielding 76 adults for randomization. The mean patient age was 53 years old, and most subjects were men and Caucasian. Slightly more than half of participants experienced at least mild delusions or hallucinations. Baseline clinical and demographic data were similar between treatment groups.
Retention of patients at the end of the 6-month treatment period was 86%. The mean rate of therapy attendance was 92%, and a mean of 75% homework assignments were completed.
Antipsychotic and anticholinergic medications remained fairly stable during the study period in both groups.
At the end of the study period, participants in the therapy group performed better on the Independent Living Skills Survey compared with subjects in the control group. However, therapy was not superior to usual care in the performance-based skills assessment, the measurement of positive and negative symptoms of schizophrenia, or the depression rating scale.
Two subjects in each treatment group were hospitalized during the follow-up period.
The therapy group experienced a significant improvement in measurements of self-reflectiveness and self-certainty compared with the control group. This improvement was associated with a reduction in the positive symptoms of schizophrenia.
Participants in the therapy group experienced greater rates of understanding the lessons taught within their group sessions compared with the control group.
Pearls for Practice
Previous research in younger adults with schizophrenia has demonstrated that social skills training can improve behavioral measures of social skill, self-rated assertiveness, and hospital discharge rate.
Cognitive behavioral social skills training can improve social functioning in middle-aged and older patients with schizophrenia.


Αυτό που κατάλαβα απο το παραπάνω άρθρο είναι οτι η κοινωνική εκπαίδευση σε σχιζοφρενείς είναι αποτελεσματική ώς ένα βαθμό αλλά και εξαρτάται απο το μέγεθος της ασθένειας. Γενικά όμως νομίζω πως μπορεί να βοηθήσει η κατάλληλη ψυχοθεραπεία απο τη στιγμή που παίρνει κάποιος τα φάρμακα του όπως του λέει ο γιατρός του.

Δεν δουλευει το λινκ πρεπει να κανεις εγγραφη ή κατι τετοιο...βασικα εχω παρει και ενα εξειδικευμενο βιβλιο πανω στο θεμα...αγγλοφωνο αλλα παραειναι εξιδεικευμενο απευθυνεται σε επαγγελματιες και ειναι πολυ κουραστικο στο διαβασμα...για αυτο δεν εχω καθισει να το διαβασω.

Απο το google δουλευε κανονικά..τεσπα το αφήνω όπως έχει..

Κανε αντιγραφη-επικολληση ολο το αρθρο αν θες.

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