Social skills training in psychiatric rehabilitation: recent findings

Abstract

This article is a detailed critique of six recent evaluations of the effects of social skills training on the functioning and quality of life of individuals with schizophrenia. Given the many factors that affect individuals' social and role functioning, the results of the six evaluations are complex and interpretable only after careful consideration of their many methodological and procedural differences. The general pattern of their results indicates, however, that when skills training is conducted with specificity and highly structured instructional techniques, significant and durable increases in targeted behaviors and knowledge ensue. Social functioning and objective quality of life improve if (1) the knowledge and skills improved by training are actually relevant to the variables assessed by the outcome measures (e.g. workplace knowledge and skills contribute to the outcome of improved employment, not just local economic conditions); (2) the deficiencies in individuals' functioning reflect deficits in the relevant behaviors and knowledge (e.g. deficits in an individual's interpersonal skills are observable in the workplace and these skills are needed for improved employment); and (3) the environment provides prompts and reinforcers for the use of these new behaviors and knowledge (e.g. improved workplace interpersonal skills are rewarded by praise and increased social acceptance by peers and supervisors). Thus, unlike the rapid improvements in symptoms effected by psychotropic medication, the benefits of social skills training occur slowly, and only with sufficient, carefully conducted, training. Hence, the expectations for the benefits of training must reflect the complexity of the, many, factors that affect functioning, and the painstaking, careful and detailed nature of effective training. The review ends with several recommendations for improving the efficiency and generality of training, including developing more precise assessments of individuals and roles, standardizing training and presenting it in self-directed formats, and increasing environmental supports.