Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia

OBJECTIVE: The authors compared the community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals. METHOD: Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments. RESULTS: Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning. CONCLUSIONS: Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy.     

Current approaches to assessment and treatment of persons with serious mental illness.

Psychologists increasingly have the opportunity to work with persons with serious and chronic mental illnesses. Managed care encourages services that rely less on hospital treatment and more on a combination of brief and intensive outpatient therapy and long-term, low-cost maintenance and support. Diagnostic practices needed to be effective in such an environment include categorical and functional assessment. Psychological treatments that have been demonstrated effective include cognitive-behavioral social skills training, pragmatic supportive therapy, personal therapy, the multimodal functional model, therapeutic contracting, case management, and multiple family therapy. These innovative assessment and treatment techniques are described along with some experimental treatments of cognitive dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Effectiveness Therapy for Children: Three-Year Follow-Up.

This study reports the results of a 3-year follow-up assessment of children and adolescents diagnosed with social anxiety disorder (social phobia) and treated with Social Effectiveness Therapy for Children (SET-C), a comprehensive behavioral treatment program combining social skills training, peer generalization, and individualized exposure. Among 32 children initially treated with the protocol, 29 completed the follow-up assessment and were evaluated with a multidimensional assessment strategy, including self-report, parental report, clinician ratings, and behavioral assessment. Results indicated that the majority of posttreatment gains were maintained at 3-year follow-up, and 72% of treated children continued to be free of a social phobia diagnosis 3 years later. These findings support the long-term efficacy of SET-C for children and adolescents suffering from social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using positive psychology with special mental health populations.

In our clinical practice, we have attempted to use a positive psychology approach in working with people with schizophrenia and youths with behavioral disorders. We present three clinical applications that use a positive psychology approach with these populations: group treatment with persons with schizophrenia; individual cognitive stimulation therapy with persons with schizophrenia; and computer-facilitated dialogue and therapy with persons with schizophrenia and adolescents with behavioral disorders. These three clinical applications using positive psychology are consistent with those traditional treatment goals that aim to increase clients' functioning and improve their quality of life. Given that many people with long-standing emotional "problems" have difficulties initiating change or internalizing feedback regarding their behavioral deficits, the therapeutic environment and clinical interactions need to focus equally on clients' strengths and skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol treatment training in psychology internship programs.

This investigation was designed to study alcohol treatment training by focusing on the components of training provided in psychology internship programs approved by the American Psychological Association. Data from 137 training sites revealed that two content areas—group psychotherapy and relapse prevention—were rated as most relevant to alcohol treatment training. Six other domains (aftercare, Alcoholics Anonymous, marital/family therapy, stress management/relaxation procedures, social skills training, and cognitive therapy) were rated as at least quite relevant. The extent to which interns were exposed to these content areas was variable. These findings are discussed in the context of issues surrounding alcohol treatment training among psychology interns and the provision of clinical services to alcohol-abusing patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preliminary evaluation of the incidence and control of insects--pest control in Polish hospitals

The influence of environmental factors upon the social skills in schizophrenia is beyond doubt. The family environment of schizophrenic patients has been extensively described. Some research revealed those features of emotional context of the family, which influence the exacerbation of schizophrenia. Those features are called the Expressed Emotion Index (EE). The Expressed Emotion Index has great prognostic value and it seems interesting to examine the influence of the family environment as described by EE, upon the social skills. This paper contains both a characterization of the family environment described by various aspects of EE and an analysis of its influence on the social skills. Possible connections of EE with premorbid functioning of schizophrenic patients, and with psychopathological symptoms, as well as cognitive processes are also described. In the analysis of interrelation of EE and the social skills it is very important to consider both qualitative and quantitative aspects of Expressed Emotion Index. Various aspects of the family environment seem to be connected with specific cognitive dysfunctions and various psychopathological symptoms. In a similar way, various social skills seem to be determined by different internal and external factors.     

Characteristics predicting social functioning and treatment response in clients impaired by extreme shyness: Age of onset and the public/private shyness distinction.

52 adults that were functionally impaired by extreme shyness participated in an interview that assessed factors surrounding shyness onset, social functioning, strategies for coping with shyness, and behavioral skill in social interactions. 34 Ss then participated in an 8-wk behavioral treatment program that provided training in social skills. Ss reporting early onset also described their parents as shy, while Ss reporting later onset had a childhood history of emotional or physical abuse. Ss with observable behavioral deficits were more likely to benefit from the behavioral treatment program than were shy Ss with few overt symptoms. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skills, social outcomes, and cognitive features of childhood social phobia.

Social skills, social outcomes, self-talk, outcome expectancies, and self-evaluation of performance during social-evaluative tasks were examined with 27 clinically diagnosed social phobic children ages 7–14 and a matched nonclinical group. Results showed that, compared with their nonanxious peers, social phobic children demonstrated lower expected performance and a higher level of negative self-talk on social-evaluative tasks. In addition, social phobic children showed social skills deficits as assessed by self- and parent report, an assertiveness questionnaire, and direct behavioral observation. Furthermore, compared with the control group, social phobic children were rated by themselves and others as significantly less socially competent with peers and were found to be less likely to receive positive outcomes from peers during behavioral observation. Implications for the assessment and treatment of childhood social phobia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family treatment and medication dosage reduction in schizophrenia: Effects on patient social functioning, family attitudes, and burden.

The effects of 2 family intervention programs (supportive family management [SFM], including monthly support groups for 2 years; or applied family management [AFM], including 1 year of behavioral family therapy plus support groups for 2 years), and 3 different neuroleptic dosage strategies (standard, low, targeted) on social functioning of patients with schizophrenia, their relatives' attitudes, and family burden were examined. AFM was associated with lower rejecting attitudes by relatives toward patients and less friction in the family perceived by patients. Patients in both AFM and SFM improved in social functioning but did not differ, whereas family burden was unchanged. Medication strategy had few effects, nor did it interact with family intervention. The addition of time-limited behavioral family therapy to monthly support groups improved family atmosphere, but did not influence patient social functioning or family burden. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of aggression for an adult diagnosed with schizophrenia at a public psychiatric hospital.

The effectiveness of a behavioral program to treat chronic aggression in an adult male individual diagnosed with schizophrenia at a public psychiatric hospital was evaluated. A behavioral plan was developed to provide the client with positive social interactions, social skills training, and positive reinforcement for prosocial behavior; no negative consequences were implemented. The number of aggressive acts declined with the introduction of the behavioral plan and ultimately remitted even without ongoing reinforcers. This article demonstrates the value of psychological intervention in treating aggression with a treatment-resistant client in an in-patient setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of an integrative family therapy for substance-abusing adolescents: Toward the mutual enhancement of research and practice.

Presents a family therapy approach for substance-abusing adolescents that integrates present-centered, problem-focused skills from structural, strategic, functional, and behavioral family therapies. The treatment model has been applied to 138 client families in a multisite, multiyear study. Findings related to the model's school components concern decreasing the family's resistance to treatment, restraining immediate change, assessing the presenting problem, interrupting dysfunctional sequences of behavior, and providing assertion skill training. The model provides the therapists with a guide for planning interventions, but creative permutations grow out of the unique characteristics of both the client families and the therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of controlled research on social skills training for schizophrenia.

A meta-analysis of randomized, controlled trials of social skills training for schizophrenia was conducted. Outcome measures from 22 studies including 1,521 clients were categorized according to a proximal-distal continuum in relation to the presumed site of action of skills training interventions, with content mastery tests and performance-based measures of skills assumed to be most proximal, community functioning and negative symptoms intermediate, and general symptoms and relapse most distal. Results reveal a large weighted mean effect size for content-mastery exams (d = 1.20), a moderate mean effect size for performance-based measures of social and daily living skills (d = 0.52), moderate mean effect sizes for community functioning (d = 0.52) and negative symptoms (d = 0.40), and small mean effect sizes for other symptoms (d = 0.15) and relapse (d = 0.23). These results support the efficacy of social skills training for improving psychosocial functioning in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Therapeutic Contract Program: An individual-oriented psychological treatment community.

Describes the theoretical orientation and operating structure of the Therapeutic Contract Program (TCP), an inpatient milieux treatment strategy established in part as a response to the promise offered by newer, cognitively oriented advances in the field of behavior therapy. The utility of behaviorally oriented treatment for inpatient populations is often questioned, owing to the fact that the token economy is generally taken to be the most appropriate model from which to design behavioral management programs. A drawback to this basically operant approach is that it eschews the development of cognitive coping skills. The TCP is an inpatient treatment strategy designed to foster such cognitive coping and self-control repertoires. Each patient's treatment contract is a document with a series of intentional statements that convey an expectation that certain behaviors will be engaged in or initiated in the upcoming week. Patients, with staff assistance, undertake a functional analysis of their therapeutic needs and use this to develop long-term contract goals, with each long-term goal being addressed by a series of short-term goals that can be implemented on a weekly basis. Core programs of the TCP include self-control training, group social skill training, and specialized programs for the following behavioral disorders: anorexia nervosa, obsessive-compulsive problems, chronic pain, and impulse disorder. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skills training with schizophrenics: A meta-analytic evaluation.

A meta-analytic review of 27 studies on social skills training with schizophrenics was conducted to address 3 critical issues in the literature: (1) the magnitude of treatment effects relative to different outcome measures; (2) the extent of the generalization and maintenance of treatment effects; and (3) the impact of 2 methodological issues: diagnostic clarity and training variations. Social skills training has a strong, positive impact on behavioral measures of social skill, self-rated assertiveness, and hospital discharge rate, and a moderate impact on relapse rate. In addition, when behavioral measures are used, the data support generalization and maintenance of skill gains. However, effects are only marginally significant for broader ratings of symptoms and functioning. Diagnostic homogeneity, the number of techniques used, and the amount of training do not appear to be significantly associated with outcome. Specific directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Assessing and treating culturally diverse clients: A practical guide.

Reviews the book, Assessing and treating culturally diverse clients: A practical guide by Freddy A. Panaigua (see record 1996-97152-000). This book is a timely and provocative delineation of highly relevant considerations to be made by counselors, psychotherapists, and other mental health professionals in the delivery of services to multicultural groups. The book deals with four ethnic populations in the United States—African American, Hispanic, Asian, and American Indian. Panaigua's contribution is part of a series on Multicultural Aspects of Counseling by Sage Publications. The purpose of the series is to increase the mental health practitioner's knowledge and sensitivity to cultural differences and to assist in alleviating bias in the therapeutic process. This purpose is accomplished with precision and insight by Panaigua. Unlike some other books dealing with cultural diversity, Panaigua's work offers specific treatment methods which have been demonstrated to be successful in treating members of the targeted groups. Problem solving and social skills training are recommended in some cases. In other instances, assertiveness training, music therapy, or direct advice are the modalities of choice. In other cases, education, medication, or behavioral approaches are preferred. Assessing and Treating Culturally Diverse Clients can serve the educational needs of graduate students in the fields of psychology, counseling, family therapy, and social work. It is an excellent guide for use in either the training or practice of these helping professions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High school students as therapeutic agents with young children experiencing school adjustment difficulties: The effectiveness of a filial therapy training model.

Filial therapy has been used since the early 1960s to train parents as therapeutic agents for children experiencing a broad range of social, emotional and behavioral difficulties. Using a pretest-posttest control group design, this study examined the efficacy of a filial therapy model in training high school students to be effective helpers with young children experiencing school adjustment difficulties. 32 high school students enrolled in a Peer Assistance and Leadership course titled PALs were trained to become therapeutic change agents for identified prekindergarten and kindergarten students. The PALs students received training and supervision in child-centered play therapy skills that they practiced in weekly play sessions with their assigned child. Results from the statistical analyses reveal that the experimental group of high school students receiving filial therapy training demonstrated a significant increase in their empathic interactions with children and that the experimental group of children receiving the play therapy intervention experienced a significant reduction in problem behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Comprehensive Soldier Fitness Program: Family skills component.

Field combat stress clinics and research have identified the signature event that precedes thoughts of suicide and homicide in combat soldiers in Iraq and Afghanistan: a distressing personal relationship event with a stateside partner. In response to this alarming information, we have identified critical factors and precipitating incidents as well as critical social skills that form the basis for changing communication between soldiers and their stateside partners. A pilot program is described that proved effective with small groups of soldiers who were led by a male–female professional team and given structured reading and social skills training exercises based on Gottman and Silver's (1999) book The seven principles for making marriage work. Recommendations for future training are made based upon our assessment of the family issues facing the combat soldier in Iraq and Afghanistan. In conclusion, we describe the family fitness interventions and program elements of the skill building trainings within the family component of the Comprehensive Soldier Fitness program, which can be delivered via online interactive technology as well as face to face with families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support predict 5-year outcome in 1st-episode schizophrenia.

Investigations of social support in schizophrenia have been relatively sparse. In this research, patients with 1st-episode schizophrenia or affective psychosis were asked to describe supportive social relationships immediately prior to their 1st lifetime treatment contact and were interviewed 18 months and 5 years later for assessment of their social and occupational functioning. The results indicated that 18-month adaptive functioning was lower than in the year prior to 1st treatment contact but at 5 years rose above that seen both at baseline and 18 months. Moreover, social support from nonfamily members of the social network predicted 5-year adaptive functioning in the schizophrenia (n?=?54) group but not in the affective psychosis (n?=?55) group. Support from family did not predict 5-year outcome in either group. Together, these findings replicate and extend earlier findings that social support predicts outcome in 1st-episode schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive talk training in an adult with traumatic brain injury

Social skills often create a barrier to placement in less restrictive environments for persons with TBI. This case study illustrated the use of a positive talk program in the treatment of a person with long-standing social skill deficits. Occupational therapy intervention with speech-language consultation began with an evaluation of the cognitive barriers that influenced the client's social behavior. Work with the client's concrete concept formation, decreased memory, and poor generalization skills led to the development of the positive talk training program described. Through an understanding of the underlying cognitive deficits that influenced the client's behavior, the clinical team was able to develop an individual treatment plan. The intervention resulted in modification of behavior that would have required placing the client in a restricted environment. In the final analysis, the client's social skills improved to a level where he could be discharged to a less restrictive environment.     

Social skill deficit interventions for substance abusers.

Because substance abusers demonstrate significant cognitive and behavioral skill deficits, 2 social competency models of habilitation are proposed to increase abusers' life management skills and coping abilities. Social problem-solving training programs focus on generic cognitive problem-solving deficits, while social skills training programs address specific behavioral deficiencies. Social problem solving is a cognitive-behavioral approach that teaches people how to think, emphasizing thinking that is alternative, consequential, means-end, perspective taking, and social-causal. Social skills training may be taught using modeling, role playing, rehearsal, coaching, and feedback. Both approaches have been successful for increasing social adjustment and diminishing psychopathology among high-risk substance abusers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)