Social Skills Training May Reduce Negative Symptoms in Patients With Schizophrenia

Social skills training (SST) is effective for treating negative symptoms in schizophrenia, according to a meta-analysis in Schizophrenia Bulletin comparing SST and other interventions on a number of outcomes.

“The effect sizes reported are impressive for a group-based psychological intervention suggesting that SST may have potential as a cost-effective alternative to individual therapies addressing negative and general symptoms in health care systems struggling to provide routine psychological intervention,” lead author David T. Turner, Ph.D., of Vrije University, The Netherlands, and colleagues wrote.

In recent years, addressing negative symptoms—passive or apathetic social withdrawal, communication difficulties, blunting of affect, and rigid or stereotypical thinking—has been recognized as central to improving quality of life and long-term recovery for patients with schizophrenia. During this time, trials of SST, originally developed in the 1970s to address interpersonal and social functioning, have been expanded to include studies of effects on negative symptoms.

Turner and colleagues searched the literature for randomized, controlled trials of social skills training, including those that compared SST against active controls (such as cognitive-behavioral therapy [CBT]), treatment as usual (standard treatment offered in the clinical setting), and waiting-list controls. Twenty-seven randomized, controlled trials with 1,437 participants were included in the analysis.

SST demonstrated superiority for negative symptoms and for scores on general psychopathology over both treatment-as-usual and active controls, as well as when all comparators were pooled. The effect sizes reported for SST for negative symptoms were “marginally greater than those reported for CBT for positive symptoms and marginally smaller than those reported for antipsychotics,” according to the report. “If we consider CBT as an intervention addressing positive symptoms and SST for negative symptoms, each intervention has effects of roughly equivalent magnitude for its target area,” the researchers stated.

“The meta-analysis by Turner and colleagues … reconfirms the efficacy of social skills training for improving social skills and reducing negative symptoms in people with schizophrenia,” Philip Harvey, Ph.D., of the University of Florida and Eric Granholm, Ph.D., of the University of California, San Diego wrote in a related editorial. “These consistently-replicated findings that SST improves social skills, negative symptoms, and functioning relative to standard care suggests that existing standard services for schizophrenia can be improved by adding SST.”

For related information, see the Psychiatric News article “Study Suggests Cariprazine May Have Direct Effects on Negative Symptoms.”

(Image: iStock/FangXiaNuo)

Cognitive Remediation, Vocational Rehab Create 'Total Dose Effect' for Schizophrenia

Cognitive remediation therapy (CRT) for schizophrenia is being combined with vocational rehabilitation and other psychosocial interventions to create multimodal interventions aimed at improving “real-world” functioning. That’s what Philip Harvey, Ph.D., the Leonard M. Miller Professor of Psychiatry and Behavioral Sciences at the University of Miami Miller School of Medicine, said at the International Congress of Schizophrenia Research in Orlando, Fla., this week. The title of his talk was “Cognitive Remediation and Cognitive Enhancement: State of the Art.”

Harvey (pictured above at the congress) provided an overview of a field that has garnered increasing interest among schizophrenia researchers: the effort to address cognitive impairments, which have been shown to be more crucial to long-term functional outcome—and more stubbornly resistant to treatment—than positive symptoms of psychosis. Harvey described a trend toward using cognitive remediation in combination with other psychosocial interventions—especially vocational rehabilitation—that can produce robust effects even in a relatively short period, suggesting the importance of a multimodal strategy with a “total dose effect” that may be as important as the duration of treatment. Several researchers at the congress described cognitive remediation efforts that are embedded within vocational rehabilitation programs.

“When I look at these data, what I see is that there seems to be this total dose treatment effect,” Harvey said. “If you give people 100 sessions of CRT and nothing else, or 20 sessions of CRT plus vocational rehabilitation, you get the same outcome…. It’s very encouraging to me to review data on cognitive enhancement therapies that not only make your cognition better, but make it look like you are doing better in the world in a short time period.”

For more about Harvey's research on cognitive remediation, see the American Journal of Psychiatry.

(image: Mark Moran/ Psychiatric News)