CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 24SOCIAL SKILLS TRAININGWENDY N. TENHULAALAN S. BELLACKIn this chapter we describe one of the most promising and empirically supported approachesto improvement of role functioning and quality of life for people with schizophrenia:social skills training (SST). Although the phenomenology of schizophrenia ishighly heterogeneous, common characteristics of the illness can generally be classifiedinto four domains: positive symptoms, negative symptoms, cognitive impairment, and socialdysfunction. Social dysfunction has been found to be very common in people withschizophrenia. The deficits are stable over time and relatively independent of other domainsof the illness (e.g., social impairment persists even during periods when othersymptoms have remitted). They are also resistant to treatment with antipsychotics, includingnew-generation medications. Social deficits in patients with schizophrenia includedifficulty initiating and sustaining conversations, and inability to achieve goals or havetheir needs met in situations requiring social interactions. Ultimately, these impairmentsmanifest themselves in profound difficulties in role functioning. For many patients withschizophrenia, poor social functioning, odd interpersonal behavior, and stigmatizing experiences,in combination with social anxiety, contribute to isolation, inadequate socialsupport, and functional impairment, which in turn serve to diminish patients’ opportunitiesto develop and improve their social skills. Skills deficits account for a significant portionof variance in ability to fulfill social roles and in quality of life.The social skills model provides a basis for understanding social function and dysfunctionin schizophrenia, and the development of SST. This model posits that socialcompetence is based on a set of three component skills: (1) social perception, or receivingskills; (2) social cognition, or processing skills; and (3) behavioral response, or expressiveskills. Social perception, the ability to read or decode social inputs accurately, includesaccurate detection of both affect cues, such as facial expressions and nuances of voice,gesture, and body posture, and verbal content (what the interpersonal partner is saying)and contextual information. Social cognition involves effective analysis of the social stimulus,integration of current information and historical information (e.g., what the partner240