CLINICAL HANDBOOK OF SCHIZOPHRENIA

24. Social Skills Training 241has done in previous interactions and one’s experience in similar social situations), andplanning an effective response. Behavioral response includes the ability to generate effectiveverbal content, to speak with appropriate paralinguistic characteristics, and to usesuitable nonverbal behaviors, such as facial expression, gestures, and posture. Effectivesocial behavior requires the smooth integration of these three component processes tomeet the demands of specific social situations.The use of the term skills in the model is intended to emphasize that social competenceis based on a set of learned abilities rather than traits, needs, or other intrapsychicprocesses. Conversely, ineffective social behavior is often the result of social skills deficits.Research suggests that virtually all social behaviors are learnable (i.e., they can be modifiedby experience or training), and an extensive body of literature supports the socialskills model, including the utility of conceptualizing social dysfunction as a function ofskills deficits.Social dysfunction is hypothesized to result from three circumstances: when the individualdoes not know how to respond appropriately, when an individual does not useskills in his or her repertoire when needed, or when appropriate behavior is underminedby socially inappropriate behavior. Each of these circumstances appears to be common inschizophrenia. First, there is good reason to believe that people with schizophrenia do notlearn key social skills. Children who later develop schizophrenia in adulthood have beenfound to have subtle attention deficits in childhood that may interfere with the developmentof social relationships and the acquisition of basic social skills. Schizophrenia oftenstrikes first in late adolescence or young adulthood, a critical period for mastery of adultsocial roles and skills, such as dating and sexual behaviors, work-related skills, and theability to form and maintain adult relationships. Many individuals with schizophreniagradually develop isolated lives, punctuated by periods in psychiatric hospitals or in communityresidences that remove them from their non-mentally-ill peer group, provide fewopportunities to engage in age-appropriate social roles, and limit social contacts to mentalhealth staff and other severely ill persons. Second, cognitive impairment, especiallydeficits in social cognition and executive processes, interferes with both social perceptionand social problem solving.The social skills model postulates that functional outcomes can be improved by enhancingsocial skills and/or ameliorating skills deficits with a structured behavioral intervention:SST. As such, and given that improving social role functioning and quality of lifehas been a major goal of treatment and rehabilitation for schizophrenia, SST can play animportant role in the treatment of persons with schizophrenia.DESCRIPTION OF SSTSST is a treatment procedure that has been developed to address social problem-solvingskills deficits directly, with the goal of enhancing social functioning. The basic technologywe present for teaching social skills was developed in the 1970s and has not changedsubstantially in the intervening years. SST interventions are tailored to meet the real-life,current-day difficulties that affect the social experiences of each participant, but severalcommon core elements are present regardless of the specific skills being taught. Thesecore elements are presented and described here. In general, SST is a highly structured educationalprocedure that employs didactic instruction, breaking skills down into discretesteps, modeling, behavioral rehearsal (role playing), and social reinforcement.With each new skill, the therapist provides an introduction in which he or she discussesthe rationale for teaching the skill and presents the steps of the skill. The steps of