SOCIAL SKILLS TRAINING FOR SCHIZOPHRENIA PATIENTES: IMPROVING RECREATIONAL, RESIDENTIAL AND VOCATIONAL OUTCOMES

Abstract
Based on the Integrated Psychological Therapy (IPT) for schizophrenia patients, we developed three social skills training programs for residential, vocational and recreational functioning. This study compared the effectiveness of the newly developed programs (experimental group) with a traditional social skills training (control group). Experimental and control groups were compared in terms of social functioning, cognitive abilities, psychopathology and relapse rates. We selected 105 patients with a diagnosis of schizophrenia or schizoaffective disorder according to ICD-10 and assigned them to one of the different treatment groups, using a matching procedure. The treatment lasted six months; a follow-up assessment was carried out after one and two years. In the experimental groups higher global treatment effects were obtained on almost all dependent variables. The developed programs have demonstrated their effectiveness and they might facilitate the abilities of schizophrenia patients for their better integration into community.

Key words
Esquizofrenia, entrenamiento de desempeños sociales, terapia cognitivo-conductual, rehabilitación, trastorno esquizoafectivo, recaída, integración social

Bibliografía del artículo

1. Roder, V.; Zorn, P.; Brenner, H.D. Verhaltenstherapeutische Ansätze zu sozialen Fertigkeiten und Problemlösefertigkeiten schizophrener Patienten: Ein Überblick. In: Böker, W.; Brenner, H.D. (eds.). Behandlung schizophrener Psychosen. Stuttgart, Germany: Enke, 111-135, 1997.
2. Roder, V.; Zorn, P.; Brenner, H.D. Kognitiv-behaviorale Programme für schizophren Erkrankte zum Aufbau sozialer Kompetenzen im Wohn-, Arbeits- und Freizeitbereich. Überblick und empirische Ergebnisse. Verhaltenstherapie Psychosoziale Praxis; 2: 195-211, 2000.
3. Cohen, R.; Florin, I.; Grusche, A.; Meyer-Osterkamp, S.; and Sell, H. Dreijährige Erfahrung mit einem Münzsystem auf einer Station für extrem inaktive, chronisch schizophrene Patienten. Zeitschrift für klinische Psychologie, 2:243-277, 1973.
4. Smith, E.T.; Bellack, A.S.; and Liberman, R.P. Social skills training for schizophrenia: Review and future directions. Clinical Psychology Review, 16:599-617, 1996.
5. Liberman, R.P., and Eckman, T.A. Dissemination of skills training modules to psychiatric facilities. Overcoming obstacles to the utilisation of a rehabilitation innovation. In: Brenner, H.D., and Böker, W., eds. Schizophrenia as a systems disorder. British Journal of Psychiatry, 155(suppl. 5):117-122, 1989.
6. Liberman, R.P.; Wallace, C.J.; Blackwell, G.; Eckman, T.A.; Vaccaro, J.V.; and Kuehnel, T.G. Innovations in skills training for the seriously mentally ill: the UCLA social and independent living skills modules. Innovations and Research, 2:43-60, 1993.
7. Brenner, H.D.; Hodel, B.; Roder, V.; and Corrigan, P. Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia. Schizophrenia Bulletin, 18(1):21-26, 1992.
8. Brenner, H.D.; Roder, V.; Hodel, B.; Kienzle, N.; Reed, D.; and Liberman, R.P. Integrated psychological therapy for schizophrenic patients. Seattle, WA: Hogrefe & Huber, 1994.
9. Roder, V.; Brenner, H.D.; Kienzle, N.; and Hodel, B. Integriertes Psychologisches Therapieprogramm (IPT) für schizophrene Patienten. Munich, Germany: Psychologie Verlags Union, 1988.
10. Roder, V.; Brenner, H.D.; Kienzle, N. Integriertes Psychologisches Therapieprogramm bei schizophren Erkrankten (IPT). 5. überarbeitete Auflage. Weinheim, Germany: Beltz, 2002.
11. Roder, V.; Jenull, B.; Brenner, H.D.; Heimberg, D.; and Hirsbrunner, A. Kognitive Verhaltenstherapie bei schizophren Erkrankten im Wohn-, Arbeits- und Freizeitbereich: Erste Ergebnisse. Verhaltenstherapie, 5:68-80, 1995.
12. Roder, V.; Jenull, B.; and Brenner, H.D. Teaching schizophrenic patients recreational, residential and vocational skills. International Review of Psychiatry, 10:35-41, 1998.
13. Roder, V.; Zorn, P.; Müller, D.; Brenner, H.D. Improving Recreational, Residential and Vocational Outcomes for Patients with Schizophrenia. Psychiatric Services, 52 (11): 1439-1441, 2001.
14. Roder, V.; Brenner, H.D.; Müller, D.; Lächler, M.; Zorn, P.; Reisch, T.; Bösch, J.; Bridler, R.; Christen, C.; Jaspen, E. Schmidl, F.; Schwemmer, V. Development of specific social skills training programmes for schizophrenia patients: results of a multicentre study. Acta Psychiatrica Scandinavica, 105: 363-371, 2002.Roder, V., Zorn, P.; Andres, K.; Pfammatter, M.; Brenner, H.D. Ein Praxishandbuch zur verhaltenstherapeutischen Behandlung schizophren Erkrankter. Bern, Switzerland: Huber, 2002.
15. Dilling, H.; Mombour, W.; and Schmidt, M.H. Internationale Klassifikation der Krankheiten in der 10. Revision (ICD-10). Berne, Switzerland: Huber, 1991.
16. American Psychiatric Association. DSM-IV: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: The Association, 1994.
17. Oswald, W.D., and Roth, E. Der Zahlen-Verbindungs-Test (ZVT). Göttingen, Germany: Hogrefe, 1978.
18. Abels, D. Konzentrations-Verlaufs-Test (KVT). Göttingen, Germany: Hogrefe, 1961.
19. Brickenkamp, R. Aufmerksamkeits-Belastungs-Test (Test d2). Göttingen, Germany: Hogrefe, 1975.Hecht, H.; Faltermaier, A.; and Wittchen, H.U. Social Interview Schedule (SIS). Materialien zur Klinischen Pschologie und Psychotherapie. Regensburg, Germany: Roderer, 1987.
20. Jung, E.; Krumm, B.; Biehl, H.; Maurer, K.; and Bauer-Schubart, C. Mannheimer Skala zur Einschätzung sozialer Behinderung. Weinheim, Germany: Beltz, 1989.
21. Mundt, C.; Fiedler, P.A.; Pracht, B.; and Rettig, R. InSka (Intentionalitätsskalen) - ein neues psychopathometrisches Instrument zur quantitativen Erfassung der schizophrenen Residualsymptomatik. Nervenarzt, 56:146-149, 1985.
22. Overall, J.E., and Gorham, D.R. The Brief Psychiatric Rating Scale. Psychological Reports, 10:799-812, 1962.
23. CIPS Collegium Internationale Psychiatriae Scalarum. Internationale Skalen für Psychiatrie. Weinheim, Germany: Beltz, 1981.
24. Andreasen, N.C. Scale for the Assessment of Negative Symptoms (SANS). University of Iowa City, 1981.
25. Ackenheil, M.; Dieterle, D.M.; Eben, E.; and Pakesch, G. Beurteilung der Minussymptomatik (SANS) - Münchener Version, University of Munich, Germany, 1985.
26. Zerssen, D.v. Die Befindlichkeits-Skala. Weinheim, Germany: Beltz, 1976.
27. Schulz, H.; Nübling, R.; and Rüddel, H. Entwicklung einer Kurzform eines Fragebogens zur Therapiemotivation. Verhaltenstherapie, 5:89-95, 1995.
28. Dahl, G. Reduzierter Wechsler-Intelligenztest (WIP). Testzentrale der Schweizer Psychologen, Berne, Switzerland: Huber, 1986.
29. Cohen, J. Statistical power analyses for the behavioral sciences. Hillsdale, NJ: Erlbaum, 1988.
30. Mueser, K.T.; Wallace, C.J.; and Liberman, R.P. New developments in social skills training. Behaviour Change, 12:31-40, 1995.

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