Charles J. Wallace

Assessment of Interpersonal Problem-Solving Skills

A new instrument for assessing social skills of schizophrenic patients, Assessment of Interpersonal Problem-Solving Skills (AIPSS), is a videotaped-based test with an examiners administration and scoring manual. The test measures an examinees ability to describe an interpersonal social problem, to derive a solution to the problem, and to enact a solution in a role-played simulation test. In a study using a sample of schizophrenic outpatients and a comparison group of nonpatients, we found that the test had adequate psychometric properties, and the patients demonstrated deficits on all scales relative to the nonpatients. The results of the study also provided partial support for the validity of an information-processing model of social skills, which was used as a basis for constructing the AIPSS. Thus, the AIPSS represents a departure from previous methods of assessing social skills.

Group Cognitive Behavior Therapy or Social Skills Training for Individuals With a Recent Onset of Psychosis? Results of a Randomized Controlled Trial

This study aimed at determining the effectiveness of group cognitive behavior therapy (CBT) for recent onset psychosis in comparison with a recognized intervention for individuals with severe mental illness–social skills training. One hundred twenty-nine participants took part in a single-blind randomized controlled trial with repeated measures (baseline, 3 months, and 9 months). Participants were randomized to 1 of 3 conditions: group CBT, group social skills training for symptom management, or a wait-list control group. Both interventions were delivered by mental health staff with minimal training. Both treatments resulted in improvements on positive and negative symptoms compared with the wait-list control group, with the CBT group having significant effects over time on overall symptoms, and post-treatment effects on self-esteem, and active coping skills compared with the wait-list control group and lower drop-out rates than the skills training group. Therapist fidelity was adequate for both treatment conditions. Group CBT for psychosis is a promising intervention for individuals with recent onset of psychosis and their mental health professionals.

Deficits in social schemata in schizophrenia

Several recent studies have examined the manner in which social information is processed in an attempt to better understand the interpersonal functioning deficits of schizophrenia. In this study, the manner in which schizophrenic subjects represent social information, and the relationships between these social representations and measures of information processing, are examined. Specifically, 30 DSM-IIIR patients with schizophrenia and 15 normal controls were assessed on measures of social schema processing, information processing, and symptomatology. Results showed that schizophrenic patients earned significantly lower schema processing scores than the normal comparison group. Schema deficits of the schizophrenic group were significantly associated with recall memory and vigilance. These findings suggest that deficits in the representation of social information provides a unique perspective for understanding the interpersonal dysfunctions of schizophrenia.

Learning medication self-management skills in schizophrenia: Relationships with cognitive deficits and psychiatric symptoms

Previous research has shown that the psychosocial skill learning of patients with schizophrenia is associated with several aspects of information processing. These processes may limit the effectiveness of skills training. The contributions of visual vigilance, verbal memory, conceptual flexibility, and psychiatric symptoms to medication self-management skill learning were examined in 30 subjects with schizophrenia. Results showed that skill learning was significantly associated with recall memory and visual vigilance but not with conceptual flexibility. Additional analyses showed that skill learning was not related to psychotic symptoms; nonsignificant trends were found with an index of negative symptoms. These findings may help clinical investigators develop cognitive rehabilitation strategies that facilitate psychosocial skill learning for this population.

Social Processing Correlates of Nonverbal Social Perception in Schizophrenia

This study examines the relationship of nonverbal social perception to other areas of social functioning in schizophrenia. One model of interpersonal problem-solving skills presents a sequence of receiving, processing, and sending skills. Social perception skills best fit the first stage in this model: receiving skills. As expected, schizophrenic subjects (N = 29) were less skillful than normal subjects (N = 15) on measures of social problem solving, understanding of social sequences, and social judgment. In addition, performance on these tasks was significantly related to nonverbal social perception, but only for the schizophrenic group. Thus, deficits in nonverbal social perception are related to other measures of social functioning in schizophrenia. Implications of these findings for understanding and treating social deficits in schizophrenia are discussed.

New Developments in Social Skills Training

Social skills training (SST) has emerged as one of the most widely practiced methods of psychiatric rehabilitation. The purposes of this article are to review the research about its effects, propose guidelines for its practice, and discuss several related methodological and clinical issues such as promoting generalisation, predicting the degree of benefit, and integrating training with other rehabilitation services. The research suggests that SST, when conducted using appropriate curricula and teaching techniques, helps individuals with schizophrenia acquire relevant interpersonal and instrumental skills. Generalisation of these skills can be promoted by simultaneously linking training to the opportunities, prompts, and consequences needed to perform the skills in the extra-training environments. Long-term SST appears to be necessary in order to produce significant improvements in community functioning. The article concludes with suggestions for future clinical research.

Declarative and Procedural Learning in Schizophrenia: A Test of the Integrity of Divergent Memory Systems

A comparison of learning rates between schizophrenia patients and normals on measures tapping different memory systems may provide clues about relatively preserved areas of learning in schizophrenia. The present study assessed declarative (nonsense syllable list learning) and procedural (pursuit rotor tracking) learning in a group of chronic schizophrenia inpatients and a group of normal adults. Approximately equivalent baselines were obtained for the two groups on both measures. The results revealed a significant group trial interaction on the declarative memory measure, exemplified by a shallower learning slope for the patient group. For the procedural learning measure, there was no significant group block interaction; that is, both groups showed similar learning slopes. These findings suggest a relative preservation of selected procedural aspects of learning in schizophrenia.

Interpersonal problem-solving therapy for schizophrenics and their families

Abstract Twenty-eight male schizophrenics who were living with relatives high on “expressed emotion,” were randomly assigned to 10 weeks of inpatient, intensive social skills training or holistic health therapy plus family therapy. While both groups showed equivalent degrees of improvement in psychopathology during the inpatient treatment period, twice as many patients relapsed and required rehospitalization in the holistic health therapy group than in the social skills training group.

The use of brief isolation to suppress delusional and hallucinatory speech

Abstract Isolation of 15 min duration (time-out, TO) was used to consequate the delusional and hallucinatory speech of a 33-yr-old female, chronic psychotic impatient. Delusional speech was defined as saying any one of 30 false statements; hallucinatory speech was defined as saying any audible verbalization to an unobservable stimulus. Delusional speech was recorded during two different types of conversations: six daily 5 min conversations conducted in a specific locale; 18 daily 1-min conversations conducted at any place on the patients unit. TO was applied, withdrawn, and then reapplied first to the 5-min conversations and then to any delusional or hallucinatory verbalization emitted everywhere on the unit. Results indicated that TO was effective in suppressing delusional and hallucinatory speech, but the effects did not generalize from the 5-min to the 1-min conversations. When an attempt was made to fade TO from a continuous to an intermittent schedule, delusional speech increased to baseline levels. Additional observations made during the periods of TO indicated that the patient significantly increased the frequency of her delusional and hallucinatory verbalizations. This suggested that TO functioned as a punisher rather than as removal from social reinforcement which had initially been hypothesized as maintaining delusional and hallucinatory speech.

Functional Assessment of Independent Living Skills

Abstract Functional assessment of persons with psychiatric disabilities requires reliable and valid instruments that can be used by clinicians for planning psychosocial rehabilitation services. Two such instruments, the Independent Living Skills Inventory and the Independent Living Skills Survey are operationalized and behaviorally specific tools that can be administered as questionnaires or interviews. Both instruments have well-documented reliability and validity and are ‘user-friendly.”