A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia.
OBJECTIVE
The number of older patients with chronic schizophrenia is increasing. There is a need for empirically validated psychotherapy interventions for these patients. Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. The authors compared treatment as usual with the combination of treatment as usual plus cognitive behavioral social skills training.


METHODS
The randomized, controlled trial included 76 middle-aged and older outpatients with chronic schizophrenia, who were assigned to either treatment as usual or combined treatment. Cognitive behavioral social skills training was administered over 24 weekly group sessions. Blind raters assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery.


RESULTS
After treatment, the patients receiving combined treatment performed social functioning activities significantly more frequently than the patients in treatment as usual, although general skill at social functioning activities did not differ significantly. Patients receiving cognitive behavioral social skills training achieved significantly greater cognitive insight, indicating more objectivity in reappraising psychotic symptoms, and demonstrated greater skill mastery. The overall group effect was not significant for symptoms, but the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms.


CONCLUSIONS
With cognitive behavioral social skills training, middle-aged and older outpatients with chronic schizophrenia learned coping skills, evaluated anomalous experiences with more objectivity (achieved greater cognitive insight), and improved social functioning. Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.
Granholm
Eric
E
Department of Veterans Affairs San Diego Healthcare System (116B), 3350 La Jolla Village Dr., San Diego, CA 92161, USA. egranholm@ucsd.edu
McQuaid
John R
JR
McClure
Fauzia Simjee
FS
Auslander
Lisa A
LA
Perivoliotis
Dimitri
D
Pedrelli
Paola
P
Patterson
Thomas
T
Jeste
Dilip V
DV
D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000379:methods; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy; D012559:Schizophrenia / Q000534:rehabilitation / Q000628:therapy*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D016896:Treatment Outcome