Conclusions
Social disability affects the individual’s occupational and school performance, impacts on self-care, and hinders family relationships and interpersonal interactions. Social skills interventions are the treatment of choice to improve this disability. Although there are a wide variety of programs that aim to improve social functioning in people suffering from schizophrenia, it seems clear that these programs must address directly the essential components of both pillars of functional outcome: social cognition and social competence. Furthermore, depression and social anxiety are common concomitants of schizophrenia that have been treated almost exclusively with medication. However, by integrating
social skills training procedures into evidence-based psychological treatments for these comorbid disorders, mood and anxiety disorders will be more effectively treated (Kopelowicz et al., 2006). This integration should take into account the
stage of the illness: family interventions and psychoeducation for crisis therapy; the pure behavioural approaches (token economy) for negative symptoms in chronic patients; and CBT for positive symptoms, poor insight and poor compliance, in the early stages of the disorder. Thus, a pragmatic combination of psychosocial interventions, such us SST plus CBT or SST plus psychoeducation, could clearly enhance the treatment outcomes and the patient’s recovery process.Although the fifth edition of the Diagnostic and statistical manual of mental disorders introduces no change on the diagnostic B criteria (social/occupational dysfunction) for schizophrenia, some changes made in the A criteria should be taken into consideration when planning to offer SST to a person presenting negative symptoms and poor social functioning. Experts have found that avolition and diminished emotional expression are key aspects of negative symptoms; and they consider that diminished emotional expression describes better the nature of the affect abnormality in schizophrenia than the affective flattening. Thus, the A criteria’s fifth characteristic is now negative symptoms, i.e. diminished emotional
expression and avolition (Tandon et al., 2013).Finally, the generalization of social skills to clients’ natural environments is
clearly one of the main challenges for clinicians when applying SST interventions.In fact, they can be further supplemented by community-based in vivo skills training (Glynn et al., 2002) and by enlisting “indigenous supporters” to prompt Social skills training for people with schizophrenia 473 the use of skills in real-life situations (Tauber et al., 2000), as well as by the use of advanced technologies like VR (Rus-Calafell et al., 2014).