Social Skills Training

According to Liberman (1988) the following skills are necessary to display socially competent behaviour:

• accurate perception of the social situation;

• translation of the perception into a plan of action;

• the execution of the behaviour with adequate verbal and non-verbal behaviour.

In social skills training, patients learn to be more effective in expressing their emotions and to assert themselves. The training can be conducted in individual and group format. In addition to verbal assertiveness the training covers non-verbal aspects of assertiveness, like voice pitch, posture and eye contact.

Social skills training may target (change in) the following behaviours: making a request, refusing a request, expressing a personal opinion, expressing criticism, responding to criticism, asserting oneself. Over the course of repeated role-play the patient learns to perform these behaviours in a more adequate fashion. Key techniques used by the therapist include modelling, feedback, and behavioural rehearsal. The patient is gradually shaped into effective execution of the required skills. Homework assignments include the registration of (naturally occurring) difficult social situations and, later in therapy, the deliberate practice of the instructed skills in selected difficult social situations.

Social skills training has demonstrated its efficacy in treating patients with social phobia (Mersch, et al., 1991; Stravinsky & Armado, 2002). However, patients with other problems can also benefit from social skills training as a component of their treatment. For example, several lines of evidence support the importance of skills training for alcoholics. Among an inpatient group of alcohol-dependent patients in Norway, the effect of social skills training was compared to a (non-treatment) control group (Erikson et al., 1986). At one year follow-up, patients who had received social skills training had consumed significantly less alcohol and had worked more days than the control patients. Further, studies indicate that alcoholics'coping skills are inferior to the coping skills of non-alcoholics in situations that commonly pose a risk of relapse, such as family conflicts and parties in which there is a pressure to drink (Monti & Rohsenow, 1999). In addition, a substantial number of patients who relapsed reported frustrating situations in which they were unable to express their anger adequately, prior to their relapse (Marlatt, 1996). Social skills training now is a central component of various relapse prevention programmes (Emmelkamp & Vedel, 2006; Monti & Rohsenow, 1999).

Lewinsohn & Hoberman (1982) proposed the hypothesis that a social skills deficit may be responsible for the deficit in social reinforcement that a depressed person experiences. A number of studies demonstrated that social skills training not only leads to improved social skills but also to improved mood (Emmelkamp, 1994).

Social skills training was also an effective part of the treatment among chronic psychiatric patients and schizophrenics. It led to improvements in both behavioural assessments and behaviour at the clinic (Dilk & Bond, 1996; Heinssen, Liberman & Kopelowicz, 2000; Penn & Mueser, 1996). Generally, social skills training led to significant improvements in social skills on role-play tests, but not on psychopathology. The question remains to what extent the acquired behaviours generalize to outside the psychiatric setting. Social skills training certainly does not represent a panacea for schizophrenia (Emmelkamp, 2004).

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Anxiety and Depression 101

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