Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social skills training with schizophrenics: A meta-analytic evaluation.

A meta-analytic review of 27 studies on social skills training with schizophrenics was conducted to address 3 critical issues in the literature: (1) the magnitude of treatment effects relative to different outcome measures; (2) the extent of the generalization and maintenance of treatment effects; and (3) the impact of 2 methodological issues: diagnostic clarity and training variations. Social skills training has a strong, positive impact on behavioral measures of social skill, self-rated assertiveness, and hospital discharge rate, and a moderate impact on relapse rate. In addition, when behavioral measures are used, the data support generalization and maintenance of skill gains. However, effects are only marginally significant for broader ratings of symptoms and functioning. Diagnostic homogeneity, the number of techniques used, and the amount of training do not appear to be significantly associated with outcome. Specific directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can I trust you? Negative affective priming influences social judgments in schizophrenia.

Successful social interactions rely on the ability to make accurate judgments based on social cues as well as the ability to control the influence of internal or external affective information on those judgments. Prior research suggests that individuals with schizophrenia misinterpret social stimuli and this misinterpretation contributes to impaired social functioning. We tested the hypothesis that for people with schizophrenia, social judgments are abnormally influenced by affective information. Twenty-three patients with schizophrenia and 35 healthy control participants rated the trustworthiness of faces following the presentation of neutral, negative (threat-related), or positive affective primes. Results showed that all participants rated faces following negative affective primes as less trustworthy than faces following neutral or positive primes. Importantly, this effect was significantly more pronounced for participants with schizophrenia, suggesting that schizophrenia may be characterized by an exaggerated influence of negative affective information on social judgment. Furthermore, the extent that the negative affective prime influenced trustworthiness judgments was significantly associated with patients' severity of positive symptoms, particularly feelings of persecution. These findings suggest that for people with schizophrenia, negative affective information contributes to an interpretive bias, consistent with paranoid ideation, when judging the trustworthiness of others. This bias may contribute to social impairments in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia

OBJECTIVE: The authors compared the community functioning of outpatients with persistent forms of schizophrenia after treatment with psychosocial occupational therapy or social skills training, with the latter conducted by paraprofessionals. METHOD: Eighty outpatients with persistent forms of schizophrenia were randomly assigned to receive either psychosocial occupational therapy or skills training for 12 hours weekly for 6 months, followed by 18 months of follow-up with case management in the community. Antipsychotic medication was prescribed through "doctor's choice" by psychiatrists who were blind to the psychosocial treatment assignments. RESULTS: Patients who received skills training showed significantly greater independent living skills during a 2-year follow-up of everyday community functioning. CONCLUSIONS: Skills training can be effectively conducted by paraprofessionals, with durability and generalization of the skills greater than that achieved by occupational therapists who provide their patients with psychosocial occupational therapy.     

Group sensitivity training: Update, meta-analysis, and recommendations.

This investigation was a meta-analysis of the effectiveness of group sensitivity training. Analysis of 63 studies revealed a moderate size, heterogeneous effect (weighted mean d?=?0.62) on all outcome measures. Categorical model testing indicated that group sensitivity training had significantly larger effects on behavioral measures than on self-report measures (mean ds?=?1.03 and 0.44, respectively). Moreover, effect sizes for behavioral measures were moderated by the size of treatment groups, the number of sessions, and the precision of measurement recording. That is, interventions involving larger groups and meeting for more sessions had larger effect sizes, as did studies involving more discrete outcome measures. As recommended elsewhere, future studies need to explore group processes and mechanisms of change in group sensitivity training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analytic evaluation of skills training research for individuals with severe mental illness.

A meta-analysis of 68 studies examined the effectiveness of skills training for individuals with severe mental illness and the influence of such factors as methodological rigor, choice of outcome measures, and service settings. The methodological quality of these studies was generally very good. Skills training was found to be moderately to strongly effective in increasing skill acquisition and reducing psychiatric symptoms. However, effect size varied by type of outcome measure, with situationally specific measures yielding larger effects than measures of skill usage and role functioning. Studies rarely examined whether acquired skills were used outside the training setting. Surprisingly, most studies were confined to inpatient settings, and most focused exclusively on social skills. Implications are discussed for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognitive basis of impaired empathy in schizophrenia.

Patients with schizophrenia show impaired emotional and social behavior, such as lack of theory of mind and misinterpretation of social situations. However, there is a paucity of work focusing on the empathic abilities of these patients. The present study was designed to examine the degree of impairment in cognitive and affective empathy in schizophrenia and to evaluate the contribution of executive prefrontal functions to empathy in these patients. To explore the neurocognitive processes that underlie the empathic ability in schizophrenic patients, the relationship between empathy scores and the performance on a cognitive flexibility task that assesses dorsolateral and orbitofrontal functioning (set shifting and reversal, respectively) was examined in 26 patients with schizophrenia and 31 healthy control subjects. Results indicated that patients with schizophrenia were significantly impaired in both cognitive and affective empathy compared with healthy control subjects. The degree of impaired empathy related to the severity of negative symptoms. In addition, patients showed impaired performance on measures of both shifting and reversal. However, while cognitive empathy was particularly related to measurements of orbitofrontal (rather than dorsolateral) functioning, affective empathy was related to measures of social functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drinking outcomes following drink refusal skills training: Differential effects for African American and non-Hispanic White clients.

Determining whether a particular treatment works for specific groups of people can help tailor dissemination of evidence-based alcohol treatments. It has been proposed that individuals from different racial groups might have better outcomes in treatments that are sensitive to sociocultural issues that impact alcohol use among these groups. The current study was a secondary analysis of data from the combined behavioral intervention (CBI) condition of the COMBINE study. Those randomly assigned to CBI (n = 776) had the opportunity to receive up to 9 skills training modules, which were chosen by the therapist. The goal of the current study was to determine whether receiving 1 of the CBI modules, drink refusal and social pressure skills training, predicted differential outcomes among African American clients. Results indicated that African American clients who received the drink refusal skills training module (n = 25) had significantly fewer heavy drinking days (d = 0.79) 1 year following treatment than African Americans clients who did not receive the module (n = 35). African American clients who received the module also had significantly fewer heavy drinking days (d = 0.86) than non-Hispanic White clients who received the module (n = 241). Good clinical outcomes at 1 year posttreatment were observed among 80% of African Americans who received the module, compared with 54% of African Americans who did not receive the module and 52% of non-Hispanic White clients who did receive the module. Although small sample size limits interpretation, findings provide preliminary evidence supporting the inclusion of drink refusal skills training as part of alcohol interventions for African American clients. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment

OBJECTIVE: To determine the efficacy of teaching patients with bipolar disorder (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. DESIGN: Single blind randomised controlled trial with matching on four baseline variables using a minimisation algorithm. SETTING: Mental health services in four NHS trusts (one teaching, three non-teaching). SUBJECTS: 69 patients with bipolar disorder who had had a relapse in the previous 12 months. INTERVENTIONS: Seven to 12 individual treatment sessions from a research psychologist plus routine care or routine care alone. MAIN OUTCOME MEASURES: Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardised interviews every six months for 18 months. RESULTS: 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and control groups (log rank 7.04, df=1, P=0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P=0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P=0.003) and employment (mean difference 0.7 (0.1 to 1.3), P=0.030) by 18 months. CONCLUSION: Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.     

The Relationship Between Neuropsychological Functioning and Driving Ability in Dementia: A Meta-Analysis.

A meta-analysis of 27 primary studies was conducted to examine the relationship between neuropsychological functioning and driving ability for adults with dementia. When studies using a control group were included, the relationship between cognitive measures and on-road or non-road driving measures was significant for all reported domains; mean correlations ranged from .35 to .65. Caregiver reports of driving ability and cognitive variables were correlated significantly only on measures of mental status and visuospatial skills. When studies using a control group were excluded, moderate mean correlations were observed for visuospatial skills and on-road or non-road measures, and for mental status with non-road tests. Other effects were small or nonsignificant. Implications for basing driving recommendations on neuropsychological testing are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurocognition and functional outcome in early-onset schizophrenia and attention-deficit/hyperactivity disorder: A 13-year follow-up.

Objective: The relation between neurocognitive impairments and functional outcome has been documented in both early onset schizophrenia (EOS) and attention-deficit/hyperactivity disorder (ADHD), but less is known about the long-term relation between these factors. The present study investigates how neurocognition at baseline is related to measures of functional outcome at 13-year follow-up in subjects with EOS and ADHD. Method: Subjects with EOS (n = 15), ADHD (n = 19), and healthy controls (n = 30) were followed up 13 years after initial assessment. All subjects were between 12 and 18 years of age at baseline and between 24 and 30 at follow-up. They were retested at T2 with the same comprehensive neurocognitive test battery as used at T1, and reassessed with various symptom and behavior ratings and functional outcome measures. Results: Both groups were characterized by reduced functional outcome at follow-up, although of different magnitude and type, compared with healthy controls. In the EOS group, neurocognitive baseline measures were associated with social functioning at follow-up (η2 between .26 and .41), while for the ADHD group, no significant predictions were found. Conclusions: Adolescents with EOS and ADHD are characterized by poor functional outcome compared with healthy controls when reassessed as young adults. Executive function, memory and attention were related to social and community functioning in EOS. For ADHD no significant predictions were found although functional outcome was poor. For both groups treatment should focus on training of social skills and activities of daily living to enhance the long-term functional outcome. For EOS cognitive remediation should also be considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs.

This study evaluated the efficacy of 2 programs for preventing depressive symptoms in adolescents. Participants were 380 high school students randomly assigned to a cognitive-behavioral program (CB), an interpersonal psychotherapy-adolescent skills training program (IPT-AST), or a no-intervention control. The interventions involved eight 90-min weekly sessions run in small groups during wellness classes. At postintervention, students in both the CB and IPT-AST groups reported significantly lower levels of depressive symptoms than did those in the no-intervention group, controlling for baseline depression scores; the 2 intervention groups did not differ significantly from each other. The effect sizes, using Cohen's d, for the CB intervention and the IPT-AST intervention were 0.37 and 0.26, respectively. Differences between control and intervention groups were largest for adolescents with high levels of depressive symptoms at baseline. For a high-risk subgroup, defined as having scored in the top 25th percentile on the baseline depression measure, the effect sizes for the CB and the IPT-AST interventions were 0.89 and 0.84, respectively. For the whole sample, sociotropy and achievement orientation moderated the effect of the interventions. Intervention effects were short term and were not maintained at 6-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telephone-based coping skills training for patients awaiting lung transplantation.

Impaired quality of life is associated with increased mortality in patients with advanced lung disease. Using a randomized controlled trial with allocation concealment and blinded outcome assessment at 2 tertiary care teaching hospitals, the authors randomly assigned 328 patients with end-stage lung disease awaiting lung transplantation to 12 weeks of telephone-based coping skills training (CST) or to usual medical care (UMC). Patients completed a battery of quality of life instruments and were followed for up to 3.4 years to assess all-cause mortality. Compared with UMC, CST produced lower scores on perceived stress, anxiety, depressive symptoms, and negative affect and improved scores on mental health functioning, optimism, vitality, and perceived social support. There were 29 deaths (9%) over a mean follow-up period of 1.1 year. Survival analyses revealed that there was no difference in survival between the 2 groups. The authors conclude that a telephone-based CST intervention can be effectively delivered to patients awaiting lung transplantation. Despite the severity of pulmonary disease in this patient population, significant improvements in quality of life, but not somatic measures or survival to transplant, were achieved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of treatment strategies for clients functionally impaired by extreme shyness and social avoidance.

Compared a treatment that combined graduated exposure to fear-provoking situations and training in other-focused social skills with graduated exposure alone and waiting list control conditions. Ss were 52 adults (aged 20–50 yrs) who reported impairment in their social, occupational, and heterosocial functioning due to extreme shyness. Improvement in social functioning was assessed through self-reported social activities in the community, through judges' ratings of a laboratory-based social interaction, and through therapists' ratings. Ss who received a combination of graduated exposure and interpersonal process training improved significantly more on measures of community functioning and therapist ratings than did Ss who received graduated exposure procedures alone or waiting list Ss. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of memory training on the subjective memory functioning and mental health of older adults: A meta-analysis.

The effectiveness of memory training on the subjective memory functioning and mental health of older adults was examined in a meta-analysis. Effect sizes indicated that memory training led to improved subjective memory functioning (d++?=?.19), but the magnitude of the improvement was less than that obtained on objective memory measures (d++?=?.66) in the meta-analysis of P. Verhaeghen, A. Marcoen, and L. Goossens (1992). However, no differences in effectiveness were found among mnemonic training, expectancy modification, or placebo procedures such as unstructured practice. Improvement of subjective memory functioning was enhanced by including pretraining in skills such as the use of imagery and by including interventions to improve participants' attitudes toward the effects of aging on memory functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness outcomes of four age versions of the Strengthening Families Program in statewide field sites.

Family dysfunction is unacceptably high nationally and internationally with high costs to society in adolescent problems. A number of evidence-based (EB) parenting and family interventions have been proven in research to improve children's outcome. The question remains whether these EB family programs are as effective in practice. This article summarizes research outcomes from a quasi-experimental, 5-year statewide study of the 14-session Strengthening Families Program (SFP) with over 1,600 high-risk families. The study compared outcomes including effect sizes for the four different age versions of SFP (SFP 3–5, 6–11, 10–14, and 12–16 years). Quality assurance and program fidelity were enhanced by standardized training workshops, site visits by evaluators, and online supervision. Outcomes were measured using the SFP Parent Retrospective testing battery containing self-report standardized clinical measures of 18 parent, family, and child outcomes. The 2 repeated measures by 4 group ANOVA compared the four different age versions of SFP. All of the outcome variables for the four programs were statistically significant at less than the p d = .77 for SFP 6?11 years to effect size of d = .67 for SFP 3–5 and 10–14. The largest effect sizes were for improvements for the SFP 6–11 condition in Family Communication and Family Strengths and Resilience (d = .76 for both), Family Organization (d = .75), Parental Supervision (d = .73), Parenting Efficacy (d = .70), and Positive Parenting (d = .67). Parental alcohol and drug use was reduced most in the SFP 12–16 year version (d = .43). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blood parameter and heart rate response to training in Andalusian horses

The psychopathology and associated disabilities experienced by persons with schizophrenia have only partially responded to conventional pharmacological and psychosocial treatment approaches. Biobehavioral treatment and rehabilitation employs behavioral assessment, social learning principles, skills training, and a focus on the recovery process to amplify the effects of pharmacotherapy. Utilizing the Medline database, we review a selection of English-language studies published from 1970 to 1994 that support the effectiveness of each of the components of biobehavioral therapy, such as case management, psychopharmacology with behavioral assessment, psychoeducation, family involvement, and social skills training. An integrated biobehavioral therapy directed toward early detection and treatment of schizophrenic symptoms, collaboration between consumers and caregivers in managing treatment, family and social skills training, and teaching coping skills and self-help techniques has been documented to improve the course and outcome of schizophrenia, as measured by symptom recurrence, social functioning, and quality of life. A case vignette is presented to illustrate the successful integration of biobehavioral therapies into a treatment system that focuses on consumers' attempts to become increasingly responsible for recovering from illness.     

Crystallized verbal skills in schizophrenia: Relationship to neurocognition, symptoms, and functional status.

Objective: To study the relationship of superior (i.e., ≥ 90th percentile), average (11th?89th percentile) or extremely low (i.e., ≤ 10th percentile) crystallized verbal skills to neurocognitive profiles, symptoms and everyday life function in schizophrenia. Method: Crystallized verbal skill was derived from Vocabulary subtest scores from the Wechsler Adult Intelligence Scale (WAIS). Out of a sample of 165 stable outpatients with schizophrenia we identified 25 participants with superior crystallized verbal skill, 104 participants with average verbal skill, and 36 participants with extremely low crystallized verbal skill. Each participant was administered measures of attention, working memory, verbal learning and memory, problem-solving and processing speed, as well as symptom and performance-based adaptive life skill assessments. Results: The magnitude of neuropsychological impairment across the three groups was different, after adjusting for group differences in education and duration of illness. Working memory, and verbal learning and memory skills were different across all three groups, while processing speed differentiated the extremely low verbal skill group from the other two groups and problem-solving differentiated the very low verbal skill group from the superior verbal skill group. There were no group differences in sustained attention. Capacity measures of everyday life skills were different across each of the three groups. Conclusion: Crystallized verbal skill in schizophrenia is related to the magnitude of impairment in neurocognitive function and performance-based skills in everyday life function. Patterns of neuropsychological impairment were similar across different levels of crystallized verbal skill. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

SOCIAL: An integrative framework for the development of social skills.

Despite significant advances in the field of social neuroscience, much remains to be understood regarding the development and maintenance of social skills across the life span. Few comprehensive models exist that integrate multidisciplinary perspectives and explain the multitude of factors that influence the emergence and expression of social skills. Here, a developmental biopsychosocial model (SOCIAL) is offered that incorporates the biological underpinnings and socio-cognitive skills that underlie social function (attention/executive function, communication, socio-emotional skills), as well as the internal and external (environmental) factors that mediate these skills. The components of the model are discussed in the context of the social brain network and are supported by evidence from 3 conditions known to affect social functioning (autism spectrum disorders, schizophrenia, and traumatic brain injury). This integrative model is intended to provide a theoretical structure for understanding the origins of social dysfunction and the factors that influence the emergence of social skills through childhood and adolescence in both healthy and clinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotion responsivity, social cognition, and functional outcome in schizophrenia.

Social functioning deficits have long been a defining feature in schizophrenia, but relatively little research has examined how emotion responsivity influences functional outcome in this disorder. The goal of the current study was to begin to elucidate the relationships between emotion responsivity, social cognition, and functional outcome in schizophrenia. Participants were 40 outpatients diagnosed with schizophrenia or schizoaffective disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) and 40 controls. Each participant completed measures of emotion responsivity, social cognition (both emotion and social perception), and functional outcome. Individuals with schizophrenia demonstrated somewhat reduced emotion responsivity for positive and negative stimuli, as well as deficits in both social cognition and functional outcome, in comparison with controls. Additionally, results indicated that both social perception and emotion responsivity were positively correlated with functional outcome. Importantly, the relationship of emotion responsivity to functional outcome was not mediated by social perception and showed a significant relationship to functional outcome independent of social cognition. This finding suggests that emotion responsivity is an important factor in understanding functional outcome in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)