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Social-skills Training Improves Negative Symptoms in Psychosis

December 11, 2017

By Anne Harding

NEW YORK—Social-skills training (SST) is effective for improving negative symptoms in schizophrenia, according to a new systematic review and meta-analysis.

“In terms of psychosocial interventions for negative symptoms of psychosis, social-skills training seems to perform the best,” Dr. David T. Turner of Vrije Universiteit in Amsterdam, one of the new study’s authors, told Reuters Health in a telephone interview.

SST, offered in a group setting, is intended to develop and improve interpersonal skills, and is usually offered to people with psychosis or schizophrenia-spectrum disorders, Dr. Turner and his team note in Schizophrenia Bulletin, online November 14.

The psychological intervention was developed in the 1970s to assist psychiatric patients returning to the community, they add, and was shown to be effective for reducing social anxiety. Since then, several different types of SST have been developed, and some incorporate techniques used in cognitive-behavioral therapy (CBT).

Negative symptoms in people with psychosis include social withdrawal, difficulty in communicating, blunted affect, and rigid or stereotypical thoughts. Most interventions and research have focused on positive symptoms, such as delusions and racing thoughts, rather than negative symptoms, Dr. Turner and his colleagues note.

The UK National Institute for Health and Care Excellence (NICE) guidelines recommend against SST for psychosis, and some U.S. guidelines state that SST is not effective for symptom reduction. CBT is widely used in the UK for psychotic patients, they add, but focuses on addressing positive symptoms.

Dr. Turner and his colleagues looked at 27 randomized controlled trials of SST including 1,437 people in all. Using Hedges’ “g” to measure effect size, they found SST was significantly superior to treatment as usual (TAU, g=0.3), active controls (g=0.2-0.3), and comparators pooled (g=0.2-0.3) for improving negative symptoms; it also outperformed TAU and pooled comparators for improving general psychopathology (g=0.4 and 0.3, respectively). SST had no significant effect on positive symptoms.

The effect sizes seen for SST on negative symptoms was roughly similar to that seen for CBT and positive symptoms, the researchers note, “although unlike CBT, SST is not routinely recommended in treatment guidelines for psychological intervention.”

“Further high-quality outcome research may help clarify doubts regarding the applicability and durability of SST in practice,” Dr. Turner and his team add. “At the very least, a randomized controlled trial with stringent methodology applying SST for negative symptoms in a routine mental healthcare setting is warranted.”


Schizophr Bull 2017.

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