Effects of cognitive therapy on social functioning for persons with chronic schizophrenia and other severe psychiatric disorders

Despite optimal neuroleptic medication, many persons with chronic schizophrenia and other severe psychiatric disorders have pronounced social skills deficits which contribute to poor social functioning and high relapse rates. In the last several decades social skills training has become an increasingly important treatment in psychiatric rehabilitation. Research indicates social skills training produces behavior changes but there is mixed evidence concerning generalization. Lack of generalization of social skills has led to an increasing focus on cognitive deficits which may hinder generalization. Efforts to remediate cognitive deficits have been encouraging. It is unclear, however, if remediation of cognitive deficits facilitates improvements in acquisition and generalization of social skills. The present study examined the effects of group cognitive therapy for persons with chronic schizophrenia and other severe psychiatric disorders. Nine subjects, receiving the standard psychiatric rehabilitation program plus group cognitive therapy, and eight subjects, receiving the standard psychiatric rehabilitation program, were compared on measures of symptomology, cognitive functioning, skill training performance and social behavior. Follow-up procedures were conducted five months later. The present study found limited evidence to suggest cognitive therapy was effective in remediating cognitive deficits or in facilitating improvements in the acquisition and/or generalization of social skills. The experimental group did improve significantly in self-neglect compared to the control group and there is some preliminary evidence that persons receiving cognitive therapy have achieved greater stability and a higher level of functioning in the community compared to persons in the control group. Both groups improved significantly in their overall level of symptomology, average rate of rehabilitation progress, and in role plays of interpersonal problem solving situations. Factors which may have contributed to the limited cognitive therapy effects, such as the effectiveness of the standard psychiatric rehabilitation program, the small size and heterogeneity of the groups, the amount of cognitive therapy, group differences resulting from the research design, and the possible inadequacy of the measures, are discussed