Skill Building: Assessing the Evidence
Abstract
Objective
Methods
Results
Conclusions
Description of the service
About the AEB Series
Feature | Description |
---|---|
Service definition | Skill building is a direct service that helps individuals enhance their capacity to successfully accomplish a task or goal. Skill-building services generally are based on psychoeducational and cognitive-behavioral approaches. They assist individuals with developing or improving competencies in the areas of self-help, self-care, adaptation, or socialization. These skills can help prevent relapse and aid recovery from mental and substance use disorders. |
Service goals | Assist in illness self-management, medication management, and management of physical health; improve life skills (for example, activities of daily living and community living skills such as transportation, financial management, shopping, and cooking); and improve cognitive and intellectual skills (for example, learning and organizational skills, attention, and memory), interpersonal and intrapersonal skills, self-help and advocacy skills, and skills in functional areas such as employment and education |
Populations | Adults who have serious mental illnesses (usually schizophrenia, schizophreniform, or schizoaffective disorders), adults with substance use disorders or co-occurring mental and substance use disorders, and adults with bipolar and other affective disorders (limited research) |
Settings for service delivery | Outpatient mental health centers, day treatment programs, inpatient facilities, consumers’ homes |
Methods
Search strategy
Inclusion and exclusion criteria
Strength of the evidence
Effectiveness of the service
Results
Level of evidence
Study | Focus of review | Outcomes measured | Summary of findings |
---|---|---|---|
Mueser et al., 2002 (26) | Illness management approaches, including medication management, relapse prevention, coping skills training, and cognitive-behavioral tailoring | Medication adherence; relapses and rehospitalizations; severity of symptoms, including psychotic symptoms; social adjustment; quality of life | Behavioral tailoring improved taking medication as prescribed; symptom severity, psychotic symptoms, relapses, and rehospitalizations were all reduced in multiple RCTs. Several studies of illness management found improvement in social adjustment and quality of life. |
Pilling et al., 2002 (27) | Social skills training and cognitive remediation for treating negative symptoms of schizophrenia | Social skills training: relapse, treatment compliance, global adjustment, social functioning, quality of life. Cognitive remediation: attention, verbal memory, visual memory, mental state, executive functioning | No reliable benefits were associated with social skills training or cognitive remediation. The interventions were not recommended for clinical practice. |
Twamley et al., 2003 (39) | Cognitive training for individuals with schizophrenia | Cognitive performance, symptoms, everyday functioning | Cognitive training was effective in improving cognitive performance, psychiatric symptoms, and everyday functioning, but it was not effective in lessening cognitive impairments characteristic of schizophrenia. |
Bellack, 2004 (29) | Psychosocial rehabilitation strategies (social skills training, cognitive-behavioral therapy, and cognitive remediation) for individuals with schizophrenia and other severe mental illness | Social skills training: psychotic symptoms, relapse, behavioral skills, social role function, specialized behavioral skills, self-efficacy. Cognitive-behavioral therapy: delusions, hallucinations, overall symptoms, relapse, social role functioning, depression, negative symptoms, durability of effects | The strongest support was for effectiveness of social skills training, which is most appropriate for treating social impairment rather than schizophrenia more broadly. Results showed promising preliminary support for cognitive-behavioral therapy among people with psychotic disorders. |
Kopelowicz et al., 2006 (31) | Social skills training for individuals with schizophrenia | Disease management, independent living skills | Inconsistent evidence was found for effectiveness of social skills training on psychopathology. Social skills training should not be considered as a stand-alone treatment, but it is important to include it as part of a holistic rehabilitation program. |
Pfammatter et al., 2006 (9) | Social skills training, cognitive remediation, cognitive-behavioral therapy, and coping interventions for people with schizophrenia, families, and others | Social skills training: acquisition of social skills and assertiveness, psychopathology, hospitalization rates. Cognitive remediation: executive functioning, cognitive processing. Cognitive-behavioral therapy: acquisition of cognitive strategies, symptom severity | Social skills training: inconsistent findings in RCTs did not support the large effects found in quasi-experimental studies of acquisition of social skills and assertiveness and low to moderate effects for reductions in psychopathology and hospitalization rates. Author meta-analysis of 19 RCTs confirmed large and enduring effects on social skills, moderate improvement in social functioning, a slight reduction in psychopathology, and a significant decrease in hospitalization rate at follow-up. Cognitive remediation: RCTs did not support evidence of effectiveness. Quasi-experimental studies supported small to moderate effects on general cognitive functioning. Cognitive-behavioral therapy: studies supported medium to large effects on severity of symptoms through cognitive restructuring and cognitive enhancement strategies, with stability at follow-up. |
Roder et al., 2006 (46) | Integrated Psychological Therapy for individuals with schizophreniab | Neurocognition, psychopathology, psychosocial functioning | Integrated Psychological Therapy was more effective than control conditions across all outcomes, including symptoms, psychosocial functioning, and neurocognition. Results were consistent across settings (inpatient and outpatient, academic and nonacademic) and phases of treatment (acute and chronic). |
McGurk et al., 2007 (40) | Cognitive remediation for individuals with schizophrenia | Cognitive performance, symptoms, psychosocial functioning | A medium effect was found for improved cognitive performance, a slightly lower effect for improved psychosocial functioning, and a small effect for improved symptoms. Studies in which adjunctive psychiatric rehabilitation was provided found significantly greater effects on psychosocial functioning than studies that provided cognitive remediation alone. |
Kurtz and Mueser, 2008 (11) | Social skills training for individuals with schizophrenia | Content mastery, performance-based skill measures, community functioning, negative symptoms, general symptoms, relapse | Impact of social skills training was strongest for content mastery, followed by performance-based measures of social and independent living skills and psychosocial functioning. Impact was least strong for negative symptoms. Impact was weakest on relapse and positive symptoms. |
Wykes et al., 2008 (24) | Cognitive-behavioral therapy for individuals with schizophrenia | Positive and negative symptoms of psychosis, functioning, mood, hopelessness or suicidality, social anxiety | Cognitive-behavioral therapy had modest effects on positive and negative symptoms, functioning, mood, and social anxiety, but it may exacerbate hopelessness or suicidality. |
Dixon et al., 2010 (2) | Psychosocial interventions (including skills training) for individuals with schizophrenia | Interpersonal and everyday living skills as indicated by proximal (for example, role play) and distal (for example, community functioning) measures | Skills training that is focused on clearly defined activities, situations, and problems can improve social interactions, independent living, and other community functioning outcomes for individuals with schizophrenia. Evidence was weaker regarding the effect of skills training on relapse, symptoms, and general psychopathology. |
Arbesman and Logsdon, 2011 (14) | Occupational therapy interventions for individuals with serious mental illness | Independent living skills | Skills training improved independent living skills. |
Roder et al., 2011 (25) | Integrated Psychological Therapy for individuals with schizophreniab | Documented symptoms, neurocognitive and social functioning, quality of life, well-being, treatment satisfaction | Integrated Psychological Therapy was more effective than control conditions across outcomes (including symptoms, psychosocial functioning, and neurocognition), settings (inpatient and outpatient, academic and nonacademic), and phases of treatment (acute and chronic). Those who had been ill longer were less likely to improve. |
Wykes et al., 2011 (23) | Cognitive remediation therapy for individuals with schizophrenia | Cognition, symptoms, functioning | Cognitive remediation had durable effects on global cognition and functioning but unreliable effects on symptoms. Effects were the strongest when patients were clinically stable, cognitive remediation was provided in combination with other psychiatric rehabilitation, and a strategic approach was adopted along with adjunctive rehabilitation. |
Anaya et al., 2012 (41) | Cognitive remediation for individuals with schizoaffective disorder, affective psychosis, and unipolar and bipolar affective disorders | Cognitive functioning | Cognitive remediation was at least as effective for affective and schizoaffective disorders as it was for schizophrenia. |
Kurtz and Richardson, 2012 (19) | Behavioral training programs for individuals with poor social cognitive functioning | Proximal social cognitive measures, treatment generalization (symptoms and observer-rated community and institutional functioning) | Social cognitive training had moderate to large effects on facial affect recognition and small to moderate effects on theory of mind, but it did not affect social cue perception or attribution style. For measures of generalization, moderate to large effects were noted on total symptoms and observer-rated community and institutional functioning. Effects of social cognitive training programs on positive and negative symptoms of schizophrenia were nonsignificant. |
Tungpunkom et al., 2012 (10) | Life skills programs for individuals with chronic mental health problems | Life skills, relapse, mental state, global state, service outcomes, general functioning, behavior, adverse effects, engagement with services, satisfaction with treatment, quality of life, economic outcomes | No significant change was noted in life skills. Samples were “so small that any firm conclusions are impossible.” None of the outcomes were significantly different between the life skills, peer support, and control groups. |
Mueser et al., 2013 (8) | Psychosocial treatment (including social skills training and supported education) for individuals with schizophrenia | Social skills training: skills acquisition, content mastery, assertiveness, social and community functioning, social and daily living skills, psychopathology. Supported education: work or school outcomes | Strong evidence was found for effectiveness of social skills training in improving aspects of social competence. Integrated programs, including supported education, were associated with improvements in work and school compared with usual treatment. |
Social and life skills training.
Social cognitive training.
Cognitive remediation.
Cognitive-behavioral therapy.
Integrated approaches.
Effectiveness of the service
Social and life skills training.
Social cognitive training.
Cognitive remediation.
Cognitive-behavioral therapy.
Integrated approaches.
Specific populations.
Discussion
Evidence for the effectiveness of skill building: high
Conclusions
Acknowledgments and disclosures
References
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Cover: Griselda, by Maxfield Parrish. © Copyright 2014 National Museum of American Illustration™, Newport, Rhode Island. Photos courtesy of Archives of the American Illustrators Gallery™, New York City.
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