Social Skills Training in Hong Kong Chinese Patients with Chronic Schizophrenia

Abstract Objective: To examine the efficacy of social skills training in Hong Kong Chinese patients with schizophrenia. Patients and Methods: Thirty six hospital inpatients with residual schizophrenia were randomised to receive either social skills training (n = 18) or supportive group discussion (n = 18) for 30 hours in group-format of 2 sessions per week for 8 weeks. Results: There was no improvement in symptoms or social functioning after completion of either social skills training or supportive group discussion. There was also no difference between the 2 groups in terms of symptoms or social functioning. The relapse rate was similar across the 2 groups. Conclusion: Social skills training is not an effective psychosocial intervention for patients with chronic schizophrenia in Hong Kong. Key words: Schizophrenia, Social adjustment, Social behaviour Introduction Social skills training (SST) has been used to improve the social skills and social functioning of patients with schizophrenia. The literature generally supports that patients with schizophrenia can acquire social skills through SST, including simple and complex social behaviour. (1-4) Despite the apparent evidence for the efficacy of SST for improving social skills in patients with chronic schizophrenia, many unanswered questions remain. Most studies primarily recruited men, because these studies were conducted in veterans hospitals (3); the results may not be readily generalisable to women. Furthermore, a meta-analysis showed that effect size was dependent on the type of outcome measure. (4) Effect size was substantially smaller when the assessment was conducted outside the treatment setting or differed in form or content from the training exercises. Meta-analyses have also found that inpatients and severely ill patients benefited less from SST. (3,4) In a recent meta-analysis with stringent selection criteria of randomised controlled studies, the conclusion was significantly different from previous reviews; there was no clear evidence for any benefits of SST on global functioning, social functioning, relapse rate, quality of life, or treatment compliance. (5) There is a paucity of randomised studies of SST among the Chinese population. At the time of writing, only 3 studies had been performed in a Chinese population (1 in China, (6) 1 in Hong Kong, (7) and 1 in Taiwan (8)). A recent randomised pilot study found that inpatients with schizophrenia receiving 8 weekly 3-hour sessions of SST had significant improvement in social behaviour as measured by the Social Behaviour Schedule (SBS). (9,10) The training had little effect on negative symptoms, which were usually more enduring and resistant to such a brief psychosocial intervention. The therapist time was not controlled and the sample size was small (n = 14). Following the encouraging results of the pilot study, the current study was an attempt to investigate the efficacy of SST with a methodologically rigorous study. The objectives of this research were to: * test whether SST is effective in improving the social functioning and social skills of Chinese patients with chronic schizophrenia * investigate whether SST is more effective than other types of group treatment (i.e., supportive group discussion for the purposes of this study) * investigate whether the effect of SST, if any, can be maintained * test whether SST can reduce/avert relapses in comparison with supportive group discussion. Patients and Methods Patients This was a single-centre prospective rater-masked randomised controlled trial with a 6-month follow-up period. Eligible patients were randomly allocated to 1 of 2 treatments: SST and usual treatment or supportive group discussion and usual treatment. Patients were assessed for social functioning, psychopathology, and relapse before and after the treatment phase (8-week period). …