Skill Building for Psychosis

skill buildingOne of the very hard things about many psychiatric disorders, including bipolar disorder and schizophrenia, is that they often begin at a time that is critical to the development of many skills and abilities needed for successful adult life.

Many years ago we visited a wonderful program in Atlanta developed for young people with schizophrenia called STARS. The program was intended to be a comprehensive treatment approach that helped people with schizophrenia live fulfilling adult lives. It had remarkable rates of success.

One of the many creative things about the approach that the STARS program took, was that it tried to address practical social skills as well as skills related more directly to managing the symptoms of schizophrenia.

Perhaps the most popular educational component involved having young college volunteers come in and coach the patients on dating skills. After all, many of them missed out entirely on this experience because they were so symptomatic. And if you miss out on dating skills in high school and college, you end up at a serious disadvantage for the rest of your life.

We ran across this article, which summarizes a comprehensive review of the literature on the importance of skill building for all treatment programs and we were reminded of our visit to STARS, and of the importance of providing comprehensive help to people with serious psychiatric disorders…

Skill building—which involves strategies for helping adults with serious mental illness manage their illness, develop daily-living skills, and succeed in recovery—should be a foundation for rehabilitation services covered by comprehensive insurance benefit plans. That’s the finding from the study, “Skill Building: Assessing the Evidence,” published in Psychiatric Services in Advance.

Researchers from multiple institutions searched meta-analyses, research reviews, and individual studies from 1995 through March 2013. In this review, they examined four key components of skill building: social skills training (including life skills training), social cognitive training, cognitive remediation, and cognitive-behavioral therapies that target skills for coping with psychotic processes. The researchers chose from three levels of evidence (high, moderate, and low) on the basis of benchmarks for the number of studies and quality of their methodology.

More than 100 randomized controlled trials and quasi-experimental studies support rating the level of evidence as high. Study outcomes indicated strong effectiveness for social skills training, social cognitive training, and cognitive remediation, especially if these interventions are delivered through integrated care approaches. Results are somewhat mixed for life skills training (when studied alone) and cognitive-behavioral approaches.

“The current body of research has established the value of skill-building approaches,” the researchers said. “Although further research will help clarify their effects on some outcomes, research is not needed to support the decision to include skill-building approaches as covered services, particularly for individuals with schizophrenia and other psychotic disorders.”