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Social Skills Training (SST)

psychiatrist with patient

Introduction to social skills training 

Social skills trainingIn some cases, the most devastating effects of psychological and mental disorders are their effects on the social aspect of life. Humans are social creatures and thrive on interaction with others. Without this, depression and isolation are inevitable, leading to further detrimental consequences on one’s mental health. Equipping people who otherwise have no social skills or practice in social skills with the necessary tools is becoming a prominent technique in psychotherapy.

What are social skills?

Social skills are the behaviours, verbal and non-verbal, that we use in order to communicate effectively with other people. Social skills are governed by culture, beliefs and attitudes. They continuously change and develop throughout our lives. Somebody that uses social skills to effectively interact with friends, family, workmates and strangers is said to have social competence.

Some examples of social skills are:

  • Eye contact with others during conversation
  • Smiling when greeting people
  • Shaking hands when meeting someone
  • Using the right tone and volume of voice
  • Flirting
  • Expressing opinions to others
  • Perceiving how others are feeling and showing empathy
  • Appropriate emotional responses (e.g. crying when something sad happens; laughing when someone says something funny)

The list of social skills goes on and on. Many of us do not even realise that these are skills but treat them as part of everyday life. Unfortunately, for some people socialising is not that easy, perhaps because they lack social skills or do not feel comfortable using their social skills.

What is social skills training (SST)?

Social skills training is a type of psychotherapy that works to help people improve their social skills so they can become socially competent. SST is predominantly a behavioural therapy but cognitive therapy can also be used in some situations to maximise the success of SST. This psychotherapy can be done one-on-one or in a group situation.

Who can benefit from SST?

SST is mainly used for individuals that are diagnosed with certain mental or psychological disorders and whose symptoms involve poor social functioning. However, anyone who wants to improve their social skills and social confidence can benefit from this psychotherapy.

The major disorders that are accompanied with social dysfunction are:

It is important to remember that, although SST can be very effective in helping people learn the necessary skills, it is very rare for SST to be a stand alone therapy. There are always underlying reasons why people are experiencing social difficulty and these too need to be treated, either with drugs or a combined psychotherapy.

The diagram below will help explain this. The arrows represent symptoms that negatively affect one another:

Vicious psychological cycle

As you can see, there are many factors that contribute to worsening social skills, which in turn impair many other aspects of our lives. For example, social skill deficits cause social isolation, and social isolation worsens social skills. These are just some examples of the many vicious cycles that we see in psychology.

Treating only one aspect of the cycle without treating the other would be pointless; the condition will simply arise again and again. For example, there is no point learning the social skills if you are too anxious to use them!

What is involved in SST?

Social skills training will almost always be combined with some other type of psychotherapy, most often cognitive-behavioural therapy. The amount of time needed to complete an SST program varies depending on how well you are learning the techniques and how much confidence you have in using the skills in a social environment. Typically, eight one-hour sessions are standard.

Basic SST implementation structure

All social skills training follows the same basic structural and implementation outline:

Identifying the problem 

Firstly, the major social problem needs to be identified. For example, are the problems with socialising predominantly a fear of large gatherings of people? Or speaking to people at work? In order to figure out the major problems, the patient and psychologist work together through discussion. Sometimes the psychologist may want to observe the patient’s behaviour; this is mainly with inpatient settings or children in the classroom.

The underlying psychology behind the social problems also needs to be determined. Sometimes social problems are a result of a mental illness (e.g. schizophrenia), or they may have arisen from a past trauma. Once these problems and reasons have been determined, your psychologist can determine what skills need to be focused on, how best to teach the skills, and what other therapies are required to help with the underlying issues.

Setting the goals

As with any type of psychotherapy, your psychologist will help you develop specific goals for the therapy. This will include a broad overall goal as well as focused goals that may change from session to session. For SST, the broad overall goal may be the ability to socialise comfortably in the staffroom, whereas the individual goals will be skill-specific (e.g. learning how to greet someone, ask how they are and respond appropriately).

Once each goal or skill is mastered, the goal for the next session becomes more difficult. Keeping the overall goal in mind will help you overcome times when you feel like giving up on the therapy.

Modelling

Before you are expected to perform the skill, your psychologist will model the skill you are focusing on, so that you can see exactly what you need to do before attempting to do it yourself.

Roleplaying

After your psychologist has modelled the skill, you will be asked to roleplay. This practice is a very important aspect of SST. It may feel odd to roleplay, but until you have practised the skill, it is hard to use it outside the safety and confinement that therapy sessions provide.

Feedback

Your psychologist will provide feedback at the end of each session. This feedback will help you to identify your strengths and weaknesses, and the things you especially need to work on and practise.

Homework! 

In between sessions, your psychologist will set little “homework” challenges that you are required to do in your own time throughout the week. Usually the homework will carry on directly from the session, so that you practise the new skill you learnt. Depending on your success at meeting the challenge, you will focus on a new, more difficult skill in the next session.

Children and SST

Social skills trainingHow you socialise as a child is different to socialising as an adult, so social skills training for children is different to that for adults. Not only do people of different age groups socialise differently, but they are also associated with different psychological and mental dysfunctions. Therefore, social skills training will be very different in terms of goals and teaching methods between different age groups. The basic implementation plan, however, is the same.

Regardless of whether a child is diagnosed with a psychological disorder or not, it is very important to develop social skills in childhood. Any child with a social problem can be referred to a psychologist; this will greatly benefit them in the future. Minor social problems in childhood can turn into serious antisocial or anxious problems in the future.

High-functioning autism and Asperger’s syndrome

The core deficit in high-functioning autism (HFA) and Asperger’s syndrome (AS) are social dysfunctions. Individuals with HFA and AS are very cognitively capable, and are often very aware of their social deficits. This can be very distressing and depressing. Unfortunately, these children will not naturally “outgrow” their social deficits.

It is very important to train social skills early before they become more and more distressed about their social isolation, which may become worse and manifest as serious antisocial behaviours in adolescence.

The social skills that are commonly focused on in HFA and AS are:

  • Eye contact
  • Smiling
  • Sharing: A very important part of school and play activities is the ability to share with others.
  • Sustaining conversations
  • Listening
  • Empathy

A lot of the social deficits in autistic spectrum disorders arise because children cannot “place themselves in other people’s shoes”. SST aims to teach them how to try to understand others’ feelings, and how to show caring by giving appropriate emotional responses.

Bullying and peer pressure

Bullying and peer pressure are very prominent issues in primary schools. A lot of the time, children who have not quite developed social skills are isolated and picked on. Not only does this severely damage children’s self-confidence, but it also causes them to withdraw from most aspects of school life.

SST for these children aims for peer group acception. The training is a combination of cognitive-behavioural and social learning. It focuses on:

  • Encouraging attitudes and behaviours which enhance positive social interactions (i.e. prosocial behaviour); and
  • Building coping strategies for dealing with peer pressure and bullying. This is will also work positively on self-esteem.

Throughout the sessions, basic social skills are also taught, depending upon what specific social area the child struggles with.

SST for adolescence and adulthood

Schizophrenia

One of the core deficits of schizophrenia is cognitive impairment, including working memory, problem solving and attention. Along with the psychotic symptoms, these make many schizophrenic patients socially incompetent. The lack of cognitive functions means that teaching these patients to act socially is very difficult. Therefore, the training is very structured. Each skill is broken up into smaller parts to make it easier for the patient to remember and follow through.

The social skills program for schizophrenics are based upon their negative or affective symptoms. The social skills commonly focused on are:

  • Eye contact
  • Smiling: People with schizophrenia tend to have flattened emotional and facial responses due to the side effects of their medication. Learning how to give a simple smile can make all the difference.
  • Showing appropriate emotional responses: A negative symptom of schizophrenia is inappropriate responses in social situations (e.g. laughing when others are being serious and vice versa). SST aims to train schizophrenics to recognise when laughing is appropriate and when they should be serious.
  • Sustaining conversations: Knowing how to ask and answer questions, give and receive compliments.
  • Listening: In order to respond to others it is important to listen effectively. SST teaches how to actively listen to others.

Schizophrenia is a disorder with many symptoms and side effects. Social skills training is not a stand alone treatment option.

Social phobia / social anxiety

Social phobia is a subtype of anxiety disorder. It is the fear of social situations. A person may have social phobia since childhood, or it may have developed throughout adolescence or adulthood. Regardless of the cause, SST training alone will not fix the situation. SST can be very effective in combination with other psychotherapy programs (e.g. self-management skills training) for treating the underlying anxiety causing the fear.

There are many reasons a person could have developed social phobias or social anxiety. It is important to first gain insight into why the person has the condition, and what aspect of socialising they are fearful of. The social skills commonly focused on in social phobias are:

  • Appropriate speech volume: People with social phobias tend to speak very quietly, making it difficult for them to communicate with others.
  • Intonation: Learning which words to emphasise in conversation is important for conveying different meanings. “Is Dave going home?” has a different meaning to “Is Dave going home?”.
  • Expressing opinions: It is very difficult for some people to express their opinions on certain topics, particularly when the environment seems intimidating (e.g. the workplace).  SST helps people learn how to voice their feelings in a non-threatening manner.
  • Self-confidence: People who are fearful in social situations are, more often than not, the people who get bullied and walked over because they cannot stand up for themselves. SST helps people learn how to stand up for their own rights.
  • Awareness: People with social anxiety are often irrational about how much others are judging them. No one else can tell when your palms are sweaty and your heart is racing, but when people obsess over these physiological processes, they become more stressed and anxious. SST teaches people to focus on what is happening in the social environment rather than their internal physiology.

Vocational SST

Work is an essential part of our lives and society. Studies show that when people do not work, they feel depressed and unsatisfied. Thus, situating mentally ill people in the workplace has become a primary aim of rehabilitation. In order for people to maintain a job, they must have the necessary social skills. The lack of these is why many people are unable to stay employed.

It is best to adapt vocational SST to a specific job. It is very difficult for mentally ill patients to generalise workplace social skills to any environment, as different jobs require different relations.

Dating SST

An exciting and important part of human life is our interaction with people to whom we are sexually attracted. However, for many people who experience social dysfunction, the prospect of dating is very intimidating and threatening. With the right social skills, dating can be a more relaxing and enjoyable experience. The regular social skills are focused on in SST, as well as ones specific for dating:

  • Planning dates
  • Asking for dates
  • Increasing physical attractiveness
  • Flirting: Nonverbal communication and verbal communication
  • Complimenting and receiving compliments
  • Active listening

Maintaining the skills learnt in therapy

PRACTISE, PRACTISE, PRACTISE! There is no other way to maintain or improve skills. If a skill is practised enough, it will become second nature, much like driving a car. People who have social difficulties will never improve by avoiding social situations. The skills learnt in SST must be remembered and constantly used in day to day activities. This is the only way you will overcome your social issues.

You should also attend follow-up psychotherapy sessions.

Effectiveness

Social skills training can be very effective if you have self-efficacy. If you are consistent and determined, practise your skills and come back for follow-ups, you are likely to benefit from SST.

References

  1. Myers DG. Chapter 17: Social Psychology. In: Brune C. Psychology 7th Edition. New York: Worth Publishers; 2003. 694-741.
  2. Bellack AS. Skills training for people with severe mental illness. Psychiatric Rehabilitation Journal. 2004; 27(4): 375-391.
  3. Kopelowicz A, Liberman RP, Zarate R. Recent advances in social skills training for schizophrenia. Schizophrenia Bulletin. 2006; 32(1): S12-23.
  4. Hofmann SG. Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy. 2005; 36(4): 193-209.
  5. Dam-Baggen RV, Kraaimaat F. Group social skills training or cognitive group therapy as the clinical treatment of choice for generalised social phobia? Journal of Anxiety Disorders. 2000; 14(5): 437-51.
  6. Rao PA, Beidel DC, Murray MJ. Social skills interventions for children with Asperger’s syndrome or high-functioning autism: A review and recommendations. Journal of Autism and Developmental Disorders. 2008; 38(2): 353-61.
  7. DeRosier ME. Building relationships and combating bullying: Effectiveness of a school-based social skills intervention. Journal of Clinical Child and Adolescent Psychology. 2004; 33(1): 196-201.
  8. Seo JM, Ahn S, Byun EK, Kim CK. Social skills training as nursing intervention to improve the social skills and self-esteem of inpatients with chronic schizophrenia. Archives of Psychiatric Nursing. 2007; 21(6): 317-26.
  9. Cheung LC, Tsang HW. Factor structure of essential social skills to be a salesperson in retail market: Implications for psychiatric rehabilitation. Journal of Behaviour Therapy and Experimental Psychiatry. 2005; 36(4): 265-80.
  10. Curran JP. Social skills training and systematic desensitisation in reducing dating anxiety. Behaviour Research and Therapy. 1975; 13(1): 65-8.
  11. Dilk MN, Bond GR. Meta-analytic evaluation of skills training research for individuals with severe mental illness. Journal of Consulting and Clinical Psychology. 1996; 64(6): 1337-46.

Dates

Posted On: 6 August, 2008
Modified On: 24 March, 2014

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