Cognitive factors in the social skills of schizophrenic patients: implications for treatment

This chapter illustrates how changes have occurred in a clinical research program designed to develop and evaluate treatment techniques for improving the social skills of chronic schizophrenic patients. These changes have been primarily in the definition of a socially skilled response; rather than defining such responses solely in terms of motor behaviors, we have attempted to include several cognitive elements hypothesized to be critical aspects of the process of producing an effective social response. The inclusion of these cognitive elements suggests that the findings of experimental psychopathologists about the perceptual, attentional, and information-processing dysfunctions of schizophrenic individuals may be highly relevant to the development of more effective treatment techniques. For example, a patient may make an ineffective social response because of an attentional or perceptual dysfunction that results in inaccurate reception of critical social and situational stimuli. Similarly, an ineffective response may be produced because of an information-processing dysfunction that makes a patient generate a restricted number of alternative and evaluate them incorrectly. If these attentional, perceptual, and information-processing dysfunctions are not simply linked to variations in symptomatology but represent enduring deficiencies, then an effective treatment strategy may require either that these dysfunctions be remedied (if at all possible) or that an environment be created that compensates for them. Of course much more information is needed about the extent to which these dysfunctions might affect performance in the social situations patients commonly face. Certain situations may be relatively simple, requiring attention to only one or two critical stimuli and a response that is well within the social repertoires of most patients. Other situations may be far more complex, requiring a high degree of sustained attention and complex, "subtle" responses that are not within the social repertoires of most patients. For example, anecdotal observations made during the use of the techniques to teach friendship /dating skills suggest that ongoing conversations are particularly difficult for patients. These situations seem to require a high degree of sustained attention to keep track of shifts in topics, detect changes in the partner's emotions, and introduce planned changes in the stream of conversation. Other situations, such as asking for items from nurses, seem relatively simple and can be performed fairly well by patients, even those who are highly symptomatic.(ABSTRACT TRUNCATED AT 400 WORDS)