|Year : 2008 | Volume
| Issue : 1 | Page : 59-61
Brief social skills training (BSST) in a general hospital psychiatry unit in India
TM Ismail Shihabuddeen1, Susan Anand2, PS Gopinath3
1 Dept.of Psychiatry, Yenepoya Medical College, Deralakatte, Mangalore-575018, India
2 Yenepoya Nursing College, Deralakatte, Mangalore-575018, India
3 Emeritus Professor - Psychiatry, 24, KuvempuLayout, Gubbi Cross, Kothanur, Bangalore, India
T M Ismail Shihabuddeen
Dept.of Psychiatry, Yenepoya Medical College, Deralakatte, Mangalore-575018
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Social disability has been found to be a potent predictor of symptom exacerbations and rehospitalizations. It is clear that social skills training is an effective strategy. Accessibility for the mental health consumers and the availability of services are the two main reasons which highlights the felt need of the brief skill development program in the GHPU during their hospitalization. This article reviews the need for brief skills training to enhance client's social competence to reach optimal functioning which in turn may decrease the risk of relapse or revolving door syndrome and may prevent further deterioration of individual's skills during their long stay in a GHPU's.
Keywords: Brief Social Skills Training, General Hospital Psychiatry Unit.
|How to cite this article:|
Ismail Shihabuddeen T M, Anand S, Gopinath P S. Brief social skills training (BSST) in a general hospital psychiatry unit in India. Indian J Psychol Med 2008;30:59-61
|How to cite this URL:|
Ismail Shihabuddeen T M, Anand S, Gopinath P S. Brief social skills training (BSST) in a general hospital psychiatry unit in India. Indian J Psychol Med [serial online] 2008 [cited 2019 Nov 18];30:59-61. Available from: http://www.ijpm.info/text.asp?2008/30/1/59/43136
| Introduction|| |
Social skills are interpersonal behaviors that are socially acceptable or sanctioned in a particular community or society. When florid symptomatology is controlled by medication, most individuals who had psychiatric condition are left with social skills deficits due to various reasons. These deficit may increase the risk of relapse, where as enhanced social competence may decrease that risk. Social competence is based on the set of component response skills. These skills are learned or learnable.
| Concepts|| |
Social skill training was introduced in the 1970's mainly in the form of single case studies. Since then, the group format has been forward to be more popular as it is not only cost effective but also enhances generalization of skills by providing a learning experience (P.S.Gopinath & Kiran Rao, 1994). Impairment in social functioning is not simply a by product of positive and negative symptoms of Schizophrenia but an independent domain of the illness (Lenzeweger, M.F et al, 1991). Social dysfunction may results from three circumstances are:
- When the individual does not know how to perform appropriately.
- When he or she does not use skills in his or her repertoire when they are called for.
- When appropriate behaviors undermined by socially inappropriate behavior.
These circumstances are especially common in Schizophrenia (Bellack, A.S.et al, 1997). Poor social competence contributes to the improvised equality of life in many clients. This interferes with functioning within the family or in the work place. In addition, social disability has been found to be a predictor of symptom exacerbations and rehospitalization (P.S.Gopinath & Kiran Rao, 1994). The most promising strategy for alleviating social disability and enhancing social competence has been social skills training (Wallace, E.J.et al, 1980).
It is clear that social skills training is an effective strategy, more work needs to be done on issues pertaining to brief social skills training during hospitalization. The care must be taken while choosing the client for Brief social skills training (BSST). The factors that can affect social functioning such as severity of psychotic symptoms, motivational factors, environmental and neurobiological factors must be taken into consideration. The brief training is more conducive if a GHPU has a Day Care Centre attached to the Psychiatry wards. Team work approach is essential for effectiveness of the training. Nurse available in the wards need to be trained to communicate and deal with the identified client for encouraging and maintaining the learned skills or taught skills throughout the hospitalization.
Skills training which is often regarded as the principal intervention in Psychiatric Rehabilitation is grounded in the assumption that many clients are left with disability in- spite of optimal pharmco therapy. Skill development interventions systematically and directly attempt to change the clients' behavior in a comprehensive array of behavioral, cognitive and functional domains.
Psychosocial interventions are feasible and realistic at GHPU, when we consider the current mental health care system of our country. One finds that the major source of care for the person with psychiatric disability in our country is by GHPU's, may be due to the fact that these units are more accessible, approachable, less stigmatizing and families could easily visit and stay with the client. Proximity of the other medical departments ensures high quality of the care of the client associated with physical problems (Shihabuddeen Ismail, T.M, 2007).
Most clients with psychiatric conditions have some deficits in social skills and social role functioning. However, there is a considerable variability among clients in the precise nature and severity of those deficits. In assessing client's social skills the practitioner must answer the following four questions (Bellack, A.S & Morrison, R.L, 1982):
- Does the client manifest some dysfunctional interpersonal behavior?
- What are the specific circumstances or the situations in which the dysfunction occurs?
- What is the source of dysfunctions?
- What specific social skills deficits does the client have?
Self reports and interviews with either the client or collaterals provide indirect evidence about social behavior and social skills. Such of the client, but it always has limited reliability. The only way to determine precisely what the client does and does not do in a specific observation is to collect direct evidence by observing the person in the environment. Though ward behavior observation is conducive in a GHPU, direct observation is impractical in most clinical and research settings. The best strategy for dealing with the constraint is to have the client role play in simulated interactions that mimic the natural environment. Role playing is the widely used strategy for assessing social skills.
Steps in BSST:
- Identifying the client's problem behaviors as deficits and excesses.
- Identifying the strength to capabilities which serve as the template on which skill acquisition can be facilitated.
- Assess the diversity of disability in psychosocial role functioning, so that the realistic training module can be used.
- Involve the significant care giver for monitoring the progress and to be supportive for learning or re-learning.
- Consistent reinforcement and maintenance of therapeutic support by the multi disciplinary team members.
- Evaluation of progress during discharge in terms of skill development.
- Homework assignment to be monitored by the identified care giver.
- Follow-up review during OP visits for pharmacological interventions.
| Conclusion|| |
Skill development program has derived from social learning and human resource development principles which utilize active and directive learning approaches. Varieties of social skills training models are available to the contemporary practitioner. Brief social skills training is aimed at enhancing skills which can be learned during their hospitalization. This includes learning skills related to self care and personal hygiene, ward behavior, compliance behavior, interpersonal skills with significant others, ADL skills etc. This assumed to change the psychiatry ward environment better for the consumers. Eclectic approach may be used as per the assessed needs of the individual client.
| References|| |
|1.||Bellack, A.S et al (1997) 'Schizophrenia and social skills' In Social Skills Training for Schizophrenia' New York: The Guilford Press: 3-20. |
|2.||Bellack, A.S ; Morrison, R.L (1982) 'Impersonal dysfunctions' In A.S.Bellack,M. Hersen & A.E Kazdin (Eds) ' Interpersonal HANDBOOK OF Behavior modification and therapy (PP 717748) New York Plenum Press. |
|3.||Gopinath, P.S; Kiran Rao (1994) 'Rehabilitation in Psychiatry: an overview' Indian Journal of Psychiatry, 36 (2) 45-60. |
|4.||Lenzenweger M.F; Dwarkin, R.H & Wethington, E (1991) 'examining the underlying structure of schizophrenic phenomenology: Evidence for a three process model, Schizophrenia Bullettin, 17,515-524. |
|5.||Shihabuddeen Ismail, T.M (2007) 'Eclectic approach to psychosocial interventions at General Hospital Psychiatry Unit', Annual National Conference of Indian Psychiatric Society Souvenir, 42-44. |
|6.||Wallace, C.J et al (1980) 'a review and principles of social skills training with Schizophrenia patients' Schizophrenia Bulletin, (6), 42-63. |