Running Head: SOCIAL SKILLS TRAINING 1

Social Skills Training in Adults with Schizophrenia

Improves Social Functioning
Jessica Brauzer and Tambra Rasmussen
The University of Utah Department of Occupational & Recreational Therapies
Running Head: SOCIAL SKILLS TRAINING 2

Introduction Commented [AT1]: running head should be different on

1st page vs other pages

According to the World Health Organization (2016), more than 21 million people worldwide are

affected by schizophrenia. Per Chong et al. (2016), schizophrenia was one of the top 25 causes of

disability worldwide in 2013. Chong et al. also reported that the United States spends up to $60 billion

dollars per year on direct and indirect care for people with schizophrenia. From these statistics, it is

clear that schizophrenia can be both a financial burden for the community as well as an emotional

burden for those directly affected. Some people with schizophrenia are unable to live independently

due to their symptoms. A diagnosis of schizophrenia or schizoaffective disorder makes day to day

activities very difficult, and may significantly impact interpersonal relationships. It is a diagnosis that has

been stigmatized by the general public, and is not always understood by family members and

friends. The associated symptoms are overarching into all aspects of daily life, potentially taking a

physical and emotional toll on the individual experiencing them. Commented [AT2]: very nice first paragraph

There are three main categories of schizophrenic symptoms, positive symptoms, negative

symptoms, and cognitive symptoms. All three categories have the potential to affect the social Commented [AT3]: probably should have cited the DSM
or something in this paragraph
functioning of people experiencing them. Positive symptoms are what most people associate with

schizophrenia and may include hallucinations such as hearing voices or seeing things that are not there,

delusional thoughts, disorganized thinking, and in severe cases, perseverant movements such as rocking

back and forth. Negative symptoms can manifest as issues with volition, a flat affect, and a reduction in

feeling emotions. Negative symptoms may be misdiagnosed as other disorders such as depression, or

may look like indolence to someone who is unfamiliar with schizophrenia. Cognitive symptoms may

consist of difficulty with executive function, impaired working memory and trouble focusing. Overall, it

is a disorder that is difficult to manage without the use of up to date evidence based interventions.

It is imperative to conduct and examine research focused on the most effective evidence based

treatments for people living with schizophrenia in order to improve their quality of life and the quality of
Running Head: SOCIAL SKILLS TRAINING 3

life of those who act as caregivers. There are many potential treatments for schizophrenia including

medication, hospitalization, Psychotherapy, Family Therapy, Electroshock Therapy, Cognitive Behavioral

Therapy, and Social Skills Training (SST). Occupational therapists working with schizophrenic clients Commented [AT4]: clients with schizophrenia

often use SST as an intervention. Though multiple research studies have been completed on SST as an

intervention for schizophrenia, there is not a consistent measurement of outcomes. Additionally,

sample sizes have been historically small. Empirical evidence to support the effectiveness of SST to

improve positive, negative, and cognitive symptoms in individuals with schizophrenia is lacking. The

purpose of this systematic review is to determine if SST is an effective intervention for adults with

schizophrenia. Commented [AT5]: Very nice job restructuring the intro.

It reads really well!

Methods Commented [AT6]: bold and no extra spaces

In order to find our articles, we used the CINAHL and PubMed databases. Initially we searched

for schizophrenia with no exclusion criteria which yielded 12,688 articles on CINAHL and 125,573 articles

on PubMed. We narrowed our search by using both schizophrenia and SST as our inclusion

criteriasearch terms. This yielded 95 articles on CINAHL and 479 articles on PubMed. Finally, we

excluded articles that were published more than ten years ago. Limiting our date range produced 33

articles on CINAHL and 227 on PubMed. To further narrow our list, articles needed to specifically

address SST as an intervention and use SST along with occupational therapy. We only found one article

specific to occupational therapy. Next, we expanded our inclusion criteria by looking for articles that

were Randomized Control Trials (RCT) using SST in order to show the highest levels of evidence possible

in our results. We also included studies with a non-randomized pre-posttest design as well as single

group studies with a pre-posttest design. Finally, we confirmed that articles were in English or

translated to English. This narrowed the studies used to a total of ten articles including the occupational

therapy specific study. We applied the PeDro scale to the RCT’s to better determine the levels of
Running Head: SOCIAL SKILLS TRAINING 4

quality. The RCT’s used ranged from 6-7 on the PeDro scale. Levels of evidence for all articles ranged

from 1-3. Commented [AT7]: ok, so how did you judge the quality
of these?

Results Commented [AT8]: bold

Bucci et al. (2013) examined 72 patients with schizophrenia in a two group randomized control

trial design. The study looked at Social Skills Individualized Training (SSIT) versus Neurocognitive

Individualized Training (NIT) as an effective intervention for real world function. Results from the study

showed that the NIT group demonstrated significant improvement in attention, verbal memory, and

portions of executive function. The SSIT group showed significantly worsening results in visual-spatial

memory and it did not have an effect on other cognitive areas that were studied. Regarding real world

functioning results, the NIT group improved significantly in interpersonal relationships, whereas, the

SSIT group showed significant improvements on the quality of life scale. Overall, results from this study

do not support SST as an effective treatment for improving social functioning for patients with

schizophrenia. This study contained several limitations. One of the interviews used to confirm

diagnoses of the patients was the MINI-plus because it was easier to use, however the DSM-IV would

have been better as it is a more comprehensive assessment tool. Secondly, the study was a smaller

randomized control trial design. The optimal design for this study would have included NIT and placebo,

NIT and SSIT, SSIT and placebo, and placebo. This however would have called for a larger sample size. Commented [AT9]: great first summary!

Granholm, Holden, Link, McQuaid, and Jeste (2013) examined the efficacy of Cognitive

Behavioral Social Skills Training (CBSST) as an effective psychosocial intervention to improve functioning

in older individuals with schizophrenia, and whether defeatist performance attitudes were associated

with change in functioning in CBSST. They used an 18-month, single-blind RCT to study 79 veteran and

non-veteran participants with schizophrenia between the ages of 45-78. The comparison intervention in

this study, Goal-Focused Supportive Contact (GFSC), was supportive group therapy that focused on
Running Head: SOCIAL SKILLS TRAINING 5

achieving functional goals. Results from the study found that both treatments showed significant

improvements in amotivation, depression, anxiety, positive self-esteem, and life satisfaction for adults

with schizophrenia. However, CBSST provided significantly better social functioning results for adults

with schizophrenia, thus it was inferred that, “…functioning improved to a greater extent in CBSST than

in GFSC, suggesting CBT and SST interventions may be more potent interventions to improve

functioning, especially for individuals with more severe defeatist attitudes and social skills deficits”

(Granholm et al., 2013, p?). One limitation of the study included participant dropout that varied across

assessments because of either refusal to participate or lost interest, however, 81% of the randomized

participants were included in the analyses.

Granholm et al. (2014) examined two treatment interventions designed to improve social skills

functioning in patients with schizophrenia. This study was influenced by a prior 2013 study that was

previously conducted on older veteran and non-veteran patients with schizophrenia. They decided to

conduct this study on patients with schizophrenia over the age of 18, making the sample age population

broader and younger. They used a 21 month RCT to study 149 patients with schizophrenia and examine

CBSST versus a GFSC. Results from the study showed that CBSST was found to significantly improve

negative symptoms, which can considerably impact day to day life for patients with

schizophrenia. Overall, results from this study show that CBSST is an effective treatment intervention to

improve social skills functioning and negative symptoms for patients with schizophrenia. A limitation of

this study was the high dropout rate, which will limit result interpretations.

Horan et al. (2009) examined a 6 week clinical trial which evaluated a 12-session social cognitive

skills training program designed to address four aspects of social cognition (affect perception, social

perception, attributional style, and Theory of Mind) in outpatients with schizophrenia or schizoaffective

disorder. Thirty- one stabilized outpatients with schizophrenia in an RCT were randomly assigned to a

social cognition skills training intervention or a time-matched control condition, Illness Self-
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Management and Relapse Prevention Skills Training. Results from the study showed that the social

cognition group exhibited significant improvement in facial affect perception, which was one of the four

targeted social domains. The participants in this group stated that the SST intervention was engaging

and applicable to their daily life. These results suggest the efficacy of a social cognitive intervention for

community-dwelling outpatients with schizophrenia, and how effective it will be in helping these

individuals to better interact with others in their everyday life. Some limitations of this study include

the small sample size, the predominantly male sample population which limited the generalizability of

the findings, and the brief period of training.

Kumar et al. (2015) examined the effectiveness of six months of SST on five residents living in an

inpatient facility with chronic schizophrenia. They conducted a single group, pre-posttest design and

administered a Social Adaptive Functioning Evaluation (SAFE) scale on these individuals in order to see if

their behavior could be changed. Results from the study showed that SST helped to decrease social

anxiety, enhance social functioning, and maintain personal hygiene. The patients significantly improved

on medication adherence and their ability to make requests or express feelings on any problematic

issues. Limitations of this study include small sample size, no control group, and being comprised of

only male participants.

Kurtz, Mueser, and La Greca (2008) examined whether SST was effective in improving social

skills in patients with schizophrenia. This 1,521 sample size meta-analysis was conducted using 22

Randomized Control Trials to support the positive impact of SST on content mastery of skills, everyday

life social skills, psychosocial functioning, and negative symptoms. One limitation from this meta-

analysis includes failure to report crucial sample information. Some of the studies did not report age of

illness onset or medication dosage indicating that some variables may have had an impact on SST.

Park et al. (2011) examined the usefulness of Virtual Reality (VR) in a social rehabilitation

setting. This study was designed to compare SST using VR role-playing (SST-VR) to traditional role-
Running Head: SOCIAL SKILLS TRAINING 7

playing (SST-TR). This study consisted of a randomized controlled trial which included 91 inpatients with

schizophrenia who were assigned to either SST-VR or SST-TR. Results from the study showed that during

the 10 group sessions, the SST-VR group showed greater interest in SST and comprehension of the skills

than the SST-TR group. After the 10 group sessions, the SST-VR group had signif? greater improvement

in conversational skills and assertiveness than the SST-TR group, but less in nonverbal skills. This study

displayed that implementing VR into SST may be beneficial in improving conversational skills and

assertiveness for adults with schizophrenia. One limitation of the study is based on the technology

used. Although the technology is innovative it is also expensive and requires additional resources.

Rus-Calafell, Gutierrez-Maldonado, and Ribas-Sabate (2013) explored the effectiveness of using

a VR program to improve social skills in patients with schizophrenia. This single group, pre-posttest

design studied 15 patients with schizophrenia from Spain that were between the ages of 18-55. Results

from the study indicate that VR social skills training helped significantly? improved negative symptoms,

anxiety, and social activities for adults with schizophrenia. A limitation of this study was that results

were based off a small, uncontrolled, pilot study.

Shimada, Nishi, Yoshida, Tanaka, and Kobayashi (2016) examined a quasi-experimental, non-

randomized control trial that included 51 patients with schizophrenia from an inpatient hospital. The

study examined the effects of adding an Individualized Occupational Therapy program (IOT) to a Group

Occupational Therapy program (GOT) to see if it would improve neurocognition, positive and negative

symptoms, and social functioning among recently hospitalized patients with schizophrenia. Results from

the study showed that the GOT + IOT group showed significant improvements in memory, verbal

fluency, attention, executive function, and overall symptoms, all of which are important for everyday

social functioning. This study suggests that a combination of GOT + IOT in psychiatric facilities may

improve psychosocial treatment of schizophrenia. Limitations of the study include short-term

Running Head: SOCIAL SKILLS TRAINING 8

hospitalized patients with acute schizophrenia and limited results of the study because it was conducted

at a single site.

Weinberg, Shahar, Davidson, McGlashan, and Fennig (2009) examined a three group, non-

randomized trial that studied the role that employment status had on the association between negative

symptoms and social functioning on 77 patients diagnosed with schizophrenia. They predicted that

those who worked in a community setting would have a higher level of social functioning over

time. Results from this study showed that patients with schizophrenia working in a mental health

setting, or those who are unemployed, significantly improved in their negative symptoms and had better

social skill functioning than those working in a community setting. Limitations of the study include

sample size, the utilization of only two waves of measurements, and the length of time of previous

employment in each of the employment settings. Commented [AT10]: beautiful job on your results! Very
happy with this

Discussion Commented [AT11]: bold

Results from this research study suggest that SST is an effective treatment intervention to

improve negative, positive, and cognitive symptoms in adults with schizophrenia. Improvements were

also noted in attention span, recognizing facial affect, assertiveness, feelings of social anxiety, and

medication compliance, all of which may impact a person’s social functioning. Park et al. (2011) and

Rus-Calafell et al. (2013) examined the effectiveness of VR role-play as an intervention for improving

social skills as opposed to more traditional methods. From their studies it was determined that

conversational skills and assertiveness improved in the SST-VR group more than the SST-TR group, but

less in nonverbal skills. Granholm et al. (2013) and Granholm et al. (2014) found that CBSST is a more Commented [AT12]: probably could just say Granholm et
al. (2013; 2014)
effective treatment than GFSC because it significantly improved negative symptoms, increased

motivation, and improved life satisfaction in adults with schizophrenia. Their research was found to be
Running Head: SOCIAL SKILLS TRAINING 9

applicable to a wide range of ages, as one study examined older veteran and non-veterans and the other

studied ages 18 and above.

Shimada et al. (2016) was the only article applicable to an occupational therapy (OT) setting, and

their findings demonstrated that GOT + IOT improves psychosocial functioning in adults with

schizophrenia. Bucci et al. (2013) was the sole article found that indicated worsening effects on

schizophrenic symptoms by adding SST. Their study found that neurocognitive training was more

effective.

Overall, the common assessment measures were consistent across the research articles and

showed that adding a social skills type intervention improved overall functioning in adults with

schizophrenia. Findings from these articles demonstrate that SST is a promising intervention in an OT

setting. These articles suggest that utilizing SST is effective for both inpatient and outpatient OT

clinics. SST was found to help adults with schizophrenia improve eye contact with others, increase their

assertiveness and confidence, and improve verbal and non-verbal conversational skills. SST is also

applicable to OT because it is useful for a wide age range of adults with schizophrenia. Although we

found that SST is an effective intervention, further research appears warranted based on our

findings. Most of the previously completed research we discovered regarding SST in adults with

schizophrenia showed an improvement in social functioning. Unfortunately, most of these studies were

done with small samples or were short term. Common limitations from these studies include small

sample size, higher dropout rate, and broadening of their research sites. Future research is necessary to

better demonstrate that SST improves social functioning in adults with schizophrenia. Based on our

findings, a Level A, Class 11a clinical recommendation would be a reasonable and beneficial treatment Commented [AT13]: ? pretty sure you mean IIa not 11a

for this type of population.

Running Head: SOCIAL SKILLS TRAINING 10

References

Bucci, P., Piegari, G., Mucci, A., Merlotti, A., Chieffi, M., De Riso, F., De Angelis, M., Di Munzio,

W., & Galderisi, S. (2013). Neurocognitive individualized training versus social skills

individualized training: a randomized trial in patients with schizophrenia. Schizophrenia

Research, 150, 69-75

Chong, H. Y., Teoh, S. L., Wu, D. B., Kotrium, S., Chiou, C., & Chaiyakunapruk, N. (2016)

Global economic burden of schizophrenia: a systematic review. Neuropsychiatric Disease

Treatments, 12, 357-373 doi:10.2147/NDT.S96649

Granholm, E., Holden, J., Link, P. C., McQuaid, J. R., & Jeste, D. V. (2013). Randomized controlled trial of

cognitive behavioral social skills training for older consumers with schizophrenia: Defeatist

performance attitudes and functional outcome. The American Journal of Geriatric Psychiatry :

Official Journal of the American Association for Geriatric Psychiatry, 21(3), 1-17

doi:10.1016/j.jagp.2012.10.014.

Granholm, E. Holden, J., Link, P. C., & McQuaid, J. R. (2014). Randomized clinical trial of cognitive

behavioral social skills training for schizophrenia: improvement in functioning and experiential

negative symptoms. Journal of Consulting and Clinical Psychology, 82,(6), 1173-1185 doi:

10.1037/a0037098

Horan, W. P., Kern, R. S., Shokat-Fadai, K., Sergi, M. J., Wynn, J. K., & Green, M. F. (2009). Social

cognitive skills training in schizophrenia: an initial efficacy study of stabilized outpatients.

Schizophrenia Research, 107(1), 47-54. doi:10.1016/j.schres.2008.09.006

Kurtz, M. M., Mueser, K. T., & La Greca, A. M. (2008). A meta-analysis of controlled research of social
Running Head: SOCIAL SKILLS TRAINING 11

skills training for schizophrenia. Journal of Consulting and Clinical Psychology, 76, 491-504. doi:

10.1037/0022-006X.76.3.491.

Kumar, B., & Singh, A. R. (2015). Efficacy of social skills training for the persons with chronic

schizophrenia. The Qualitative Report, 20(5), 660-696. Retrieved from

http://nsuworks.nova.edu/tqr/vol20/iss5/10

Park, K. M., Ku, J., Choi, S. H., Jang, H. J., Park, J. Y., Kim, S. I., & Kim, J. J. (2011). A virtual reality

application in role-plays of social skills training for schizophrenia: a randomized, controlled trial.

Psychiatry Research, 189(2), 166-172. doi:10.1016/j.psychres.2011.04.003

Rus-Calafell, M., Gutierrez-Maldonado, J., & Ribas-Sabate, J. (2013). A virtual reality-integrated program

for improving social skills in patients with schizophrenia: a pilot study. Journal of Behavior

Therapy and Experimental Psychiatry, 45, 81-89

Shimada, T., Nishi, A., Yoshida, T., Tanaka, S., & Kobayashi, M. (2016). Development of an

individualized occupational therapy programme and its effects on the neurocognition,

symptoms and social functioning of patients with schizophrenia. Occupational Therapy

International, 23, 425–435. doi: 10.1002/oti.1445.

Weinberg, D., Shahar, G., Davidson, L., McGlashan, T. H., & Fennig, S. (2009). Longitudinal associations

between negative symptoms and social functioning in schizophrenia: the moderating role of

employment status and setting. Psychiatry: Interpersonal and Biological Processes, 72(4), 370-

381. doi: 10.1521/psyc.2009.72.4.370

World Health Organization. (2016) Schizophrenia. Retrieved from

http://www.who.int/mediacentre/factsheets/fs397/en/
Running Head: SOCIAL SKILLS TRAINING 12

Commented [AT14]: your chart is super nice. 

Study Participants Therapy Characteristics Outcome Measure Results

Bucci et al. N(total)=72 Time: 12 months NIT NIT:improvement in attention,

(2013) N(NITgroup,)=32 (baseline assessment, SSIT verbal memory, portions of
Level 1 N(SSITgroup)=40 6 mo rehab PANSS executive function.
Randomized NIT group assessment, 6 month QLS
Control Trial Males= 81% rehab assessment) CPT
(RCT) Females= 19% Place: Outpatient AVLT
SSIT no impact,
PeDro=7 Mean Age=39.48 units of 5 sites PMIT
neurocognitive function
SSIT group Group based WCST
worse
Males=74% TMT
Females=26% CI
Mean Age= 37.27
Real world functioning: NIT
group showed improvement
in interpersonal relationships

SSIT group showed

improvement in QLS

Granholm et N(total)=79 Time: 36 session (2 ILSS Functioning: signif. ↑ or more

al. (2013) N(Veteran)=27 hours each session), 18 DPAS positive in CBSST than in
Level 1 N(Non-Veteran)=52 month period (baseline CMT GFSC, esp. for participants
Randomized N(CBSST) (Cognitive assessment, 9 month PANSS w/ more severe defeatist
Control Trial Behavioral Social Skills assessment, 9 month Variety of cognitive performance attitudes
(RCT) Training)=41 assessment) assessments
PeDro=6 N(GFSC) (Goal-Focused Place: Outpatient clinic
Supportive Contact)=38 Group-based
Both treatments: comparably
Males=55%
significant ↑ in motivation,
Females=45%
depression, anxiety, positive
Mean Age=55
self-esteem and life
satisfaction.

Granholm et N(total)= 149 Time: 36 session (2 ILSS CBSST group showed

al. (2014) N(CBSST)=73 hours each session), 21 DPAS greater ↑ in negative
Level 1 N(GFSC)=76 month period (baseline, CMT symptoms, functioning, and ↓
Randomized N(CBSST) 4.5 month, 9-month, MASC a defeatist attitude than
Control Trial Males= 63% 15-month, and 21- PSR Toolkit GFSC.
(RCT) Females= 37% month follow-up Other various
PeDro=6 Mean Age=41.1 assessments. cognitive
N(GFSC) Place:Outpatient clinic assessment, similar
Both groups showed ↑ in
Males=70% Group-based to Granholm (2013)
positive symptoms
Females=30% study
Mean Age=41.6

Horan et al. N(total)=31 Time:6 week clinical Facial Emotion Id Social Cognition group:large,
(2009) N(Social Cognition trial Test signif. ↑ in facial affect
Level 1 Group)=15 12 one-hour session, PONS Test-->Social perception
Randomized N(Control Group)=16 2x/week Perception
Control Trial Gender= 87% Male: Training took place in AIHQ-->attributional
(RCT) SC group=100% Male: groups of 6 participants style
Results support: efficacy of a
PeDro=6 Control group with two facilitators TASIT
social cognitive intervention
Mean Age=50.7 Place: Outpatient clinic MCCB
for community-dwelling
Social Cognition group Group -Based
outpatients and encourage
Mean Age=45.9
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24-item Brief further development of this tx

Psychiatric Rating approach
Scale
Likert scales

Kumar & N(total)=5 males Time: 6 months, 1.5 SAFE scale SST:helped ↓ social anxiety,
Singh (2015) N(35 y/o)=2 hours,1x/week ↑ social functioning, maintain
Level 3 N(45 y/o)=3 (Baseline assessment personal hygiene, ↑
1-group pre- Population= India and 6 mo assessment) medication adherence, ↑
posttest Mean Gender= 100% Place: Patient’s work patients ability to make
design male sites, library, and wards requests/express feelings/
Mean age could not be Group-Based sort out problematic issues
determined from the Patients showed ↑ in
information provided in the confronting difficult situations
study

Kurtz, Mueser, N(total)=1521 Time:N/A Proximal Measures: SST:found to ↑ psychosocial

& La Greca Range of sample Place: N/A Content Mastery functioning in schizophrenia
(2008) sizes=16-240 participants Exams
Level 1 Article Date ranges=1973- Proximal Mediational
Meta-analysis 2006 Measures: Social
Specific outcomes: “skills and
of 23 RCTs Skills and Daily Living
educational groups higher on
Randomized Male=71% Skills
knowledge & skills tests than
Control Trials Female=29% Intermed. Measures:
tx as usual group”.
(RCTs) Mean age= 37.7 y/o Psychosocial
PeDro=N/A functioning, Negative
symptoms
Distal Measures: SST showed ↑ in personal
Other psychiatric wellbeing and total subscales
symptoms, Relapse, of the SAS II than supportive
rehospitalization group therapy intervention
group.

SST group showed ↑ in

symptoms, global function,
lower relapse and high
compliance with medication

Park et al. N(total)=91 Time: 10 semi-weekly Primary outcomes→ Throughout 10 sessions:

(2011) N(SST-VR)=46 group sessions Social Skills: voice, SST-VR group showed
Level 1 (Social Skills Training- Place: Inpatient Clinic non-verbal and greater interest in SST and
Randomized Virtual Reality Role Play) Group Based conversational skills generalization of the skills
Control Trial N(SST-TR)=45 using SBS than the SST-TR group
(RCT) (Social Skills Training- Secondary
PeDro=6 Traditional Role Play) outcomes→ RAS
Males=6.6% RCS SPSI-R
After SST: SST-VR group ↑
Females=93.4%
in conversational skills and
Mean Age=29.65
assertiveness than the SST-
TR group, but ↓ in nonverbal
skills

The VR application in role-

plays of SST may be a useful
supplement to traditional SST
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Rus-Calafell, N(total)= 15 Time: 16, one- hour Psychopathology: ↑ in negative symptoms was
Gutierrez- Population= Spain sessions PANSS still being maintained at
Maldonado, & Males=58.3% Place: Inpatient clinic Social Performance & follow up testing
Ribas-Sabate Females =41.7% Individual-based anxiety: AI
(2013) Mean Age=36.5 SSIT
Level 3 SADS
Patients were more assertive
1-group pre- SFS
post tx, but this result was not
posttest
maintained at the time of
design
follow up testing
(Pilot Study)

↑ in social interactions were

shown to ↑ post-test as well
as in follow up testing

Shimada et al. N(total)=51 Time: Baseline Prim. outcome: Participants in GOT + IOT
(2016) N(GOT+IOT)=30 assessment & 3 mo BACS-J -->assess demonstrated signif. ↑ in
Level 2 (Group Occupational post-assessment cognitive functioning verbal memory,working
Non- Therapy + Individualized Place: Inpatient clinic Secondary outcomes: memory, verbal fluency,
randomized Occupational Therapy) Group-based PANSS--> assess attention, and executive
Design N(GOT)=21 symptoms function & symptoms
(voluntarily Males=51.9% GAF scale --> assess compared to those in stand-
assigned) Females=48.1% social functioning and alone GOT group
Mean Age=42.23 symptoms

Weinberg et N(total)=77 Time:6 week PANSS Individuals with high levels of

al. N(unemployed)=34 intervention SFS negative symptoms who were
(2009) N(employed,mental health Place: Outpatient clinic employed in community
Level 2 setting)=23 Group-based settings revealed substantial
Non- N(employed,community ↓ in social functioning over
Randomized setting)=20 time compared to
Design Population=Israel unemployment or to
(voluntarily Males=67% employment in specialty
assigned) Females=33% mental health settings
Mean Age=42.5

Note:AI=Assertion Inventory;AVLT = (Auditory Verbal Learning Task)BACS-J=Brief Assessment of Cognition in Schizophrenia-

Japanese version;CI = (Category Instances);CMT=(Comprehensive Module Test);CPT = (Continuous Performance Test-AX);DPAS
=(The Defeatist Performance Attitude Scale);GAF scale=Global Assessment of Functioning;ILSS=(Independent Living Skills
Survey);MASC=(Maryland Assessment of Social Competence);MCCB=(Matrics Consensus Cognitive Battery);NIT =
(Neurocognitive Individualized Training);PANSS = (Positive and Negative Syndrome Scale);PMIT = (Picture Memory and
Interference Test);PSR Toolkit=(Psychosocial Rehabilitation Toolkit);QLS = (Quality of Life Scale);;RAS= (Rathus Assertiveness
Schedule);RCS= (Relationship Change Scale);SADS=Social Avoidance and Distress Scale;SAFE scale=Social Adaptive
Functioning Evaluation; SBS (Trower’s Social Behavior Scales);SFS= Social Functioning Scale;SPSI-R= (Social Problem Solving
Inventory-Revised);SSIT=Simulated Social Interaction Test;SSIT = (Social Skills Individualized Training);TASIT=(The Awareness of
Social Inference Test);TMT = (Trail Making test);WCST = (Wisconsin Card Sorting Test)

Note: ↑=significantly improve or increase, ↓=decrease in performance