Social skills training for persons with mental illness

As social beings we interact, learn and are interdependent. Social skills are components of behavior that help an individual to learn, understand and adapt across various social circumstances. The Albert Ellis Institute in New York defines social skills as the skill or ability to facilitate interactions, recognize and reciprocate emotional cues from others, and communicate with others in various social situations.

Overall, social skills are abilities that can be learned and that are necessary to get along with others, and to create and maintain satisfying relationships in a community or society at large.

Importance of social skills training for persons with mental illness

Persons with mental illness might have social skills deficits such as an inability to express their thoughts, feelings and emotions appropriately. Such deficits in social skills in some persons with mental illness (and not all) could arise either as part of the illness, or because the early onset of the illness may have restricted their opportunities to learn new social skills, or use the skills that they have learned. Sometimes symptoms of the mental illness, such as anxiety, may interfere with the utilization of the skill. 

Many research studies have shown the relationship of cognitive deficits such as poor attention, incoherent speech, difficulty in learning and retaining information, to the social functioning of persons with mental illness. Emphasizing the role of social skills training, Dr Poornima Bhola, associate professor of psychology, NIMHANS, says "Social skills are important in the process of recovery and the training can help persons with social skill deficits to learn specific skills needed to live, learn and work in the community with minimum support. Addressing social skill deficits in persons with mental illness is an essential component in the treatment process."

Social skills training can help persons with mental illness lead a functional life. 

Social skills include:

• Verbal – such as the form, structure, content, context and amount of speech

• Nonverbal – Eye contact, facial expressions, posture and personal distance

• Paralinguistic – Volume, pace, tone and pitch

• Social perception – processing of social information to make appropriate decisions and responses

• Assertiveness

• Conversational skills – such as starting and sustaining a conversation  

• Expressions of empathy, affection, sadness, and similar emotions that are appropriate to the context and expectations of the society

• Other skills related to management and stabilization of one's illness

Depending on the individual's or family’s needs and requirements, the individuals are trained either in generic social skills such as greeting someone, or making a request, and specific social skills which are work-related, such as assertiveness, negotiation skills, grooming, interaction skills with employers and colleagues. Also, the training is done step wise from simple to complex skills. 

Individualized and group training

Social skills training can be done in both an individual and a group setting. In India, where the cultures and languages of patients tend to be varied, an individualized training is preferred. However, in rehabilitation settings where the group is more or less homogeneous in language or level of skill deficits, the training is done in a group, involving a facilitator. The facilitator leads the group and encourages equal participation by all the members of the group.

Role of family

In the Indian context, family gatherings are an important aspect of socialization. Families play an important role in being the first to identify social skill deficits. Family members or caregivers can be therapeutic allies in the training process. Families can ensure a safe environment for the individual to apply the skills learned in an individual setting. 

Real-world application of social skills training

Social skills training varies from person to person. The structure of social skills training is decided based on the individual’s:

• Level of functioning

• Skill deficits 

• Requirements or needs 

• Personality prior to the illness 

Therefore, the focus of social skills training is to work within the person’s life situation, cultural background, gender and the basic personality. While doing so, it is important to see if the person is comfortable.

According to the skill identified, it is broken down into simple tasks. These tasks are taught and rehearsed in an individual setting through role-modeling, role plays, videos and followed by feedback and assignments. The skills learned can be translated differently in different environments and settings. To reduce the gap between training and real-world application, the individuals need opportunities, encouragement, and reinforcement for practicing the skills in relevant situations.

This article has been written based on inputs given by Dr Poornima Bhola, associate professor of clinical psychology, NIMHANS