Effectiveness of Structured Social Skills Training versus Conventional Occupational Therapy in Enhancing Social Performance and Skill Retention in Chronic Schizophrenia: A Randomized Controlled Trial

Abstract

Background: Social performance deficits are core disabling features of chronic schizophrenia that respond poorly to pharmacotherapy alone. This trial compared a structured Social Skills Training (SST) programme with Conventional Occupational Therapy (COT) in improving social performance and its retention after treatment cessation.
Methods: In an assessor-blinded randomized controlled trial, 80 clinically stable patients with chronic schizophrenia (18-50 years) were block-randomized to SST (n = 40; 45 minutes of six-component SST plus 45 minutes of COT, twice weekly for 12 weeks) or COT (n = 40; 90 minutes of COT on the same schedule). Social performance was assessed with the culturally validated Vellore Assessment of Social Performance (VASP) at baseline, 12 weeks (post-intervention) and 4 weeks post-intervention (follow-up). Mann-Whitney U, Friedman and Bonferroni post-hoc tests were used.
Results: Groups were comparable at baseline (VASP p = 0.367). Overall VASP scores improved from 45.98 ± 6.35 at baseline to 54.03 ± 7.16 post-intervention and 52.70 ± 6.97 at follow-up. The SST group significantly outperformed the COT group post-intervention (mean rank 52.08 vs 28.93; U = 337.0; p < 0.001) and at follow-up (49.01 vs 31.99; U = 459.5; p = 0.001). Within-group gains were significant in both groups, but stronger in SST (pre vs post, p = 0.001) than COT (p = 0.016), and post-test gains were retained at follow-up in both groups without significant decline.
Conclusion: Structured SST integrated with occupational therapy is superior to conventional occupational therapy alone in improving social performance in chronic schizophrenia, and the gains are retained at least four weeks after treatment cessation.