One of the central problems presented by schizophrenics is related to serious difficulties in the area of interpersonal and social interaction . Positive symptoms (hallucinations or delusional ideas), negative symptoms (difficulties in expressing emotions) and disorganization of language and behavior have a very unfavorable impact on the patient's daily performance in their personal, family, professional or social environment.
In this article, we will look at one of the tools for improving the quality of relationships between people with schizophrenia and their social environment. This is the MOSST program: Metacognition-Oriented Social Skills Training .
Current psychological interventions in schizophrenia
Psychological interventions that have traditionally demonstrated greater effectiveness have been geared toward promoting social skills and enhancing a behavioral repertoire that enables the individual to develop a competent role in both their personal and community contexts. Thus, multicomponent cognitive-behavioral interventions that include elements such as learning and problem-solving strategies , behavioral rehearsals, modeling, self-control and self-instruction training, cognitive learning strategies, and family psychoeducational interventions have proven their superior effectiveness in several investigations compared to other types of interventions in which the components are worked on separately.
However, although Social Skills Training (SST) is considered an essential part of intervention in schizophrenia and is highly recommended in many different clinical contexts, according to Almerie (2015), it seems that the difficulty in applying the strategies worked on during the session in the patient's real context, the so-called generalization capacity, compromises the effectiveness rates of this type of treatment.
On the other hand, authors such as Barbato (2015) have demonstrated that a fundamental deficit element refers to the difficulties at the metacognitive level that schizophrenics present , that is, the ability to reflect and analyze one's own thoughts, feelings, intentions, attitudes and behaviors, one's own behavior and that of other people, and the representation that these patients make of their everyday reality.
- You may be interested in: "Cognitive Behavioral Therapy: What does it consist of and what principles is it based on?"
What skills are worked on?
Currently, the main treatments in schizophrenia are well derived from behavior modification techniques , in order to improve the person's psychosocial functioning and reduce positive symptoms or, more recently, the focus on cognitive social work skills to achieve greater understanding and more competence in their interpersonal functioning and in understanding the mental and emotional states involved in this type of interaction.
According to the theoretical proposal of Lysaker et al. (2005), there are four basic processes of metacognition:
- Self-reflexivity : think about your own mental states.
- Differentiation: think about the mental states of others.
- Decentralization: understand that there are other perspectives in interpreting reality besides yours.
- Mastery: Integrate subjective information more broadly and adaptively.
Oriented towards the promotion of the indicated skills and continuing with the proposals of Lysaker (2011), who worked on the application of a type of psychotherapy based on optimizing the power of self-reflection, or Moritz and Woodward (2007), who focused their interventions on getting patients to identify incorrect or biased reasoning repertoires, Ottavi et al. (2014) developed the MOSST program (Metacognition-Oriented Social Skills Training).
MOSST Program Components
This innovative and promising initiative presents many elements in common with the main EHS described above, although it tries to give greater emphasis to the power of generalization of the contents worked on in therapy, to promote the understanding and expression of metacognitive phenomena, in addition to giving more weight to the use of the modeling and role-playing technique .
Application conditions
As for its particularities, firstly, the application of the program is carried out in a hierarchical manner, so that the simplest skills are initially addressed (for example, recognizing one's own thoughts – self-reflexivity), and subsequently, progress is being made towards the training of more complex capabilities related to the Mastery component.
On the other hand, the physical space where sessions take place should be free from interruptions or interfering sounds. The environment should be relaxed and fun, yet safe for patients, so that therapists can be active agents, expressing self-disclosure and positively validating participants. All of this fosters the establishment of a positive bond between patient group members and therapists , or metacognitive facilitators (MF), who guide them through the sessions.
On a practical level, this program was developed for outpatients with stable symptomatic profile, without neurological diagnosis or mental retardation . Groups are made up of 5 to 10 people, and 90-minute sessions occur weekly. Each session focuses on a different skill. The following are the components of the program:
- Greet others.
- Listen to others .
- Request information.
- Start and end conversations.
- Keep conversations going .
- Receive and praise.
- Make and reject requests.
- Compromise and negotiate.
- Suggest activities .
- Give constructive criticism.
- Respond to negative reviews.
- Excuse me .
- Express unpleasant feelings
- Express positive feelings.
The sessions are divided into two distinct parts. First, a self-reflection practice is carried out, recalling a specific situation and answering some questions to improve metacognitive recall in patients. Subsequently, , the same process is carried out in the representation of live roles and listening to a narration, both delivered by therapists.
In the second block of the session, a second stage is carried out by the participants, prior preparation of the specific ability to practice and ends with a discussion of the evaluation of the metacognitive states experienced or observed by the group members during the representation.
In conclusion: the effectiveness of MOSST
Otavii et al. (2014) found promising results after applying MOSST in small groups, both in patients with chronic schizophrenia and in individuals with incipient psychotic episodes .
Subsequently, once the program had been adapted to Spanish, Inchausti and his team (2017) corroborated Ottavi's results, achieving a high level of patient acceptance and a high rate of therapeutic efficacy. This is reflected in increased interpersonal performance, improved social relationships, and a decrease in disruptive or aggressive behaviors .
Despite all of the above, due to the novelty of the proposal, Inchausti indicates the need for further studies that rigorously validate what has been found by the researchers mentioned so far.
References:
- Ottavi, P., D'Alia, D., Lysaker, P., Kent, J., Popolo, R., Salvatore, G., and Damaggio, G. (2014a). Metacognition-oriented social skills training for individuals with long-term schizophrenia: Methodology and clinical illustration. Clinical Psychology and Psychotherapy, 21 (5), 465–473. doi: 10.1002/cpp. 1850
- Inchausti, F., García-Poveda, N.V., Prado-Abril, J., Ortuño-Sierra, J., Gainza-Tejedor, I. (2017). Metacognition-oriented social skills training (MOSST): theoretical framework, work methodology and description of treatment for patients with schizophrenia. Psychologist's papers 2017, vol. 38 (3), pp. 2014-212.