One of the problematic centers of people with schizophrenia is linked to serious difficulties in the area of interpersonal and social interactions. The positive symptoms (hallucinations or delusions), the negative symptoms (difficulties of emotional expression) and the disorganization of the language and the behavior interfere very adversely with the daily performances in the personal, family, professional or social status of the patient.
In this article, we will see what is one of the tools to improve the quality of the relationship between people with schizophrenia and their social environment. Here is the MOSST program: Social skills training oriented towards metacognition.
Current psychological interventions in schizophrenia
Psychological interventions, traditionally more effective, have aimed to promote social skills and improve a behavioral repertoire that allows the person to develop a competent role both in the personal sphere and in the community context. Thus, multi-component cognitive-behavioral interventions where elements such as learn coping and problem-solving strategies, Behavioral testing, modeling, training in self-control and self-learning, learning cognitive strategies and family psychoeducational interventions have been shown to be superior in terms of effectiveness in multiple surveys over d ” other types of interventions where the components are worked separately.
However, while social skills training (EHS) is considered an essential part of intervention in schizophrenia and is highly recommended in a wide variety of clinical settings, according to Almerie (2015), it appears that the difficulty of applying the strategies worked out during the session in the real context of the patient, the so-called generalization capacity, compromise the effectiveness rates of this type of treatment.
On the other hand, authors like Barbato (2015) have shown that a fundamental element is deficient refers to the metacognitive difficulties that schizophrenics presentThat is, the ability to reflect and analyze one’s own thoughts, feelings, one’s own attitude and behavior intentions and those of others, and the representation that these patients make of their daily reality.
What skills are we working on?
Currently the main treatments for schizophrenia come from behavior modification techniques in order to improve a person’s psychosocial functioning and reduce positive symptoms or, more recently, to focus on working on social cognition skills to gain a better understanding and competence in his interpersonal functioning and understanding of mental states and emotional involved in such interactions.
According to the theoretical proposition of Lysaker et al. (2005) four are the basic processes of metacognition:
- self-reflexivity: Think about his own mental states.
- Differentiation: thinking about the mental states of others.
- Decentralization: understanding that there are other perspectives in the interpretation of reality apart from your own.
- Domain: integrate subjective information in a broader and adaptive way.
Emphasize the promotion of the indicated skills and pursue the proposals of Lysaker (2011), who worked on the application of a type of psychotherapy based on the optimization of the power of self-reflection, or Moritz and Woodward ( 2007), who focused their interventions on getting patients to identify repertoires of incorrect or biased reasoning, Eighth pass. (2014) developed the MOSST program (Metacognition oriented social skills training).
Components of the MOSST program
This new and promising initiative has many common elements in the main EHS and described above, although it tries to put more emphasis on the power of generalization of the contents worked in therapy, to promote understanding and expression. metacognitive phenomena. in addition to giving more weight to the use of modeling and role-playing techniques.
Conditions of application
As for its peculiarities, first of all, the application of the program is done in a hierarchical way, so that the simplest skills are first approached (for example recognizing one’s own thoughts – self-reflexivity) and then progressing to training more complex skills linked to the Domain component.
On the other hand, the physical space where the sessions take place must be free from interruptions or parasitic noise. The environment should be relaxed and playful while safe for the patients, so that the therapists are active agents who participate, express personal revelations and positively validate the participants. All this favors the establishment of a positive bond between patient group members and therapists, Or metacognitive facilitators (FM), who guide them in the sessions.
In practical terms, this program is designed for ambulatory patients who present a stable symptomatic profile without a diagnosis of neurological or mental retardation. Groups are made up of 5-10 people and 90-minute sessions are held weekly. In each of them, a different skill is worked on. Here are the components of the program:
- Greet the others.
- Listen to others.
- Ask for information.
- Start and end conversations.
- hold conversations.
- Receive and congratulate.
- Make and reject requests.
- Engage and negotiate.
- suggest activities.
- Write constructive criticism.
- Respond to negative reviews.
- Express unpleasant feelings
- Express positive feelings.
The sessions are divided into two distinct parts. First, a self-reflection practice is performed by recalling a specific situation and answering certain questions to improve their metacognitive evocation in patients. later the same process is performed on a live role representation and hearing a story, both from therapists.
In the second block of the session, there is a second staging performed by the participants, a prior preparation of the specific skill to be practiced, and ends with a discussion on the evaluation of the metacognitive states experienced or observed by the members. of the group during the performance.
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 subjects with incipient psychotic episodes.
Subsequently, once the adaptation of the program to Spanish was completed, Inchausti and his team of collaborators (2017) corroborated what had been achieved by Ottavi, achieving a high level of patient acceptance and a high rate. in terms of therapeutic efficacy. This is transmitted through an increase in the performance of interpersonal activities, an improvement in social relations and a decrease in disruptive or aggressive behavior.
Despite all that has been said, due to the novelty of the proposal, Inchausti indicates the need for more studies that rigorously validate what has been found by the researchers mentioned so far.
- Ottavi, P., D’Alia, D., Lysaker, P., Kent, J., Popolo, R., Salvatore, G. and Damaggio, G. (2014a). Metacognition oriented social skills training for people 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, NV, Prat-Abril, J., Ortuño-Serra, J., Gainza-Tejedor, I. (2017). Metacognition-oriented social skills training (MOSST): theoretical framework, work methodology and description of treatment for patients with schizophrenia. Psychologist Papers 2017, vol. 38 (3), p. 2014-212.