Structured learning therapy with transfer training for chronic inpatients

Abstract

PROBLEM Chronic institutionalized patients frequently do not respond to psychotherapy. They also seem to be overrepresented from lower socioeconomic classes(*-4 ) . We believe that most psychotherapy techniques are not tailored to these individuals, since they were developed by middle and upper-class professionals for middle and .upper-class clients (2, 5 ) . Therefore, we have developed a treatment approach called structured learning therapy (SLT) for these "forgotten" individuals. SLT consists of modeling, role-playing and social feedback-reinforcement, a direct 'form of skill training that can help chronic patients learn socially appropriate behavior. A previous study ( 3 ) demonstrated some limited effectiveness of SLT to increase positive social interaction among acute and chronic inpatients, but did not incorporate a dimension of skill training familiar to all students of learning theorytransfer training. Thus, we designed this study to see whether the addition of on-site training enhances the effectiveness of SLT to modify behavior. Our hypotheses were that, in terms of skill acquisition, 5 weeks of SLT and 2 weeks of transfer training > 7 weeks of SLT > 5 weeks of SLT > 7 weeks of social therapy > no therapy. The skills to be acquired were appropriate social interactions during mealtimes that ranged from proper eating behavior to holding conversations. METHOD Subjects.One hundred and twenty chronic inpatients were recruited with the assistance of ward psychiatrists and nurses and agreed to participate. The age range was 19-72 (mdn. = 40), the sexes were represented almost equally and diagnoses were mixed. Mental retardation, sociopathy, and alcohol or drug addiction were excluded.Procedure. Amateur actors made five videotapes, each of which demonstrated a progressively more complex form of meal-time social behavior. The first involved such scenes as using utensils and eating posture. The second modeled perfunctory interactions such as walking past someone with a tray, making room for someone a t the table, etc. The third showed how to request the salt, excuse self from table, offer to get seconds, etc. The fourth demonstrated how to hold conversation. The fifth modeled how to handle negative situations such as spilled food, holding up the line, etc. Both verbal and body language aspects of social appropriateness were stressed. One group of college students was trained to use SLT procedures, while another was trained to interact in a social-companionship form of therapy. The study patients were assigned either to SLT or social therapy after pretesting. Those in the SLT condition met in groups of 10 three times a week (1 hour each) for 5 weeks in the hospital's TV studio. Each session started with the showing of that week's tape, a discussion of the tape, role-playing and videotaping situations relevant to the tape's theme, and playing back the role plays with a great deal of positive reinforcement as the patient's role plays became more and more similar

A Preliminary Randomized Controlled Trial of Two Social Skills Interventions for Youth With High-Functioning Autism Spectrum Disorders

“…Each skill is presented in eight steps: (a) define the skill, (b) model the skill, (c) establish skill need, (d) to (f) engage in role-play, (g) provide feedback, and (h) assign skill homework. This approach has been studied for a wide array of populations, focusing on a myriad of target skills, including assertiveness among youth with intellectual disability (Fleming, 1977), and social skills in withdrawn inpatients (Gutride, Goldstein, & Hunter, 1974). Controlled trials (Lopata et al, 2010) have found significant Skillstreaming effects for youth with HFASD on parent-and staff-reported social skills measures, as well as family-reported satisfaction, indicating that this is among the most research-supported knowledgetraining SSIs.…”

Social-skills training: An initial appraisal.

“…A second study by Gutride et al (1974) compared SLT with a social-companionship therapy. This time the investigators measured more specific skills (e.g., excusing self while passing in line, sitting at an occupied table, proper use of napkin, acknowledging others when they leave) than in the previous study.…”

Structured learning therapy: Training for community living.

“…In many of these studies, changes in both the immediate posttherapy and later real-life (transfer) skill level were examined. In two such investigations, Gutride et al (1973Gutride et al ( , 1974 found significant immediate post-therapy and later transfer changes in an array of social interaction skill behaviors in samples of withdrawn asocial inpatients. Immediate and transfer effects were also obtained in two additional inpatient studies testing SLT for its skill enhancement effectiveness, in these instances with geriatric, psychiatric inpatients (Lopez, 1977;Lopez et al, 1979).…”