Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Social skills training (SST) based on social learning model having procedure of modeling, role playing, feedback, and reinforcement was indicated to have limitations in generalization and continuance. In order to overcome these limitations, problem solving model including cognitive training has been proposed. However, it is hard to apply for schizophrenia because patients with the illness have significant deficits in information processing such as thinking, learning, and remembering. Based on well-established principles of social learning for improving social skills of schizophrenia having cognitive deficit, we developed new training instrument using virtual reality (VR) technique as an adjuvant tool for traditional SST. This preliminary study was performed to investigate usability of VR technique as a new training instrument on SST for patients with schizophrenia and to evaluate the effectiveness of SST using VR technique.

Methods: Twelve patients with schizophrenia who were between 20 to 45 years old at the Severance Mental Health Hospital in Korea were recruited. Training was performed for a small group with 4-6 patients, and consisted of 10 sessions for 60-80 minutes on twice a week during 5 weeks. Sessions were divided into three categories, conversational skills (self-introduction, listening, and starting-maintaining-ending conversation), self assertiveness skills (making requests and refusing requests), and emotion expression skills (expressing positive and negative feelings). SST using VR technique was matched for training time, format and structure of training compared with traditional SST, and just added to VR technique as teaching aids. In order to evaluate the usability and preliminary effectiveness, patients completed the questionnaires on interest, usefulness, application, spontaneity, and expectation on every session. Data were collected at the first period (session 1-4), middle period (session 5-7), and last period (session 8-10). Blind raters assessed the change of social behavior from pre-post role playing. In addition, patient's symptom was evaluated using the Positive and Negative Syndrome Scale.

Results: Mean scores to subjective evaluation of patients on the SST using VR technique were scored 3.5±0.8 at first, 3.8±0.6 at middle, and 3.9±0.6 at last for the interests, 3.7±0.8 at first, 3.9±0.5 at middle, and 3.9±0.7 at last for the usefulness, 3.7±0.5 at first, 3.7±0.5 at middle, and 3.8±0.7 at last for the application, and 4.0±0.6 at first, 4.2±0.7 at middle, and 4.2±0.6 at last for the expectation, which could be regarded as positive and improvement gradually. Spontaneity on participation was evaluated 60.4% at first, 71.2% at middle, and 83.3% at last. In addition, significant differences in social behavior were found between pre and post evaluation (z=-3.059, p=0.002].

Implications for practice: We developed the new training instrument using VR technique as teaching aids and this VR system applied to conventional SST for improving social skills of patients. In conclusion, SST using VR technique gradually can improve the interest and concern of patients, and assist an active participation of patients experiencing the difficulties on attention, concentration and memory. Therefore, this VR instrument could be used for teaching and training positively and expected to apply for assessing and evaluating on social behavior of patients with schizophrenia.