Social skills training and negative symptoms.

Matousek et al. (1992) tested social skills training plus a card game called Stacking the Deck. They worked with three adults who had schizophrenia and flat affect.

The team used a multiple-baseline design across behaviors. They measured eye contact, voice volume, and conversational turns.

Each patient showed tiny bumps in the trained skills, but the baselines wiggled a lot. The gains did not stick once the game ended.

Negative symptoms like blunted mood barely moved. The authors call the results 'small and fragile.'

Hodos et al. (1976) got big, steady gains with the same BST recipe in psychiatric in-patients. The difference: they rehearsed real ward requests, not a card game.

Berler et al. (1982) warn that role-play scores can rise while playground behavior stays flat. Their mixed result mirrors the weak transfer seen here.

EGranieri et al. (2020) meta-analysis shows medium-to-large effects for social skills training in autism. The 2020 paper pools 18 studies, so the tiny 1992 effect looks like an outlier.

If you run social skills groups for adults with schizophrenia, add real-life rehearsal and in-vivo coaching. Skip tabletop games unless you embed them in natural conversations. Track generalization on the ward or in the community, not just at the clinic table.