541174

research-article2014
WJNXXX10.1177/0193945914541174Western Journal of Nursing ResearchUzdil and Tanrıverdi

Intervention Studies
Western Journal of Nursing Research
2015, Vol. 37(9) 1142­–1159
Effect of Psychosocial © The Author(s) 2014
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DOI: 10.1177/0193945914541174
Functional Remission wjn.sagepub.com

of Patients With
Schizophrenia

Nurcan Uzdil1 and Derya Tanrıverdi2

Abstract
This study was conducted as a two-group pretest–posttest design to
determine the effect of psychosocial skills training on functional remission
levels of patients with schizophrenia. A total of 100 patients were divided
into the training group (n = 50) and the control group (n = 50). The data
were collected using a Personal Information Form and Functional Remission
of General Schizophrenia (FROGS) scale. The 13-session training program
was given in the form of face-to-face group training and 45- to 60-min
sessions twice a week. Training was completed by five groups. Every group
comprised of 9 to 12 individuals on average. The training group had higher
scores significantly on functional remission levels compared with the control
group after psychosocial skills training (p < .001). Psychosocial skills training
has become considerably effective in increasing the functional remission
levels of patients with schizophrenia.

Keywords
functional remission level, psychosocial skills training, schizophrenia

1İnönü University, Malatya, Turkey

2Gaziantep University, Gaziantep, Turkey

Corresponding Author:
Derya Tanrıverdi, Gaziantep University, Faculty of Health Sciences, Department of Psychiatric
Nursing, Gaziantep, Turkey.
Email: [email protected]

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Uzdil and Tanrıverdi 1143

Schizophrenia is a chronic psychiatric disorder that causes numerous behav-

ior and thought process disorders due to important changes in the structure,
physiology, and chemistry of the brain (Yüksel, 2006). Some of the main
treatment objectives when treating schizophrenic disorders are functional
remission, independent living, and being reaccepted into society (Lançon et
al., 2011; Llorca et al., 2009). The main component of schizophrenia treat-
ment is pharmacotherapy; however, pharmacotherapy alone is not sufficient
by itself in treatment of schizophrenia. Patients who respond well to pharma-
cotherapy still experience difficulties in adapting to society, disruptions in
interpersonal relationships, communication issues with family members, dis-
ruptions in occupational functioning, and insufficiencies in self-care. Daily
activities, establishing and maintaining social interactions, social function-
ing, and occupational functioning are among the functionality areas expected
from patients (Aydemir, 2009; Soygür, 1999).
The most suitable method for schizophrenia treatment is integrating phar-
macotherapy with various specific mental and social interventions (Marder et
al., 1996; Schooler, 2006). The main objective of psychosocial rehabilitation
programs is to improve functioning. Special treatments such as social skills
training and intensive programs such as psychoeducational family treat-
ments, or integrated treatment programs have been now used to a great extent.
Such programs have increased social and occupational functioning of
patients, and have been effective in reintroducing schizophrenic patients into
society (Chowdur, Dharitri, Kalyanasundaram, & Suryanarayana, 2011;
Torres, Mendez, Merino, & Moran, 2002; Vázquez-Morejón & García-
Bóveda, 2000).
Psychosocial skills training is an addition to pharmacotherapy, and one of
the frequently used methods in the rehabilitation of schizophrenic patients.
As well as providing an insight into health and treatment, psychosocial skills
training contains training programs aimed at increasing the functioning areas
such as daily life skills, administrative and financial management, house-
work, interpersonal relations, social environment, and occupational function-
ing (Emiroğlu, Karadayı, Aydemir, & Üçok, 2009). Numerous studies have
determined the effectiveness of psychosocial skills training, which uses cog-
nitive and behavioral treatment techniques, in preventing or minimizing the
recurrence and worsening of the illness, and in increasing the social function-
ing and quality of life of patients (Granholm, McQuaid, & McClure, 2005;
Herz et al., 2000; Hogarty, Anderson, & Reiss, 1991; Marder et al., 1996;
Stenberg, Jaaskelainen, & Röyks, 1998; Üçok, Atlı, Çetinkaya, & Kandemir,
2002; Yıldız, Veznedaroğlu, Eryavuz, & Kayahan, 2004).
Conducted studies conclude that schizophrenic patients require health
training in line with the difficulties they experience (Chien, Kam, & Lee,

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1144 Western Journal of Nursing Research 37(9)

2001; Chien & Norman, 2003). One of the most important roles of the psy-
chiatric nurse, which is an integral part of the mental health team, is health
training. The goal of the psychiatric nurse in this role is to determine educa-
tional requirements of patients and their families to protect and improve their
health, help planning specific educational programs to meet these require-
ments, and provide them to the individuals (Babacan-Gümüs, 2006).
There is a need for studies aimed at increasing the functioning of schizo-
phrenic patients (Chowdur et al., 2011). There are a limited number of studies,
which concentrate on the effect of psychosocial skills training in schizophrenic
patients on their functioning level. Conducted studies examine the social func-
tioning of schizophrenic patients (Chambon, Marie-Cardine, & Dazord, 1996;
Lachler, Roder, & Osterhausen, 2003; Xiang et al., 2006; Yıldız et al., 2004),
but not other functioning areas so much (Üçok et al., 2002).
The purpose of this study is to investigate the effect of psychosocial skills
training on functional remission level (social functioning, health and treat-
ment, daily life, occupational functioning) of schizophrenic patients. The
study was based on the hypothesis that psychosocial skills training increases
the functioning levels of patients with schizophrenia.

Method
Sample
This study was designed as a two-group pretest–posttest study. The study was
conducted at the polyclinics of Elazığ Mental Health and Illnesses Hospital.
Sample group of the study was composed of a total of 100 patients (50
patients in the training group and 50 patients in the control group) who met
the eligibility criteria. A total of 30 patients did not wish to participate in this
study; the reasons behind why they did not wish to be a part of such an envi-
ronment are the social withdrawal and reluctance that came with their illness,
along with lack of time and transportation. Of the patients in both groups,
68% were male. The percentage of patients having the disease for more than
10 years was 52% in the training group and 62% in the control group. Table
2 illustrates demographic characteristics of the sample. Inclusion criteria of
the study were as follows: giving consent to participate in the study, being
literate, aged between 18 and 60, having been followed up with the diagnosis
of schizophrenia according to diagnostic criteria in the Diagnostic and
Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR;
American Psychiatric Association [APA], 2000) and being schizophrenic
outpatients in remission stage, not participated in such a training program for
the past 5 years, being willing to participate in the study by signing a written

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Uzdil and Tanrıverdi 1145

informed consent after a detailed presentation of all procedures, and being

open to cooperation and communication. An alternate sequence of enroll-
ment was used for the randomization of patients to the training group or con-
trol group (i.e., the first patient was enrolled in the training group, the second
in the control group, etc.). Analyses revealed that there was no difference
between control variables (age groups, gender, employment status, income
status, existence of chronic diseases, illness duration, and the number of hos-
pitalization) of patients in the training group and in the control group, and
that both groups were similar to each other (p > .05). While the training group
took psychosocial skills training with routine treatment, the control group
received routine treatment given by a psychiatrist.

Measures
Personal Information Form. The Personal Information Form was prepared by
the researchers and involved eight questions regarding sociodemographic
characteristics of patients, the course of the disease, and treatment.

Functional Remission of General Schizophrenia (FROGS) scale. The FROGS scale

was developed by Llorca et al. (2009). The scale’s validity and reliability stud-
ies were conducted by Emiroğlu et al. (2009). The 19-item scale is a 5-point
Likert-type scale that measures functional remission independent from
patient’s symptoms. The scale has four subscales: Social Functioning, Daily
Life, Health and Treatment, and Occupational Functioning. The period ques-
tioned during assessment is the month prior to the interview. Every item has
five assessment levels: “non applicable” (the first level), which indicates the
lowest remission level; “partially applicable” (the second level); “sufficiently
applicable” (the third level); “nearly completely applicable” (the fourth level);
and “applicable at outstanding level” (the fifth level), which is equivalent to an
“ideal” function level. Scores of the scale range from 19 (minimum) to 95
(maximum). There are questions to help the interviewer evaluate every item.
The reliability coefficient of the scale developed by Llorca et al. was .90. The
reliability coefficient of the scale in validity and reliability studies conducted
by Emiroğlu et al. was .89. The reliability coefficient of the scale for this study
was .87. Item analysis process performed for the general total and subscales
gave significant results at level of .01 in all techniques. For this reason, it was
decided that items were excellent and could remain in the scale (p < .01). As a
result of factor analysis, four factors with an eigenvalue above 1 were found.
Results of correlation made between general total and subscales to test content
validity showed that there was a high correlation in the range of .93 and .62.
Correlation should be present between valid and reliable scales having similar

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1146 Western Journal of Nursing Research 37(9)

characteristics to determine the construct validity. For this reason, the criterion
validity was performed between this scale and Quality of Life Scale and
showed a high correlation (r = .82, p < .0001; Emiroğlu et al., 2009).

Intervention
The psychosocial skills training. Psychosocial skills training is a form of behav-
ior therapy used by therapists and trainers to help persons who have difficul-
ties related to other people. A major goal of social skills training is that
regardless of having emotional problems teaching persons about the verbal
and nonverbal behaviors involved in social interactions. Trainees learn to
change their social behavior patterns by practicing selected behaviors in indi-
vidual or group therapy sessions. Another goal of social skills training is
improving a patient’s ability to function in everyday social situations. Train-
ing of social skills was shown to be effective in treating patients with a broad
range of emotional problems and diagnoses (“Social Skills Training,” n.d.).
Difficulty experienced by schizophrenic patient in establishing interpersonal
relations, their unsociable attitudes not sharing emotions, and nature of psy-
chotic symptoms may give the impression that these patients are not able to
avail group therapies. However, group therapies provide peer support, friend-
assisted training, and an environment, where their reality testing is assessed,
for patients accepting to be included in the group. They also provide an
opportunity for sharing and solution of long-lasting problems of chronic dis-
ease. The fact that patients have similar problems enables them to converse
with each other and produce a common solution. It helps to acquire necessary
skills to sustain healthy relationships. Interactions in the group not only
develop emotional relations but also bring skills of social relations. Group
therapies have a positive effect on decreasing of social anxiety of patients,
increasing of communication skills, acquisition of fundamental social skills,
and increasing of creative activities (Üçok et al., 2002; Yıldız, 2007).
The interventionist who performed the psychosocial skills training had
participated in a psychosocial skills training course program before the start
of study and received certification for psychosocial skills training. The inter-
ventionist, who was a mental health nurse, conducted all the sessions to
maintain consistency. The psychosocial skills training sessions were orga-
nized in accordance with the Psychosocial Skills Training Practice Guide,
which was developed by Yıldız (2001). The content of the psychosocial skills
training was formed using this manual and some other studies in the literature
(McKay, Davis, & Fanning, 2006; Özkan, 2008; Yıldız, 2001). It focused on
the communication skills, problem-solving skills, psychosis and antipsy-
chotic drug therapy, recognizing and coping with stimulants, avoiding

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Uzdil and Tanrıverdi 1147

alcohol and drugs, learning and applying hygiene rules, and methods to cope
with stress. The content was constructed as a booklet and distributed to
patients at the end of the psychosocial skills training. Table 1 illustrates a
brief outline of each session. At least one session was discussed under every
subheading. Every session contained certain objectives; every session was
evaluated with training purpose-relevant role-plays and issue-specific solu-
tions after each session. In addition, group members were given homework,
to be completed until the next session, and related to the skill of the role-
playing. Homework was discussed in company with comments and feed-
backs in the first session of the following week. Patients attended regular
checkups with their doctors throughout their group training. All patients
attended every session; none of them experienced exacerbation or was hospi-
talized during treatment. Five patients did not attend a few sessions. These
sessions were made up.

Procedure
First, patients were informed about the necessity and the importance of the
psychosocial skills training and encouraged to participate with the patients’
psychiatrist. Patients who contacted the primary researcher were invited to
participate in the study and were given detailed information about the pur-
pose and procedure of the study. All of them signed the written consent after
a full explanation of the study and their rights was made. After admission to
the study, information regarding the location of the intervention was given.
After having a preinterview with all patients with schizophrenia in the train-
ing and control groups, Personal Information Form and FROGS (pretest)
were applied. Before application of pretest, patients did not know which
group they were in. Then, patients in the training group were invited to the
training according to randomization. Trainings were conducted in the semi-
nar hall located in the hospital. This hall was designed as suitable for training.
Training was given by taking the level of comprehension of patients into
consideration. Training involved verbal lectures, visual materials (projec-
tors), question–answer sessions, role-plays, exercises, and homework.
Especially role-playing was effective in collecting the attention of the
patients. Patients in the training group were informed about the training, the
purpose of the study, and the method, and given the study plan in written. The
13-session training program was given in the form of face-to-face group
training and for 45 to 60 min twice a week. During sessions, breaks were
taken with treats. Such breaks enabled patients to have an opportunity to col-
lect their attention again and to converse with each other except for the train-
ing, and thus, training environment was tried to be made attractive.

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1148 Western Journal of Nursing Research 37(9)

Table 1. The Psychosocial Skills Training Program.

Session 1 Preparation session
Promoting the program, explaining the rules
Letting them express their feelings and outline their problems
Session 2 Communication skills
Points to be considered an effective communication
The use and importance of body language in communication
What are encouraging-breaker behavior and expressions in communication?
Role-play
Session 3 Problem-solving skills
Learning problem-solving steps
Bring solution suggestions to problems
Sessions 4 and 5 Psychosis and antipsychotic drug therapy
Helping patients understand the nature, and variability of symptoms and
diagnosis
Promoting antipsychotic drugs
Providing information about effects and side effects of antipsychotic drugs
Session 6 Treatment assessment
Learning right drug use
Doubts related to medication treatment, the importance of adaptation to
treatment
The teaching of treatment evaluation schedule
Information about psychosocial treatments
Session 7 Side effects of drugs
Antidepressant drugs, antipsychotic drugs, anxiolytic (anxiety-relieving)
drugs, anticholinergic drugs, and reducing side effects
Side effects list
Session 8 Recognizing and coping with warning signs of schizophrenia
Learning the messenger and warning signs of schizophrenia
What factors that could cause exacerbation of the disease?
Session 9 Recognizing and coping with persistent symptoms
What are the persistent symptoms of schizophrenia?
Recommended techniques to cope with persistent symptoms
Session 10 Risks caused by the use of alcohol or substances in schizophrenia
Teaching adverse effects of the use of alcohol or substances and the benefits
of avoiding them
Session 11 Learning and applying hygiene rules
What is personal hygiene?
Hand hygiene, nail care and hygiene
Skin, mouth, hair, and foot hygiene
Session 12 Methods to cope with stress
Concept of stress
Ways to reduce stress
Teaching that stress is a triggering factor for recurrence
Learning to fight with negative thoughts
Gaining self-confidence
Session 13 Evaluation
Evaluation of the program, taking feedback
Giving the certificates of achievement

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Uzdil and Tanrıverdi 1149

Training was completed by 50 patients and five groups. Every group

involved 9 to 12 individuals. Interviews (posttest) were conducted on
scheduled days within 3 months after completion of the training with the
patients in the training group and within 3 months after performing pretest
with the patients in the control group. Similar studies were taken into
account to determine the time for posttest assessments (Arslantaş, Sevinçok,
Uygur, Balcı, & Adana, 2009; Tartaç & Özkan, 2011). During the inter-
views, FROGS (posttest) was readministered to patients with schizophre-
nia. Patients were called to remind them of the interviews. At the end of the
program, the patients participating in the training were given an achieve-
ment certificate to promote participation in different training programs. A
training booklet was distributed to patients in the control group after the
posttest, in accordance with ethical values. There were no incentives paid
to participants.

Analysis
The SPSS 13.0 software package was used to assess the data. Regarding the
assessment of the data, percentage, arithmetic mean, and standard deviation
were used for distributions of patients in the training and control groups
based on their descriptive characteristics and medical history, Yates-corrected
chi-square test and independent-samples t test were used to compare control
variables among patients in the control and training groups. While depen-
dent-samples t test was conducted to compare the pre- and posttest mean
scores of the scale, the independent-samples t test was used for comparison
of mean scores of the scale among patients in the control and training groups.
The strength of association was expressed as odds ratios with 95% confi-
dence interval. Cronbach’s alpha was used to assess the internal consistency
of the scales. The level of significance was set at p < .05.

Results
Characteristics of Patients
In our study, 68% of patients constituting the training and control groups
were male, and 32% were female. Eighty-four percent of patients in the train-
ing group and 80% of patients in the control group were unemployed. Eighty-
two percent of patients in the training group and 62% patients in the control
group were on regular medication. Forty-four percent patients in the training
group and 52% patients in the control group were hospitalized 6 or more
times (Table 2).

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1150 Western Journal of Nursing Research 37(9)

Table 2. Patients in the Training Group and Control Group Based on Their
Descriptive Characteristics.
Control Group Training Group

Characteristics n % n %

Age groups
22-35 years 19 38.0 24 48.0
36 years and above 31 62.0 26 52.0
Gender
Female 16 32.0 16 32.0
Male 34 68.0 34 68.0
Marital status
Single 29 58.0 41 82.0
Married 21 42.0 9 18.0
People they live with
Mother/father/sibling 26 52.0 25 50.0
Spouse/children 19 38.0 25 50.0
Alone 5 10.0 — —
Education level
Literate 8 16.0 2 4.0
Primary school 30 60.0 24 48.0
High school and university 12 24.0 24 48.0
Employment status
Yes 10 20.0 8 16.0
No 40 80.0 42 84.0
Income level
Income equal to outgoings 27 54.0 23 46.0
Income less than outgoings 23 46.0 27 54.0
Illness duration
1-10 years 19 38.0 24 48.0
More than 10 years 31 62.0 26 52.0
Medication status
Regular 31 62.0 41 82.0
Irregular 19 38.0 9 18.0
Help in taking medication
Yes 41 82.0 28 56.0
No 9 18.0 22 44.0
Number of hospitalizations
1-5 24 48.0 28 56.0
6 and more than 6 26 52.0 22 44.0
Schizophrenia in relatives
Yes 20 40.0 22 44.0
No 30 60.0 28 56.0

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Uzdil and Tanrıverdi 1151

Table 3. A Comparison of Total Pretest and Posttest FROGS Score Mean and
Score Mean of Subscales for Patients in the Training Group and the Control Group.
Between Groups
Pretest Posttest (At Posttest) Within Groups

Scale Groups M SD M SD ta p tb p

Total score of FROGS 3.287 <.001

Control group 50.30 10.47 51.46 10.00 2.566 <.05
Training group 49.00 10.91 58.02 9.96 15.396 <.001
Subscales
1. 
Social Functioning 1.383 >.05
Control group 17.52 4.32 18.02 4.09 2.469 <.05
Training group 16.46 4.22 19.12 3.86 9.472 <.001
2. Health and Treatment 5.546 <.001
Control group 10.20 2.56 10.88 2.48 3.743 <.001
Training group 10.36 3.42 13.86 2.88 14.828 <.001
3. Daily Life Skills 2.667 <.01
Control group 18.30 3.97 18.20 3.67 0.437 >.05
Training group 17.62 4.40 20.24 3.97 11.297 <.001
4. 
Occupational Functioning 0.862 >.05
Control group 5.28 2.76 5.24 2.77 0.573 >.05
Training group 5.48 2.42 5.72 2.32 2.201 <.05

Note. FROGS = Functional Remission of General Schizophrenia.

a. t test for independent groups.
b. t test for dependent groups.

Effect on Functioning
While total score mean of FROGS was 49.00 ± 10.91 for patients in the train-
ing group, it was 50.30 ± 10.47 for patients in the control group. According
to Table 3, patients in the training group had a pretest FROGS score mean of
49.00 ± 10.91, and a posttest score mean of 58.02 ± 9.96; the difference was
significant (p < .001). Patients in the control group had a pretest FROGS
score mean of 50.30 ± 10.47, and a posttest score mean of 51.46 ± 10.00; the
difference was significant (p < .05). While the increase in scores of the con-
trol group was 1.39, the increase in scores of the training group was 9.02. In
terms of the score increase seen in the control and training groups, the
increase in the training group was statistically significant higher (t < 10.621,
SD < 98, p < .001).
The subscale “Social Functioning” score mean of patients in the training
group was 16.46 ± 4.22 for the pretest and 19.12 ± 3.86 for the posttest; the
difference was significant (p < .001). The subscale “Health and Treatment”
score mean of patients in the training group was 10.36 ± 3.42 for the pretest
and 13.86 ± 2.88 for the posttest; the difference was significant (p < .001).

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1152 Western Journal of Nursing Research 37(9)

The subscale “Daily Life Skills” score mean of patients in the training group
was 17.62 ± 4.40 for the pretest and 20.24 ± 3.97 for the posttest; the differ-
ence was significant (p < .001). The subscale “Occupational Functioning”
score mean of patients in the training group was 5.48 ± 2.42 for the pretest
and 5.72 ± 2.32 for the posttest; the difference was significant (p < .001). The
training was effective in the subscale “Health and Treatment” at the highest
rate and in the subscale “Occupational Functioning” at the lowest rate.
The difference between patients in the training and control groups in terms
of the score mean of FROGS score and score means of its four subscales was
compared and analyzed separately for pretest and posttest (Table 3).
According to the table, there was no statistically significant difference
between total score mean of FROGS and subscale score means obtained by
patients in the training group during the pretest and total score mean of
FROGS and subscale score means obtained by patients in the control group
during the pretest (p > .05). For the posttest, FROGS total score mean of the
training group was 58.02 ± 9.96 and FROGS total score mean of the control
group was 51.46 ± 10.00; the difference between the two groups was signifi-
cant (p < .01, Table 3).

Discussion
This study was conducted to investigate the effects of psychosocial skills
training on functional remission levels (social functioning, health and treat-
ment, daily life, occupational functioning) of schizophrenic patients. To the
best of our knowledge, this is the first study to show the effectiveness of a
combined pharmacological treatment plus psychosocial skills training pro-
gram in multiple functioning areas in patients with schizophrenia. To assess
the efficacy of psychosocial skills training, the baseline functionality of
patients was primarily evaluated because it was important to know at what
level their functioning was before psychosocial skills training. For the pre-
test, FROGS total score mean was 49.00 ± 10.91 for the training group and
50.30 ± 10.47 for the control group. The minimum score of the scale is 19,
and the maximum score is 95. According to these figures, patients in both the
training group and the control group had average functioning scores. In terms
of all subscales scored, patients in both the training group and the control
group had similar average functioning scores. These results concluded that
schizophrenia has a moderate adverse effect on functioning level of patients.
However, scale mean scores of patient in this study were lower compared
with other studies conducted by using the same scale (Emiroğlu et al., 2009;
Lançon et al., 2011). The reason for this situation is associated with the fact

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Uzdil and Tanrıverdi 1153

that sample group of the other studies consisted of inpatients or long-stay

patients.
The purpose of rehabilitation studies in the treatment of schizophrenia is
to increase functioning to the highest level possible in areas of daily life
skills, administrative and financial management, housework, interpersonal
relations, social environments, and occupational functioning (Emiroğlu et al.,
2009; Lançon et al., 2011). Interventions directed at rehabilitation such as
psychosocial skills training can be recommended to help achieve this purpose
when treating schizophrenia.
The total score mean of FROGS scale for patients in the training group
after the training was significantly higher in comparison with their total score
mean of FROGS scale before the training. This result determined that psy-
chosocial skills training given to schizophrenic patients significantly
increases the functional remission levels. This result confirms the hypothesis
of this study: “Psychosocial skills training given to schizophrenic patients
increases the functional remission levels of patients.” It could be asserted that
the training activities experienced/developed by patients during the training
process enable them to take an effective role in their own illness, develop
coping skills, carry intragroup interactions outside the group, change their
perception of stress, and develop their sense of belonging (Ahmed &
Goldman, 1994; Chambon, Eckman, & Trinh, 1992; Liberman, Wallace, &
Blackwell, 1993).
The total score mean of FROGS scale obtained by patients in the control
group during the posttest was significant higher than their total score mean of
FROGS scale during the pretest. Even though there was an increase in func-
tional remission for control group, the posttest total score mean of FROGS
scale for patients in the training group was significantly higher in comparison
with the posttest total score mean of FROGS scale for patients in the control
group. The reason behind the difference in the control group was that patients
visiting for treatment purposes started to take their medication regularly after
their initial visit.
The posttest score mean of “Social Functioning” subscale for patients in
the training group was significantly higher than their pretest score mean of
“Social Functioning” subscale. The posttest score mean of “Social
Functioning” for patients in the control group was also significantly higher
than their pretest score mean of “Social Functioning.” The increase in the
training group was significantly higher compared with the control group. The
training given had a significant effect on the “Social Functioning” subscale,
which included patients being able to present themselves in social relations,
their personal activities, communications with their family members and
friends, social environment, and emotional and sexual relationships.

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1154 Western Journal of Nursing Research 37(9)

Conducted studies have determined that psychosocial skills training increased

the social skills and talking face-to-face—sociability skills of patients (Chien
& Norman, 2003; Penn, Mueser, Doonan, & Nishith, 1995), decreased
adverse symptoms with role-playing and problem solving (Akpınar, 2008;
McKee, Hull, & Smith, 1997), and increased their social functioning levels
(Chambon et al., 1996; Doğan, Doğan, Tel, Çoker, & Polatöz, 2004; Lachler
et al., 2003; Xiang et al., 2006; Yıldız et al., 2004). All these results support
results of our study.
The score mean of the subscale “Health and Treatment” for patients in the
training group was significant higher after training in comparison with the
score mean of health and treatment subscale before training. The training
given had a significant effect on the “Health and Treatment” subscale, which
questions how much patients know about their illnesses, symptoms, treat-
ment programs, and recurrence symptoms; how much they adhere to their
treatment; whether they take the necessary precautions to protect their health;
and whether they cope with the side effects of their treatment. Based on this,
we can assume that with the increase in functional remission, patients can
take the necessary precautions to protect their health, cope with the side
effects of treatment, develop their insight into treatment, and increase their
adherence to the treatment. In their study, Razali, Hasanah, and Khan (2000)
determined that psychosocial skills training was effective, patients were more
successful in understanding and accepting their illnesses, and they could
establish a better eye contact. Conducted studies have reported that training
of psychosocial skills decreased the side effects of medication and increased
the rate of taking medication regularly (Eryıldız, 2008; Leucht & Heres,
2006; Mann et al., 1993; Smith, Bellack, & Liberman, 1996; Yıldız et al.,
2004). The last health and treatment score mean for patients in the control
group was significantly higher compared with their initial health and treat-
ment score mean. While the increase for the control group was 0.68, it was
3.50 for the training group. The difference between the posttest scores of the
training group and the control group was significant. It is thought that the
increase in the control group was due to the fact the patients were informed
about their illness and treatment by their doctor during the course of their
study.
The posttest score mean of the subscale “Daily Life” for patients in the
training group was significantly higher compared with their pretest score
mean of daily life. According to the “Daily Life” subscale, patients are
expected to sleep/get up, abide by biological rhythms such as mealtimes, eat,
their administration and finance management, personal image and care, con-
trol aggressive or antisocial behavior, and adjust to stress and unexpected
circumstances. Training was significantly effective on daily life.

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Uzdil and Tanrıverdi 1155

The score mean of the subscale “Occupational Functioning” for patients in

the training group was significantly higher after training compared with their
score mean of occupational functioning before training. The training was sig-
nificantly effective on patients in this group. Occupational functioning
decreases in schizophrenic patients. Unemployment or not being able to work
is one of the most important issues that affect the life of individuals with
schizophrenic disorder. Schizophrenic individuals are required to structure
their lives to increase the living standards (Torres et al., 2002). Psychosocial
rehabilitation studies increase patients’ social and occupational functioning,
and help schizophrenic patients to reintroduce themselves to society. There is
a requirement for occupational rehabilitation studies directed at patients reac-
quiring their educational or occupational functioning (Chowdur et al., 2011).
Increasing the occupational functioning of patients is one of the basic objec-
tives of schizophrenia rehabilitation. Another aim of treatment is that patients
reach the stage where they can independently manage their own household
(Lançon et al., 2011); families should give the patients responsibilities to
achieve this goal.
Our study concluded that psychosocial skills training increased the func-
tional remission of schizophrenic patients. An increase was identified in all
four subscales (Social Functioning, Health and Treatment, Daily Life, and
Occupational Functioning) of FROGS as a result of psychosocial skills train-
ing. Just being content with pharmacotherapy in treating schizophrenia is not
a very realistic approach. Psychosocial skills training combined with phar-
macotherapy have a positive effect on functionality of patients with
schizophrenia.
Schizophrenia is an illness that requires long-term treatment and creates a
financial burden for both society and the family. Psychosocial skills training
can convert patients into producers from consumers, and costs can be reduced.
It is expected that including this training program to the routine treatment of
schizophrenia will give rise to important results. Psychosocial skills training
should be thought of as an important choice due to its effectiveness in treat-
ment of schizophrenia, and it should be extended. However, it is obvious that
such programs are not sufficiently incorporated within routine practices at
psychiatric clinics, and psychiatric nurses do not play a sufficient role in
these practices, and in fact, psychiatric nurses have an eminent position in the
process of providing systematic support to patients and their families.
Standard questionnaire forms to determine functioning level of patients and
their knowledge requirements should be generated and used in clinics.
Psychosocial skills training should be delivered by psychiatric nurses using
the data to achieve the said purpose.
Limitations of this study include a small sample size, performing the post-
test evaluation only once, and failure to assess long-term effects. These

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1156 Western Journal of Nursing Research 37(9)

limitations should be taken into account in future studies. The study findings
could be generalized to only patients with schizophrenia, because the study
did not include patients with other psychiatric disorders.

Authors’ Note
This study is based on Nurcan Uzdil’s master’s thesis.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

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