ABSTRACT
The past two decades have brought increasing empirical and clinical evidence of the importance of “behavioral therapies” (Craighead, Kazdin, & Mahoney, 1981) in the rehabilitation of people with severe and persistent mental disorders (Anthony, 1979; Bedell, Archer, & Marlowe, 1980; Bedell & Michael, 1985; Bellack & Hersen, 1978; Bellack, Turner, Hersen, & Luber, 1984; Goldsmith & McFall, 1975; Margules & Anthony, 1976; Wallace & Liberman, 1985). The most effective psychiatric rehabilitation programs use “multimodal” strategies that combine social skills training and other behavioral interventions with judiciously prescribed psychotropic medications. A combination of these treatments results in lower relapse rates and higher levels of social adjustment than does the use of psychoactive drugs alone (Hierholzer & Liberman, 1986). Although there is uncertainty about the typology of symptoms addressed by each modality, it generally is thought that psychiatric medications alleviate “positive signs” of the disorders, for example, hallucinations and delusions, and that psychosocial and behavioral interventions modify “negative signs,” for example, social skills deficits (Andreasen & Olsen, 1982). More recently, behaviorally oriented “self-medication” skills-training groups (Crockett et al., 1989; Liberman, 1986; Verbosky, 1983) have also been shown to have indirect effects on “positive signs” by improving knowledge, skills, and compliance in groups of people treated with psychopharmacology (Dow, Verdi, & Sacco, 1991; Eckman, Liberman, Phipps, & Blair, 1990; Hogarty et al., 1986).
