FEASIBILITY EVALUATION OF COGNITIVE BEHAVIORAL THERAPY-BASED INTERVENTION FOR ENHANCING SOCIAL SKILLS AMONG SECONDARY SCHOOL CHILDREN IN PAKISTAN: A RANDOMIZED CONTROLLED TRIAL

Cognitive Behavioral Therapy based Social skills intervention is used in present study to reduce social skills deficits among secondary school children. This intervention aimed to enhance child's ability to socialize, interact well with others, recognize social cues, and behave appropriately according to the context and situation. This intervention includes strategies that help students in following areas:
1. Emotions and their relationship with behavior according to situation and context.
2. Non-verbal skills in social communication.
3. Appropriate conversation in relationships/ How to improve relationships.
4. Empathy training.
5. Assertiveness.
6. Self-monitoring of behaviour.
7. Conflict-resulotion.
4.

This CBT based social skills intervention is conducted in group sessions. It consists of 8 group sessions that are to be conducted on weekly basis, every session is of 50 minutes. session wise details are as follows:
Session 1: Introduction/ Establishing Expectations/ Rapport building
Goals :
• Students get an understanding of program goals.
• Students understand group expectations.
• Students will learn group guidelines that needs to be adhered.
Activities and procedures:
1. Group members and therapist will introduce themselves to each other.
2. Group members will come to the board to write their expectations of the group. Rest of the members will agree.
3. Identify emotions: therapist will ask to identify emotions from the video, and explain how do they know that emotion being displayed for example is happiness, or anger etc.
Session 2: Psychoeducation
Goals :
• Children will learn what are social skills..
• Children will learn importance of social skills.
• Appropriateness of Social behavior according to situation and context.
Activity procedure:
Activity/Procedure
1. Taking the basic feeling, each person will share the account when they felt surprised, sad etc.
2. Metaphor of monster and mouse.
3. Discussion Questions.
4. Students will be presented by different social situations and will be asked about appropriate strategy to use in each of them.
5. Feedback
Session 3: Non-Verbal Skills
Goals:
• Students will learn what are non-verbal skills.
• What are basic social communication skills/non-verbal skills.
• Appropriate non-verbal skills according to context.
• Why are they important.
• How to enhance non-verbal skills.
Activities/ Procedures
Activity/ procedure
1. Eye spy
2. Handouts
3. Discussion Questions.
4. Role plays/practice.
5. Feedback
Session 4: Conversation in Relationships
Goals:
• What makes up a relationship and what kind of relationships people have.
• What language to be used in order to establish and maintain relationships.
• What makes a relationship good or bad.
• Past mistakes in broken or bad relationships.
• Think about new beginnings/ solutions.
Activity/ procedure
1. Review discussion about nonverbal social skills form previous session
2. Activity sheet “Conversation in Relationships”
Step 1. Starting point of the session will be what relationship means
Step 2. A list of relationships will be generated
Step 3. Students will make a list of important relationships they have now and from past.
Step 4 . Group will discuss what makes a relationship good or bad
Step 5. Maps.
Step 6: each person will take turn and share in the group about one relationship in which they have not worked well and one relationship that is a success
Step 7 New Beginnings.
Step 8. Each group member will identify one communication situation that was difficult for them. Can be from past present or future. The counselor can take role of the other person and people act out what they wish they had said or what they plan to say in future.
Home work:
At the end of the session each member will agree to observe one social encounter before the next meeting and be ready to tell every one about it.
Things to notice are:
1. What the people talked about
2. How they spoke to each other
3. Use of body language
Session 5: Empathy
Goals:
• To teach young people how to communicate empathy and
• To gain greater insights into the meaning and importance of empathy.
• Practice empathy
Activity/ procedure
1. Review of the home assignment
2. Discussions
3. Activity sheet assignment“ Empathy- To feel What others are feeling”
1. Observe.
2. Think
3. Ask
4. Empathize.
5. Record their response.
4. Roleplays
5. Feedback
Homework: Assignment sheet "Empathy"
Session 6: Assertiveness and Self-monitoring
Goals:
• Students will learn what is self-monitoring of behavior and assertiveness.
• They will learn skills of self-management and self-rewarding
Activity/ procedure
1. Review discussion skills that have been learnt so far from the previous sessions
2. Handout discussion
Step 1 What is assertiveness ( As students have already learned the metaphor of mouse, lime and monster in previous session)
Step 2 Setting targets
3.Self-monitoring
Step 1 Do you know that famous atheletes and models monitor their own behavoior? Why they do that?
Step 2 Do you think it will help to monitor your own behaviour?
Step 3. Self-monitoring forms, students will be provided with instructions to fill those forms. Therapist will use his own form as a specimen on slides.
Step 4 students will think about the behaviours they want to change and will write them on monitoring forms
Step 5 students will choose rewards for themselves
4. Feedback
Home work: Learners will be provided with Self-monitoring forms to complete as home assignment also.
Session 7: Conflict resolution
Goals:
• Students will learn what is conflict resolution.
• They will learn that arguments and disagreements are often the result of a need for social confirmation of our beliefs and attitudes.
• People need to learn, realize, and feel comfortable with the idea that not all issues are resolvable.
Activity/ procedure
1. Homework discussion
2. Activity sheet “ Conflicts and resolving conflicts-1”
3. Discussion on tip sheet
Step 1 What is conflict? And what is conflict resolution
Step 2 Write. Students will write the following things and share with their group members
1. examples of different conflicts that occur with your friends? Your family? Your classmates?
2. What happens when these get out of hand? How do you feel? How does the other person feel?
3. What happens if you “resolve" these conflicts before they become serious?
Step 3. How to resolve conflicts – “ Tip sheet”
4. Roleplays: 1. Demonstration by therapist. 2. Demonstration by students
5. Feedback
Home work
Students will be provided with the sheets Activity sheet “ Conflicts and resolving conflicts-2” in which they need to record the following
Think about the last conflict you had with someone that didn't workout very well. What went wrong? What could you have done to make things work out better? How would better conflict resolution skills have changed what happened?
Session 8: Putting it all together or Closing
Goals
• Review of the content of previous sessions
• Observation of behavioral progress.
• Students will relate what has been leant with practical examples.
Activity/ procedure
1. Review of the previous session and home work
2. Discussions
3. Sample Discussion questions
• Has anyone be able to use these skills at home or at school?
• We learnt about use of non-verbal skills who remembers that?
• Students will share the example of using the skills learnt in previous sessions-
4. Activity chart
5. Closing notes
6. Feedback

2022-08-22

2022-10-17

Children will learn social skills and their social skills deficits will decrease. Students scores on Personal Adjustment Risk Index will be improved.

Children will learn to generalize the skills by practicing them in new environments. Cognitive Behavior Therapy based social skill training program will provide adolescents with knowledge to perform a social skill and how to perform the skill in accurate manner according to the context or situation. Moreover, they will learn how to exhibit appropriate social skills in presence of competing problem behaviours.

Social skills training program will also help in reduction in behavioral and emotional risk index.

Children will lean to manage their emotions and behaviors in social contexts.

Experimental design
Mixed Design

A parallel group randomized control trial was conducted from 15th August, 2022 to 17th October 2022. Stratified Random design was used for that purpose. Initially four schools were selected from Rawalpindi district and screening of a 651 students were done using BASC-BESS 3. Students who were shown to have issues related to social skills deficits were screened and informed consent was obtained. 28 students were available for recruitment in treatment and control group. Simple random sampling was used to allocate students in two arms. 14 students were allocated in treatment and 14 were allocated in control group.

fishbowl

student, group level randomization for treatment

Yes

4

22 students

11 control, 11 treatment