Effects of Communal Living Skills on Improving Activities of Daily Living of Male Patients with Schizophrenia

Research Article

J Schizophr Res. 2014;1(1): 4.

Effects of Communal Living Skills on Improving Activities of Daily Living of Male Patients with Schizophrenia

Anahita Khodabakhshi Koolaee* and Mohammad Reza Falsafinejad

1Department of counseling, Islamic Azad University, Science and Research Branch of Arak, Iran

2Department of Education and psychology, Allame Tabatabaii University, Iran

*Corresponding author: Anahita khodabakhshi koolaee, Department of counseling, Islamic Azad University, Science and Research Branch of Arak, Arak, Iran

Received: September 01, 2014; Accepted: October 24, 2014; Published: October 27, 2014


Aim: This study examined the effect of communal living skills on activity of daily living of schizophrenia patients.


Twenty-four patients who resided in psychiatric center were randomly assigned to two groups. The experimental group received ten grouptraining sessions and control group received routine nursing care.

Results: Compared with patients randomized to routine nursing care treatment, communal living skills training patients function on every day living skills improved significantly after intervention. While, the changes were absent in the nursing care group.

Conclusion: Study results revealed that a communal living skills training program might improve daily life skills in schizophrenia patients. In addition, findings suggest that implementing psychosocial interventions may increase the patients' independence and quality of life.

Keywords: Communal living skills; Activities of daily living; Schizophrenia


Schizophrenia is one of the most disability disorders of different psychiatric diseases. These patients have marked impairments and worse function in behavioral problems, community life skills, understanding interpersonal boundaries than other groups of psychiatric patients [1]. In addition, patients with schizophrenia have lack in independent living, self-care, social skills, and vocational skills [2]. As Patterson et al [3] cited "currently, the most effective method of treatment is symptomatic and involves the use antipsychotic drugs". While, for ability to facing real world, reduction in symptom do not enough [3]. Although, the researches indicated Social Skills Training (SST) is beneficial for schizophrenia patients, but without focusing on social functions and activities daily life, SST is not enough helpful [4]. Communal living skills as a part of social skills training can help psychotic patients to dealing with daily situations. The communal living skills helping patients to facing daily living challenges and encourages them to learn living with the other people with severe mental illness at supervised residences in the community or even at time with family. As Bellack et al [5] explained these skills address common situations such as; being concerned that falsely accused by others of doing something that one did or not do, poor eating and drinking manners, have lack of knowledge about hygiene and psychical health [5]. American Occupational Therapy Association (AOTA) defined Activity Daily Livening (ADL) as "the components of everyday activity including self-care, work and play/leisure activities" [6]. Bellack et al mentioned "repeated practice of communal skills and posting the steps of the skills in common living areas can minimize the stress and tension of communal living for clients and staff members alike". There are the bodies of evidence that indicated the influence of social skills training on negative symptoms,

demographic characteristics; gender, age, social and economical status, and improving social skills and neuropsychological functions among schizophrenia patients [7-10]. In this study, we examined the communal living skills as sub-skills of social skills training and we minimized steps to 10 session's group training. The goal of this study was to test the efficacy of an intervention aimed at every-day living skills titled "Communal Living Skills (CLS) based on Bellack et al [5], specifically designed for Activities Daily Living (ADL) of male middle age patients of schizophrenia lived in supervised residents psychiatric intuition in Tehran, Iran. We hypothesized that patients participating in the CLS intervention program would indicated greater improvements in ADL and compare them with the control group received routine nursing care.



The study was conducted in Razi residents' psychiatric center in Tehran. The diagnostic criteria established by two psychiatrists according to American psychiatric association 4th revised diagnostic and statistical manual of mental disorders (DSM-IV). Patients diagnosed with schizophrenia were randomly assigned to experimental and control groups. Twelve male participants were enrolled in the experimental group where they participated in communal living skills training and 12 male subjects were assigned in control group and received the routine nursing care. The patients' demographic information and checklist of daily living skills were recorded. The checklist of daily living skills was measured before treatment and one week after the end of intervention. The measure was used to examine the difference of ADL between the experimental and control groups. Before the intervention, patients agree and sign the informed contest forms. The experimental group received via a 60-minutes communal skills training course once a week and for 10 weeks. During each course, the first 10 minutes were used for warming up and homework exercises, 10 minutes were used for explanation of rationale of using the skills, 30 minutes applied for demonstration and role-play based on the steps of the skills and the last 10 minutes were used for feedback and sharing the ideas. The clinical psychologist chosen to be the group leader had ten years of clinical experience in the department of psychiatry and trained as a leader and co-leader in Communal Living Skills and social skillstraining groups.


  1. The demographic information included the patients' age, educational status, marital status, number of hospitalization, occupation before disease, and supportive recourses.
  2. The checklist of Activity Daily Living skills (ADL) was developed by Karbalaei Ismail [11]. The checklist consisted of 55 selfreport items and 3 sub-scales including self-care, communicational skills, and problem behaviors. The participants were required to answer using a five-point Likert scale, with a range of scores from 10 (good ADL) to 85 (severe worse ADL). The cronbach a coefficient was. 81 and test-retest reliability four weeks later was .79 [11].

Communal living skills training intervention

In order to identify important areas of our intervention, we started by reviewing the literature on the use of social skills training for schizophrenia patients. We based our intervention on Bellack and colleagues [5]. The communal living skills training is a part of social skills training. According to bellack et al this manual is dividing to sub-skills including; locating your missing belongs, what to do if you think somebody has something of yours, asking for privacy, checking out your beliefs, reminding someone not to spread germs, and eating, and drinking politely. Each skill has steps and homework to exercise.

Format of routine nursing care treatment

Participants randomized to comparison or control condition received only their usual medication. None of the patients reported participating in any other psychosocial treatment during this study.

Statistical used repeated measures analysis of covariate (ANCOVA) to address our main hypothesis to determine whether participation in CLS intervention was improving Activity Daily Living (ADL) of patients compared with the routine nursing care group. All participants were tested at baseline and after completion of the 10-weels intervention. Other descriptive statistical were used to analyzed the demographic information.


Sample characteristics

The sociodemographic characteristics of patients in two groups of were summarized (Table 1).