SOCIAL SKILLS TRAINING AND STRESS AT THE UNIVERSITY: A CASE STUDY

ABSTRACT

The application of Social Skills Training in the university context can be effective in reducing the stress perceived by students. Therefore, the objective of this article was to describe, in the format of a single case study, the therapeutic process of a Social Skills Training carried out with a Psychology student, also presenting data regarding the effectiveness of the intervention. Pre- and post-test assessments were performed using the following instruments: Social Skills Inventory 2 (IHS2-Del-Prette), Perceived Stress Scale (PSS-14), interviews and field diary. It was possible to verify the improvement of social skills such as refusing and making requests, dealing with criticism and exposing displeasure and requesting a change in the other’s behavior, and reduction of stress levels based on qualitative and quantitative data, with maintenance of these results in the follow-up of six weeks. It was concluded that the Social Skills Training carried out enabled the participant to improve her university experience.

Keywords:
social skills training; stress; case study

RESUMO

A aplicação do Treinamento de Habilidades Sociais no contexto universitário pode ser eficaz para a redução do estresse percebido pelos estudantes. Assim, o objetivo do presente artigo foi descrever, no formato de um estudo de caso único, o processo terapêutico de um Treinamento de Habilidades Sociais realizado com uma estudante de Psicologia, apresentando dados referentes à eficácia da intervenção. As avaliações pré e pós-teste foram feitas com os seguintes instrumentos: Inventário de Habilidades Sociais 2 (IHS2-Del-Prette), Escala de Estresse Percebido (PSS-14), entrevistas e diário de campo. Contatou-se o aprimoramento de habilidades sociais como recusar e fazer pedidos, lidar com críticas e expor desagrado e solicitar mudança de comportamento do outro, e redução dos níveis de estresse com base em dados qualitativos e quantitativos, com manutenção desses resultados no follow-up de seis semanas. Concluiu-se que o Treinamento de Habilidades Sociais realizado possibilitou a melhora da experiência na universidade para a participante.

Palavras-chave:
treinamento de habilidades sociais; stress; estudo de caso

RESUMEN

La aplicación del entrenamiento de Habilidades Sociales en el contexto universitario puede ser eficaz para la disminución del estrese percibido por los estudiantes. Delante eso, el objetivo del presente artículo fue describir, en el molde de un estudio de caso único, el proceso terapéutico de un entrenamiento de Habilidades Sociales realizado con una estudiante de Psicología, que presentaba, también, datos referentes a la eficacia de la intervención. Las evaluaciones antes y e después de la prueba se hicieron con los siguientes instrumentos: Inventario de Habilidades Sociales 2 (IHS2-Del-Prette), Escala de Estrese Percibido (PSS-14), entrevistas y diario de campo. Fue posible constatar el perfeccionamiento de habilidades sociales como recusar y hacer pedidos, lidiar con críticas y exponer desagrado y solicitar cambio de comportamiento del otro, y reducción de los niveles de estrese con base en datos cualitativos y cuantitativos, con manutención de esos resultados en elfollow-upde seis semanas. Se concluye que el Entrenamiento de Habilidades Sociales realizado posibilitó la mejora de la experiencia en la universidad para la participante.

Palabras clave:
entrenamiento de habilidades sociales; estrese; estudio de caso

INTRODUCTION

In stress and coping transaction theory by Lazarus and Folkman (1984), the stress phenomenon involves, in addition to physical reactions, a cognitive assessment process. The primary cognitive assessment will determine the way a person perceives the situation and their response to it. A situation will be perceived as stressful when, first, individuals regard it a threat, considering a wide context that includes situational, personal, and background factors.

In a secondary assessment, the resources for confrontation are analyzed and the response to the event is consciously planned. The confrontation resources, a.k.a coping, can be focused on the problem, acting on the root of stress in order to change it, or I emotion, acting on the regulation of emotional responses to the problem (Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986; Folkman, Lazarus, Gruen, & Delongis, 1986).

When it is felt that the demand presented by the event overloads or exceeds their resources, the situation is perceived as stressful (Lazarus & Folkman, 1984). With changes in the environment and with the results of the employed coping strategies, there are re-assessments of the situation that is initially perceived as stressful. After the re-assessment, which it the third phase in the cognitive assessment, changes in the perception of the initial situation or in the way to deal with it, might take place (Lazarus & Folkman, 1984).

There are numerous personal resources to deal with the demand of life and they include the category of social skills (Lazarus & Folkman, 1984), that are resources related to the skill to communicate and behave with other people suitable and effectively, facilitating problem solution on collaboration with other people. Thus, social skills are resources for confrontation to stress, and consequently with factors of protection to health (Feitosa, 2020; Lazarus & Folkman, 1984).

A review study showed that social skills are risk factors or protection to mental health, they can be associated to psychic suffering and the stress experience in the university course (Graner & Cerqueira, 2019). In this sense, the Training of Social Skills (THS) would increase the university students’ capacity to adapt to the changes or transitions of human development cycles (Feitosa, 2020), which might explain the efficacy of the stress reduction (Bezerra, Feitosa, Wagner, Rodríguez, & Rodrigues, 2022).

However, there is a scarcity, in national literature as well as in international, of studies that connect the THS with the stress that is perceived by the university students. On the other side, in a research realized with 50 university students in Iran, it was possible to verify that the training of social skills and of communication promoted greater levels of psychological wellbeing and happiness (Eshkaftki, Ghazanfari, & Solati, 2020).

The THS, as defined by A. Del Prette and Z. A. P. Del Prette (2017a), is a set of procedures, activities, and techniques that are structured in the intervention format and is mediated by a therapist aiming at acquisition and/or the improvement of social skills. The application of the THS in the university context justifies itself in the considerable levels of stress experienced by the students (Preto, Souza, Sousa, Fernandes, Pereira, & Cardoso, 2020).

The national literature points at the efficacy of THS programs for stress reduction among students: in Nazar, Pering, Girotto and Kucmanski (2020), researchers concluded that the THS led to a reduction in the levels of stress and to an enhancement in social skills. However, despite the crescent number of intervention research works that verify the efficacy of THS (A. Del Prette & Z. A. P. Del Prette, 2017b), there is still a scarcity of studies that relate to protocols and that explain in further detain the step-by-step of procedures and techniques used in an intervention.

The intervention protocols (Z. A. P. Del Prette & A. Del Prette, 2017) and the announcement of the qualitative analysis of the therapeutic process led to the correct reapplication of research works and the realization of other similar intervention studies. The announcement of the THS therapeutic process as an intervention program justifies itself by complementing and detailing information in the protocols, benefiting not only professionals that study the area of social skills but also students that engage in this type of program as a mode of prevention, education and mental health care for university students.

The therapeutic process is understood here as the method for management of intervention techniques applied in a structured session and the observed changes (Feitosa, 2020; Leonardi, 2017). Thus, researchers chose to elaborate a case study that could present the report on the experience of conducting a program for the promotion of social skills, with the description of the established therapeutic process.

The case study does not aim at investigating the effect of a survey or testing a certain hypothesis. Rather, it intends to describe a therapeutic process by means of a faithful, systematic, and longitudinal narrative, which comprehends information on the studied individual, on the realized interventions, and on the resulting changes (Leonardi, 2017). According to Lima (2011), the case study can be characterized as a detailed investigation into a single entity, in this case, an individual, with the acquisition of descriptive information that leads to an assessment on the relations between different phenomena.

In this case, the phenomenon to be considered is the way of promoting social skills for the reduction of stress among university students. Thus, the objective of the present article is to describe, in the format of a single case study, the therapeutic process of a THS realized with a psychology student, while in addition presenting data referring to the intervention in terms of reduction of stress levels and amplification of the repertoire of social skills.

METHOD

Participants

The participant that was included in the case study is female and was in the Psychology course in 2019, year of realization of the intervention. Additional information on the participant was not displayed here with the intention to protect her identity. The therapist and assistant were, in the period, mastering students in the Psychology Post-Graduation Program at the same university as the student and had experience in the mediation of THS groups.

Instruments

The participant was assessed with the following instruments: Inventory of Social Skills 2 Del-Prette (Z. A. P. Del Prette & A. Del Prette, 2018): nationally validated self-report instrument with excellent internal consistency (Cronbach’s alpha = 0,944), to characterize social performance and assess the repertoire of social skills for different social confront situations.

Perceived Stress Scale - PSS-14 (Carnegie Mellon University, 2015; Cohen, Kamarck, & Mermelstein, 1983): self-assessment scale to access the frequency at which an individual has dealt with unexpected situations or situations that represented overloads and demanded an assessment of this individual’s perception of control and emotional state regarding implicit stressful events (Cohen & Williamson, 1988).

The Portuguese version of the referred scale, used in the present study, is presented in the work by Feitosa, Silva and Bezerra (2015). According to these authors, resembling the original study in English, PSS-14 presented acceptable rates of precision and reliability, with time stability in the test-retest (r=0,79, p<0,001) and good internal consistency (Alpha=0,85 in the test and Alpha=0,86 in the re-test). According to Coutinho (2016), there is the classification of the scores: between zero and 18,6 is a low stress level; from 18,7 to 37,2 is a medium stress level; from 37,3 on, there is high stress level.

Interviews: interview scripts used at two moments: before the intervention for baseline assessment, establishment of rapport and access to complaints and demands and their resources to handle stressful interpersonal situations and, after the intervention, in the follow-up assessment for the verification of acquisition and the maintenance of social skills.

Field diary: records included events that took place in every session, observations made by the therapist and her assistant, and speeches by the participant that were uttered during the THS and that could indicate deficits and acquisitions.

The participant was assessed with the IHS2-Del-Prette (Z. A. P. Del Prette & A. Del Prette, 2018) and the PSS-14 (Carnegie Mellon University, 2015; Cohen, Kamarck, & Mermelstein, 1983), at four different moments: before the beginning of intervention (baseline assessment realized individually on August 28^th 2019), approximately one month later, in the first meeting (pre-test realized collectively on September 12^th 2019), in the last meeting (post-test realized collectively on October 24, 2019) and approximately six months after the conclusion of the group (follow-up that was realized individually on December 16 2019). These assessments led to the gathering of quantitative data.

Concerning qualitative data, they were collected by means of interviews (realized with the participant before and after the intervention, in the baseline and follow-up assessments) and of the notes takes by the researcher in the filed diary during the intervention, which were related to the performances of each participant in the realized meetings.

Procedures

The realization of the intervention research with the THS obtained approval by the Ethics Committee of the Federal University of Rondonia (CAAE 09193119.6.0000.5300) and the participant signed two copies of an Informed Consent Term. The intervention was advertised on social networks for students enrolled in courses in the health areas in the involved university, in combination with the link to a form for manifesting interest. Researchers contacted by telephone the individuals who demonstrated interest by filling in the form so that further information could be provided.

The THS was realized at the university school-clinic. There were seven weekly meetings with a duration of approximately one hour each. The sessions were guided by a plan that had been previously elaborated by the researcher, whose objectives focused on interpersonal relations in the university context, based on complaints reported in the initial interview and in the most precarious social skills that had been indicated by the results of the previous application of the IHS2-Del-Prette (Z. A. P. Del Prette & A. Del Prette, 2018). The theme contents for each session and their objectives, as well as the techniques used along the THS in order to structure the therapeutic process, came directly from A. Del Prette and Z. A. P. Del Prette (2013), Soares and Del Prette (2013), A. Del Prette and Z. A. P. Del Prette (2017b) and are listed on Box 1.

Box 1
Structuring Themes, Objectives and Techniques of The THS Sessions.

The techniques were applied in a semi-directed way, that is, the instructions for realization of behavioral rehearsals and other activities were conducted in a directive way. However, the level of participation and the quantity of information and personal experiences to be shared were decisions of the participant, while researchers respected the level of personal revelation, which characterized non directiveness (Feitosa, 2020).

The management of the group was assisted by a co-therapist with experience in the mediation of THS interventions, whose participation consisted of a registration of the sessions in real punctual contributions during the meetings and an exchange of impressions on events during the training. The function of the lead therapist, in her turn, was planning and mediating all meetings, in addition to recording information on the sessions in the field diary.

Leading to the accomplishment of the objective of the present study, there was an in-depth analysis of one of the cases that made up the THS group intervention. The choice of the case was based on information that was a result of the initial assessment (pre-intervention) of the participant, which indicated a behavioral repertoire that was rather precarious regarding important interpersonal skills for the university context because the participant presented difficulty to request and accept help or favors, to be assertive, and handle criticism. Besides that, the results of the final assessment (post-intervention) also influenced the choice of case: it was possible to verify that the intervention probably contribute to an improvement in the aforementioned interpersonal skills, in which the participant presented difficulties.

The results of the group in this intervention research can be found in Bezerra et al. (2022). The pseudonym attributed to refer to the participant during the report of the intervention experience was Clarice, and that will the denomination used from now on.

Data Treatment

For qualitative analysis, the contents of the initial interview (pre-intervention, when there were questions on the interpersonal difficulties experienced at the university and ways of handling such difficulties) and of the follow-up interview (post-intervention, with questions on the benefits of the THS) were transcribed an analyzed by means of the creation of theme categories. Some of these reports are described in the present study. Besides that, the performance of the participant, by means of direct observation throughout the intervention, was recorded in the field diary, and then studied and used for presenting the advancements of the participant.

The quantitative data, obtained with the applications of the instruments IHS2-Del-Prette (Z. A. P. Del Prette & A. Del Prette, 2018) and PSS-14 (Carnegie Mellon University, 2015; Cohen et al., 1983), were tabulated by the Statistical Package for the Social Sciences for WindowsIBM Software (SPSS, version 24.0).

Structure of the sessions

The applied THS sessions presented generally similar structure, except for the first and the last meeting, which presented some differences. In the first meeting, researchers realized the pre-test assessment, the presentations, the therapeutic contract, and a brief explanation on the concept of social skills and how they would be process throughout the intervention. In the last meeting, researchers realized the post-test assessment, the feedbacks and the conclusion.

During the other sessions, the structure was established by means of the use of the following selected techniques: (1) Exhibit with dialogue, consisting of brief pedagogical and theoretical presentation of concepts related to the theme and to the social skill to be processed; (2) Problem solution, which is a process for the comprehension and solution of problems. This technique is divided into six phases, three of which were applied in the sessions, in processes of group decision: (2.1) Problem Definition, where discussions were conducted on situations experienced at the university and experiences concerning the theme were shared. In addition, answers were given to questions such as “what is the problem situation? What is going on? With whom, when, where? What do you want in situations of this nature and what are the obstacles you wish to overcome?”; (2.2) Survey on alternatives and strategies, which consisted of the brainstorming of possible ways to handle the situation that causes stress and of the sharing of hints and strategies used by the participants themselves or by the therapist, based on the literature in the area (Soares & Del Prette, 2013); (2.3) Assessment of the obtained alternatives, when participants were asked to try and put into practice the alternatives and strategies that had been obtained and assessed; (3) Behavioral rehearsals of skills related to the theme in order to put into practice, in an interactive and analogous context, which was something processed during the sessions. The structure of the rehearsals was made by means of reports of specific difficulties and that were experienced by most of the members of the group; (4) Interpersonal homework (TIC), with the proposal that the participants reflect on the contents of the meetings and try to put into practice what had been learned along the week what had been learned, while paying attention to the way they did it, the consequences of the behavior and how they felt in the situation, which was a process that contributed to the development of self-monitoring. In addition, the TIC were provided with instructional exercises, which are pencil-and-paper tasks for the elaboration of answers, while applying and exemplifying strategies. Still concerning the TIC, they were retaken in the following session. The procedure consisted of the report by participants on the realization of the proposed task, which allowed the therapist to observe the effects of the content processed in the previous session on the behavior of the group. All techniques demonstrated above were found in A. Del Prette e Z. A. P. Del Prette (2017b), where the complete descriptions can be found.

RESULTS AND DISCUSSION

The therapeutic process was described by mean of the techniques handled in Clarice’s trajectory along the intervention, while taking into consideration initial difficulties, advancements achieved during each session, and skills that had been learned in the THS.

Experience report on the case

Based on the initial interview and on the baseline assessments and pre-tests realized by Clarice, it is possible to produce a survey on the most serious interpersonal difficulties that were previous to the THS in the university context: making requests, which included more specific situations that included asking for favors, asking for/accepting help and searching for information; being assertive, which included a greater tendency to passivity in situations that involved saying no or disagreeing, expressing discomfort, and asking others to change their behavior; and handling criticisms, which includes situations of exposure that could result in the receiving of criticisms by others.

In the first session of the THS, Clarice soon demonstrated her difficulty when participants were asked introduce themselves. It was observed that she avoided visual contact at that moment and was the last one to say something, even verbalizing that the situation itself said a lot about her. However, there was a pleasant surprise in the second meeting, in which the theme was public exhibit, when Clarice voluntarily participated in the discussions in two moments. In the retaking of the TIC, there was an opportunity to put into practice what was discussed in the first meeting, when we discussed the importance of expressing positive feelings for strengthening connections and, at the moment of elaboration of alternatives and strategies, Clarice spoke about an association strategy that she used when she gave presentations on topics about which she did not know much.

In the third session, Clarice verbalized that she had been putting into practice during the week a strategy that had been shared by another participant in the previous session. The strategy can be classified as focused on emotion (Folkman et al., 1986, p. 572), because it consisted of “defusing the importance” of a stressful demand, that is, attributing less meaning to a certain situation that is the source of stress and, somehow, reassess it in a positive way.

In the fourth meeting, in which the theme was refusing request, in order to introduce the discussion, the participants were questioned about their assertive, passive, or aggressive behaviors and which behaviors were most often used. Clarice said that she considered herself rather passive and relucted to say “no” for lack of motivation for explaining herself to explain herself and for fear of reactions to her refusal. However, in the following year, it was possible to verify an advance in this area: she shared the information that she had managed to say no for the realization of an academic practice on her birthday. She explained that she was able to share with the group her desire to change the date and obtained success in this interaction.

In the sixth session, Clarice spoke again about considering herself passive but linking it to her difficulty to express discomfort and request a change in behavior, which was the theme in that session. However, still in the same meeting, Clarice volunteered to participate in the realized behavioral rehearsal. For that rehearsal, researchers used a situation that the participant herself had experienced and had not been able to handle the way she thought would have been ideal. Thus, it was possible for her to practice what had been approached in the meeting, in a situation that was analogous to the one she had experienced. The action indicated advancements regarding her initial performance and motivation to improve her social skills.

In the last session, researchers realized the post-test assessments and the conclusion. However, before it happened, at the moment of retaking the TIC proposed in the previous session, Clarice affirmed that she planned to use a technique that had been introduced to criticize and require a change in behavior in an assertive way. The participant reported that there was a situation with a teacher who demanded this type of behavior and that she believed she would be able to calmly communicate her discomfort to the teacher. In addition, Clarice mentioned that it would be better to change the situation and that, maybe, it would be a mistake to refrain from action. At the end of the seventh and last meeting, in her feedback, the participant said that she had been reflecting on what she had learned and on the fact that from then on she would be better able to handle diverse situations.

In this sense, it is possible to observe that Clarice’s reports illustrate the stress and coping process of the transactional model (Lazarus & Folkman, 1984). In the first session of the THS, in which the theme was requesting and accepting favors, Clarice said that it was quite difficult for her to request and accept help and reported a stressful event that she had recently experienced: As she did not have the means to go by herself to an extra-class activity that she participated in, a classmate proposed to give her regular rides (stressful situation), but she could not accept it and, consequently, it became impossible for her to keep on practicing the extra-class activity, which is something that she regretted. Clarice’s refusal of the offer might have been due to fear of being a nuisance to those who were there to help her (primary assessment), which led to avoidance of the situation (coping with stressful situation). The result of this way of handling the situation was that she failed to take part in the activity for lack of the means to get there by herself, which generated negative feelings and loss of her sense of control, perceiving stress).

In the follow-up interview, realized approximately six weeks after the conclusion of the THS, Clarice had reassessed the situation and reported that, after the fifth meeting, om making requests, she finally realized that she could not “keep on losing stuff for fear of asking for them”. Therefore, after that she became able to better request and accept help in similar situations (coping with social skills). Still applying the transactional theory, social skills change the quality of the interaction between individuals and their environment, and promote a transition from a troubled relation towards a relation that generates a cognitive assessment that is more satisfactory and compatible with a sense of wellbeing (Lazarus & Folkman, 1984). Along the THS, Clarice started to make a more positive secondary assessment regarding her capacity to face potentially stressful interpersonal situations.

Thus, as Clarice felt that the demand presented by the interpersonal event exceeded the confrontation resources that are focused on the problem, the situation was perceived as stressful and the answer as coping, focused on the emotion, it was the avoidance or the escaping from the situation in order to handle stress, but maintaining it. During the THS, she learned to use and improve her social skills (making requests and being assertive, for example) employing them in her everyday life as coping strategies that are focused on the problem. Based on this change, there was the cognitive retaliation of the situation that was initially perceived as stressful, and was a result of the reduction of their perceived stress. The efficacy of the social skills as coping strategies seems to have increased Clarice’s motivation to actively interact with the environment, solving interpersonal problems in order to maximize the achievement of what was appreciated, sustaining the high frequency use of these skills.

In the qualitative assessment of the follow-up, it was possible to verify the improvement of social skills such as: refusing and making requests, handling criticisms, expressing discomfort, asking for changes in other individuals’ behaviors, and public exposure. The qualitative data reinforce the quantitative results, discriminated on Box 2.

Box 2
Average Stress Levels and the Participant’s General Score of Social Skills.

Consequently, the results of the present study corroborate the notion that the THS has the potential to contribute to the students’ mental health and wellbeing (Graner & Cerqueira, 2019; Eshkaftki et al., 2020), and can be efficient in the promotion of social skills in the university context (Lopes, Dascanio, Ferreira, Del Prette, & Del Prette, 2017) and employed in stress reduction (Bezerra et al., 2022; Nazar et al., 2020). The application of the THS in this context justifies itself by the considerable levels of stress that are experienced by the students (Preto et al., 2020). The correct application of the research works and the realization of other similar studies on intervention with THS requires the use of protocols (Z. A. P. Del Prette & A. Del Prette, 2017) in which detail, by means of a description of the therapeutic process, contributes by providing examples how the technical structure of each session relates with the positive results that are expected in a specific psychological theory.

FINAL CONSIDERATIONS

Based on the initial assessment realized with Clarice, it was ´possible to verify that the most serious difficulties in the interpersonal relations included tendency to passivity and in situations that demanded refusing an offer or a request; disagreeing, expressing discomfort, and requesting a change in other individuals’ behaviors; making requests and accepting help; handling criticisms, which included situations of exposure that could lead to the receiving of criticism by others. During the intervention, it was possible to observe that, every week, Clarice became increasingly participative, and even volunteered for an activity of behavioral rehearsal. Such attitude was considered an advancement due to the shyness she demonstrated in the first meeting.

The later assessments of the THS hinted at improvement in social skills for refusing and making requests, expressing discomfort and requesting changes in the behavior of others, and public exposure. In addition, the quantitative results that were produced before and after the THS, referring to Clarice’s stress and repertoire of social skills, also suggested that the THS was efficient for the reduction of the levels of stress and for the amplification of the participant’s repertoire of social skills.

It is possible to reach the conclusion that there might be signs that the therapeutic process indeed led to an improvement in the experience at the university for the participant whose case was assessed in the present study. The results were compatible with the predictions of the transactional theory of stress and coping by Lazarus and Folkman, indicating reliability for the application of the training for social skills in the university context in order to increase social skills and reduce stress. We expect that, with the information regarding the structure of the realized intervention and that were share in this article, it becomes possible to replicate this type of intervention by other authors, especially psychologists in the area of mental health.

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  Research realized with financial support by the Coordination for Improvement of Higher Education Personnel (CAPES).

Publication Dates

• Publication in this collection
  15 Jan 2024
• Date of issue
  2024

History

• Received
  22 Oct 2020
• Accepted
  11 Dec 2021