Cognitive Behavioral Social Skills Training (CBSST) is a structured group therapy developed by Eric Granholm and colleagues at the University of California San Diego. It combines two well-established traditions — cognitive behavioural therapy for psychosis and behavioural social skills training — into a single programme aimed at improving day-to-day functioning. It is one of the few therapies in the field designed explicitly around the question: what stops a person with schizophrenia from doing the things they want to do, and how do we rebuild those skills?
CBSST is a manualised group therapy that integrates cognitive techniques with explicit social skills practice, aimed at improving real-world functioning in people with schizophrenia and related disorders.
Why CBSST exists
Two decades of research on schizophrenia outcomes have made one thing clear: symptom reduction does not automatically translate into functional recovery. People can be relatively free of voices and delusions and still struggle to manage a conversation with a landlord, attend a job interview, or maintain friendships. The barriers are a combination of:
- Cognitive symptoms — slowed processing, working memory difficulties
- Negative symptoms — reduced motivation, blunted affect, social withdrawal
- Defeatist beliefs — "I will fail anyway," "people don't want me around"
- Skill deficits from years of withdrawal and missed development
CBSST addresses all four. The cognitive work targets the defeatist beliefs and motivational barriers; the skills work rebuilds the practical abilities; the group format provides the social context in which both can be practised.
How CBSST is structured
CBSST is delivered in groups of four to eight people over roughly 18 to 36 weekly sessions, depending on the version. The full course is divided into three modules, each lasting six to twelve sessions, repeated in cycles so participants can join and leave with less disruption.
Module 1: Cognitive skills
Adapted CBT for psychosis. Participants learn to identify their own defeatist beliefs ("I will mess this up," "no one wants to talk to me"), examine the evidence, and generate alternatives. The work is paced and concrete; the therapist uses worksheets, role-play, and group brainstorming rather than abstract Socratic dialogue.
Module 2: Social skills
Direct, behavioural training in conversation skills, assertiveness, and problem-solving. Sessions follow the classic social skills format: instruction, modelling, role-play, feedback, repetition. Participants practise things like starting a conversation, asking a question of a clerk, declining an unreasonable request, or making a phone call to a clinic.
Module 3: Problem-solving skills
A structured five-step approach to everyday problems: define the problem, brainstorm solutions, evaluate the options, choose and plan, then review. Examples are drawn from participants' actual lives — finding a doctor, dealing with a noisy neighbour, planning a visit with family.
Between sessions, participants do small, agreed homework assignments that put the skills into practice in their own lives and report back the next week.
What the evidence says
Several randomised trials, primarily by Granholm's group and collaborators, have compared CBSST to control conditions including supportive group therapy and treatment as usual. Findings include:
- Improvement in self-reported functioning
- Reductions in defeatist beliefs and increases in cognitive insight
- Modest improvements in negative symptoms, particularly motivation
- Effects on functioning sustained at 12-month follow-up
CBSST does not reliably reduce positive symptoms — that is not its target. Its claim to fame is functional recovery, which other therapies often promise but few measurably deliver.
Who CBSST is for
- People with schizophrenia or schizoaffective disorder whose acute symptoms are reasonably stable
- People whose negative symptoms or social anxiety limit their day-to-day life
- People who can tolerate group settings
- People at any stage of recovery — CBSST has been used both early and many years post first episode
- Adults of any age, including older adults; an adapted version exists for middle-aged and older participants
Who it is not for (yet)
- People in acute psychotic episodes
- People with severe disorganisation that prevents engagement with structured group exercises
- People for whom group settings cause significant paranoia that does not settle
Why the group format matters
The group is not just a delivery vehicle; it is the laboratory. Skills are rehearsed with peers who share the diagnosis and the experience. Participants give each other feedback and witness each other's progress. For people whose social isolation has been measured in years, the group itself is one of the active ingredients.
If group sessions worsen voices, paranoia, or thoughts of self-harm, raise it with the therapist. The work should feel hard but workable; serious destabilisation is a signal to pause.
How to find CBSST
CBSST is offered through some psychiatric rehabilitation programmes, clubhouses, and academic medical centres in the US, with growing international use. The manuals and training programmes are available through the developer's group at UC San Diego. Patients can ask their treatment team or local clubhouse whether CBSST or a similar integrated skills programme is available.
How CBSST relates to other therapies
- Versus CBTp. CBTp is usually individual and focuses on symptom-related distress; CBSST is group and focuses on functional skills. Many people benefit from both.
- Versus social skills training alone. Older social skills programmes lacked the cognitive component; CBSST adds it explicitly.
- Versus IMR or WRAP. IMR is broader illness self-management; WRAP is patient-led wellness planning. CBSST is specifically about cognitive and social skill rebuilding.
The big picture
CBSST is one of the few therapies in psychosis explicitly built around what people actually want from recovery — being able to do their lives. It is not glamorous; it is rooms with worksheets and role-plays. It is also one of the most under-distributed interventions in the field. For someone for whom the next step is a job interview or a return to school or a coffee with an old friend, asking the team about CBSST or an equivalent integrated skills programme is one of the more practical questions to raise.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.