The efficacy of social skills training for individuals with schizophrenia


Published: Oct 15, 2020
Keywords:
Social skills training Schizophrenia
Παρασκευή Ντούσια
Αντώνης Κατσαμάγκος
Μαρίνα Οικονόμου
Abstract

Ten individuals with schizophrenia and two with schizoaffective disorder received group training in social skills, including conversation skills, friendship skills, and dating skills as well as problem-solving skills. The training, coupled with case management, was administered twice per week for one hour each session for a total of 5 months. The primary
outcome measures were the Social Contact and Communication subscales of the Life Skills Profile, the WHOQOL-BREF, and the Self-efficacy/self-esteem subscale of the Empowerment Scale. Based on these, participants’ social functioning, community functioning, and self-efficacy perceptions were assessed respectively. Measures were taken at pre-treatment and post-treatment. Patients’ social functioning and
community functioning improved over time whereas self-efficacy beliefs did not significantly change. Patients who completed homework assignments frequently improved more in social contact compared to patients who completed homework assignments infrequently. Findings suggest that social skills training for outpatients with chronic mental illness leads to acquisition of social skills that are important in everyday life. Case management is a critical aspect of treatment that enhances learning and transfer of social skills outside the immediate training setting. Benefits from social skills homework assignments mainly depend on the type of homework.

Article Details
  • Section
  • RESEARCH PAPERS
Downloads
Download data is not yet available.
References
Addington, J., & Addington, D. (2000). Neuro -
cognitive and social functioning in schizophrenia:
a 2.5 year follow-up study. Schizophrenia
Research, 44, 47-56.
Addington, J., McCleary, L., & Munroe-Blum, H.
(1998). Relationship between cognitive and social
dysfunction in schizophrenia. Schizophrenia
Research, 34, 59-66.
Anzai, N., Yoneda, S., Kumagai, N., Nakamura, Y.,
Ikebuchi, E., & Liberman, R. P. (2002). Training
persons with schizophrenia in illness selfmanagement:
a randomized controlled trial in
Japan. Psychiatric Services, 53(5), 545-547.
Auther, A. M., Lencz, T., Smith, C. W., Bowie, C. R.,
Cornblatt, B. A., (2003). Overview of the first
annual workshop on the schizophrenia prodrome.
Schizophrenia Bulletin, 29(4), 625-631.
Bandura, A. (1969). Principles of behavior
modification. NY: Holt, Rinehart, & Winston.
Bellack, A. S. (2004). Skills training for people with
severe mental illness. Psychiatric Rehabilitation
Journal, 27(4), 375-391.
Bellack, A. S., Green, M. F., Cook, J. A., Fenton, W.,
Harvey, P.D., Heaton, R. K., Laughren, T., Leon,
A. C., Mayo, D. J., Patrick, D. L., Patterson, T. L.,
Rose, A., Stover, E., & Wykes, T. (2007).
Assessment of community functioning in people
with schizophrenia and other severe mental
illnesses: a white paper based on an NIMHsponsored
workshop. Schizophrenia Bulletin,
(3), 805-822.
Bellack, A. S., Morrison, R. L., Wixted, J. T., & Mueser,
K. T. (1990). An analysis of social competence in
schizophrenia. British Journal of Psychiatry, 156,
-818.
Bellack, A. S., & Mueser K. T. (1993). Psychosocial
treatment for schizophrenia. Schizophrenia
Bulletin, 19(2), 317-336.
Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta,
J. (2004). Social skills training for schizophrenia.
A step-by-step guide. New York: The Guilford
Press.
Bellack, A. S., Turner, S. M., Hersen, M., & Luber, R.,
F. (1984). An examination of the efficacy of social
skills training for chronic schizophrenic patients.
Community Psychiatry, 35, 1023-1028.
Bentall, R. P., Simpson, P. W., Lee, D. A., Williams, S.,
Elves, S., Brabbins, C., & Morrison, A. P. (2010).
Motivation and avolition in schizophrenia
patients: The role of self-efficacy. Psychosis, 2(1),
-22.
Benton, M. K. & Shroeder, H. E. (1990). Social skills
training with schizophrenics: a meta-analytic
evaluation. Journal of consulting and clinical
psychology, 58(6), 741-747.
Blanchard, J. J., & Neale, J. M. (1994). The
neuropsychological signature of schizophrenia:
generalized or differential deficit? American
Journal of Psychiatry, 151, 40-48.
Bobes, J., Garcia-Portilla, P., Saiz, P. A., Bascaran, T.,
& Bousono, M. (2005). Quality of life measures
Παρασκευή Ντούτσια, Αντώνης Κατσαμάγκος και Μαρίνα Οικονόμου
in schizophrenia. European Psychiatry, 20, 313-
Bradshaw, W. & Brekke, J. S. (1999). Subjective
experience in schizophrenia: factors influencing
self-esteem, satisfaction with life, and subjective
distress. American Journal of Orthopsychiatry,
(2), 254-260.
Braff, D. L., Heaton, R., Kuck, J., Cullum, M.,
Moranville, J., Grant, I., & Zisook, S. (1991). The
generalized pattern of neuropsychological
deficits in outpatients with chronic schizophrenia
with heterogeneous Wisconsin Card Sorting Test
results. Archives of General Psychiatry, 48, 891-
Browne, S., Roe, M., Lane, A., Gervin, M., Morris, M.,
Kinsella, A., Larkin, C., O’Callaghan, E. (1996).
Quality of life in schizophrenia: relationship to
sociodemographic factors, symptomatology and
tardive dyskinesia. Acta Psychiatrica Scandina -
vica, 94, 118-124.
Bruene, M. (2005). ‘‘Theory of mind’’ in schizophre -
nia: a review of the literature, Schizophrenia
Bulletin, 31(1), 21-42.
Buchanan, W., Kreyenbuhl, J., Kelly, D. L., Noel, J. M.,
Boggs, D. L., Fischer, B. A., Himelhoch, S., Fang,
B., Peterson, E., Aquino, P. R., & Keller, W.
(2010). The 2009 schizophrenia PORT psycho -
phar ma cological treatment recommendations
and summary statements. Schizophrenia Bulletin,
(1), 71-93.
Bullock, W. A., Ensing, D. S., Alloy, V. E., & Weddle,
C. C. (2010). Leadership education: evaluation of
a program to promote recovery in persons with
psychiatric disabilities. Psychiatric Rehabilitation
Journal, 24(1), 3-10.
Bustillo, J. R., Lauriello, J., Horan, W. P., & Keith, S. J.
(2001). The psychosocial treatment of
schizophrenia: an update. American Journal of
Psychiatry, 158, 163-175.
Chien, H., Ku, C., Lu, R., Chu, H., Tao, Y., & Chou, K.
(2003). Effects of social skills training on
improving social skills of patients with schizo -
phrenia. Archives of Psychiatric Nursing, 17(5),
-236.
Corcoran, C., Walker, E., Huot, R., Mittal, V., Tessner,
K., Kestler, L., & Malaspina, D. (2003). The stress
cascade and schizophrenia: etiology and onset.
Schizophrenia Bulletin, 29(4), 671-692.
Corrigan, P. W. (1991). Social skills training in adult
psychiatric populations: a meta-analysis. Journal
of Behavior Therapy and Experimental Psychiatry,
(3), 203-210.
Corrigan, P. W., Mueser, K. T., Bond, G. R., Drake,
R. E., & Solomon, P. (2008). Principles and
Practice of Psychiatric Rehabilitation. An Empirical
Approach. New York: The Guildford Press.
Corrigan, P. W., Giffort, D., Rashid, B. S., Leary, M. S.,
& Okeke, I. (1999). Recovery as a psychological
construct. Community Mental Health Journal,
(3), 231-239.
Corrigan, P. W., Wallace, C. J., & Green, M. F. (1992).
Deficits in social schemata in schizophrenia.
Schizophrenia Research, 8, 129-135.
Couture, S., Penn, D. L., & Roberts, D. L. (2006). The
functional significance of social cognition in
schizophrenia: a review. Schizophrenia Bulletin,
(1), 44-63.
Dickinson, D., Iannone, V. N., Wilk, C. M., & Gold, J.
M. (2004). General and specific cognitive deficits
in schizophrenia. Biological Psychiatry, 55, 826-
Dilk, M. N. & Bond, G. R. (1996). Meta-analytic
evaluation of skills training research for individuals
with severe mental illness. Journal of Consulting
and Clinical Psychology, 64(6), 1337-1346.
D’Zurilla, T. J. & Goldfried, M. R. (1971). Problem
solving and behavior modification. Journal of
Abnormal Psychology, 78(1), 107-126.
Eckman, T. A., Wirshing, W. C., Marder, S. R.,
Liberman, R. P., Johnston-Cronk, K., Zimmer -
mann, K., & Mintz, J. (1992). Technique for
training schizophrenic patients in illness selfmanagement:
a controlled trial. American Journal
of Psychiatry, 149, 1549-1555.
Eklund, M. & Hansson, L. (2007). Social network
among people with persistent mental illness:
associations with sociodemographic, clinical and
health-related factors. International Journal of
Social Psychiatry, 53(4), 293-305
Falloon, I. R., Lindley, P., McDonald, R., & Marks, I. M.
(1977). Social Skills Training of out-patient
groups. A controlled study of rehearsal and
homework. British Journal of Psychiatry, 131(6),
-609.
Foster Green, M., Kern, R.S., Braff, D. L. & Mintz, J.
(2000). Neurocognitive deficits and functional
outcome in schizophrenia: are we measuring the
“right stuff”? Schizophrenia Bulletin, 26(1), 119-
Farrer, C. & Franck, N. (2007). Self-monitoring in
Η αποτελεσματικότητα της εκπαίδευσης στις κοινωνικές δεξιότητες 49
schizophrenia. Current Psychiatry Reviews, 3(4),
-251.
Frith, C. D. & Corcoran, R. (1996). Exploring the
‘theory of mind’ in people with schizophrenia.
Psychological Medicine, 26, 521-530.
Glynn, S. M., Marder, S. R., Liberman, R. P., Blair, K.,
Wirshing, W. C., Wirshing, D. A., Ross, D., &
Mintz, D. (2002). Supplementing clinic-based
skills training with manual-based community
support sessions: effects on social adjustment of
patients with schizophrenia. American Journal of
Psychiatry, 159(5), 829-837.
Goldberg, J. O. & Smidt, L. A. (2001). Shyness,
sociability, and social dysfunction in schizo -
phrenia. Schizophrenia Research, 48, 343-349.
Granholm, E., Auslander, L. A., Gottlieb, J. D.,
McQuaid, J. R., & McClure, F. S. (2006).
Therapeutic factors contributing to change in
cognitive-behavioral group therapy for older
persons with schizophrenia. Journal of Contem -
porary Psychotherapy, 36(1), 31-41.
Granholm, E., McQuaid, J. R., McClure, F. S.,
Auslander, L. A., Perivoliotis, D., Pedrelli, P.,
Patterson, T., & Jeste, D. V. (2005). A randomized
controlled trial of cognitive behavioral skills
training for middle-aged and older outpatients
with chronic schizophrenia. American Journal of
Psychiatry, 162, 520-529.
Green, M. F., Olivier, B., Crawley, J. N., Penn, D. L., &
Silverstein, S. (2005). Social cognition in
schizophrenia: recommendations from the
measurement and treatment research to improve
cognition in Schizophrenia New Approaches
Seminar. Schizophrenia Bulletin, 31(4), 882-887.
Ginieri-Coccosis, M., Triantafillou, E., Tomaras, V.,
Liapas, I. A., Christodoulou, G. N., & Papa -
dimitriou, G. N. (2009). Quality of life in mentally
ill, physically ill and healthy individuals: The
validation of the Greek version of the World
Health Organization Quality of Life (WHOQOL-
questionnaire. Annals of General Psychiatry,
(1), 23-37.
Halford, W. K., & Hayes, R. (1991). Psychological
rehabilitation of chronic schizophrenic patients:
recent findings on social skills training and family
psychoeducation. Clinical Psychology Review,
, 23-44.
Harvey, C. A., Jeffreys, S. E., McNaught, A. S.,
Blizard, R. A., & King, M. B. (2007). The Camden
schizophrenia surveys III: five-year outcome of a
sample of individuals from a prevalence survey
and the importance of social relationships.
International Journal of Social Psychiatry, 53(4),
-356.
Hayes, R. L., Halford, W. K., & Varghese, F. T. (1995).
Social skills training with chronic schizophrenic
patients: effects on negative symptoms and
community functioning. Behavior Therapy, 26,
-449.
Heinssen, R. K., Liberman, R. P., & Kopelowicz, A.
(2000). Psychosocial skills training for schizo -
phrenia.: Lessons from the laboratory. Schizo -
phrenia Bulletin, 26(1), 21-46.
Holmes, M. R., Hansen, D. J., & Lawrence, J., S.
(1984). Conversational skills with aftercare
patients in the community: social validation and
generalization. Behavior Therapy, 15, 84-100.
Hooker, C., & Park, S. (2002). Emotion processing
and its relationship to social functioning in schizo -
phrenia patients. Psychiatry Research, 112, 41-50.
Inoue, S., Tanaka, S., Shimodera, S., & Mino, Y.
(1997). Expressed emotion and social function.
Psychiatry Research, 72, 33-39.
Ji-Min, S., Sukhee, A., Eun-Kyung, B., & Chul-Kweon,
K. (2007). Social skills training as nursing
intervention to improve the social skills and selfesteem
of inpatients with chronic schizophrenia.
Archives of Psychiatric Nursing, 21(6), 317-326.
Katschnig, H. (2000). Schizophrenia and quality of
life. Acta Psychiatrica Scandinavica, 102, 33-37.
Kopelowicz, A., Liberman, R. P., & Zarate, R. (2006).
Recent advances in social skills training for
schizophrenia. Schizophrenia Bulletin, 32(S1),
S12-S23.
Kopelowicz, A., Zarate, R., Gonzalez Smith V., Mintz,
J., Liberman, R. P. (2003). Disease management
in latinos with schizophrenia: a family-assisted,
skills training approach. Schizophrenia Bulletin,
(2), 211-228.
Kurtz, M. M. & Mueser K.T. (2008). A meta-analysis of
controlled research on social skills training for
schizophrenia. Journal of Consulting and Clinical
Psychology, 76(3), 491-504.
Liberman, R. P. (2008). Recovery from disability.
Manual of psychiatric rehabilitation. VA: American
Psychiatric Publishing, Inc.
Liberman, R. P., DeRisi, W. J., & Mueser, K. T. (1989).
Social skills training for psychiatric patients. MA:
Allyn & Bacon.
Liberman, R. P., Mueser, K. T., Wallace, C. J., Jacobs,
Παρασκευή Ντούτσια, Αντώνης Κατσαμάγκος και Μαρίνα Οικονόμου
H. E., Eckman T., & Massel, H. K. (1986). Training
skills in the psychiatrically disabled: learning
coping and competence. Schizophrenia Bulletin,
(4), 631-647.
Liberman, R. P., Wallace, C. J., Blackwell, G.,
Kopelowitz, A., Vaccaro, J., & Mintz, J. (1998).
Skills training versus psychosocial occupational
therapy for persons with persistent schizo -
phrenia. American Journal of Psychiatry, 155(8),
-1091.
Marder, S. R., Wirshing, W. C., Mintz, J., McKenzie, J.,
Johnston, K., Eckman, T. A., Lebell, M.,
Zimmerman, K., & Liberman, R. P. (1996). Twoyear
outcome of social skills training and group
psychotherapy for outpatients with schizo -
phrenia. American Journal of Psychiatry, 153(12),
-1592.
Martin, J. A. & Penn, D. L. (2002). Attributional style in
schizophrenia: an investigation in outpatients with
and without persecutory delusions. Schizophre -
nia Bulletin, 28(1), 131-141.
Matousek, N., Edwards, J., Jackson, H. J., Rudd, R.
P., & McMurry, N. E. (2004). Social skills training
and negative symptoms. Behavior Modification,
, 39-63.
Mojtabai, R., Nicholson, R. A., & Carpenter, B. N.
(1998). Role of psychosocial treatment
management of schizophrenia: a meta-analytic
review of controlled outcome studies. Schizo -
phre nia Bulletin, 24(4), 569-587.
Mueser, K. T., Bellack, A. S., Douglas, M. S., &
Morrison, R. L. (1991). Prevalence and stability of
social skills deficits in schizophrenia. Schizo -
phrenia Research, 5, 167-176.
Mueser, K. T., Bellack, A. S., Morrison, R. L., &
Wixted, J. T. (1990). Social competence in
schizophrenia: premorbid adjustment, social skill,
and domains of functioning. Journal of Psychiatric
Research, 24(1), 51-63.
Mueser, K. T., Doonan, R., Penn, D. L., Blanchard, J.
J., Bellack, A. S., Nishith, P., & DeLeon, J. (1996).
Emotion recognition and social competence in
chronic schizophrenia. Journal of Abnormal
Psychology, 105(2), 271-275.
Mueser, K. T., Penn, D. L., Blanchard, J. J., & Bellack,
A. S. (1997). Affect recognition in schizophrenia:
a synthesis of findings accross three studies.
Psychiatry, 60(4), 301-308.
Mueser, K. T., Valentiner, D. P., & Agresta, J. (1997).
Coping with negative symptoms of schizophrenia:
patient and family perspectives. Schizophrenia
Bulletin, 23(2), 329-339.
Οικονόμου, Μ. (2000a). Ψυχοκοινωνικές Θεραπείες.
Στο βιβλίο «Ψυχιατρική» Β’ Τόμος,
(επιμ. έκδοσης: Γ. Ν. Χριστοδούλου και Συνεργά-
τες). Ψυχιατρική Κλινική Πανεπιστημίου Αθηνών.
Αθήνα: ΒΗΤΑ, σελ. 806-814.
Οικονόμου, Μ. (2000b). Ο ρόλος της οικογένειας
στην ψυχοκοινωνική αποκατάσταση.
Στο βιβλίο «Προληπτική Ψυχιατρική», (επιμ. έκδοσης:
Γ. Ν. Χριστοδούλου, Β. Π. Κονταξάκης, Μ. Π. Οι-
κονόμου), Αθήνα: Ψυχιατρική Κλινική Πανεπι-
στημίου Αθηνών, σελ. 181-186.
Patterson, T. L., Mausbach, B. T., McKibbin, C.,
Goldman, S., Bucardo, J., & Jeste, D. V. (2006).
Functional adaptation skills training (FAST): a
randomized trial of a psychosocial intervention for
middle aged and older patients with chronic
psychotic disorders. Schizophrenia Research, 86,
-299.
Park, K., Ku, J., Choi, S., Jang, H., Park, J., Kim, S.
I., & Kim, J. (2011). A virtual reality application in
role plays of social skills training for schizo -
phrenia: a randomized controlled trial. Psychiatry
Research, 189, 166-172.
Parker, G., Rosen, A., Edmur, N., & Hadzi-Pavlov, D.
(1991). The Life Skills Profile: Psychometric
properties of a measure assessing function and
disability in schizophrenia. Acta Psychiatrica
Scandinavica, 83,145-152.
Penn, D. L., & Mueser, K. T. (1996). Research update
on the psychosocial treatment of schizophrenia.
American Journal of Psychiatry, 153(5), 607-617.
Penn, D. L., Hope, D. A., Spaulding, W., & Kucera, J.
(1994). Social anxiety in schizophrenia.
Schizophrenia Research, 11, 277-284.
Pfammater, M., Junghan, U. M., & Brenner, H. D.
(2006). Efficacy of psychological therapy in
schizophrenia: conclusions from meta-analyses.
Schizophrenia Bulletin, 32(1), 64-80.
Pilling, S., Bebbington, P., Kuipers, E., Garety, P.,
Geddes, J., Martindale, B., Orbach, G., & Morgan,
C. (2002). Psychological treatments in schizo -
phrenia: II. Meta-analyses of randomized control
trials of social skills training and cognitive
remediation. Psychological Medicine, 32, 783-791.
Pratt, S. I., Mueser, K. T., Smith, T. E., & Lu, W.
(2005). Self-efficacy and psychosocial functioning
in schizophrenia: a mediational analysis.
Schizophrenia Research, 78, 187-197.
Η αποτελεσματικότητα της εκπαίδευσης στις κοινωνικές δεξιότητες 51
Prouteau, A., Verdoux, H., Briand, C., Lesage, A.,
Lalonde, P., Nicole, L., Reinharz, D., & Stip, E.
(2005). Cognitive predictors of psychosocial
functioning outcome in schizophrenia: a followup
study of subjects participating in a
rehabilitation program. Schizophrenia Research,
, 343-353.
Rogers, E. S., Chamberlin, J., Langer Ellison, M., &
Crean, T. (1997). A consumer-constructed scale
to measure empowerment among users of
mental health services. Psychiatric Services,
(8), 1042-1047.
Rosen, A., Hadzi-Pavlovic, D., & Parker, G. (1989).
The Life Skills Profile: A measure assessing
function and disability in schizophrenia.
Schizophrenia Bulletin, 15(2), 325-337.
Rosen, A., Hadzi-Pavlovic, D., Parker, G., Trauer, & T.
(2006). The Life Skills Profile. Background, items, and
scoring for the LSP-39, LSP-20, and the LSP-16.
Προήλθε από http://www.blackdoginstitute. org.au/
research/tools/index.cfm, 3 Οκτωβρίου, 2009.
Rund, B. R. (1998). A review of longitudinal studies of
cognitive functions in schizophrenia patients.
Schizophrenia Bulletin, 24(3), 425-435.
Seaton, B. E., Goldstein, G., & Allen, D. N. (2001).
Sources of heterogeneity in schizophrenia: the
role of neuropsychological functioning. Neuro -
psy chology Review, 11(1), 45-67.
Scott, J. E. & Dixon, L. B. (1995). Psychological
interventions for schizophrenia. Schizophrenia
Bulletin, 21(4), 621-630.
Segrin, C. (1992). Specifying the nature of social skill
deficits associated with depression. Human
Communication Research, 19(1), 89-123.
Shevington, S. M., Lofty, M., & O’Connell, A. K.
(2004). The World Health Organization’s
WHOQOL-BREF quality of life assessment:
psychometric properties and results of the
international field trial. A report from the
WHOQOL Group. Quality of Life Research, 13,
-310.
Smith, T. E., Hull, J. W., Goodman, M., Hedayat-
Harris, A., Willson, D. F., Israel, L. M., & Munich,
R. L. (1999). The relative influences of symptoms,
insight, and neurocognition on social adjustment
in schizophrenia and schizoaffective disorder.
The Journal of Nervous and Mental Disease,
(2), 102-108.
Snyder, M. (1974). Self-monitoring of expressive
behavior. Journal of Personality and Social
Psychology, 30(4), 526-537.
Spaulding, W. D., Reed, D., Sullivan, M., Richardson,
C., & Weiler, M. (1999). Effects of cognitive
treatment in psychiatric rehabilitation. Schizo -
phrenia Bulletin, 25(4), 657-676.
Spencer, P. G., Gillespie, C. R., & Ekisa, E. G. (1983).
A controlled comparison of the effects of social
skills training and remedial drama on the
conversational skills of chronic schizophrenic
inpatients. British Journal of Psychiatry, 143, 165-
Stirling, J. D., Hellewell, J. S. E., & Ndlovu, D. (2001).
Self-monitoring dysfunction and the positive
symptoms of schizophrenia. Psychopathology,
, 198-202.
Trauer, T., Duckmanton, R.A. Chiu, E. (1995). The life
skills profile: a study of its psychometric
properties. Australian and New Zealand Journal of
Psychiatry, 29(3), 492-499.
Valencia, M., Rascon, M. L., Juarez, F., & Murow, E.
(2007). A psychosocial skills training approach in
Mexican out-patients with schizophrenia. Psycho -
logical Medicine, 37, 1393-1402.
Ventura, J., Nuechterlein, K. H., Subotnik, K. L.,
Green, M. F., & Gitlin, M. J. (2004). Self-efficacy
and neurocognition may be related to coping
responses in recent-onset schizophrenia.
Schizophrenia Research, 69, 343-352.
Wallace, C. J., & Liberman, R. P. (1985). Social skills
training for patients with schizophrenia: a
controlled clinical trial. Psychiatry Research, 15,
-247.
Wallace, C. J., Liberman, R. P., McKain, S. J.,
Blackwell, G., & Eckman, T. A. (1992). Effe -
ctiveness and replicability of modules for
teaching social and instrumental skills to the
severely mentally ill. American Journal of Psychiatry,
(5), 654-658.
Wowra, S. A., & McCarter, R. (1999). Validation of the
empowerment scale with an outpatient mental
health population. Psychiatric Services, 50(7),
-961.
Zubin, J. & Spring, B. (1977). Vulnerability – a new
view of schizophrenia. Journal of Abnormal
Psychology, 86(2), 103-126.

Similar Articles

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)