The lack of social skills and self-image distorsions are frequently met in the avoidant personality disorder (APD) and although the personality disorders are egosyntonic, subjects could experience prolonged dysforic episodes and a will to change their relationship patterns.

To evaluate the efficacy of social skills training on the overall APD features and on the self-image distorsions, in particular.

A group of 12 subjects with APD, diagnosed using Structured Clinical Interview for Axis II Disorders of DSM IV (SCID II), were included in a psychotherapy program focused on social skills training with 2 sessions per week, for 3 months, with a follow-up visit after 6 months from baseline. These patients were included in an individual therapy (12 sessions) and group therapy (12 sessions). All of these subjects were monitored using a semi-structured interview focused upon the avoidant-type cognitive schemata and self-image related automatic cognitions. A diary was held by every patient and cognitive restructuring was monitored, as well as the effect of role-playing, imaginative and in vivo exposures.

The social skills training decreased the occurrence of social exposure associated discomfort, self-image self-reported automatic cognitions (as reflected by the diary entries). The overall evolution reflected an increase in self-confidence and a more stable sense of self in relationships, although the SCID II confirmed the maintenance of the APD diagnosis at follow-up visit.

Social skills training has a positive impact over the self-image, decreasing the social exposure discomfort and inadequacy feelings in the patient relationships.