OBJECTIVE: The study compared the effects of social skills training and social milieu treatment on symptoms of schizophrenia, particularly on negative symptoms. METHODS: Thirty-three patients aged 18 to 55 years with a diagnosis of schizophrenia were randomly assigned to a nine-week program of social skills training or social milieu treatment. Patients were assessed at three-, six-, and nine-week intervals during treatment and at follow-up using the Positive and Negative Syndrome Scale (PANSS), which measured both positive and negative symptoms of schizophrenia and general psychopathology. RESULTS: Fifteen patients completed social skills training, and 13 completed social milieu treatment. Comparison of PANSS scores at different assessment times showed that both treatments were effective in reducing symptoms, but social skills training appeared to be more effective in reducing negative symptoms. No differences were found between treatment groups in relapse rates or in symptom measures at three-month follow-up. However, six-month follow-up data available only for the social skills training group showed that improvement in negative symptoms had begun to decline. CONCLUSIONS: Psychosocial approaches are a necessary component in the treatment of patients with schizophrenia, and social skills training appears to be particularly helpful. The gradual decline in improvement in negative symptoms at six-month follow-up suggests the need for more extended treatment.