Bell MD, Zito W, Greig T, et al. Neurocognitive enhancement therapy with vocational services: work outcomes at two-year follow-up

VA Connecticut Healthcare System, Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA. Bell.Morris_D+@West-Haven.VA.Gov
Schizophrenia Research (Impact Factor: 3.92). 09/2008; 105(1-3):18-29. DOI: 10.1016/j.schres.2008.06.026
Source: PubMed


Neurocognitive enhancement therapy (NET) is a remediation program for the persistent and function-limiting cognitive impairments of schizophrenia. In a previous study in veterans, NET improved work therapy outcomes as well as executive function and working memory. The present study aimed to determine whether NET could enhance functional outcomes among schizophrenia and schizoaffective patients in a community mental health center receiving community-based vocational services.
Patients (N=72) participated in a hybrid transitional and supported employment program (VOC) and were randomized to either NET+VOC or VOC only. NET+VOC included computer-based cognitive training, work feedback and a social information information-processing group. VOC only also included two weekly support groups. Active intervention was 12 months with 12 month follow-up. Follow-up rate was 100%.
NET+VOC patients worked significantly more hours during the 12 month follow-up period, reached a significantly higher cumulative rate of competitive employment by the sixth quarter, and maintained significantly higher rates of employment.
NET training improved vocational outcomes, suggesting the value of combining cognitive remediation with other rehabilitation methods to enhance functional outcomes.

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    • "Along the same line, another review which focuses on the interaction between supported employment services (SE) and cognitive functioning has pinpointed that provision of SE alone may improve some basic cognitive domains such as attention and psychomotor speed, but that it is more difficult to address impairments in higher order functions including working memory, verbal learning and memory , and executive function (McGurk and Mueser, 2004). Several later randomized controlled studies further demonstrated that SE in combination with cognitive remediation training (CRT) significantly maximized the positive employment outcomes of SE alone by 12 to 24 months (McGurk et al., 2005; Bell et al., 2008). In the present study, we take a step further by exploring whether improving neurocognitive functions by CRT can boost vocational outcomes beyond what integrated social skill training can do in our ISE program. "
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    ABSTRACT: The present study aims to investigate the synergistic effects of cognitive remediation training (CRT) on Integrated Supported Employment (ISE). ISE blends individual placement support service with work-related social skills training for Chinese people suffering from schizophrenia or schizoaffective disorder. Ninety participants with schizophrenia or schizoaffective disorders were recruited from two psychiatric outpatient services in Hong Kong. They were randomly assigned into the ISE+CRT (n=45) and ISE (n=45) conditions. Blinded assessments on vocational, clinical, psychological, and neurocognitive outcomes were conducted by independent assessors. The two groups were followed up at 7 and 11months. Both groups yielded similar improvements across several outcome domains assessed immediately after the interventions and at 7 and 11month follow-ups, but no significant group differences were found. Significant positive trends over time in vocational, clinical and cognitive outcomes consistently favored the ISE+CRT condition. While both the ISE+CRT and ISE groups demonstrated improvement in vocational, clinical, psychological, and neurocognitive outcomes, there was no evidence to show that cognitive remediation facilitated further improvement in these domains beyond gains associated with ISE alone. Further investigation is needed to fully exploit the synergistic potential of ISE combined with CRT, and to better understand which individuals experience a maximal benefit from the specific rehabilitation program components. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 06/2015; 166(1-3). DOI:10.1016/j.schres.2015.05.013 · 3.92 Impact Factor
    • "Ce taux d'insertion est passé de 61, 5 % à 82, 8 % et de 94, 4 % à 89, 4 % des personnes lorsque a été ajouté un entraînement des compétences sociales. Par contre, le maintien dans l'emploi est passé de 36,17 semaines à 46,94 semaines lors de l'ajout d'un entraînement des compétences sociales, alors qu'il a stagné lors de l'ajout d'une remédiation cognitive [31]. Ces données, qui reposent sur un nombre très restreint d'études (en l'occurrence une seule étude avec remédiation cognitive et une seule étude avec entraînement des compétences sociales en ce qui concerne la mesure du maintien dans l'emploi), montrent le rôle positif de la remédiation cognitive quant à la possibilité d'obtenir un emploi et celui de l'entraînement des compétences sociales pour se maintenir en poste. "
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    • "Since a CCT intervention typically involves many procedural features beyond the CCT program itself, which include trainer contact, socialization, motivational prompts, increased stimulation , and the traditional Hawthorne expectancy bias and retest effect, it is vital to compare the putative effects of CCT on productivity outcomes with respect to an intensity-matched active control (AC) condition to make valid inferences (Jacoby and Ahissar, 2013). Yet, of the thirteen trials of CCT in vocational settings mentioned above, seven (Gopher et al., 1994; Vauth et al., 2005a; McGurk et al., 2007, 2009; Bell et al., 2008; Cassavaugh and Kramer, 2009; Pradhan et al., 2011) did not include an AC arm. "
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    ABSTRACT: Cognitive skills are important predictors of job performance, but the extent to which computerized cognitive training (CCT) can improve job performance in healthy adults is unclear. We report, for the first time, that a CCT program aimed at attention, memory, reasoning and visuo-spatial abilities can enhance productivity in healthy younger adults on bookkeeping tasks with high relevance to real-world job performance. 44 business students (77.3% female, mean age 21.4 ± 2.6 years) were assigned to either (a) 20 h of CCT, or (b) 20 h of computerized arithmetic training (active control) by a matched sampling procedure. Both interventions were conducted over a period of 6 weeks, 3-4 1-h sessions per week. Transfer of skills to performance on a 60-min paper-based bookkeeping task was measured at three time points-baseline, after 10 h and after 20 h of training. Repeated measures ANOVA found a significant Group X Time effect on productivity (F = 7.033, df = 1.745; 73.273, p = 0.003) with a significant interaction at both the 10-h (Relative Cohen's effect size = 0.38, p = 0.014) and 20-h time points (Relative Cohen's effect size = 0.40, p = 0.003). No significant effects were found on accuracy or on Conners' Continuous Performance Test, a measure of sustained attention. The results are discussed in reference to previous findings on the relationship between brain plasticity and job performance. Generalization of results requires further study.
    Frontiers in Psychology 07/2014; 5:794. DOI:10.3389/fpsyg.2014.00794 · 2.80 Impact Factor
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