Cognitive Training of Supported Employment: 2–3 Year Outcomes of a Randomized Controlled Trial

Department of Psychiatry, Dartmouth College, Hanover, New Hampshire, United States
American Journal of Psychiatry (Impact Factor: 12.3). 04/2007; 164(3):437-41. DOI: 10.1176/appi.ajp.164.3.437
Source: PubMed


To address cognitive impairments that limit the effectiveness of supported employment services for patients with schizophrenia, a cognitive training program, the Thinking Skills for Work Program, was developed and integrated into supported employment services.
Patients with severe mental illness (N=44) and prior histories of job failures who were enrolled in supported employment programs at two sites in New York City were randomly assigned to receive either supported employment alone or supported employment with cognitive training. Measures at baseline and 3 months included a brief cognitive and symptom assessment. Work outcomes were tracked for 2-3 years.
Patients in the supported employment with cognitive training program demonstrated significantly greater improvements at 3 months in cognitive functioning, depression, and autistic preoccupation. Over 2-3 years, patients in the supported employment with cognitive training program were more likely to work, held more jobs, worked more weeks, worked more hours, and earned more wages than patients in the program offering supported employment alone.
The findings support the feasibility of integrating cognitive rehabilitation into supported employment programs and suggest that more research is warranted to evaluate the effects of the Thinking Skills for Work Program.

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    • "Cognitive impairment is a core feature of schizophrenia [4] [16], and deficits affecting processing speed, attention/vigilance, working memory, and executive function correlate with poor functional outcomes [3] [19] [29]. Antipsychotic agents significantly control clinical symptoms, especially positive symptoms. "
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    ABSTRACT: Individual-level Cognitive Remediation Therapy (CRT) has been shown to be effective for cognitive improvement and social function amelioration. Here, we aimed to test the efficacy of group-based CRT in Chinese subjects with schizophrenia. One-hundred and four inpatients were randomly assigned to either 40 sessions of small-group CRT therapy or therapeutic contact-matched Musical and Dancing Therapy (MDT). Cognitive and social functioning, as well as clinical symptoms, were evaluated over the course of treatment. Specifically, cognitive function was evaluated using a battery of cognitive measurements, clinical symptoms were evaluated using the Positive and Negative Syndrome Scale, and social function was evaluated using the Nurse's Observation Scale for Inpatient Evaluation-30. All patients were evaluated pre- and post-treatment. Forty-four individuals in the CRT group and 46 in the MDT group completed all of the planned treatments and analyses. Cognitive functions, especially cognitive flexibility and memory, showed significant improvement in the CRT group over the course of the study. The MDT group also showed improvement in several cognitive flexibility assessments, but the degree of improvement was significantly greater in the CRT group. Several social-function factors exhibited a significant improvement in the CRT group, but not in the MDT group. Cognitive function improvement correlated positively with social function without predicting social function change. We conclude that group-based CRT is an effective and promising therapy.
    Full-text · Article · Aug 2015 · Neuroscience Letters
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    • "A recent report by leading British scientific societies cited CCT as a potentially effective intervention to improve workplace performance , stressing the importance of examining the transferability of CCT into vocational tasks (Academy of Medical Sciences, 2012). Previous studies have reported positive effects of CCT on tasks with high psychomotor demands such as flight (Hart and Battiste, 1992; Gopher et al., 1994), driving (Roenker et al., 2003; Cassavaugh and Kramer, 2009; Pradhan et al., 2011) and laparoscopic surgery (Schlickum et al., 2009; Adams et al., 2012), as well as enhanced employment outcomes in schizophrenic patients (Vauth et al., 2005b; McGurk et al., 2007; Bell et al., 2008; Lindenmayer et al., 2008; McGurk et al., 2009). Conversely, a recent RCT conducted by our group (Borness et al., 2013) did not find any effect of an online CCT program on job performance in a large cohort of white collar employees of an Australian public sector organization. "
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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.
    Full-text · Article · Jul 2014 · Frontiers in Psychology
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    • "Though it is not the goal of our review, it is important to note that all articles with drill and strategy approaches to training reported between-group improvements of the targeted deficits. Furthermore, eight of the 17 studies with follow up measures at either three, four or six months also reported sustained gains in cognition [25,32,37,41,45,47,48,50],[64]. "
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    ABSTRACT: Background The purpose of this article was to conduct a review of the types of training offered to people with schizophrenia in order to help them develop strategies to cope with or compensate for neurocognitive or sociocognitive deficits. Methods We conducted a search of the literature using keywords such as “schizophrenia”, “training”, and “cognition” with the most popular databases of peer-reviewed journals. Results We reviewed 99 controlled studies in total (though nine did not have a control condition). We found that drill and practice training is used more often to retrain neurocognitive deficits while drill and strategy training is used more frequently in the context of sociocognitive remediation. Conclusions Hypotheses are suggested to better understand those results and future research is recommended to compare drill and strategy with drill and practice training for both social and neurocognitive deficits in schizophrenia.
    Full-text · Article · May 2014 · BMC Psychiatry
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