The Indianapolis Vocational Intervention Program: A cognitive behavioral approach to addressing rehabilitation issues in schizophrenia

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
The Journal of Rehabilitation Research and Development (Impact Factor: 1.43). 01/2005; 42(1):35-45. DOI: 10.1682/JRRD.2003.05.0083
Source: PubMed


Despite wishing to return to productive activity, many individuals with schizophrenia enter rehabilitation with severe doubts about their abilities. Negative beliefs in schizophrenia have been linked with poorer employment outcome. Accordingly, in this paper, we describe efforts to synthesize vocational and cognitive behavior therapy interventions into a 6-month manualized program to assist persons with schizophrenia spectrum disorders overcome negative beliefs and meet vocational goals. This program, the Indianapolis Vocational Intervention Program (IVIP), includes weekly group and individual interventions and is intended as an adjunct to work therapy programs. The IVIP was initially developed over a year of working with 20 participants with Structured Clinical Interview for the Diagnostic and Statistical Manual-I (SCID-I) confirmed diagnoses of schizophrenia or schizoaffective disorder who were actively engaged in 20 hours per week of work activity. For this paper, we explain the development of the treatment manual and the group and individual interventions and present case examples that illustrate how persons with severe mental illness might utilize the manualized intervention.

Download full-text


Available from: Paul H Lysaker
    • "Specific behavioral techniques may be used to foster motivation and engagement and thereby promote treatment gains despite overall symptom severity. Given the results of this study and the positive association between intrinsic motivation and goal-oriented behaviors reported previously ( Medalia and Richardson, 2005), integrating treatment practices that aim to increase intrinsic motivation or address negative cognitions that may interfere with intrinsic motivation (Davis et al., 2005; Horan et al., 2010; Lysaker et al., 2005a Lysaker et al., , 2005b) might further bolster vocational outcomes. There are several limitations to the current study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Intrinsic motivation is a construct commonly used in explaining goal-directed behavior. In people with schizophrenia, intrinsic motivation is usually subsumed as a feature of negative symptoms or underlying neurocognitive dysfunction. A growing literature reflects an interest in defining and measuring motivational impairment in schizophrenia and in delineating the specific role of intrinsic motivation as both an independent predictor and a mediator of psychosocial functioning. This cross-sectional study examined intrinsic motivation as a predictor of vocational outcomes for 145 individuals with schizophrenia and schizoaffective disorder participating in a 6-month work rehabilitation trial. Correlation and mediation analyses examined baseline intrinsic motivation and negative symptoms in relation to work hours and work performance. Data support a significant relationship between intrinsic motivation and negative symptoms and significant correlations with outcome variables, such that lower negative symptoms and greater intrinsic motivation were associated with better work functioning. Moreover, in this sample, intrinsic motivation fully mediated the relationships between negative symptoms, work productivity, and work performance. These results have significant implications on the design of work rehabilitation interventions for people with schizophrenia and support a role for targeting intrinsic motivation directly to influence vocational functioning. Future directions for research and intervention are discussed.
    No preview · Article · Sep 2011 · The Journal of nervous and mental disease
  • Source
    • "Previous approaches to modeling data from rolling therapy groups. Despite the ubiquity of groups with rolling admissions in practice [Kadden et al. (2001); Kadden and Litt (2004); Monti et al. (2002); Rohsenow et al. (2001, 2004); Davis et al. (2005); Granholm et al. (2005); Center for Substance Abuse Treatment (2005)], very little attention has been devoted to developing appropriate statistical methods for such data. In a review article, the possibility was discussed of using standard hierarchical models that used group as the clustering variable (e.g., Figure 1), but was dismissed because it ignores the complex attendance pattern within the group [Morgan-Lopez and Fals-Stewart (2006)]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Group therapy is a central treatment modality for behavioral health disorders such as alcohol and other drug use (AOD) and depression. Group therapy is often delivered under a rolling (or open) admissions policy, where new clients are continuously enrolled into a group as space permits. Rolling admissions policies result in a complex correlation structure among client outcomes. Despite the ubiquity of rolling admissions in practice, little guidance on the analysis of such data is available. We discuss the limitations of previously proposed approaches in the context of a study that delivered group cognitive behavioral therapy for depression to clients in residential substance abuse treatment. We improve upon previous rolling group analytic approaches by fully modeling the interrelatedness of client depressive symptom scores using a hierarchical Bayesian model that assumes a conditionally autoregressive prior for session-level random effects. We demonstrate improved performance using our method for estimating the variance of model parameters and the enhanced ability to learn about the complex correlation structure among participants in rolling therapy groups. Our approach broadly applies to any group therapy setting where groups have changing client composition. It will lead to more efficient analyses of client-level data and improve the group therapy research community's ability to understand how the dynamics of rolling groups lead to client outcomes.
    Full-text · Article · Jun 2011 · The Annals of Applied Statistics
  • Source
    • "Therapists were a doctoral level psychologist (LD), master's level clinicians and predoctoral graduate students in clinical psychology. The CBT and supportive psychotherapy have been described elsewhere in detail (Davis et al., 2005) and the CBT intervention was linked with improvements in vocational function (Lysaker et al., 2009). A blinded rater was able to correctly identify 100% of randomly selected CBT and supportive sessions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research to identify client factors that impact treatment outcome has found that deficits in metacognitive abilities and weaker therapeutic alliance are both associated with poorer treatment outcomes for schizophrenia. However, it is unknown if metacognition and therapeutic alliance are related in any way, in particular, if metacognitive abilities predict therapeutic alliance. This study explored whether differing capacities for mastery, a domain of metacognition that involves the ability to use knowledge about mental states to respond to psychological challenges, predicted client perceptions of therapeutic alliance assessed by the Working Alliance Inventory - Short Form (WAI-S). Participants were 63 adults with schizophrenia or schizoaffective disorder enrolled in a 6-month program of cognitive behavioral or supportive therapy, placed into a high, intermediate or minimal mastery group as measured by the Metacognitive Assessment Scale (MAS). Repeated measures ANOVA found group effects for the total WAI-S score, with the high and intermediate mastery groups having better alliance scores than the minimal mastery group. The group effects approached significance when neurocognition was controlled for. Results suggest that greater capacity for mastery predict stronger therapeutic alliance, but do not predict its development over time.
    Full-text · Article · Mar 2011 · Schizophrenia Research
Show more