title: Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation.
abstract: Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed-computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)-to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM-IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after 8 weeks. Analyses of covariance controlling for basis-level functioning demonstrated that patients receiving CAST plus vocational rehabilitation showed greater improvement on attention and verbal memory but not on planning ability. Patients receiving TSSN plus vocational rehabilitation failed to demonstrate improvement in negative symptoms. CAST plus vocational rehabilitation was found to be associated with a higher rate of successful job placement at the 12-month followup interval. Hierarchical logistic regression analyses demonstrated that improvement in short- and long-term verbal memory predicted a higher proportion of variance of successful job placement in the followup than pretreatment history of employment alone. Cognitive training as an adjunct to inpatient vocational rehabilitation demonstrated cognitive improvement, which was found to be associated with successful job placement in the followup. TSSN's efficacy was less clear; reasons for this uncertainty are provided.
authors.affiliation: Research Group of Cognitive-Behavioral Intervention for Schizophrenia, Department of Psychiatry and Psychotherapy, University Hospital of freiburg, Germany. rvauth@uhbs.ch
authors.forename: Roland
authors.initials: R
authors.lastname: Vauth
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Corrigan
authors.forename: Martin
authors.initials: M
authors.lastname: Clauss
authors.forename: Margarete
authors.initials: M
authors.lastname: Dietl
authors.forename: Marlene
authors.initials: M
authors.lastname: Dreher-Rudolph
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Stieglitz
authors.forename: Rainer
authors.initials: R
authors.lastname: Vater
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D009483:Neuropsychological Tests; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D020377:Self Efficacy; D012720:Severity of Illness Index; D016896:Treatment Outcome