title: Cognitive remediation for vocational rehabilitation nonresponders.
abstract: Cognitive remediation in people with severe mental illnesses (SMI) that interfere with work, but less research has evaluated its effects in those who have not benefitted from vocational services. Participants with SMI (83% schizophrenia) who had not benefitted from vocational rehabilitation were randomized to vocational services enhanced by training vocational specialists in recognizing cognitive difficulties and providing job-relevant cognitive coping strategies (Enhanced Vocational Rehabilitation: E-VR), or similarly enhanced vocational services and cognitive remediation (Thinking Skills Work: TSW). Cognition and symptoms were assessed at baseline, post-treatment (9months), and follow-up (18months), with work tracked weekly for 3years. Fifty-four participants were randomized to E-VR (N=26) or TSW (N=28). Participants in TSW had high rates of exposure to the program (89%) and improved more than those in E-VR on cognitive functioning post-training, with attenuation of some gains at the 18-months. Participants in TSW and E-VR did not differ significantly in competitive work (57% vs. 48%) or paid employment (61% vs. 48%) over the 3-year study, although those in TSW were more likely to be engaged in any work activity, including paid or volunteer work (75% vs. 50%, p=0.057), and had more weeks of work activity (23.04 vs. 48.82, p=0.051), and improved marginally more on the clinical symptoms. The significantly higher education level of participants in E-VR than TSW at baseline may have obscured the effects of TSW. This study supports the feasibility and potential benefits of cognitive remediation for persons who have not benefited from vocational rehabilitation.
authors.affiliation: Center for Psychiatric Rehabilitation, Boston University, United States; Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, United States; Department of Psychiatry, Dartmouth Medical School, Hanover, NH, United States; Dartmouth Psychiatric Research Center, Concord, NH, United States. Electronic address: mcgurk@bu.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: McGurk
authors.affiliation: Center for Psychiatric Rehabilitation, Boston University, United States; Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, United States; Department of Psychiatry, Dartmouth Medical School, Hanover, NH, United States; Dartmouth Psychiatric Research Center, Concord, NH, United States.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
authors.affiliation: Department of Psychiatry, Dartmouth Medical School, Hanover, NH, United States; Dartmouth Psychiatric Research Center, Concord, NH, United States.
authors.forename: Haiyi
authors.initials: H
authors.lastname: Xie
authors.affiliation: Brooklyn Community Services, Brooklyn, NY, United States.
authors.forename: Karin
authors.initials: K
authors.lastname: Feldman
authors.affiliation: Brooklyn Community Services, Brooklyn, NY, United States.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Shaya
authors.affiliation: Brooklyn Community Services, Brooklyn, NY, United States.
authors.forename: Leslie
authors.initials: L
authors.lastname: Klein
authors.affiliation: Department of Psychiatry, Dartmouth Medical School, Hanover, NH, United States; Dartmouth Psychiatric Research Center, Concord, NH, United States.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D003071:Cognition; D000072466:Cognitive Remediation; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000534:rehabilitation; D012565:Schizophrenic Psychology; D017211:Treatment Failure
keywords: Cognitive remediation; Compensatory strategies; Employment; Severe mental illness; Thinking Skills for Work; Vocational rehabilitation