A CBT Intervention Targeting Competitive Work Outcomes for Persons With Mental Illness.
A CBT Intervention Targeting Competitive Work Outcomes for Persons With Mental Illness.
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针对精神疾病患者的有竞争力的工作成果的 CBT 干预。
DOI：
10.1176/appi.ps.670504
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Lysaker,PaulH
中科院分区：
文献类型：
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作者：
Kukla,Marina;Strasburger,AmyM;Lysaker,PaulH
工作是精神病患者的首要目标。尽管辅助就业(SE)服务帮助这一人群中的一些人找到了工作，但许多人仍然失业。在获得就业的精神疾病患者中，工作期限是有限的。为了解释糟糕的工作结果，这些文献指出了SE服务没有常规解决的障碍，例如与工作相关的自我效能感低、对工作的矛盾心理、低动机、神经认知缺陷和元认知障碍。因此，制定有效减少这些障碍和改善就业成果的辅助干预措施已成为当务之急。与自闭症服务相结合，认知行为疗法(CBT)是改善精神疾病患者就业结果的首选方案。传统上，CBT一直被用来减少精神症状。然而，这些干预措施对社区功能的好处较少，可能是因为传统的CBT方法并没有明确地将功能改善作为预期的结果。我们试图通过开发和检验CBT干预的可行性和初步有效性来填补这一空白，以增强针对社区工作的SE服务。参与者通过SE计划在城市退伍军人事务医疗中心分三波招募-2014年12月、2015年4月和2015年8月。CBT for Work Success Program(CBTw)改编自印第安纳波利斯职业干预计划(IVIP)，这是一种CBT干预措施，附带手册，适用于从事临时性、非竞争性工作的精神分裂症患者。一种基于经验的、迭代的、循序渐进的过程被用来调整iVIP，以适应那些正在寻找竞争性工作的一系列精神疾病患者的需求。新调整的干预措施CBTw在三波参与者中进行了试点；离职访谈获得了对该项目的反馈。参与者的反馈和小组协调人的反馈指导了干预方案的进一步修订，最终形成了CBTw方案和参与者手册。CBTw是为有社区工作目标的就业者和失业者的需要量身定做的，包括以每周一小时小组形式举办的12次会议。CBTw
Work is a preeminent goal for persons with mental illness. Although supported employment (SE) services help some in this population acquire jobs, many remain unemployed. Among individuals with mental illness who obtain employment, job tenure is limited. In an effort to explain poor work outcomes, the literature identifies barriers that SE services do not routinely address, such as low work-related self-efficacy, ambivalence toward work, low motivation, neurocognitive deficits, and impairments in metacognition. Consequently, the development of adjunctive interventions that effectively reduce these barriers and improve employment outcomes has been highlighted as an urgent need. Paired with SE services, cognitive-behavioral therapy (CBT) is a prime candidate to improve employment outcomes among persons with mental illness. Traditionally, CBT has been used to reduce psychiatric symptoms. However, these interventions offer less benefit to functioning in the community, likely because traditional CBT approaches do not specifically target functional improvement as the intended outcome. We sought tofill this gap by developing and examining the feasibility and preliminary effectiveness of a CBT intervention to augment SE services targeting community work.Participants were recruited through the SE program at an urban Veterans Affairs medical center in three waves—December 2014, April 2015, and August 2015. The CBT for Work Success Program (CBTw) was adapted from the Indianapolis Vocational Intervention Program (IVIP), a CBT intervention accompanied by a manual and for persons with schizophrenia engaged in temporary, noncompetitive work. An empirically based, iterative, stepwise process was used to adapt IVIP to fit the needs of persons with a range of mental illnesses who are seeking competitive work. The newly adapted intervention, CBTw, was piloted across the three waves of participants; exit interviews elicited feedback on the program. Participant feedback and feedback from group facilitators guided further revision of the intervention protocol, resulting in a finalized CBTw protocol and participant manual. CBTw is tailored to the needs of employed and unemployed persons who have community work goals and includes 12 sessions delivered in a weekly one-hour group format. CBTw