Cognitive Enhancement Treatment for People With Mental Illness Who Do Not Respond to Supported Employment: A Randomized Controlled Trial
Cognitive Enhancement Treatment for People With Mental Illness Who Do Not Respond to Supported Employment: A Randomized Controlled Trial
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DOI：
10.1176/appi.ajp.2015.14030374
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发表时间：
2015-09-01
影响因子：
17.7
通讯作者：
McHugo, Gregory J.
中科院分区：
文献类型：
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作者：
McGurk, Susan R.;Mueser, Kim T.;McHugo, Gregory J.
目的：认知障碍是严重精神疾病患者，包括那些接受支助就业的人在竞争就业方面面临的一个严重和常见的障碍。本研究评估了一个认知增强计划，以改善认知和有竞争力的就业与精神疾病的人谁没有回应支持就业。方法：在一项随机对照试验中，107名严重精神疾病患者（46%患有精神分裂症或情感障碍），尽管接受了高水平的培训，忠诚支持就业被分配接受增强支持就业（与就业专家的专门认知培训）或加强支持就业加上工作思维技能计划，一个标准化的认知增强计划，包括计算机认知练习，策略指导，应对和补偿策略的教学。研究助理每周追踪竞争性就业情况，持续2年，评估员对治疗分配情况不知情，评估了基线、认知增强训练结束时以及基线后12个月和24个月的认知功能。工作思维技能组的参与者在认知功能的测量方面比仅增强支持就业组的参与者改善得更多，并且一直具有更好的竞争力。后续行动期间的就业结果，包括获得的工作（60%对36%），工作周数（23.9比9.2），（3 421美元，而1 728美元）。研究结果表明，认知增强干预可以减少阻碍工作的认知障碍，通过增加可以从支持性就业和竞争性工作中受益的人数来实现。
Objective: Cognitive impairment presents a serious and common obstacle to competitive employment for people with severe mental illness, including those who receive supported employment. This study evaluated a cognitive enhancement program to improve cognition and competitive employment in people with mental illness who had not responded to supported employment.Method: In a randomized controlled trial, 107 people with severe mental illness (46% with schizophrenia or schizo-affective disorder) who had not obtained or kept competitive work despite receiving high-fidelity supported employment were assigned to receive either enhanced supported employment (with specialized cognitive training of employment specialists) or enhanced supported employment plus the Thinking Skills for Work program, a standardized cognitive enhancement program that includes practice of computer cognitive exercises, strategy coaching, and teaching of coping and compensatory strategies. Research assistants tracked competitive employment weekly for 2 years, and assessors blind to treatment assignment evaluated cognitive functioning at baseline, at the end of cognitive enhancement training, and 12 and 24 months after baseline.Results: Participants in the Thinking Skills for Work group improved more than those in the enhanced supported employment only group on measures of cognitive functioning and had consistently better competitive employment outcomes during the follow-up period, including in jobs obtained (60% compared with 36%), weeks worked (23.9 compared with 9.2), and wages earned ($3,421 compared with $1,728).Conclusions: The findings suggest that cognitive enhancement interventions can reduce cognitive impairments that are obstacles to work, there by increasing the number of people who can benefit from supported employment and competitive work.