Cognitive behavioral therapy to enhance competitive work outcomes

描述 研究人员背景：库克拉博士拥有普渡大学(印第安纳波利斯)临床心理学博士学位，目前是退伍军人事务部HSR&D CIEBP的研究科学家。库克拉博士在精神康复方面拥有丰富的研究经验和兴趣，尤其是改善成年精神病患者功能的循证实践。库克拉博士的主要研究领域是增强患有精神疾病的退伍军人的竞争性工作功能。项目背景：有精神疾病的退伍军人比没有精神疾病的退伍军人和普通人群更有可能失业。因此，这些失业的退伍军人经常依赖政府福利，并遭受一系列有害后果。退伍军人管理局支持的就业计划提供个性化的职业援助，在解决这一失业问题方面部分有效。不幸的是，40%的人即使在这种援助下也找不到工作，那些找到工作的人很难保住他们，因为大多数人在4到8个月内失去工作。过去的研究表明，在庇护工作中工作的精神疾病患者会对自己的工作能力和工作成功产生自我挫败的想法。认知行为疗法(CBT)已被证明与精神康复方法相结合在改善其他功能领域是有效的；然而，先前还没有研究表明CBT是否可以有效地适应和应用于改善患有精神疾病的退伍军人的竞争性就业结果。总体目标：库克拉博士对CDA-2的总体目标是获得必要的技能和专业知识，成为一名富有成效的独立退伍军人研究人员，研究并实施有效方法，增强患有精神疾病的退伍军人的社区职业功能。具体目标和研究设计：拟议的研究旨在开发一种有效且可实施的CBT干预措施，为患有精神疾病的退伍军人的竞争性工作功能量身定做。培训目标包括获得定性和混合方法以及实施科学方面的专门知识。1.目标1：确定精神病退伍军人开展竞争性工作的障碍和促进者。第一个项目PHAE包括对全国各地退伍军人医疗中心的就业支持人员进行在线调查和后续深入电话采访。这种混合方法方法将提供丰富的数据，有助于指导CBT方案的修订和调整。2.目标2：采用认知行为疗法，旨在改善患有精神疾病的退伍军人的就业竞争力。第二个项目阶段包括用于定制CBT计划以提高竞争性工作成果的形成性评估。首先，现有的CBT干预措施将根据第一阶段工作人员访谈的结果和现有的经验文献进行修订。接下来，两组精神病退伍军人将参加为期8周的团体CBT干预并提供反馈；每一波参与者经过干预后，CBT干预和治疗方案将进行修订。3.目标3：使用新调整的CBT方案进行纵向试点研究。为了测试修订后的干预措施并确定效果大小，为干预措施的大型多地点试验做准备，我们将对接受CBT干预并从事辅助就业服务的25名参与者与仅由25名参与支持就业服务的参与者组成的对照组进行比较。主要结果将包括竞争性工作结果(例如，就业时间)；次要结果将包括心理社会结果(例如，生活质量、症状、精神科住院治疗、与工作有关的自我效能、工作效率、工作成效、退伍军人满意度)。

DESCRIPTION Investigator Background: Dr. Kukla holds a Ph.D. in clinical psychology from Purdue University (Indianapolis) and is currently a Research Scientist at the VA HSR&D CIEBP. Dr. Kukla has research experience and interest in psychiatric rehabilitation, and particularly, evidence based practices that improve functioning in adults with mental illness. Dr. Kukla's primary area of research interest is enhancing competitive work functioning in veterans with mental illness. Project Background: Veterans with mental illness are more likely to be unemployed than veterans without mental illness and persons in the general population. Consequently, these unemployed veterans often rely on government entitlements and suffer a range of deleterious outcomes. VA supported employment programs, which provide individualized vocational assistance, are partially effective in tackling this unemployment problem. Unfortunately, 40% of persons cannot find work even with this assistance and those who get jobs have difficulty keeping them, as the majority of people experience a job loss within 4 to 8 months. Past studies have linked self-defeating thoughts about one's ability to work and succeed on the job in persons with mental illness working in sheltered work. Cognitive behavioral therapy (CBT) has been demonstrated effective in improving other functional domains when combined with psychiatric rehabilitation approaches; however, no prior research has addressed whether CBT may be effectively adapted and applied to improve competitive employment outcomes in veterans with mental illness. Overall Goal: Dr. Kukla's overall goal for this CDA-2 is to acquire the skills and expertise necessary to become a productive independent VA researcher studying and implementing effective ways of enhancing vocational functioning in the community in veterans with mental illness. Specific Goals & Study Design: The proposed research aims to develop an effective and implementable CBT intervention tailored for competitive work functioning in veterans with mental illness. Training goals involve gaining expertise in qualitativ and mixed methods as well as implementation science. 1. Goal 1: Identify the barriers and facilitators to competitive work functioning in veterans with mental illness. The first project phae consists of online surveys and follow-up in-depth phone interviews of supported employment staff from VA medical centers around the country. This mixed methods approach will provide rich data that will help guide the revision and adaptation of the CBT program. 2. Goal 2: Adapt a cognitive behavioral therapy program aimed at improving competitive employment outcomes in veterans with mental illness. This second project phase consists of a formative evaluation used to tailor a CBT program to improve competitive work outcomes. First, the existing CBT intervention will be revised based on the results of staff interviews in Phase 1 and existing empirical literature. Next, two groups of veterans with mental illness will participate in and provide feedback on the 8-week group CBT intervention; the CBT intervention and treatment protocol will be revised after each wave of participants goes through the intervention. 3. Goal 3: Conduct a longitudinal pilot study using the newly adapted CBT program. To test the revised intervention and determine effect sizes in preparation for a large multi-site trial of the intervention, we will compare 25 participants who receive the CBT intervention and are engaged in supported employment services to a control group comprised of 25 participants engaged in supported employment services only. Primary outcomes will include competitive work outcomes (e.g., duration of employment); secondary outcomes will include psychosocial outcomes (e.g., quality of life, symptoms, psychiatric hospitalizations, work-related self-efficacy, work productivity, work effectiveness, veteran satisfaction).