Cognitive behavioral therapy to enhance competitive work outcomes

描述 研究者背景：Dr. Kukla拥有博士学位。在普渡大学（印第安纳波利斯）的临床心理学，目前是在VA HSR & D CIEBP的研究科学家。Kukla博士在精神病康复方面有研究经验和兴趣，特别是在改善成年精神病患者功能的循证实践方面。Kukla博士的主要研究领域是增强精神疾病退伍军人的竞争性工作功能。项目背景：患有精神疾病的退伍军人比没有精神疾病的退伍军人和一般人更容易失业。因此，这些失业的退伍军人往往依赖政府的福利，并遭受一系列有害的后果。退伍军人事务部支持的就业方案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%的人即使得到这种援助也找不到工作，而那些找到工作的人很难保住工作，因为大多数人在4至8个月内失业。过去的研究表明，在庇护工作中工作的精神病患者对自己的工作能力和工作成功的自我挫败感有联系。认知行为疗法（CBT）已被证明有效地改善其他功能领域时，结合精神病康复方法;然而，没有先前的研究已经解决了CBT是否可以有效地适应和应用，以改善有精神疾病的退伍军人的就业竞争力的结果。总体目标：Kukla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VA研究人员，研究和实施有效的方法来增强社区中患有精神疾病的退伍军人的职业功能。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制。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业知识。1.目标1：确定障碍和促进者，以竞争性的工作功能在退伍军人与精神疾病。第一个项目phae包括在线调查和后续的深入电话采访支持就业的工作人员从全国各地的退伍军人管理局医疗中心。这种混合方法将提供丰富的数据，有助于指导CBT计划的修订和调整。2.目标2：调整认知行为治疗计划，旨在改善患有精神疾病的退伍军人的竞争性就业结果。第二个项目阶段包括一个形成性评估，用于定制CBT计划，以提高竞争力的工作成果。首先，现有的CBT干预措施将根据第一阶段的员工访谈结果和现有的实证文献进行修订。接下来，两组患有精神疾病的退伍军人将参与并提供对8周团体CBT干预的反馈; CBT干预和治疗方案将在每一波参与者通过干预后进行修订。3.目标3：使用新调整的CBT计划进行纵向试点研究。为了测试修订后的干预措施，并确定干预措施的大型多地点试验的准备效果大小，我们将比较25名接受CBT干预并参与支持就业服务的参与者与对照组，对照组由25名仅参与支持就业服务的参与者组成。主要成果将包括有竞争力的工作成果（例如，就业持续时间）;次要结果将包括心理社会结果（例如，生活质量、症状、精神病住院、工作相关的自我效能、工作生产力、工作效率、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).