Integrated cognitive behavior therapy to improve work outcomes in schizophrenia

综合认知行为疗法可改善精神分裂症患者的工作成果

• 批准号: 8990413
• 负责人: IRENE HURFORD
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8990413
• 关键词: Affect; Aftercare; Age; Attitude; Behavior; Behavioral; Belief; Blinded; Case Management; Cognitive; Cognitive Therapy; Cognitive remediation; Cost of Illness; Diagnosis; Disabled Persons; Disease; Education; Emotions; Employment; Enrollment; Equipment and supply inventories; Exclusion Criteria; Grant; Group Therapy; Hospitalization; Impairment; Informed Consent; Maintenance; Manuals; Measures; Mediating; Medical; Medical center; Methodology; Modeling; Moods; Motivation; Neurocognition; Neurocognitive Deficit; Neurologic; Opiate Addiction; Outcome; Outcome Measure; Participant; Patients; Philadelphia; Population; Productivity; Protocols documentation; Psychostimulant dependence; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Research Design; Schizoaffective Disorders; Schizophrenia; Services; Suicide; Supported Employment; Symptoms; Techniques; Unemployment; Veterans; Vocational rehabilitation; Work; clinically significant; design; empowerment; evidence base; follow-up; functional disability; functional outcomes; illness length; improved; inclusion criteria; individualized medicine; insight; primary outcome; programs; prospective; psychiatric rehabilitation; psychoeducation; psychosocial; psychosocial rehabilitation; public health relevance; rehabilitation service; secondary outcome; success; treatment duration; treatment planning

DESCRIPTION (provided by applicant): 1) Background: Schizophrenia is a devastating illness that costs the US over $60 billion per year, mainly due to unemployment, lost productivity, and other consequences of poor functioning. Vocational rehabilitation programs such as Supported Employment (SE) improve psychosocial functioning. However, less than 1/4 of the patients at our facility with a schizophrenia-related diagnosis participate in SE despite its availability. We have developed a new integrated Cognitive Behavior Therapy (iCBT) group therapy protocol designed for low functioning patients with schizophrenia to improve motivation and engagement in psychosocial rehabilitation programs like SE. 2) Objectives: The objective of the current proposal is to evaluate whether iCBT can improve engagement and success in an existing SE program among the most functionally disabled patients with schizophrenia. Our primary specific aim is to determine whether iCBT + SE will significantly improve work outcomes at post- treatment to a greater extent than Psychoeducation (PE) + SE in low functioning patients with schizophrenia. Our secondary aims are to evaluate the whether iCBT + SE will significantly improve work outcomes at 6 month follow-up relative to PE + SE, and whether iCBT + SE will improve functional outcomes post-treatment and at follow-up relative to PE + SE. 3) Research Design: We are proposing a prospective randomized controlled trial with participants recruited from the Philadelphia VA Medical Center (PVAMC). We will randomize 96 patients (48 patients per condition). Assessors will be blinded to participant treatment group allocation. Assessment sessions will occur at baseline, and at 6, 12, and 18 months. 4) Methodology: The study inclusion criteria are as follows: 1) Diagnosis of schizophrenia or schizoaffective disorder, 2) Severe functional disability, 3) At least 90 days since last hospitalization, 4) Receiving treatmen at PVAMC, 5) Minimal engagement in psychiatric rehabilitation services, 6) Ages 18-65, 7) Proficient in English, 8) Able to give informed consent. Exclusion criteria are: 1) Neurologic disease or damage that would make the diagnosis of schizophrenia questionable, 2) Current opioid or stimulant dependence. Patients in the iCBT condition will receive weekly or twice weekly group sessions for 12 months. iCBT follows a treatment manual developed by Perivoliotis, Grant, & Beck. The manual details the approach (engagement, behavioral activation, cognitive remediation/restructuring, maintenance) and individualized treatment planning. It also describes strategies and techniques to deal with positive and negative symptoms, mood symptoms, and suicidality. It incorporates cognitive remediation strategies.33 Patients assigned to PE will receive weekly or twice weekly group sessions for 12 months. PE follows an evidence-based model already being delivered at the PVAMC. Patients in both conditions will participate in the existing SE program at PVAMC. All participants will continue to receive any services (medical, psychiatric, case management) they were already receiving. The primary outcome measure will be the total score on the Work Behavior Inventory (WBI) at the end of treatment. Secondary outcomes measures will be total score of the WBI at follow up and the total score on the Specific Levels of Functioning inventory (SLOF) measured at post-treatment and 6 month follow-up. PUBLIC HEALTH RELEVANCE: Schizophrenia is a devastating illness that affects about 1% of the population, and significantly impairs functioning. In our VA we have over 1300 Veterans with schizophrenia or related disorders. Supported Employment (SE) is a program that has been implemented nationally throughout the VA because of a large body of evidence demonstrating improved rates of competitive employment, leading to improvements in other aspects of functioning, including quality of life. However, Veterans with schizophrenia have major impairments in motivation as part of the illness, and often will not participate in SE despite its availability. We have developd a form of integrated cognitive-behavioral therapy (iCBT) that improves motivation in people with schizophrenia. We believe that by pairing iCBT with SE, we will improve Veteran participation in SE, leading to higher rates of employment, and better overall functioning and quality of life.

描述（由申请人提供）： 1) 背景：精神分裂症是一种毁灭性的疾病，每年给美国造成超过 600 亿美元的损失，主要原因是失业、生产力下降以及功能不良的其他后果。支持就业 (SE) 等职业康复计划可改善社会心理功能。然而，尽管 SE 可供使用，但我们机构中只有不到 1/4 诊断为精神分裂症相关的患者参加了 SE。我们开发了一种新的综合认知行为疗法 (iCBT) 团体治疗方案，专为功能低下的精神分裂症患者而设计，以提高对 SE 等心理社会康复项目的积极性和参与度。 2) 目标：当前提案的目标是评估 iCBT 是否可以提高功能最严重的精神分裂症患者对现有 SE 项目的参与度和成功率。我们的主要具体目标是确定对于低功能精神分裂症患者来说，iCBT + SE 是否会比心理教育 (PE) + SE 更大程度地显着改善治疗后的工作成果。 我们的次要目标是评估相对于 PE + SE，iCBT + SE 是否会在 6 个月随访时显着改善工作结果，以及相对于 PE + SE 而言，iCBT + SE 是否会改善治疗后和随访时的功能结果。 3) 研究设计：我们提议进行一项前瞻性随机对照试验，参与者从费城退伍军人医疗中心 (PVAMC) 招募。我们将随机抽取 96 名患者（每种情况 48 名患者）。 评估人员将对参与者治疗组的分配不知情。评估课程将在基线、6、12 和 18 个月时进行。 4) 方法：研究纳入标准如下：1) 诊断为精神分裂症或分裂情感性障碍，2) 严重功能障碍，3) 自上次住院以来至少 90 天，4) 在 PVAMC 接受治疗，5) 最少参与精神康复服务，6) 年龄 18-65，7) 精通英语，8) 能够提供知情信息同意。排除标准为：1) 神经系统疾病或损伤会使精神分裂症的诊断存在疑问，2) 目前有阿片类药物或兴奋剂依赖。处于 iCBT 状态的患者将接受每周一次或每周两次的小组治疗，为期 12 个月。 iCBT 遵循 Perivoliotis、Grant 和 Beck 开发的治疗手册。该手册详细介绍了方法（参与、行为激活、认知补救/重组、维护）和个性化治疗计划。它还描述了处理阳性和阴性症状、情绪症状和自杀倾向的策略和技术。它纳入了认知补救策略。33 分配到 PE 的患者将接受每周一次或每周两次的小组治疗，为期 12 个月。 PE 遵循 PVAMC 已交付的基于证据的模型。 患有这两种疾病的患者将参加 PVAMC 现有的 SE 计划。所有参与者将继续接受他们已经接受的任何服务（医疗、精神科、病例管理）。主要结果指标是治疗结束时工作行为量表（WBI）的总分。 次要结果指标是随访时 WBI 的总分以及治疗后和 6 个月随访时测量的特定功能水平量表 (SLOF) 的总分。 公共卫生相关性： 精神分裂症是一种毁灭性的疾病，影响约 1% 的人口，并严重损害功能。在我们的退伍军人管理局，有超过 1300 名退伍军人患有精神分裂症或相关疾病。支持就业 (SE) 是一项已在整个退伍军人事务部在全国范围内实施的计划，因为大量证据表明竞争性就业率有所提高，从而改善了功能的其他方面，包括生活质量。然而，患有精神分裂症的退伍军人由于疾病的原因，动机会受到严重损害，尽管可以参加 SE，但他们通常不会参加 SE。我们开发了一种综合认知行为疗法（iCBT），可以提高精神分裂症患者的积极性。我们相信，通过将 iCBT 与 SE 结合起来，我们将提高退伍军人对 SE 的参与度，从而提高就业率、改善整体功能和生活质量。