Building Employment Skills Through Therapy for Veterans

N/ACompletedNCT01992913

VA Office of Research and Development67 enrolled

Overview

Schizophrenia/Schizoaffective Disorder is associated with serious problems with cognitive skills, social skills, and functional skills (like employment). There is a new form of cognitive behavioral therapy called integrated cognitive behavioral therapy (iCBT) that specifically addresses the cognitive, social, and functional deficits of schizophrenia/schizoaffective disorder. This study compared iCBT to the usual care (UC) that Veteran's receive. The investigators compared iCBT to UC in subjects with schizophrenia/schizoaffective disorder who are enrolled in a Supported Employment (SE) program, and evaluate whether iCBT is more helpful in improving job attainment, and other areas of functioning, both right after treatment, and 6 months after the end of treatment.

The objective of the current study was to evaluate whether integrated cognitive behavior therapy (iCBT) can improve engagement and success in an existing Supported Employment (SE) program among the most functionally disabled patients with schizophrenia/schizoaffective disorder. The iCBT condition also included computerized cognitive remediation. The primary specific aim was to determine whether iCBT will significantly improve work outcomes at post-treatment to a greater extent than Usual Care (UC) in low functioning patients with schizophrenia/schizoaffective disorder who join the SE program. The secondary aims were to evaluate the whether iCBT will significantly improve work outcomes at 6 month follow-up relative to UC, and whether iCBT will improve functional outcomes post-treatment and at follow-up relative to UC in subjects who join the SE program.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Interventions

integrated Cognitive Behavioral TherapyBEHAVIORAL

Novel CBT paradigm for schizophrenia/schizoaffective disorder

Usual CareOTHER

The usual care that Veterans receive - not limited in scope (i.e., subjects may participate in any/all available treatments, outside the study condition)

Computerized cognitive remediation (CCR)BEHAVIORAL

Part of the iCBT paradigm, a four month block of bi-weekly computerized cognitive remediation using BrainHQ program.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Diagnosis of DSM-IV schizophrenia or schizoaffective disorder (SCID) * Severe/extreme functional disability \[World Health Organization Disability Assessment Scale (WHODAS) score \> 50\] * Clinical stability (as per primary mental health provider) * Receiving treatment at the Veterans Administration * Minimal engagement in psychiatric rehabilitation services (just psychiatrist and therapist/case management in the last 6 months) * Eligible for and willing to be enrolled in Supported Employment program * Age 18 to 65 * Proficient in English * Able to give informed consent Exclusion Criteria: * Neurologic disease or damage that would make the diagnosis of schizophrenia questionable * Current opioid or stimulant dependence (SCID) * Not appropriate due to safety concerns (based on risk assessment)

Outcomes

Primary Outcomes

Workforce Participation Measure - Total Number of Jobs Attained

Measure completed by the support employment specialist that evaluates participation in the workforce: Total number of jobs attained per group across the full length of the study (Baseline to 18 month follow-up, study end)

Time frame: Baseline to post-treatment (18-months)

Overall Job Attainment Proportion

This is the proportion of participants, by group, that attained at least one job during the active portion of the study.

Time frame: Study start through 18 months of the active portion of the study.

Job Participant Composite-hours Worked

This is a composite of hours work per week X number of weeks worked, in each assessment period.

Time frame: Baseline to study intervention start point (ranging from 1-10 months), then at 6 months after intervention start, 12 months after intervention start, and then 18 months after intervention start.

Secondary Outcomes

Work Behavior Inventory

Measure completed by the supported employment specialist that evaluates work quality in an employment setting, based on the job supervisor's report, using the overall impression rating, ranging from 1 (consistently needing improvement) to 5 (consistently superior performance). Only the job supervisor's was used, rather than other options possible with the measure.

Time frame: Baseline, mid-treatment (6-months), end of treatment (12-months), and post-treatment (18-months)

Specific Levels of Functioning (SLOF)

This is measure designed to assess individual social, work, and interpersonal functioning of individuals with severe mental illness. The possible total score ranges from 30 - 150 with higher scores representing higher levels of functioning.