Cognitive Training to Improve Work Outcomes in Severe Mental Illness

认知训练可改善严重精神疾病患者的工作成果

• 批准号: 8085886
• 负责人: Elizabeth W Twamley
• 金额: $ 28.52万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8085886
• 关键词: Address; Age; Alcohol or Other Drugs use; Area; Attention; Behavioral; Bipolar Disorder; Brain Diseases; Caring; Categories; Client; Cognition; Cognitive; Cognitive deficits; Communities; Community Integration; Comorbidity; Consensus; Data; Development; Diagnostic; Disease; Distal; Economic Burden; Education; Educational Intervention; Educational process of instructing; Effectiveness; Elderly; Employment; Evidence based practice; Failure; Family; Fostering; Freedom; Goals; Habits; Health Care Costs; Impaired cognition; Income; Individual; Inservice Training; Intervention; Job Satisfaction; Lead; Learning; Length; Life; Major Depressive Disorder; Mediating; Mediator of activation protein; Memory; Mental Health; Mental Health Services; Mental disorders; Meta-Analysis; Modeling; Motivation; National Institute of Mental Health; Neurocognitive; Occupational; Occupations; Outcome; Paper; Participant; Performance; Performance at work; Problem Solving; Productivity; Prospective Studies; Psychiatric therapeutic procedure; Public Health; Quality of life; Randomized Controlled Trials; Recovery; Recruitment Activity; Rehabilitation Research; Rehabilitation therapy; Research; Role; Sampling; Schizophrenia; Services; Severities; Short-Term Memory; Specialist; Supported Employment; Symptoms; Thinking; Time; Training Programs; Unemployment; Vocational rehabilitation; Wages; Work; base; cognitive training; community reintegration; community setting; cost; disability; evidence base; executive function; improved; meetings; middle age; processing speed; programs; psychiatric disability; psychiatric rehabilitation; severe mental illness; skills; success; trial comparing

DESCRIPTION (provided by applicant): Occupational disability is one of the most devastating and costly consequences of severe mental illness (SMI). Supported employment programs such as Individual Placement and Support (IPS) are the most effective way to help people with SMI obtain competitive employment (i.e., "regular jobs" in the community). However, many clients in supported employment either do not work at all or fail to keep their jobs. The cognitive impairments and everyday functioning skills deficits of psychiatric disorders contribute to poor work outcomes, but they are modifiable with Cognitive Training. Pilot data support the effectiveness of IPS and Cognitive Training for clients with SMI, including those who are middle-aged and older. The proposed research aims to evaluate the effectiveness of augmenting IPS supported employment services with a 3-month Cognitive Training program that aims to improve attention, learning, memory, and problem-solving abilities. The Cognitive Training approach is compensatory, in that it teaches strategies for overcoming cognitive deficits, and aims to help clients develop better thinking and memory habits that will last a lifetime. In the proposed 24- month randomized controlled trial, 152 participants with SMI will receive either IPS with Cognitive Training (IPS-CT) or IPS with enhanced support (IPS-ES). The IPS vocational specialist will deliver the Cognitive Training intervention in the client's community setting of choice, along with standard IPS services (job searching, job development, and follow-along job supports). IPS-ES will control for the additional time and attention provided in the IPS-CT condition during the first 3 months. All participants will be followed for 24 months, and employment data will be collected weekly. The primary aim of the study is to evaluate the hypothesis that compared to IPS-ES, IPS-CT will result in improved cognition, functional skills, work outcomes (e.g., number of weeks worked), and quality of life. Secondary aims are to investigate the mechanisms underlying such improvements and to identify predictors of employment outcomes. If Cognitive Training is found to improve outcomes in supported employment, the psychiatric rehabilitation field will be better prepared to help clients across the age spectrum meet their vocational and community reintegration goals.

描述（由申请人提供）：职业残疾是严重精神疾病 (SMI) 最具破坏性和代价高昂的后果之一。个人安置和支持 (IPS) 等就业支持计划是帮助 SMI 患者获得竞争性就业（即社区中的“常规工作”）的最有效方法。然而，许多支持性就业的客户要么根本不工作，要么无法保住工作。精神疾病的认知障碍和日常功能技能缺陷会导致工作成果不佳，但可以通过认知训练来改变。试点数据支持 IPS 和认知训练对 SMI 客户（包括中年和老年人）的有效性。拟议的研究旨在评估通过为期 3 个月的认知培训计划增强 IPS 支持的就业服务的有效性，该计划旨在提高注意力、学习、记忆和解决问题的能力。认知训练方法是补偿性的，因为它教授克服认知缺陷的策略，旨在帮助客户养成持续一生的更好的思维和记忆习惯。在拟议的 24 个月随机对照试验中，152 名 SMI 参与者将接受 IPS 认知训练 (IPS-CT) 或 IPS 增强支持 (IPS-ES)。 IPS 职业专家将在客户选择的社区环境中提供认知培训干预，以及标准 IPS 服务（求职、工作发展和后续工作支持）。 IPS-ES 将控制前 3 个月内 IPS-CT 条件下提供的额外时间和注意力。所有参与者都将被跟踪 24 个月，并且每周收集就业数据。该研究的主要目的是评估以下假设：与 IPS-ES 相比，IPS-CT 将改善认知、功能技能、工作成果（例如工作周数）和生活质量。次要目标是调查这种改善背后的机制并确定就业结果的预测因素。如果发现认知培训可以改善支持性就业的结果，那么精神康复领域将做好更好的准备，帮助各个年龄段的客户实现他们的职业和社区重新融入目标。