Errorless Learning and Social Cognition Training for Work Rehabilitation

工作康复的无误学习和社会认知训练

• 批准号: 8276893
• 负责人: Robert S Kern
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8276893
• 关键词: Activities of Daily Living; Address; Alcohol consumption; Alcohol or Other Drugs use; Area; Award; Behavior Therapy; Behavioral; Clinical; Cognitive deficits; Cognitive remediation; Communities; Computer software; Control Groups; Coupled; Cues; Data; Educational Intervention; Emotional; Emotions; Employment; Event; Foundations; Frequencies; Impaired cognition; Impairment; Independent Living; Individual; Individual Differences; Inservice Training; Intervention; Job Satisfaction; Learning; Life; Manuscripts; Measurement; Measures; Mental Health; Methods; Mind; Modeling; Motivation; Neurocognition; Neurocognitive; Occupations; Outcome; Outcome Assessment; Outpatients; Participant; Perception; Performance; Performance at work; Personal Satisfaction; Persons; Phase; Procedures; Process; Psychotic Disorders; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Rehabilitation therapy; Research Personnel; Review Literature; Role; Sampling; Schizoaffective Disorders; Schizophrenia; Social Functioning; Social Perception; Stigmata; Stress; Support Groups; Supported Employment; Symptoms; Testing; Time; Traction; Training; Unemployment; Veterans; Work; Workplace; base; blind; cognitive function; design; disability; efficacy testing; evidence base; first episode schizophrenia; follow-up; functional outcomes; innovation; interest; intervention program; labor force participation; medication compliance; programs; research study; response; severe mental illness; skill acquisition; social; social cognition; social skills; social stigma; symptom management; theories; trend

DESCRIPTION (provided by applicant): A major mental health problem is the extremely low labor force participation of veterans with severe mental illness coupled with their overrepresentation on federal disability rolls. Reviews of the literature indicate that approximately 65% to 90% of veterans with severe mental illness are chronically unemployed. These figures are particularly discouraging given the importance of employment to personal and clinical well-being. To gain traction on this problem, it will likely be necessary to find treatments that address key determinants of work outcome. Evidence indicates that neurocognitive and social cognitive deficits are among the key determinants of functional outcome for persons with schizophrenia, a finding that underscores the basis for the current proposal. The proposed project includes two behavioral training interventions: (a) errorless learning, and (b) social cognition training. Errorless learning is a method of training that compensates for neurocognitive impairments that impede or restrict skill acquisition such as those involved in learning a new job. Social cognition training addresses impairments in neurocognitive processes associated with the perception, understanding, and response to social situations such as those involving interactions with co-workers and supervisors on the job. The efficacy of the combined use of these interventions will be examined within the context of an Individual Placement and Support (IPS) model of supported employment, the leading evidence- based approach to supported employment for persons with severe mental illness. The study has two primary aims: (a) to test the efficacy of the combined training methods on job placement and work outcome, and (b) examine determinants of job placement and work outcome. The study will recruit 108 veterans with schizophrenia or schizoaffective disorder who are interested in attaining competitive employment. Study participants will be matched on level of neurocognitive and social cognitive functioning, and randomized to one of two training groups: (a) errorless learning plus social cognition training plus IPS supported employment (EL+SCT+IPS), or (b) supported employment plus control conditions to match the experimental group on duration and frequency of training contact (IPS+). Baseline assessment will include measurement of neurocognition, social cognition, clinical symptoms, motivation, life events, alcohol and substance use, medication adherence, and personal well-being. Veterans randomized to EL+SCT+IPS will receive 12 sessions of social cognition training during the period of job search. After job placement, veterans assigned to EL+SCT+IPS will receive errorless learning training on their primary job assignment and then a second phase of social cognition training to address social difficulties on the job. Veterans randomized to IPS+ will receive symptom management training and one-on-one support matched for duration, frequency, and type of training contact in the EL+SCT+IPS group. A second baseline assessment will be conducted two weeks after job placement using the same measures administered at the first baseline plus measures of work performance, work outcome, and work-related personal well-being (e.g., job satisfaction, work stress). Veterans will then be followed for 12 months with assessments conducted every three months to examine short- and longer-term training effects. Outcome assessments will include measures of work performance, job tenure, work outcome, and work-related personal well-being. The primary analyses will examine: (a) the overall efficacy of errorless learning plus social cognition training on job placement and work outcome, and (b) predictors of job placement and work outcome. PUBLIC HEALTH RELEVANCE: Veterans with schizophrenia have exceedingly high rates of unemployment, which is a major public health issue. These rates are particularly unfortunate given the value placed on work by many veterans with schizophrenia and other forms of severe mental illness (SMI). It is clear that there are many hurdles to overcome to successfully return SMI veterans to the workplace (e.g., stigma, rules governing disability benefits, cognitive deficits). This proposal addresses one of those hurdles by introducing an innovative training approach that includes two behavioral interventions to address neurocognitive and social cognitive impairments that act as impediments to successful employment. The results of this project may serve to guide future research efforts in this area. Training procedures may need to be modified, obstacles within the workplace may need to be addressed, or individual differences may need to be addressed to better suit the needs of veterans with severe mental illness.

描述（由申请人提供）： 一个主要的心理健康问题是患有严重精神疾病的退伍军人的劳动力参与率极低，而且他们在联邦残疾名册上的比例过高。评论 文献表明，大约 65% 至 90% 患有严重精神疾病的退伍军人长期失业。考虑到就业对个人和临床福祉的重要性，这些数字尤其令人沮丧。为了获得对这个问题的关注，可能会 有必要找到解决工作成果关键决定因素的治疗方法。有证据表明，神经认知和社会认知缺陷是精神分裂症患者功能结果的关键决定因素之一，这一发现强调了当前提案的基础。拟议的项目包括两种行为训练干预措施：（a）无差错学习和（b）社会认知训练。无错误学习是一种补偿神经认知障碍的培训方法，这些障碍阻碍或限制了技能获取，例如学习新工作所涉及的技能。社会认知训练解决与感知、理解和对社交情境（例如涉及在工作中与同事和主管互动的社交情境）反应相关的神经认知过程的损伤。将在支持性就业的个人安置和支持（IPS）模式的背景下审查这些干预措施的综合使用的效果，该模式是为患有严重精神疾病的人提供支持性就业的领先的循证方法。该研究有两个主要目的：(a) 测试综合培训方法对工作安排和工作成果的有效性；(b) 检查工作安排和工作成果的决定因素。该研究将招募 108 名患有精神分裂症或分裂情感障碍且有兴趣获得竞争性就业的退伍军人。研究参与者将在神经认知和社会认知功能水平上进行匹配，并随机分配到两个训练组之一：(a) 无差错学习加社会认知训练加 IPS 支持就业 (EL+SCT+IPS)，或 (b) 支持就业加上控制条件以匹配实验组的训练接触持续时间和频率 (IPS+)。基线评估将包括神经认知、社会认知、临床症状、动机、生活事件、酒精和药物使用、药物依从性和个人幸福感的测量。随机分配到 EL+SCT+IPS 的退伍军人将在求职期间接受 12 节社会认知培训。就业安置后，分配到 EL+SCT+IPS 的退伍军人将接受其主要工作任务的无差错学习培训，然后接受第二阶段的社会认知培训，以解决工作中的社交困难。随机分配到 IPS+ 组的退伍军人将接受症状管理培训以及与 EL+SCT+IPS 组中的培训接触持续时间、频率和类型相匹配的一对一支持。第二次基线评估将在工作安排两周后进行，使用与第一次基线相同的衡量标准，加上工作绩效、工作成果和与工作相关的个人幸福感（例如工作满意度、工作压力）的衡量标准。然后将对退伍军人进行为期 12 个月的跟踪，每三个月进行一次评估，以检查短期和长期训练效果。结果评估将包括工作绩效、工作任期、工作成果以及与工作相关的个人福祉的衡量标准。主要分析将检查：（a）无差错学习加上社会认知培训对工作安排和工作结果的总体功效，以及（b）工作安排和工作结果的预测因素。 公共卫生相关性： 患有精神分裂症的退伍军人失业率极高，这是一个重大的公共卫生问题。考虑到许多患有精神分裂症和其他形式严重精神疾病 (SMI) 的退伍军人对工作的重视，这些比率尤其令人遗憾。显然，要成功让 SMI 退伍军人重返工作岗位，需要克服许多障碍（例如，耻辱、残疾福利规则、认知缺陷）。该提案通过引入一种创新的培训方法来解决其中一个障碍，其中包括两种行为干预措施，以解决阻碍成功就业的神经认知和社会认知障碍。该项目的结果可能有助于指导该领域未来的研究工作。培训程序可能需要修改，工作场所内的障碍可能需要解决，或者可能需要解决个体差异，以更好地满足患有严重精神疾病的退伍军人的需求。