Compensatory cognitive training for people with severe mental illnesses in supported employment: A randomized controlled trial
Open accessAbstract
Treatments for cognitive and functional impairments associated with severe mental illnesses are urgently needed. We tested a 12-week, manualized, Compensatory Cognitive Training (CCT) intervention targeting prospective memory, attention, learning/memory, and executive functioning in the context of supported employment for people with severe mental illnesses who were seeking work. 153 unemployed, work-seeking outpatients with schizophrenia/schizoaffective disorder (n=58), bipolar disorder (n=37), or major depression (n=58) were randomized to receive supported employment plus CCT or enhanced supported employment, a robust control group. Assessments of neuropsychological performance, functional capacity, psychiatric symptom severity, and self-reported functioning and quality of life were administered at baseline and multiple follow-up assessments over two years; work outcomes were collected for two years. Forty-seven percent of the participants obtained competitive work, but there were no differences in work attainment, weeks worked, or wages earned between the CCT and the enhanced supported employment group. ANCOVAs assessing immediate post-treatment effects demonstrated significant, medium to large, CCT-associated improvements on measures of working memory (p=0.038), depressive symptom severity (p=0.023), and quality of life (p=0.003). Longer-term results revealed no statistically significant CCT-associated improvements, but a trend (p=0.058) toward a small to medium CCT-associated improvement in learning. Diagnostic group (schizophrenia-spectrum vs. mood disorder) did not affect outcomes. We conclude that CCT has the potential to improve cognitive performance, psychiatric symptom severity, and quality of life in people with severe mental illnesses. Receiving CCT did not result in better work outcomes, suggesting that supported employment can result in competitive work regardless of cognitive status.
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RCTs have shown significant improvement with other manualized psychosocial interventions in older patients with schizophrenia, such as supported employment with or without compensatory cognitive training, to help them obtain and retain paid jobs.
“Randomized controlled trials have also shown significant improvement with other manualized psychosocial interventions in older patients with schizophrenia, such as supported employment without and with compensatory cognitive training to help them obtain and retain paid jobs282, 283.”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [283]
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References 62 · Cited by 85
Research works printed but not linked: 1
- First MB Spitzer RL Gibbon M Williams J 2002 Structured Clinical Interview for DSM-IV-TR axis I disorders, research version, patient edition. SCID-I/P Biometrics Research, New York State Psychiatric Institute New York
- Authors
- Twamley, E. W., Thomas, K. R., Burton, C. Z., Vella, L., Jeste, D. V., Heaton, R. K., & McGurk, S. R.
- Affiliations
- University of California San Diego (US)
- University of Michigan (US)
- Boston University (US)
- Corresponding author
- Twamley, Elizabeth W.
- ORCID
- Venue
- Schizophrenia Research
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 203
- Pages
- 41-48
- ISSN
- 0920-9964 (ISSN-L)
- PMC
- PMC5816728
- OpenAlex
- W2747591530
- Cited by
- 85
- References
- 62
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 6 · 2023: 11 · 2022: 17 · 2021: 9 · 2020: 13 · 2019: 8 · 2018: 5 · 2017: 1
- FWCI
- 6.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Schizophrenia Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- NIMH (R01MH080150, T32MH018399)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Safety Research › Disability Education and Employment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- compensatory cognitive training, severe mental illness
- MeSH terms
- Psychiatric Rehabilitation, Cognitive Remediation, Adult, Bipolar Disorder, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Psychotic Disorders, Schizophrenia, Employment, Supported, Outcome Assessment, Health Care, Cognitive Dysfunction
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