Cognitive Enhancement Treatment for People With Mental Illness Who Do Not Respond to Supported Employment: A Randomized Controlled Trial
Abstract
OBJECTIVE: Cognitive impairment presents a serious and common obstacle to competitive employment for people with severe mental illness, including those who receive supported employment. This study evaluated a cognitive enhancement program to improve cognition and competitive employment in people with mental illness who had not responded to supported employment. METHOD: In a randomized controlled trial, 107 people with severe mental illness (46% with schizophrenia or schizoaffective disorder) who had not obtained or kept competitive work despite receiving high-fidelity supported employment were assigned to receive either enhanced supported employment (with specialized cognitive training of employment specialists) or enhanced supported employment plus the Thinking Skills for Work program, a standardized cognitive enhancement program that includes practice of computer cognitive exercises, strategy coaching, and teaching of coping and compensatory strategies. Research assistants tracked competitive employment weekly for 2 years, and assessors blind to treatment assignment evaluated cognitive functioning at baseline, at the end of cognitive enhancement training, and 12 and 24 months after baseline. RESULTS: Participants in the Thinking Skills for Work group improved more than those in the enhanced supported employment only group on measures of cognitive functioning and had consistently better competitive employment outcomes during the follow-up period, including in jobs obtained (60% compared with 36%), weeks worked (23.9 compared with 9.2), and wages earned ($3,421 compared with $1,728). CONCLUSIONS: The findings suggest that cognitive enhancement interventions can reduce cognitive impairments that are obstacles to work, thereby increasing the number of people who can benefit from supported employment and competitive work.
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For those who did not respond to IPS, cognitive enhancement treatment had higher employment (60% vs. 36%), worked longer (23.9 vs. 9.2 weeks), and earned more ($3,421 vs. $1,728) than enhanced SE controls.
“Most recently, they found that for those that didn’t respond to IPS, the individual receiving cognitive enhancement treatments (the “Thinking Skills for Work Program”) had higher employment (60% vs. 36%), worked longer (23.9 vs. 9.2 weeks), and earned more ($3,421 vs. $1,728) than the control group that had an enhanced version of SE [65].”
From Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support (2019) · cites this paper as [65]
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- Authors
- McGurk, S. R., Mueser, K. T., Xie, H., Welsh, J., Kaiser, S., Drake, R. E., Becker, D. R., Bailey, E., Fraser, G., Wolfe, R., & McHugo, G. J.
- Affiliations
- Boston University (US)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2015-09-01
- Volume
- 172
- Issue
- 9
- Pages
- 852-861
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2128416855
- Cited by
- 171
- References
- 35
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 8 · 2023: 10 · 2022: 29 · 2021: 11 · 2020: 14 · 2019: 35 · 2018: 18 · 2017: 11 · 2016: 20 · 2015: 3
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH077210)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Safety Research › Disability Education and Employment
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Keywords
- cognitive enhancement, severe mental illness, supported employment, cognitive impairment, competitive employment, schizophrenia, schizoaffective disorder, cognitive training, coping strategies, compensatory strategies, employment specialists
- MeSH terms
- Adult, Cognition Disorders, Female, Humans, Learning, Male, Middle Aged, Neuropsychological Tests, Psychotic Disorders, Schizophrenia, Schizophrenic Psychology, Thinking, Employment, Supported
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