SU27. Cognitive Remediation Cognitive Behavioral Therapy and Occupational Outcome in Schizophrenia Spectrum Disorders: A 2-Year Follow-up Study

摘要

>Background: Neurocognitive impairment is prominent in schizophrenia and significantly related to low occupational attainment and poor occupational outcomes (August et al, 2012). Vocational rehabilitation (VR) is frequently implemented to counteract high unemployment rates. Individuals with schizophrenia however face numerous challenges such as neurocognitive impairments and psychotic symptoms. Hence, augmenting VR to address illness-related factors may optimize occupational outcomes. The aim of this study was to examine the effects of Cognitive Remediation (CR)-augmented compared to Cognitive Behavioral Therapy (CBT)-augmented VR on neurocognition and occupational functioning over a 2-year period. >Methods: One hundred and thirty-one participants underwent assessments at baseline, post-treatment (after 10 months), and follow-up (2 years after randomization). Performance on the MATRICS Consensus Cognitive Battery (MCCB), occupational status, and number of hours worked per week were recorded at all assessment points. >Results: Both intervention groups improved on several neurocognitive domains, improvements were however in favor of the CR group with significant intervention-by-time interactions for working memory (P = .009) and the composite score (P = .03). There was a significant increase in number of participants working (79% vs 80% at post-treatment and 68% vs 58% at follow-up in CBT and CR, respectively) and hours worked throughout the project period, with no between-group differences. CBT participants were working 11.6 hours a week at post-treatment and 14 hours at follow-up, whereas CR participants worked 10.6 hours at post-treatment and 11.3 hours a week at follow-up. Separate multiple regression analyses with hours worked as criterion was not significant for CBT (P = .13), but for CR (P = .03) with education (P = .03) and positive change in Working Memory (P = .02) as significant predictors. Entering the composite change score as predictor instead of separate domains produced a significant model for CR (P = .02). Significant predictors were age (P = .04) and change in the composite score (P = .007). >Conclusion: CR-augmented VR improved several neurocognitive domains, particularly Working Memory, which was central in the CR program as well as the MCCB Composite Score. Neurocognitive improvements may also be partially explained by additional strategy learning and bridging to work settings provided in the CR program perhaps reducing interference caused by neurocognitive impairments and leading to more sufficient allocation of neurocognitive resources in turn aiding in transfer of learning to vocational settings which consequently may have helped optimize occupational functioning. The major implication of these findings is that the combined effect of VR, organized collaboration between services and CBT/CR enabled a significant proportion of the participants to attain work and to increase the number of hours worked in the study.