Content area
Background
Comprehensive cognitive remediation improves cognitive and functional outcomes in people with serious mental illness, but the specific components required for effective programs are uncertain. The most common methods to improve cognition are facilitated computerized cognitive training with coaching and teaching cognitive self-management strategies. We compared these methods by dismantling the Thinking Skills for Work program, a comprehensive, validated cognitive remediation program that incorporates both strategies.
Methods
In a randomized controlled trial we assigned 203 unemployed people with serious mental illness in supported employment programs at two mental health agencies to receive either the full Thinking Skills for Work (TSW) program, which included computerized cognitive training (based on Cogpack software), or the program with cognitive self-management (CSM) but no computer training. Outcomes included employment, cognition, and mental health over 2 years. To benchmark outcomes, we also examined competitive work outcomes in a similar prior trial comparing the TSW program with supported employment only.
Results
The TSW and CSM groups improved significantly on all outcomes, but there were no differences between the groups. Competitive work outcomes for both groups resembled those of the TSW program in a prior trial and were better than the supported employment-only group in that study, suggesting that participants in both groups benefited from cognitive remediation.
Conclusions
Providing facilitated computerized cognitive training improved neither employment nor cognitive outcomes beyond teaching cognitive self-management strategies in people receiving supported employment. Computerized cognitive training may not be necessary for cognitive remediation programs to improve cognitive and functional outcomes.
Details
Memory;
Coaching;
Cognition;
Intervention;
Mental health;
Employment;
Selfmanagement;
Mental disorders;
Training;
Cognitive ability;
Clinical trials;
Functional impairment;
Vocational rehabilitation;
Verbal learning;
Thinking skills;
Cognition & reasoning;
Teaching methods;
Vocational education;
Quality of life;
Schizophrenia;
Cognitive skills training;
Supported employment;
Hypotheses;
Flexibility;
Computerization;
Executive function;
Employment interviews;
Groups;
Computer assisted instruction--CAI;
Management;
Strategies;
Teaching;
Mental health services;
Skills;
Work skills;
Illnesses
; Mueser, Kim T 1
; Xie, Haiyi 2 ; Bloch, Philippe 3 ; DeTore, Nicole R 4
; Pashka, Nicole 5 ; Guarino, Susan 6 ; Ruiz, Anabelle 5 ; Elliot, Clara 5 ; Gagnon, Heather 6 ; Bailey, Edward 6 ; Fraser, Virginia 5 ; Welsh, Jason 6 ; Cunningham, Harry 6 ; Razzano, Lisa 7 ; Wolfe, Rosemarie 8 ; Drake, Robert E 9 1 Center for Psychiatric Rehabilitation, https://ror.org/05qwgg493 Boston University , Boston, MA, USA; Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
2 Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
3 Center for Psychiatric Rehabilitation, https://ror.org/05qwgg493 Boston University , Boston, MA, USA
4 Department of Psychiatry, https://ror.org/002pd6e78 Massachusetts General Hospital , Boston, MA and Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
5 https://ror.org/01dp3s597 Thresholds, Inc. , Chicago, IL, USA
6 The Mental Health Center of Greater Manchester, Manchester, NH, USA
7 https://ror.org/01dp3s597 Thresholds, Inc. , Chicago, IL, USA; Department of Psychiatry, https://ror.org/02mpq6x41 University of Illinois , Chicago, IL, USA
8 Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
9 Department of Psychiatry, https://ror.org/00hj8s172 Columbia University , New York, NY, USA