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Cognitive Behavioral Therapy and Work Outcomes: Correlates of Treatment Engagement and Full and Partial Success in Schizophrenia

Published online by Cambridge University Press:  21 June 2013

Marina Kukla ,
Louanne W. Davis  and
Paul H. Lysaker
Marina Kukla*
Affiliation:
Roudebush VA Medical Center, and Indiana University-Purdue University, Indianapolis, USA
Louanne W. Davis
Affiliation:
Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, USA
Paul H. Lysaker
Affiliation:
Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, USA
*
Reprint requests to Marina Kukla, Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN 46202, USA. E-mail: [email protected]
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Abstract

Background: Cognitive behavior therapy (CBT) has been found to be generally effective for persons with schizophrenia. Less is known however about those who will engage in this treatment, and among those who engage, who benefits more versus less from this intervention. Aims: This study sought to identify factors associated with treatment engagement and response in persons with psychosis engaged in CBT focused on enhancing work function. Method: Participants were 50 adults with schizophrenia-spectrum disorders participating in a randomized control trial that offered both CBT and a protected employment position over 26 weeks. Survival analysis and discriminant analyses were used to analyze the data. Results: Results indicated that poor treatment engagement and engagement in work was associated with lower educational attainment, more severe baseline levels of negative symptoms, and lower baseline scores on the Arithmetic and Digit Symbol subscales of the WAIS-III. Amongst those participants who did engage, younger age and poorer working memory as assessed by the Arithmetic subscale predicted shorter initial job tenure. More severe levels of positive symptoms and lower self-esteem during the later stages of treatment were associated with worse employment outcomes across the study period. Conclusions: These findings evidence differential predictors of engagement and success and suggest that a subgroup of persons with schizophrenia engaged in CBT and a vocational placement are at risk for poor functional outcomes associated with psychological factors that evolve over time.

Keywords

Cognitive behaviour therapyschizophreniasymptomsself esteem
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 42 , Issue 5 , September 2014 , pp. 577 - 592
Creative Commons
This is a work of the U.S. Government and is not subject to copyright protection in the United States.
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013

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References

Arns, P. G. and Linney, J. A. (1993). Work, self, and life satisfaction for persons with severe and persistent mental disorders. Psychosocial Rehabilitation Journal, 17, 63–79.CrossRefGoogle Scholar
Bados, A., Balaguer, G. and Saldana, C. (2007). The efficacy of cognitive-behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63, 585–592.Google Scholar
Barrowclough, C., Tarrier, N., Humphreys, L., Ward, J., Gregg, L. and Andrews, B. (2003). Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology. Journal of Abnormal Psychology, 112, 92–99.CrossRefGoogle ScholarPubMed
Bell, M. D., Lysaker, P. H., Beam-Goulet, J. L., Milstein, R. M., and Lindenmayer, J.-P. (1994). Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Research, 52, 295–303.CrossRefGoogle ScholarPubMed
Brabban, A., Tai, S. and Turkington, D. (2009). Predictors of outcome in brief cognitive behavior therapy for schizophrenia. Schizophrenia Bulletin, 35, 859–864.Google Scholar
Butler, A. C., Chapman, J. E., Forman, E. M. and Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review, 26, 17–31.Google Scholar
Chadwick, P. (2006). Person-Based Cognitive Therapy for Distressing Psychosis. New York: Wiley.CrossRefGoogle Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.Google Scholar
Davis, L. W., Lysaker, P. H., Lancaster, R. S., Bryson, G. J. and Bell, M. D. (2005). The Indianapolis Vocational Intervention Program: a cognitive behavioral approach to addressing rehabilitation issues in schizophrenia. Journal of Rehabilitation Research and Development, 42, 35–45.CrossRefGoogle Scholar
Evans, J. D., Bond, G. R., Meyer, P. S., Kim, H. W., Lysaker, P. H., Gibson, P. J., et al. (2004). Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia. Schizophrenia Research, 70, 331–342.Google Scholar
Garety, P., Fowler, D., Kuipers, E., Freeman, D., Dunn, G., Bebbington, P., et al. (1997). London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. II: predictors of outcome. British Journal of Psychiatry, 171, 420–426.Google Scholar
Granholm, E., McQuaid, J. R., McClure, F. S., Auslander, L. A., Perivoliotis, D., Pedrelli, P., et al. (2005). A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. The American Journal of Psychiatry, 162, 520–529.CrossRefGoogle ScholarPubMed
Green, M. F. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia? The American Journal of Psychiatry, 153, 321–330.Google Scholar
Gumley, A., Karatzias, A., Power, K., Reilly, J., McNay, L. and O'Grady, M. (2006). Early intervention for relapse in schizophrenia: impact of cognitive behavioural therapy on negative beliefs about psychosis and self-esteem. British Journal of Clinical Psychology, 45, 247–260.Google Scholar
Heaton, R. K. (1993). Wisconsin Card Sorting Test Manual. Odessa, Fl: Psychological Assessment Resources.Google Scholar
Kay, S., Fiszbein, A. and Opler, L. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.CrossRefGoogle ScholarPubMed
Keijsers, G. P. J., Kampman, M. and Hoogduin, C. A. L. (2001). Dropout prediction in cognitive behavior therapy for panic disorder. Behavior Therapy, 32, 739–749.Google Scholar
Lysaker, P. H., Bond, G., Davis, L. W., Bryson, G. J. and Bell, M. D. (2005). Enhanced cognitive-behavioral therapy for vocational rehabilitation in schizophrenia: effects on hope and work. Journal of Rehabilitation Research and Development, 42, 673–682.CrossRefGoogle ScholarPubMed
Lysaker, P. H., Davis, L. W., Bryson, G. J. and Bell, M. D. (2009). Effects of cognitive behavioral therapy on work outcomes in vocational rehabilitation for participants with schizophrenia spectrum disorders. Schizophrenia Research, 107, 186–191.Google Scholar
Lysaker, P. H., Roe, D. and Yanos, P. T. (2007). Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin, 33, 192–199.Google Scholar
Lysaker, P. H., Yanos, P. T. and Roe, D. (2009). The role of insight in the process of recovery from schizophrenia: a review of three views. Psychosis, 1, 103–112.CrossRefGoogle Scholar
McGurk, S. R. and Mueser, K. T. (2006). Cognitive and clinical predictors of work outcomes in clients with schizophrenia receiving supported employment services: 4-year follow-up. Administration and Policy in Mental Health and Mental Health Services Research, 33, 598–606.Google Scholar
McQuilken, M., Zahniser, J. H., Novak, J., Starks, R. D., Olmos, A. and Bond, G. R. (2004). The work project survey: consumer perspectives on work. Journal of Vocational Rehabilitation, 18, 59–68.Google Scholar
Michon, H. W., van Weeghel, J., Kroon, H. and Schene, A. H. (2005). Person-related predictors of employment outcomes after participation in psychiatric vocational rehabilitation programmes: a systematic review. Social Psychiatry and Psychiatric Epidemiology, 40, 408–416.Google Scholar
Naeem, F., Kingdon, D. and Turkington, D. (2008). Predictors of response to cognitive behaviour therapy in the treatment of schizophrenia: a comparison of brief and standard interventions. Cognitive Therapy and Research, 32, 651–656.Google Scholar
National Institute of Health and Clinical Excellence (NICE) (2009). Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care (update). London: NICE, from http://www.guidance.nice.org.uk/CG82.Google Scholar
Penadés, R., Catalán, R., Pujol, N., Puig, O., Guarch, J., Masana, G., et al. (2010). Is memory impairment a rate limiter in cognitive behavioural therapy for chronic schizophrenia? Psychotherapy and Psychosomatics, 79, 129–130.CrossRefGoogle ScholarPubMed
Perivoliotis, D., Grant, P. M., Peters, E. R., Ison, R., Kuipers, E. and Beck, A. T. (2010). Cognitive insight predicts favorable outcome in cognitive behavioral therapy for psychosis. Psychosis: Psychological, Social and Integrative Approaches, 2, 23–33.Google Scholar
Rathod, S., Kingdon, D., Smith, P. and Turkington, D. (2005). Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics – data on a previously published randomised controlled trial. Schizophrenia Research, 74, 211–219.Google Scholar
Rathod, S., Kingdon, D., Weiden, P., and Turkington, D. (2008). Cognitive-behavioral therapy for medication-resistant schizophrenia: a review. Journal of Psychiatric Practice, 14, 22–33.Google Scholar
Razzano, L. A., Cook, J. A., Burke-Miller, J. K., Mueser, K. T., Pickett-Schenk, S. A., Grey, D. D., et al. (2005). Clinical factors associated with employment among people with severe mental illness: findings from the employment intervention demonstration program. Journal of Nervous Mental Diseases, 193, 705–713.Google Scholar
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press.Google Scholar
Salmoiraghi, A. and Sambhi, R. (2010). Early termination of cognitive-behavioural interventions: literature review. The Psychiatrist, 34, 529–532.CrossRefGoogle Scholar
Strauss, J. S. and Carpenter, W. T. (1977). Predictors of outcome in schizophrenia: III. five-year outcomes and its predictors. Archives of General Psychiatry, 34, 159–163.Google Scholar
Thomas, N., Rossell, S., Farhall, J., Shawyer, F. and Castle, D. (2011). Cognitive behavioural therapy for auditory hallucinations: effectiveness and predictors of outcome in a specialist clinic. Behavioural and Cognitive Psychotherapy, 39, 129–138.Google Scholar
Torrey, W. C., Mueser, K. T., McHugo, G. H. and Drake, R. E. (2000). Self-esteem as an outcome measure in studies of vocational rehabilitation for adults with severe mental illness. Psychiatric Services, 51, 229–233.CrossRefGoogle ScholarPubMed
Tsang, H. W. H., Leung, A. Y., Chung, R. C. K., Bell, M. and Cheung, W.-M. (2010). Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Australian and New Zealand Journal of Psychiatry, 44, 495–504.Google Scholar
Tulsky, D. S. and Price, L. R. (2003). The joint WAIS-III and WMS-III factor structure: development and cross-validation of a six-factor model of cognitive functioning. Psychological Assessment, 15, 149–162.CrossRefGoogle ScholarPubMed
Turkington, D., Dudley, R., Warman, D. M. and Beck, A. T. (2004). Cognitive-behavioral therapy for schizophrenia: a review. Journal of Psychiatric Practice, 10, 5–16.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale-III (WAIS-III) (3rd ed.). San Antonio: Psychological Corporation.Google Scholar
Westra, H. A., Dozois, D. J. A. and Boardman, C. (2002). Predictors of treatment change and engagement in cognitive-behavioral group therapy for depression. Journal of Cognitive Psychotherapy, 16, 227–241.Google Scholar
Wittmann, D. and Keshavan, M. (2007). Grief and mourning in schizophrenia. Psychiatry, 70, 154–166.Google Scholar
Wykes, T., Reeder, C., Corner, J., Williamson, C. and Everitt, C. (1993). Effects of neurocognitive remediation on executive processes in patients with schizophrenia. Schizophrenia Bulletin, 25, 291–306.Google Scholar
Wykes, T., Steel, C., Everitt, B. and Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34, 523–537.Google Scholar
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