Schizophrenia Bulletin Advance Access originally published online on February 16, 2005
Schizophrenia Bulletin 2005 31(1):55-66; doi:10.1093/schbul/sbi013
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Cognitive Strategies Versus Self-Management Skills as Adjunct to Vocational Rehabilitation
Clinical Psychologist, Consultant Psychiatrist, and Principal Investigator of the Research Group of Cognitive-Behavioral Intervention for Schizophrenia, Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany, now University Hospital Basel, Psychiatric Outpatient Department, Basel, Switzerland
Professor of Psychiatry and Executive Director, Center for Psychiatric Rehabilitation at Evanston Northwestern Healthcare, Evanston, IL
Head of the Department for Clinical and Social Psychiatry, Hospital Karlsbad-Langensteinbach, Karlsbad, Germany
Research Psychologists, Department of Psychiatry and Psychotherapy, University Hospital of Freiburg
Professor of Psychology and Head, Psychological Section, University Hospital of Basel, Psychiatric Outpatient Department
Research Psychologists, Department of Psychiatry and Psychotherapy, University Hospital of Freiburg
Send reprint requests to Dr. R. Vauth, Universitaetspital Basel, Psychiatrische Poliklinik, Petersgraben 4, CH–4031 Basel, Switzerland; e-mail: rvauth{at}uhbs.ch.
Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed—computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)—to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM–IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after 8 weeks. Analyses of covariance controlling for basis-level functioning demonstrated that patients receiving CAST plus vocational rehabilitation showed greater improvement on attention and verbal memory but not on planning ability. Patients receiving TSSN plus vocational rehabilitation failed to demonstrate improvement in negative symptoms. CAST plus vocational rehabilitation was found to be associated with a higher rate of successful job placement at the 12-month followup interval. Hierarchical logistic regression analyses demonstrated that improvement in short- and long-term verbal memory predicted a higher proportion of variance of successful job placement in the followup than pretreatment history of employment alone. Cognitive training as an adjunct to inpatient vocational rehabilitation demonstrated cognitive improvement, which was found to be associated with successful job placement in the followup. TSSN's efficacy was less clear; reasons for this uncertainty are provided.
Keywords: Cognitive therapy / group therapy / vocational rehabilitation / errorless learning / schizophrenia / treatment outcome / cognitive dysfunctions / negative symptoms
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