CBT Plus Cognitive Remediation May Improve Vocational Outcomes in Schizophrenia

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Cognitive behavioral therapy plus cognitive remediation improve work functioning and neurocognition in patients with schizophrenia.
Cognitive behavioral therapy plus cognitive remediation improve work functioning and neurocognition in patients with schizophrenia.

The results of a randomized controlled trial published in Schizophrenia Research indicated that cognitive behavioral therapy (CBT) enhanced with cognitive remediation (CBT+CR) improved work functioning and neurocognition in patients with schizophrenia more effectively than CBT alone.

Researchers randomly assigned 75 participants with schizophrenia spectrum disorder to 1 of 3 conditions: vocational support (control group; n=25), work-focused CBT (n=25), or work-focused CBT enhanced with CR (n=25). Participants underwent active intervention for 26 weeks, during which they were placed in noncompetitive work positions and attended weekly individual therapy, group therapy, and/or CR training sessions according to study condition. Investigative staff assessed hours worked, work performance, and neurocognition in participants regularly during the 6-month intervention and over an additional 12-month follow-up period.

During the active phase, researchers found a significant group-time interaction effect on both hours worked and improvement in mean Work Behavior Inventory score. Specifically, compared with the control and CBT alone groups, those in the CBT+CR group worked significantly more hours (P =.02) and had a steeper trajectory of improving Work Behavior Inventory work quality across time (P =.03). Additionally, those in the CBT+CR group experienced greater improvement in social cognition (P =.006) and verbal learning (P =.003) from baseline to 12 months. Notably, CBT alone did not improve hours worked over time compared with the control group. These results suggest that CBT alone may not be sufficient to enhance work outcomes in patients with schizophrenia, despite its efficacy in treating other symptoms.

Researchers noted that the absence of a CR-alone treatment arm limits the strength of study conclusions. The modest sample size and non-acute nature of participants' conditions additionally limit the certainty of these data. Investigators suggested future studies involving larger and more heterogeneous samples to further explore the therapeutic effects of CBT and CR on neurocognition and employment performance among patients with schizophrenia.


Kukla M, Bell MD, Lysaker PH. A randomized controlled trial examining a cognitive behavioral therapy intervention enhanced with cognitive remediation to improve work and neurocognition outcomes among persons with schizophrenia spectrum disorders [published online February 5, 2018]. Schizophrenia Res. doi:10.1016/j.schres.2018.01.012

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