Neurocognitive enhancement therapy (NET) is a remediation program for the persistent and function-limiting cognitive impairments of schizophrenia. In a previous study in veterans, NET improved work therapy outcomes as well as executive function and working memory.
The present study aimed to determine whether NET could enhance functional outcomes among schizophrenia and schizoaffective patients in a community mental health center receiving community-based vocational services.
The study setting was a Community Mental Health Center serving individuals with psychiatric disabilities.
Seventy-seven stable outpatients with diagnoses of schizophrenia or schizoaffective disorder were recruited at a large urban community mental health center. Participants met diagnostic criteria based on the Structured Clinical Interview for DSM-IV (First et al., 1996) from the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association & Task Force on DSM-IV, 1994), conducted by research psychologists, and were eligible if they were clinically stable (i.e., GAF > 30, no housing changes, psychiatric medication alterations, or psychiatric hospitalizations in the 30 days prior to intake). Exclusion criteria included history of traumatic brain injury, known neurological diseases, developmental disability, and active substance abuse within the past 30 days
The statistical consultant compared hours worked by condition across quarters over the course of the two-year study using mixed models, repeated measures ANOVAs. Analyses were performed separately for total hours of community-based work activity (transitional and competitive payment combined), and hours of community-based work activity paid exclusively by the employer (competitive payment). Because of significant skew introduced by non-working participants in each quarter, analyses were repeated using ranked data as a nonparametric check of the results. Except where corrected for multiple comparisons, alpha was set at .05 and all tests were two-tailed.
Patients (N = 72) participated in a hybrid transitional and supported employment program (VOC) and were randomized to either NET + VOC or VOC only. NET + VOC included computer-based cognitive training, work feedback and a social information information-processing group. VOC only also included two weekly support groups. Active intervention was 12 months with 12 month follow-up. Follow-up rate was 100%.
The control condition was VOC only.
NET + VOC patients worked significantly more hours during the 12 month follow-up period, reached a significantly higher cumulative rate of competitive employment by the sixth quarter, and maintained significantly higher rates of employment.
NET training improved vocational outcomes, suggesting the value of combining cognitive remediation with other rehabilitation methods to enhance functional outcomes.