Our results and those of other labs indicate important relationships between cognition and vocational functioning Cognitive ability also relevant for many other interventions and outcomes This underscores the importance of searching for ways to remediate cognitive impairments in schizophrenia.
Morris Bell Schiz res forum webinar
Combined Computerized Cognitive Remediation Treatment and Vocational Services for Schizophrenia Morris Bell, Ph.D. Yale University Department of Psychiatry Schizophrenia Research Forum Webinar December 15, 2011
Mission Statement “ Exploring Ways to Restore Cognitive and Work Capacity” Learning Based Recovery Center
Predictors of work performance Substance use Symptoms Insight Cognition
Predictors of work performance improvement <ul><li>Cognition </li></ul><ul><ul><li>Initial cognitive function predicted 44% of variance in work performance improvement </li></ul></ul><ul><ul><li>Initial cognitive function predicted 79% of variance for improvement in work quality </li></ul></ul><ul><ul><li>Best predictors of work performance improvement: </li></ul></ul><ul><ul><ul><li>Attention </li></ul></ul></ul><ul><ul><ul><li>Problem-solving </li></ul></ul></ul><ul><ul><ul><li>Verbal learning </li></ul></ul></ul><ul><ul><li>Attention is key at beginning of work program; verbal learning more important for continued improvement </li></ul></ul>Bell & Bryson, 2001 Bryson & Bell, 2003
Neurocognition, social cognition, perceived social discomfort and vocational outcomes in schizophrenia. Bell, Tsang, Greig & Bryson, Schizophrenia Bulletin, 2008
Neurocognitive Enhancement Therapy (NET) and Work Therapy (WT) Rehabilitation Research and Development, Department of Veterans Affairs
Active Intervention Follow-up Time by condition p < .05 H O U R S W O R K E D
Hours Worked for NET Responders and Non-responders over Time Active Intervention Follow-up P < .02
Work Status at 12 Month Follow-up <ul><li>Percent Employed in Competitive or Transitional Work Activity </li></ul>P = .12
NET and Supported Employment (SE) Funded by National Institute of Mental Health
Work Performance During Rehabilitation <ul><li>Greater increases in work performance scores for NET + SE (WBI Total p < .05) </li></ul><ul><li>Dimensions showing greatest differences between condition were on interpersonal dimensions </li></ul><ul><ul><li>Social Skills p < .05 </li></ul></ul><ul><ul><li>Cooperativeness p < .05 </li></ul></ul><ul><ul><li>Personal Presentation p < .05 </li></ul></ul>
Work Performance Composite Score at 12-months <ul><li>Comprised of WBI Total, Hours Worked & Job Complexity for the last 6 weeks of participation (How well you worked, how long you worked, and how hard the job was). </li></ul><ul><li>Composite scores did not differ by condition at 12 months. </li></ul><ul><li>However, Composite scores for NET+SE gave more robust predictions of work outcomes over the following 12-months </li></ul><ul><li>NET+SE R 2 = .60; SE R 2 = .36. </li></ul>
Figure 4: Cumulative Rates of Employment Transitional + Competitive Quarters Weeks Competitive p < .05
Active Intervention Follow-up Quarters H O U R S Quarterly Work Hours (Transitional and Competitive) by Condition P<.05* P<.05* * Significant group-by-time (p <.01) and linear trend (p < .01). Same results using ranked data.
Active Intervention Follow-up Quarters H O U R S Quarterly Competitive Work Hours by Condition P<.05* * Significant difference in linear trend for Quarters Q5-Q8 (p<.05).
Effect Size Differences at 2 yr FU between Cog Tx and No Cog Tx using Z scores adjusted for Baseline Functioning N = 92
Community Function at Intake and Competitive Employment over 2 years (N = 174) (Bell MD, Corbera S, Wexler B. SIRS 2012) Rates of employment for Poor QLS differ significantly by condition p<.007 %