Cognitive Strategies Versus Self-Management Skills as Adjunct to Vocational Rehabilitation

Cognitive dysfunctions and negative symptoms are ‘‘ratelimiting factors’’ for communityoutcomeandresponse topsychosocial intervention in peoplewith 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)—totarget thesebarriers torehabilitationreadiness. One hundred thirty-eightDSM–IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plusvocationalrehabilitation,TSSNplusvocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusingondeficits 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. PatientsreceivingTSSNplusvocationalrehabilitationfailed to demonstrate improvement in negative symptoms. CAST plus vocational rehabilitation was found to be associated withahigherrateof successful jobplacementat the12-month followup interval. Hierarchical logistic regression analyses demonstrated that improvement in shortand 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 associatedwith successful job placement in the followup.TSSN’s efficacy was less clear; reasons for this uncertainty are provided.