Using Cognitive Training to Improve Employment Programs for People With Severe Mental Illnesses

Unemployment in people with severe mental illnesses (SMIs), such as schizophrenia, bipolar
disorder, and major depressive disorder, has both economic and health-related costs.
Unemployed people with SMIs often report an improved quality of life after finding a job,
through increases in self-esteem, socialization, opportunities to use skills and abilities,
external structure, and income. Supported employment plans, such as Individualized Placement
and Support (IPS), help to place and support people with SMIs in jobs available in their
community. However, people with SMIs often have difficulties keeping jobs. Research suggests
these difficulties are due to cognitive deficits—underlying patterns of thought. This study
will test two versions of IPS to see which produces the best outcomes for people with SMIs
looking for jobs: one version will be supplemented with cognitive training (CT), which will
address cognitive deficits related to work, and the other version will be supplemented with
enhanced support (ES), which will increase the support people with SMIs receive with their
jobs.

Participation in this study will last 24 months. Participants will first undergo a baseline
assessment and then will be randomly assigned to receive IPS with CT or IPS with ES.
Participants in both groups will complete one IPS session and one support session—either CT
or ES—each week for 12 weeks. The IPS sessions will involve working with a vocational
counselor to find a job and then receiving support in training for and maintaining that job.
Participants receiving CT sessions will be taught strategies to improve attention, learning
and memory, and problem-solving. Participants receiving ES will receive extra sessions of
vocational support. All participants will complete assessments at six times: at study entry
and after 3, 6, 12, 18, and 24 months. These assessments will include interviews about life
circumstances, psychiatric symptoms, and job satisfaction. The first four assessment
sessions will involve additional tests—administered with a pencil and paper or on a
computer—that measure thinking, learning, memory, and problem-solving abilities.