Thinking Skills at Work: Cognitive Remediation Therapy for Patients With Serious Mental Illness (TSW)

July 21, 2020 updated by: Fraser Health

Cognitive Remediation Therapy for Patients With Serious Mental Illness Who Failed to Benefit From Supported Employment

The purpose of this study is to help people with serious mental illness get and keep the job they want by improving their thinking skills, using cognitive remediation therapy. For people with serious mental illness, the Individual Placement and Support (IPS) Program is an effective approach to help people become employed. Despite its general success, still only 55% of clients find employment. Most of that success occurs in the first three months; after six months, the chances of finding competitive work are quite low. Among those who fail to find employment with IPS, cognitive dysfunction is often a significant problem. The proposed study will target IPS clients who have not found work after 3 months of employment-support services: our hypothesis is that, after three months with no success, the addition of cognitive remediation to IPS will improve employment rates (compared to those who continue to receive IPS alone).

The proposed randomized controlled trial will use a single-blind study design, focused on IPS clients who are slow to (or may never) find employment success. Specifically, the proposed study will have two treatment arms: a) cognitive remediation added to continued IPS services, and b) continued IPS services alone. The study will collaborate with IPS workers at 11 Mental Health and Substance Use (MHSU) clinics to identify clients who are non-responders in the first 3 months, and seek their consent to participate in the study. They will be randomized to either TAU (continuation with IPS and other standard treatments), or TAU plus cognitive remediation. The CRT will consist of computerized cognitive exercise practice, strategy coaching, and teaching coping/compensatory strategies for 12 weeks. Clients will be assessed at 3-time points: prior to the start of cognitive remediation ("baseline"), end-point (3-month), and 6 months after the endpoint evaluation. Primary outcome measures will include success at gaining a competitive job, total hours of competitive employment, and neuropsychological measures of cognition.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Background Information:

The Individual Placement and Support (IPS) program is an evidence-based vocational rehabilitation services that assist individuals with mental illness or significant mental health concerns gain and maintain competitive employment in the community. Unemployment rates among people with mental illness are high, even though most people with serious mental illness want to work.

Fraser Health provides IPS services to approximately 350 MHSU clients per year in six communities. The IPS strategy helps about 55% of clients find competitive jobs, but almost half (45%) fail to find work. Among those who fail to find employment, cognitive dysfunction is often a significant problem.

Cognitive remediation therapy (CRT) is an evidence-based, psychological treatment for the neurocognitive deficits seen in patients with severe mental illness. CRT targets cognitive functioning with the goal of improving role functioning in daily life. When compared with employment intervention alone, programs that incorporate CRT have shown a variety of vocational benefits, (e.g., more likely to work, held more jobs, worked more weeks, and earned more in wages) that are maintained even at a 3-year follow-up. CRT targeted to clients who have not been successful with IPS is efficient: non-responders improved employment outcome with a number needed-to-treat (NNT) of 4 over a two-year period.

Cognitive remediation (CRT) improves thinking skills and work functioning. CRT provides specific training modules and exercises that target thinking skills known to be impaired in severe mental illness. For example, working memory and cognitive flexibility are trained through real-world exercises that teach clients to organize and manage time, focus their attention, consider errors and their consequences, control answers and plan ahead. These skills are important to be successful in obtaining and maintaining employment.

Purpose of Study:

The primary purpose of this study is to assess, for people with serious mental illness who have failed to find employment despite three months of support in the IPS program, the effects of 12 weeks of cognitive remediation therapy (CRT) on subsequent employment outcomes while they continue to receive IPS employment-support services. Hypothesis:

The first hypothesis is that adding CRT for those who have not found employment by 3 months in the program will result in better competitive work outcomes, compared to those who continue IPS alone. The second hypothesis is that participants receiving CRT will improve more in cognitive functioning than those who did not receive CRT training. The third hypothesis is that symptom severity will be related to work outcomes.

Study Type

Interventional

Enrollment (Actual)

105

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • British Columbia
      • New Westminster, British Columbia, Canada, V3L 3W7
        • Fraser Health: Royal Columbian Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

19 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Participants aged 19-60 years old
  • Enrolled in the IPS program for at least 3 months
  • Clinically stable (no changes to psychiatric medication and psychiatric hospitalization in the 30 days prior to intake)

Exclusion Criteria:

  • History of traumatic brain injury
  • Neurological disorder
  • Developmental disability
  • Difficulty understanding written and spoken English

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Cognitive Remediation Therapy
Participants in the experimental group will continue to receive IPS services, which is part of their standard care. In addition, they will be required to complete up to 5 hours per week of computerized cognitive exercises. Cognitive training can be done at home on a computer, on their own schedule. Participants will also receive 1 hour/week of individual coaching to discuss cognitive remediation progress, learn about different cognitive domains and develop ways to generalize their cognitive remediation gains.
Behavioral: Cognitive Remediation Therapy
The intervention of interest for participants in the experimental group is the addition of up to 5 hours per week of computerized cognitive exercises. Cognitive training can be done at home on a computer. For participants without access to a computer, a laptop/tablet computer with the necessary software will be provided for the duration of training. Participants will be able to complete the cognitive exercises on their own schedule, with participation verified by the software. Participants will also receive 1 hour/week of individual coaching to discuss cognitive remediation progress, e.g. to learn about different cognitive domains and develop ways to generalize their cognitive remediation gains.
No Intervention: Treatment as Usual
Participants in the control condition will continue to receive IPS services as usual.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Employment Outcomes
Time Frame: 90 days
The number of hours client worked in the past 90 days.
90 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Cognitive Functioning
Time Frame: 90 minutes
Cognitive functioning will be measured using the Matrics Consensus Cognitive Battery. The MCCB has 10 tests that measures 7 cognitive domains: speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition. Raw scores will be converted to T-score for each domain. T-score has a mean of 50 and a standard deviation of 10.
90 minutes
Psychiatric Symptoms
Time Frame: 2 weeks
Brief Psychiatric Rating Scale. The BPRS is a semi-structured interview of psychiatric symptoms over the past 2 weeks. There are 24 items rated from 1 to 7 with higher scores indicating more severe symptoms.
2 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Fraser Health

Collaborators

Ministry of Social Development and Poverty Reduction, British Columbia

Investigators

  • Principal Investigator: David Erickson, PhD, Fraser Health

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 1, 2017

Primary Completion (Actual)

March 31, 2020

Study Completion (Actual)

May 25, 2020

Study Registration Dates

First Submitted

March 16, 2018

First Submitted That Met QC Criteria

March 23, 2018

First Posted (Actual)

March 30, 2018

Study Record Updates

Last Update Posted (Actual)

July 23, 2020

Last Update Submitted That Met QC Criteria

July 21, 2020

Last Verified

July 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • FHREB No. 2016-096

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Schizophrenia and Related Disorders

Clinical Trials on Cognitive Remediation Therapy

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in India

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe