There is no conflict of interest.
Highlights
- The study's objective was to examine the impact of Cognitive Behavioral Therapy for Work (CBTw) on health outcomes.
- This study was an interrupted time series design using participant assessment data and statistical tests to compare outcomes before and after participation in CBTw.
- The study found that CBTw participation was significantly related to improvements in work functioning and psychosocial outcomes.
- This study receives a low evidence rating. This means we are not confident that the estimated effects are attributable to CBTw; other factors are likely to have contributed.
Intervention Examined
Features of the Intervention
Cognitive Behavioral Therapy for Work (CBTw) aims to help individuals with severe mental illness improve their work-related outcomes. This includes enhancing job placement opportunities, increasing wages, and promoting stable employment. The program offers job-related content within a CBT framework to address cognitive and behavioral issues that affect work performance. The CBTw program consists of 12 weekly sessions, each lasting 1 hour and held in a group setting. These sessions are designed to help participants recognize and modify negative work-related thoughts, build self-confidence, and develop coping strategies for competitive job markets.
Features of the Study
The study was an interrupted time series design conducted from 2014 to 2015 at a Veterans Affairs medical center in Indiana. Study participants included 52 adults, aged 18 to 65, who had severe mental illnesses and were receiving employment support services. Those with major cognitive deficits or severe medical conditions were not included. Most of the participants were men (89%). Among them, 41% were African American and 59% were Caucasian. The average age was 51.2 years. The diagnoses included mood disorders (40%), schizophrenia spectrum disorders (38%), anxiety disorder (14%), and posttraumatic stress disorder (8%).
Participants were assessed before and after the 12-week CBTw program. The pre-treatment assessment included questions about demographics and included instruments measuring work functioning and psychosocial outcomes. The instruments were the Beck Depression and Anxiety Inventories, the Positive and Negative Syndrome Scale, the Work-Related Efficacy Scale, the Roseburg Self-esteem Scale, and the Recovery Assessment Scale. These instruments were administered again during the post- treatment assessment. The authors used statistical tests to compare differences in outcomes before and after participation in CBTw.
Findings
Health and safety
- The study found that CBTw participation was significantly related to improvement in recovery assessment for reliance on others, increased willingness to ask for help, and self-esteem.
- The study also found that CBTw participation was significantly related to decreased negative mental health symptoms, including depression.
- The study did not find any significant relationships between CBTw participation and mental illness symptoms relating to schizophrenic spectrum disorders.
Considerations for Interpreting the Findings
The authors compared the outcomes of participants measured before and after they participated in CBTw. For these types of designs, the authors must observe outcomes for multiple periods before the intervention to rule out the possibility that participants had increasing or decreasing trends in the outcomes examined before enrollment in the program. That is, if participants who had improving health trends tended to enroll in the program, we would anticipate further increases over time, even if they did not participate in the program. Without knowing the trends before program enrollment, we cannot rule this out. Therefore, the study receives a low causal evidence rating.
Causal Evidence Rating
Topic Area
Research Guidelines
Review Protocol: Living Systematic Annual Search and Review Protocol
Review Guidelines: Causal Evidence Guidelines