A Dismantling Study of Cognitive Remediation for Supported Employment




Contact: Susan McGurk

Impaired cognitive functioning in people with severe mental illness (SMI) is an important illness-related factor that limits their ability to benefit from supported employment (SE), an evidence-based practice for improving competitive work in this population. The Thinking Skills for Work (TSW) program is a cognitive remediation program, including computer-based cognitive exercises and teaching compensatory strategies for managing cognitive difficulties, that was designed to be integrated with vocational rehabilitation services, including SE. Two randomized controlled trials (RCTs) of the TSW program provided to consumers with cognitive impairment receiving SE services, including one study from the parent R01 that the current proposal is a competing renewal for, have shown that TSW significantly improves cognitive functioning and competitive work compared to when SE services alone are provided. However, before widespread dissemination of the TSW program can occur, it is important to evaluate whether a more streamlined and efficient version of the program is equally effective, or whether some consumers require the full TSW program whereas others benefit equally from the briefer version. The most time consuming part of TSW is the computer-based cognitive exercises, yet it is unknown whether simply teaching strategies for compensating for cognitive difficulties is sufficient for overcoming the effects of cognitive impairment on work outcomes. This competing renewal is aimed at addressing this question. The proposed research will examine the importance of the cognitive exercises in the TSW program by comparing it to a briefer version of the program (the Cognitive Skills for Work (CSW) program) that omits this component (45-65 hours for TSW vs. 20-30 hours, for CSW). To compare the effectiveness of the TSW program with the streamlined CSW program, we propose to conduct a RCT at the same two sites and SE programs as our parent R01. We will randomize 200 unemployed consumers with cognitive impairment who are receiving SE to one of two programs: TSW or CSW. All consumers will continue to receive SE services throughout the study period. Cognitive and clinical assessments will be conducted at baseline, post-cognitive training, and 1- and 2-year post-randomization. Work will be tracked weekly for the 2-year study period. The results of this study could lead to a more efficient version of the TSW program (the CSW program), thereby facilitating its dissemination. The findings could also result in the identification of which consumers most benefit from the full TSW program (e.g., such as those with more severe cognitive impairments, or with schizophrenia-spectrum disorders) and which consumers benefit equally from the streamlined CSW program (e.g., consumers with less impaired cognitive functioning, or with other diagnoses). This research has significant promise for reducing the disability, costs, poor quality of life, and social stigma associated with unemployment in SMI; for increasing the potency of SE, the only evidence-based practice for improving work in this population; and for making the dream of competitive work a real possibility for consumers with cognitive impairment.

BU Center for Psychiatric Rehabilitation Staff Role
Susan McGurk, Ph.D. Co-Principal Investigator
Kim Mueser, Ph.D. Co-Principal Investigator
Philippe Bloch, M.Ed. Project Coordinator


No documents are available at this time. Please use the project contact for specific inquiries.


Inquiries related to the project should be addressed to:

Susan McGurk

Boston University, Center for Psychiatric Rehabilitation
940 Commonwealth Avenue West, 2nd Floor
Boston, MA 02215