McGurk Susan R, Mueser Kim T, Xie Haiyi, Bloch Philippe, DeTore Nicole R, Pashka Nicole, Guarino Susan, Ruiz Anabelle, Elliot Clara, Gagnon Heather, Bailey Edward, Fraser Virginia, Welsh Jason, Cunningham Harry, Rizzano Lisa, Wolfe Rosemarie, Drake Robert E
Center for Psychiatric Rehabilitation, https://ror.org/05qwgg493Boston University, Boston, MA, USA.
Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA.
Psychol Med. 2025 Jul 22;55:e208. doi: 10.1017/S0033291725100986.
Comprehensive cognitive remediation improves cognitive and functional outcomes in people with serious mental illness, but the specific components required for effective programs are uncertain. The most common methods to improve cognition are facilitated computerized cognitive training with coaching and teaching cognitive self-management strategies. We compared these methods by dismantling the Thinking Skills for Work program, a comprehensive, validated cognitive remediation program that incorporates both strategies.
In a randomized controlled trial we assigned 203 unemployed people with serious mental illness in supported employment programs at two mental health agencies to receive either the full Thinking Skills for Work (TSW) program, which included computerized cognitive training (based on Cogpack software), or the program with cognitive self-management (CSM) but no computer training. Outcomes included employment, cognition, and mental health over 2 years. To benchmark outcomes, we also examined competitive work outcomes in a similar prior trial comparing the TSW program with supported employment only.
The TSW and CSM groups improved significantly on all outcomes, but there were no differences between the groups. Competitive work outcomes for both groups resembled those of the TSW program in a prior trial and were better than the supported employment-only group in that study, suggesting that participants in both groups benefited from cognitive remediation.
Providing facilitated computerized cognitive training improved neither employment nor cognitive outcomes beyond teaching cognitive self-management strategies in people receiving supported employment. Computerized cognitive training may not be necessary for cognitive remediation programs to improve cognitive and functional outcomes.
综合认知康复可改善严重精神疾病患者的认知和功能结局，但有效项目所需的具体组成部分尚不确定。改善认知的最常见方法是在指导下进行计算机化认知训练以及教授认知自我管理策略。我们通过拆解“工作思维技能”项目来比较这些方法，该项目是一个综合的、经过验证的认知康复项目，融合了这两种策略。
在一项随机对照试验中，我们将两家心理健康机构支持性就业项目中的203名患有严重精神疾病的失业人员分配为接受完整的“工作思维技能”（TSW）项目，其中包括计算机化认知训练（基于Cogpack软件），或者接受有认知自我管理（CSM）但无计算机训练的项目。结局指标包括2年内的就业、认知和心理健康状况。为了设定结局基准，我们还在之前一项类似试验中研究了竞争性工作结局，该试验将TSW项目与仅支持性就业进行比较。
TSW组和CSM组在所有结局指标上均有显著改善，但两组之间无差异。两组的竞争性工作结局类似于之前试验中TSW项目的结局，且优于该研究中仅支持性就业组，这表明两组参与者均从认知康复中获益。
对于接受支持性就业的人群，在教授认知自我管理策略之外，提供指导下的计算机化认知训练对就业和认知结局均无改善。认知康复项目要改善认知和功能结局，计算机化认知训练可能并非必要。
