Absence of conflict of interest.
Glynn, S. M., Randolph, E. T., Eth, S., Paz, G. G., Leong, G. B., Shaner, A. L., & Vort, W. V. (1992). Schizophrenic symptoms, work adjustment, and behavioral family therapy. Rehabilitation Psychology, 37(4), 323-338.
- This study examined the impact of behavioral family therapy on male veterans’ employment.
- The study conducted a randomized controlled trial using data from self-reported responses to the Social Adjustment Scale, Version I.
- The study showed that behavioral family therapy did not have statistically significant effects on employment.
- The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we are confident that any estimated effects are attributable to behavioral family therapy and not to other factors. However, the study did not show any statistically significant effects.
Behavioral Family Therapy
Features of the Intervention
Through behavioral family therapy, veterans and their families are offered information about schizophrenia as well as education on communication skills and problem solving. Veterans Affairs staff provide these services through instruction, role playing, modeling, homework assignments, and social reinforcement. Over a one-year period, families were invited to attend about 25 behavioral family therapy sessions at a Veterans Affairs medical center. In addition, participants received Veterans Affairs customary care, which included medication management, monthly clinical evaluations, crisis intervention, and vocational and rehabilitation referrals. Additional services were also available through Veterans Affairs, including therapy groups and vocational rehabilitation services.
Features of the Study
The study conducted a randomized controlled trial, with 21 people assigned to the treatment group and 20 people assigned to the control group. In the treatment group, on average, people were 32.7 years old, had completed 13 years of education, were Caucasian (33 percent), and had never married (62 percent). Among those in the treatment group, 4 worked or attended school for more than 20 hours per week at baseline, and 5 worked or attended school on a different schedule; the authors did not describe the activities of the remaining 12 people in the treatment group. In the control group, the average age was 30.9, with 12.8 years of education. Most of the control group participants were African American (50 percent) and had never married (70 percent). Among those in the control group, 6 attended school or worked for more than 20 hours a week, and 7 attended school or worked on a different schedule; the authors did not describe the activities of the remaining 7 people in the control group.
People in the study were male veterans diagnosed with schizophrenia. Over a three-year period, people were selected from impatient admissions at the West Los Angeles Veterans Affairs Medical Center. To be eligible, patients had to be ages 18 to 55, speak English as their primary language, and have contact with a relative for at least four hours each week. They also had to have current or very recent schizophrenic symptomatic exacerbation and meet the criteria from the Diagnostic and Statistical Manual of Mental Disorders III for schizophrenia or schizoaffective disorder, as confirmed through an expanded Present State Examination.
After meeting these criteria, potential participants needed to achieve symptom stabilization criteria for at least four weeks before random assignment. This included scoring 4 or less on the Brief Psychiatric Rating Scale, which measures symptoms such as hallucinatory behavior, conceptual disorganization, and unusual thought content. Patients who met these criteria were then randomly assigned along with their families.
Female patients and those with significant substance abuse backgrounds were excluded from the study.
The treatment group received behavioral family therapy and Veterans Affairs customary care, whereas the control group received only Veterans Affairs customary care. The study team collected data through semi-structured interviews with sample members, using the Social Adjustment Scale, Version I.
- The study showed no statistically significant relationship between behavioral family therapy and employment.
Considerations for Interpreting the Findings
The study focused mostly on employment outcomes. However, the authors grouped participation in employment and education together, making it impossible to tell which people got jobs, which took part in educational activities, and which did both. Although the authors provided more information about participants at baseline (for example, 10 people were employed [n = 8] or attending college [n = 2]), they did not provide this same level of information to distinguish between employment and education as outcomes. Also, because of the small sample size (41 people), the study findings might not be applicable to other populations.
Causal Evidence Rating
The quality of causal evidence presented in this report is high because it was based on a well-implemented randomized controlled trial. This means we are confident that the estimated effects are attributable to the behavioral family therapy, not to other factors.