Absence of conflict of interest.
The study’s objective was to examine the impact of Cognitive Behavioral Therapy for Work Success (CBTw) on employment status, hours worked per week, and hourly earnings.
The study uses an interrupted time series design to compare outcomes before and after the intervention was implemented. Work outcomes were self-reported by participants and verified with vocational providers.
The study suggested that participants worked more hours per week and had higher average wages six months after the intervention compared to before the intervention.
The study receives a low evidence rating because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to CBTw; other factors are likely to have contributed.
Cognitive Behavioral Therapy for Work Success (CBTw)
Features of the Intervention
CBTw is designed to augment existing individualized vocational services to help people with serious mental illness (SMI) acquire and keep competitive employment. CBTw is a 12 session, manualized, group-based cognitive behavioral therapy program that teaches adaptive coping strategies to adjust problematic patterns of thought and behaviors related to work. Sessions were facilitated by a licensed clinical psychologist and trained masters-level clinicians and focused on managing anxiety and challenging emotions at work, improving interpersonal communication and interactions, and helping participants view themselves as capable, productive workers. The target population for this study was adult veterans with SMI who were receiving vocational services through an urban Veterans Administration (VA) medical center.
Features of the Study
The authors compared the outcomes of participants before and six months after they participated in CBTw. The sample included 52 adult veterans who were diagnosed with SMI, were currently participating in vocational services at a VA medical center in Indianapolis, had a competitive employment goal, and did not have a significant cognitive impairment or major medical condition that would inhibit participation in CBTw or competitive work. All but one of the participants completed the six-month follow-up assessment.
Eighty-five percent of participants were unemployed at baseline. Most were male. Approximately half were African American and half were White. The average age was around 50 years old, and, on average, participants had been receiving vocational services for over a year at baseline. Work outcomes were self-reported by participants and verified with VA vocational providers. The authors compared individual differences in work outcomes before and after the intervention using within-group t-tests.
- The study suggested that participants worked more hours per week, on average, six months after the intervention than before the intervention.
Earnings and wages
- The study suggested that participants’ average hourly wages were higher six months after the intervention compared to before the intervention.
Considerations for Interpreting the Findings
The authors compared the outcomes of participants before and after they participated in CBTw. CLEAR’s guidelines require that the authors must observe outcomes for multiple periods before and after 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 a strong prospect for obtaining employment tended to enroll in the program, we would anticipate increases in employment over time, even if they did not participate in the program. Without knowing the trends before program enrollment, we cannot rule this out.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to CBTw; other factors are likely to have contributed.