Himle, J., Bybee, D., Steinberger, E., Laviolette, W., Weaver, A., Vlnka, S., Golenberg, Z., Levine, D., Heimberg, R., & O’Donnell, L. (2014). Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot trial. Behaviour Research and Therapy, 63, 169-176.
- The study’s objective was to examine the effect of group-based, work-related cognitive-behavioral therapy (CBT) on work-related outcomes of unemployed, homeless people diagnosed with social anxiety disorder.
- The study was a randomized controlled trial. The authors randomly assigned eligible participants to either a treatment group, which received work-related CBT and vocational services, or to a control group, which received vocational services alone. Trained independent evaluators collected the self-reported data used in the study.
- The study found that participants assigned to the treatment group had higher job search self-efficacy and activity than participants assigned to the control group.
- The quality of causal evidence presented in this report is low. This means we are not confident that the estimated effects on employment are attributable to work-based CBT; other factors are likely to have contributed.
Features of the Study
The study was set in a vocational rehabilitation center in Detroit, Michigan, from May 2010 to March 2012. Participants were unemployed, homeless adults who had been diagnosed with social anxiety disorder, recruited among people seeking vocational services at the center. There were 58 participants, among whom 86 percent were African American, 67 percent were male, 36 percent had completed high school, and the mean age was 43. Most participants (60 percent) were assessed with having depression and 74 percent had experienced some form of substance abuse in their lifetime.
Cohorts of about six participants were randomly assigned to the treatment or control group. The treatment group received eight two-hour sessions of work-related CBT held twice weekly, as well as standard vocational services, over the course of four weeks. The control group received standard vocational services, which included career assessment, help with their resumes, job interviewing skills, and job placement help, but no CBT.
Self-reported information from participants was collected at baseline, immediately post-treatment, and three months post-treatment. The authors compared the outcomes of participants in the treatment group with those of the control group and took into account that random assignment was conducted at the cohort, and not individual, level. To estimate the impact of CBT, the authors accounted for preexisting differences in self-reported job search efficacy and mental health indicators between the treatment and comparsion groups.
- The study found that work-related CBT was associated with a statistically significant increase of 5.96 points in job search self-efficacy and 7.05 points in job search activities for treatment group members compared with the control group.
- The study found no statistically significant relationship between work-related CBT and the number of hours worked.
Considerations for Interpreting the Findings
The randomized controlled trial had a high attrition rate, which means the study cannot receive a high causal evidence rating. Randomized controlled trials with high attrition can receive a moderate causal evidence rating if the authors take steps to ensure that the groups being analyzed were comparable before receiving the treatment, by accounting for age, race and ethnicity, gender, and a pre-intervention measure of employment or earnings measured more than one year before the intervention in their empirical models. Because a pre-intervention measure of employment or earnings measured more than one year before the intervention was not available to the authors, the employment outcomes receive a low causal evidence rating.
Causal Evidence Rating
The quality of causal evidence presented in this report is low for the employment outcomes. This means we are not confident that the estimated effects on employment are attributable to work-based CBT; other factors are likely to have contributed.