Evaluation of a cognitive-behavioural intervention augmenting individual placement and support

Purpose - A feasibility study of cognitive-behavioural therapy (CBT) as an adjunct to individual placement and support (IPS) with adults with severe mental illness showed that fewer people who received CBT dropped out and more obtained jobs. The purpose of this paper is to investigate how the adjunct CBT programme worked. CBT used a problem-solving approach to address common psychological barriers to employment. Design/methodology/approach - Baseline and six-month follow-up scores were compared on measures of problem solving, executive functioning, fear of negative evaluation, self-esteem, and stigma. Findings - At baseline, the majority of the 23 participants scored within the normal range on measures. Around half of the participants showed improvement in social problem solving, executive functioning, and fear of negative evaluation. General improvements in self-esteem were seen. Change in the expected areas according to module choice was evident, however this was inconsistent. Research limitations/implications - Many participants were within normal ranges on the measures at baseline. Offering participants a choice of topics led to some people having few sessions, possibly too few to produce benefits. Although the modules on offer targeted commonly experienced problems, they may not have been the most important to these participants. Practical implications - CBT does appear to enhance IPS but the mechanisms by which this occurs is unclear. To improve adjunct CBT, there is a need to clarify the most beneficial targets and identify the mechanisms by which CBT may augment IPS. Originality/value - This study begins to identify the processes by which CBT can enhance IPS for adults with severe mental illness.