The influence of adjunctive treatment and metacognitive deficits in schizophrenia on the experience of work

Comprehensive schizophrenia treatment is subject to a number of considerations, with the most important being enhanced work function. Although various studies have explored the factors influencing patients’ performance at work, little is known about the factors influencing subjective experience, as well as to what extent the symptoms and cognitive deficits affect job satisfaction. To understand this phenomenon, data from a trial in which participants in a six-month vocational program were assigned either a standard support group or a cognitive behavioral group therapy, and asked to fill in weekly self-reports of job satisfaction was analyzed.  Before the trial, it was hypothesized that receiving cognitive behavioral therapy (CBT) would be related to generally higher and more consistent ratings of job satisfaction than in the support condition.

Schizophrenia metacognitive deficits

In the study, 100 participants with a SCID confirmed diagnosis of either schizophrenia or schizoaffective disorder were recruited from an outpatient service, and their responses measured on a Metacognition Assessment Scale (MAS-A). The participants were expected to provide random consent, upon which they were randomized to receive the IVIP CBT intervention or support services, after which the data was analyzed using SPSS. The study findings indicated that are no significant main effects of treatment and metacognition, on job satisfaction. It was also found that metacognition might moderate the effect of treatment with CBT groups not indicating consistency in job satisfaction as a consequence of metacognition. Regarding average work satisfaction, there was no main effect of treatment, or metacognitive capacity. However, a significant interaction was found between metacognitive capacity and treatment, where in the CBT group, but not in the support group, higher metacognitive capacity predicted higher average job satisfaction.

The study findings suggest within the confines of CBT, greater abilities to form complex ideas about one and others allow for the construction of ideas about the meaning of work, which may underlie work satisfaction. It is also consistent with our hypothesis that CBT allows persons to interpret negative experiences in novel ways such that single negative events do not taint larger judgments about experiences as perhaps happened in the support group. This finding correlates with other clinical trials that have shown that metacognitive capacity can be targeted with psychotherapy; with many of the factors currently undergoing controlled trials.

This trial also examined whether treatment and metacognitive capacity would be related to more consistency in job satisfaction. While it did not find any effect of treatment or metacognition, there was still a significant interaction effect, with higher metacognitive capacity leading to more varied appraisal of work satisfaction in the CBT group. Therefore, it can be generally concluded that metacognitive capacities no longer significantly predict the consistency of work satisfaction, with the findings demonstrating that persons with higher versus lower metacognitive capacity benefit in different ways from CBT treatment.

You have just read a summary of the research paper: de Jong, S., et al. “The Influence of Adjunctive Treatment and Metacognitive Deficits in Schizophrenia on the Experience of Work.Schizophrenia Research 157.1–3 (2014): 107-11. Print.

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