Mental illness is a term that varies in its breadth and depth but is associated with an emotional or behavioral disorder (American Psychiatric Association, 2013). Approximately one in four people in the general population are affected by mental illness at some point in their lives (Kessler, Merikangas & Wang, 2008; World Health Organization (2001). Naturally, mental illness is associated with functional impairments that interrupt life activities (New Freedom Commission on Mental Health, 2003). Specifically, severe mental illness often impairs one's capacity to choose, obtain and keep a job and to earn a living (Tsang, Lam, Ng & Leung, 2000). Furthermore, WHO (2007) viewed the complementary condition of mental health as a state of well-being that allows someone to work. It is recognized that there are critical barriers to employment for people with mental illness (Lysaker, Davis, Bryson & Bell, 2009). These include difficulties with interpersonal relationships and with the completion of tasks at work. There are concomitant issues in coping with stigma and work stress as well as low levels of self-efficacy or self-defeating beliefs (Marwaha & Johnson, 2004).
Cognitive behavior group therapy is one intervention that has been applied to people with emotional psychological and psychiatric difficulties. (Rachman, 1997) traced its history from a combination of behavior-modification approaches with cognitive therapies to a short term, focused approach to dealing with a specific problem. This approach centers on changing the thoughts and feelings that influence behavior. The emphasis is on learning new skills or habits in areas such as mindfulness or acceptance and commitment. The essential component is the formation of new patterns of thinking. Its effectiveness has been confirmed in a number of studies (Butler, Chapman, Forman & Beck, 2006).
Cognitive behavior group therapy incorporates diverse approaches that may focus on general improvements in cognitive functioning and social skills, managing negative and positive symptoms, reducing internalized stigma and enhancing self-efficacy or positive beliefs (see a review in Butler, Chapman, Forman & Beck, 2006). It is not clear, however, what type of cognitive-behavior therapy is best associated with specific employment outcomes. The objective of this article was to systematically summarize and synthesis the empirical evidence across studies concerning the effects of cognitive behavior group therapy on employment outcomes for people with mental illness. The results of this research study can provide a better understanding of the overall general or specific effects of cognitive behavior group therapy on employment outcomes so that industrial psychologists can design or implement intervention programs.
This systematic review indicated that there is scope for the utilization of cognitive behavior group therapy in industrial and organizational settings. Cognitive behavior group therapy had a positive impact on work related outcomes for individuals with mental illness. Nevertheless, the results of these studies are mixed. Generally speaking, cognitive behavior group therapy had positive effect on both vocational and mental illness outcomes.
Detailed descriptions of the 11 studies included in the review are listed. Amongst these 11 articles, six were conducted in the United States of America, two in the United Kingdom and one each in Canada, Switzerland and Australia. The total population size of the included articles is 623 and the number of participants in each study ranged from 19-139. The mean age of participants was 33.7 years. In eight studies, there were more male participants than females. One study included only women participants (Washington, 1999), and two studies included only men (Lysaker et al., 2005; Lysaker, Davis & Beatties, 2006). The types of mental-illness conditions included were the following: schizophrenia, depression, bipolar disorder, mood and anxiety disorders and substance dependence. Of the selected 11 studies, six were randomized controlled trials, two used a pre-test post-test design, two used quasi experimental design, and one was a naturalistic trial.
In reviewing the descriptions of cognitive behavior group therapy, five studies applied vocationally-oriented cognitive behavior group therapy, four studies used general cognitive behavior therapy, and two used general cognitive behavior group therapy in combination with vocationally oriented services as the interventions. Most studies used existing cognitive behavior therapy approaches or developed manuals to assure the standardization of the intervention. Of these 11 studies, five studies applied group cognitive behavior therapy only, three provided group and individual cognitive behavior group therapy, two provided individual cognitive behavior group therapy, and one did not specify the type of intervention.
Some research achieved provides an overview of the number of statistically significant effects for each outcome variable and also for each type of cognitive behavior group therapy. Most studies examined more than one of the six vocational variables (vocational functioning, job satisfaction, employment status, work adjustment, work involvement, expectation of success, cognitive functioning) or more than one of the four variables related to mental illness (psychological functioning, psychosocial functioning, symptom, self-esteem). There were a total of 51 results from the 11 studies. Each outcome variable is a row, and each type of treatment condition is a column. These are grouped into vocational-related outcomes (28 results), or mental-illness related outcomes (23 results).
Of these 28 sets of vocational related results, 16 (57.2%) reported that participation in or the completion of a cognitive behavior group therapy program significantly improved some aspect of vocational functioning. Statistically significant vocational outcomes were reported in 16 out of 28 results or just over half of all the outcomes. Four out of six studies improved employment status. Five out of five studies showed improved employment. Work adjustment showed no statistically significant improvement. Three out of three studies showed a statistically significant improvement in work involvement. Expectation of success and cognitive functioning showed improvement in 0.5 and 0.6 out of 2 and 5 results, respectively. It appears that general cognitive behavior group therapy plus vocational rehabilitation had the largest proportion of statistically significant workplace outcomes.
The effects of cognitive behavioral interventions on vocational outcomes (0.57) were only marginally better than those for mental-illness outcomes (0.52). Cognitive behavior group therapy had significant effects in one out of three results (0.33). Cognitive behavior group therapy had a marked effect on psychosocial functioning in seven out of 10 results. Cognitive behavior group therapy showed statistically significant outcomes in only two out of six cases with respect to symptoms and statistically significant outcomes in two out of four cases with respect to self-esteem. Overall, general cognitive behavior therapy was more effective than vocational cognitive behavior therapy as far as illness symptoms and outcomes are concerned. In contrast to vocational outcomes, the combination of general cognitive behavior group therapy plus vocational interventions was the least effective.
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- Eugene Ravenell (Author), 2018, Cognitive-behavioral therapy effects on outcomes for Employment-related groups with Mental Illness, Munich, GRIN Verlag, https://www.grin.com/document/428490