Cognitive remediation and vocational rehabilitation.

Persons with severe mental illness (SMI) who are striving to improve their work prospects are often hindered in work endeavors because of difficulties with cognitive skills, such as paying attention or concentrating, learning and remembering information, responding in a reasonable amount of time to environmental demands, and planning ahead and solving problems. In addition to limiting work functioning, cognitive impairments are obstacles to receiving the full benefits of vocational rehabilitation, including supported employment. Efforts to improve cognition in people with SMI, or cognitive remediation, have produced modest but consistent gains in a variety of cognitive domains. More recent efforts have focused on combining cognitive remediation with vocational rehabilitation in order to improve work functioning. Initial results from four published studies of combined cognitive remediation and vocational programs are encouraging, indicating improvements in both cognitive and work functioning. The approaches to cognitive remediation used in these studies vary considerably, as do the characteristics of participants, the vocational rehabilitation models, and the methods of combining cognitive and vocational therapies. The differences in key components of programs combining cognitive remediation and vocational rehabilitation indicate the need to replicate findings, and raise important questions about what aspects of the programs are associated with improvements in work.