The Effects of the Combination of Cognitive Training and Supported Employment on Improving Clinical and Working Outcomes for People with Schizophrenia in Japan

Sayaka Sato *, Kazuhiko Iwata 2, Shun-Ichi Furukawa 3, Yasuhiro Matsuda 4, Norifumi Hatsuse 5, Emi Ikebuchi 5
1 Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Japan
2 Outpatient department, Osaka Psychiatric Medical Center, Japan
3 Department of Rehabilitation, Faculty of Medicine, University of Tokyo, Japan
4 Department of Psychiatry, Nara Medical University School of Medicine, Japan
5 Department of Psychiatry, Teikyo University School of Medicine, Japan

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© Sato et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neu-rology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo, 187-8553, Japan; Tel: +81-42-341-2711; Fax: +81-42-346-2169; E-mail.


Background: In Japan, Job assistance for SMI have been not active. Compared with mental retardation, employment rate of SMI was low. The needs of the effective job assistance for SMI are growing. The purpose of this study was to determine the effectiveness of the combination approach of Cognitive Remediation (CR) and Supported Employment (SE) in clinical outcomes, including cognitive functioning and psychiatric symptoms besides vocational outcomes. Methods: The participants diagnosed with schizophrenia or schizoaffective disorder were assigned to CR+SE group (n=52) and SE group (n=57). CR comprised computer based trainings using COGPACK and group works. SE was individualized vocational support provided by employment specialists. Outcome measures included cognitive functioning, psychiatric symptoms, social functioning, performance of tasks as clinical outcomes, employment rate, duration of employment, and earned wage as vocational outcome. Results: CR+SE group displayed significantly better psychiatric symptoms (F=3.490, p<.10), interpersonal relations (F=11.695, p<.01), and social and cognitive functioning including verbal memory (F=9.439, p<.01), digit sequencing (F=5.544, p<.05), token motor tasks (F=6.685, p<.05), and overall cognitive functioning (F=8.136, p<.01). We did not find any significant difference between two groups in terms of employment rate and earned wage. Discussions: This is the first controlled study to determine the effectiveness of CR on vocational outcomes in Japan. The results showed that CR and SE programs were feasible in Japan and that CR using COGPACK had favorable effects on cognitive functioning, psychiatric symptoms, and social functioning, which is consistent with previous researches.

Keyword: Schizophrenia, cognitive remediation, supported employment, cognitive impairment, COGPACK.