How Effective is Cognitive Remediation in Enhancing Vocational
Outcomes for Job Seekers with Severe Mental Illness in Australia?
Natalia A. Contreras,
David J. Castle,
Susan L. Rossell
Cognitive Neuropsychiatry Team/Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash Central Clinical School,
Department of Psychiatry, The University of Melbourne,
Department of Psychiatry, St. Vincent’s Hospital,
Social Firms Australia,
Occupational Therapy, Monash University,
North West Area Mental Health Service, and
Brain and Psychological Sciences Research Centre, Swinburne
University of Technology
Objective: Despite advances in the treatment of people with severe mental illness (SMI), access to work for this community still remains a
challenge. Cognitive remediation (CR) is an intervention that can improve employment outcomes, especially when offered alongside employ-
ment support. This pilot study aimed to determine whether CR enhances vocational outcomes for job seekers participating in an innovative
vocationally oriented psycho-educational program implemented in Australia.
Method: Fourteen participants with SMI were enrolled in Health Optimisation Program for Employment (HOPE) and attended 20 sessions of
CR. Assessments were performed at baseline, post-CR, and 3 months follow-up. Individuals were assessed on a number of occupational and
psychosocial variables (e.g., hours of paid and unpaid work, self-esteem, quality of life, social relationships), in addition to undertaking the
MATRICS Consensus Cognitive Battery.
Results: There was no increase in hours of paid work for those in employment, but 46% of the group initiated tertiary studies between base-
line and 3-month follow-up. There was a trend towards a signiﬁcant increase in number of volunteer hours, with 31% of individuals having
initiated a non-paid activity at the end of the CR. As predicted, cognition improved over time as did psychosocial outcomes in the areas of
self-esteem, quality of life and social relationships.
Conclusions: Consistent with previous studies, CR improved psychosocial and cognitive functioning. While employment beneﬁts were not
found, promising outcomes were reported on volunteering and educational participation. This pilot suggests there may be potential for combin-
ing CR with HOPE to enhance vocation-related participation and potential employability of job seekers with SMI in Australia. Given these prelimi-
nary ﬁndings, a further clinical trial with appropriate control group and sample size is required to validate the effectiveness of HOPE+CR.
Key words: Australian setting; cognitive remediation; job seekers; psychosocial outcomes; severe mental illness; vocational functioning.
What is already known on this topic
1 Cognitive remediation is a learning-based, cognitive
skills training intervention that aims to drive endur-
ing and generalised improvements, in neurocogni-
tive, social cognitive, and/or psychosocial domains.
2 It is an intervention that has proven to be effective
in improving occupational outcomes. Moreover, CR
boosts work rates when provided in the context of
3 Despite the beneﬁts shown by CR when offered
alongside vocational training, its application con-
tinues to be limited internationally.
What this paper adds
1 This study highlights the potential beneﬁts of the
HOPE+CR intervention in improving occupation,
psychosocial, and cognitive functioning for people
2 Despite our small sample, this pilot provides the
foundation for a larger study.
3 Lastly, it provides preliminary evidence of potential
ways to enhance vocational participation for job
seekers with SMI living in Australia.
In Australia, 90% of people suffering from a severe mental
illness (SMI) report impaired functioning in daily life, with
approximately 40% having difﬁculty looking after themselves,
and 79% unemployed (Morgan et al., 2012). There is interna-
tional consensus that current therapeutic interventions need to
focus on these psychosocial sequelae (Insel, 2010). One inter-
vention that has received substantial attention in terms of
Correspondence: Natalia A. Contreras, Cognitive Neuropsychiatry Team/
Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital
and Monash Central Clinical School, Level 4, 607 St Kilda Road, Mel-
bourne, VIC 3004, Australia.
Accepted for publication 13 August 2016
Australian Psychologist 53 (2018) 144–150
© 2016 The Australian Psychological Society