673 JRRD JRRD Volume 42, Number 5, Pages 673–682 September/October 2005 Journal of Rehabilitation Research & Development Enhanced cognitive-behavioral therapy for vocational rehabilitation in schizophrenia: Effects on hope and work Paul H. Lysaker, PhD; 1–2* Gary Bond, PhD; 3 Louanne W. Davis, PsyD; 1 Gary J. Bryson, PsyD; 4–5 Morris D. Bell, PhD 4–5 1 Roudebush Department of Veterans Affairs (VA) Medical Center, Indianapolis, IN; 2 Indiana University School of Medicine, Indianapolis, IN; 3 Indiana University–Purdue University, Indianapolis, IN; 4 VA Health Care Connecticut, West Haven, CT; 5 Yale University School of Medicine, New Haven, CT Abstract—To address the effects of dysfunctional cognitions on vocational outcome of people with schizophrenia spectrum disorders, we developed the Indianapolis Vocational Interven- tion Program (IVIP), a cognitive-behavioral program of group and individual interventions. Fifty participants with schizophre- nia or schizoaffective disorder were offered 6-month work placements and randomized to receive IVIP (n = 25) or standard support services (n = 25). Hours worked were measured weekly, and work performance was assessed biweekly with the use of the Work Behavior Inventory. Hope and self-esteem were assessed at baseline and at 5 months with the Beck Hopeless- ness Scale and the Rosenberg Self-Esteem Schedule. Analysis of variance (ANOVA) revealed that the IVIP group worked sig- nificantly more weeks and had better average work perfor- mance than the standard support group. Repeated measures ANOVA of baseline and follow-up scores indicated that the IVIP group sustained baseline levels of hope and self-esteem through follow-up, while the standard support group experi- enced declines. Results provide initial evidence of the effective- ness of the IVIP. Key words: cognitive-behavioral therapy, dysfunctional beliefs, hope, psychosocial rehabilitation, schizophrenia, self-efficacy, self-esteem, severe mental illness, vocational function, work. INTRODUCTION Many unemployed or disabled adults with schizo- phrenia spectrum disorders wish to work again yet doubt their ability to succeed [1–3]. As the result of factors including stigma [4–5], practitioners’ negative expecta- tions, and the deficits associated with severe mental ill- ness, many with schizophrenia spectrum disorders view themselves as being minimally competent, of low social value, and possibly beyond help [6–8]. They may believe that they have little ability to influence their lives [9–12] and construct a personal narrative in which they expect social and vocational failure [13]. Thus these beliefs not only are distressing but also may serve as self-fulfilling Abbreviations: ANOVA = analysis of variance; BHS = Beck Hopelessness Scale; CBT = cognitive-behavioral therapy; DSM-IV ® = Diagnostic and Statistical Manual of Mental Disor- ders, Fourth Edition; ICC = intraclass correlation coefficient; IVIP = Indianapolis Vocational Intervention Program; PANSS = Positive and Negative Syndrome Scale; RSES = Rosenberg Self- Esteem Schedule; SCID-I = Structured Clinical Interview for the DSM-IV ® Axis I Disorders; SD = standard deviation; VA = Department of Veterans Affairs; WBI = Work Behavior Inventory. This material was based on work supported by the VA Rehabilitation Research and Development Service, grant D-2570R. * Address correspondence to Paul H. Lysaker, PhD; Day Hos- pital 116H, 1481 West 10th Street, Roudebush VA Medical Center, Indianapolis, IN 46202; 317-554-0000, ext. 2546; fax: 317-554-0056. Email: plysaker@iupui.edu DOI: 10.1682/JRRD.2004.12.0157