Cognitive remediation and occupational outcome in schizophrenia spectrum disorders: A 2 year follow-up study June Ullevoldsæter Lystad a,b, ⁎, Erik Falkum a,b , Vegard Øksendal Haaland c,d , Helen Bull b , Stig Evensen a , Susan R. McGurk e , Torill Ueland a,f a Division of Mental Health and Addiction, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway b Institute of Clinical Medicine, University of Oslo, Postboks 1039 Blindern, 0315 Oslo, Norway c Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Postboks 1094 Blindern, 0317 Oslo, Norway d Department of Psychiatry, Sørlandet Hospital Trust, Service Box 416, 4604 Kristiansand, Norway e Center for Psychiatric Rehabilitation, Boston University, Boston, MA, United States f Research Unit of Neuropsychopathology, Department of Psychology, University of Oslo, Postboks 1094 Blindern, 0317 Oslo, Norway abstract article info Article history: Received 26 July 2016 Received in revised form 15 December 2016 Accepted 17 December 2016 Available online xxxx Neurocognitive impairment is prominent in schizophrenia and a significant predictor of poor occupational out- comes. Vocational rehabilitation (VR) is frequently implemented to counteract high unemployment rates. Indi- viduals with schizophrenia however face numerous challenges such as neurocognitive impairments and psychotic symptoms. Hence, augmenting VR to address illness-related factors may optimize occupational out- comes. The aim of this study was to examine the effects of Cognitive Remediation (CR) combined with VR(CR + VR) compared to techniques from Cognitive Behavioral Therapy (CBT) combined with VR(CBT + VR) on neurocognition and occupational functioning over a 2 year period. A total of 131participants underwent as- sessment with the MATRICS Consensus Cognitive Battery (MCCB) at baseline, post treatment (after 10 months) and follow-up (2 years after randomization). Occupational status and number of hours worked were recorded at all assessment points. Both groups improved on several neurocognitive domains. All improvements were how- ever in favor of the CR group. There was a significant increase in number of participants working and hours worked in both groups throughout the project period, with no between-group differences. Number of hours worked at follow-up was predicted by change in Working Memory and the Composite Score in the CR group. CR-augmented VR improved several domains, particularly Verbal Learning and Working Memory, which were central in the CR program. The combination of VR and CR or CBT thus enabled a significant proportion of partic- ipants to attain and maintain work. © 2016 Elsevier B.V. All rights reserved. Keywords: MCCB Neurocognition Cognitive remediation Cognitive behavioral therapy Vocational rehabilitation 1. Introduction Neurocognitive deficits are prominent in schizophrenia (August et al., 2012; Green et al., 2004; Reichenberg et al., 2009) and significantly related to functional outcome (Bowie and Harvey, 2005; Green, 2006; Keefe, 2014; McGurk and Mueser, 2006; Shamsi et al., 2011; Strassnig et al., 2015). Neurocognitive impairment contributes substantially to low occupational attainment and poor occupational outcomes (Christensen and Stergaard, 2007; Kukla et al., 2012; Lystad et al., 2015; Strassnig et al., 2015; Vargas et al., 2014) and is an important pre- dictor of poor engagement in vocational rehabilitation (VR) (O'Connor et al., 2011). In addition to financial benefits, employment is associated with im- proved self-esteem, quality of life and lowered relapse rates in schizo- phrenia (Bond et al., 2001; Bryson et al., 2002; Bush et al., 2009; Lieberman et al., 2008; McGurk and Mueser, 2004). Although work is a commonly sought goal, considerable research has shown that employ- ment rates are consistently low, estimates ranging from 10% to 25% (Bond, 2004; Evensen et al., 2015; Marwaha and Johnson, 2004; Tandberg et al., 2011). As vocational rehabilitation gains momentum in clinical guidelines, the implementation of programs including Supported Employment (SE)/Individual Placement and Support (IPS) has increased accordingly to help individuals with schizophrenia reach their work goals. However, despite superior competitive employment outcomes in SE/IPS studies (Bond et al., 2012; Marshall et al., 2014), this group still faces numerous occupational challenges such as unwanted job discontinuations and work performance difficulties. These may be caused by illness-related barriers, including neurocognitive functioning (Allott et al., 2013; Schizophrenia Research xxx (2016) xxx–xxx ⁎ Corresponding author at: Oslo University Hospital, Division of Mental Health and Addiction, Bygg 12, Gaustad Sykehus, PO Box 4956 Nydalen, , 0424 Oslo, Norway. E-mail address: June.Lystad@medisin.uio.no (J.U.æ Lystad). SCHRES-07096; No of Pages 8 http://dx.doi.org/10.1016/j.schres.2016.12.020 0920-9964/© 2016 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres Please cite this article as: Lystad, J.U.æ, et al., Cognitive remediation and occupational outcome in schizophrenia spectrum disorders: A 2year follow-up study, Schizophr. Res. (2016), http://dx.doi.org/10.1016/j.schres.2016.12.020