Tackling ambivalence helps psychosis patients back into work

By Laura Cowen, medwireNews Reporter

Teaching motivational interviewing to clinicians providing vocational rehabilitation through individual placement and support (IPS) improves occupational outcomes for young people with early psychosis, UK researchers report.

“The motivational interviewing training was focused on the clinicians and tackled their own ambivalence as well as providing strategies to use when discussing employment with their patients”, explain Tom Craig (King’s College London) and colleagues in TheBritish Journal of Psychiatry.

They add that the “lack of encouragement” and “low expectations” conveyed by clinicians who “are often more concerned about the impact of work-related stress on the risk of relapse, rather than the psychological, social and financial benefits associated with a rapid return to employment” is one of the main reasons why relatively few young people with first-episode psychosis achieve similar occupational success to their mentally healthy peers.

In the study, two of four early intervention teams that already provided IPS were randomly assigned to receive motivational interviewing training, which aimed to provide care coordinators and vocational specialists, as well as other clinical staff, with an understanding of issues such as intrinsic motivation, ambivalence and readiness to change.

Across the four teams, 134 patients aged 18 to 35 years and not currently in work or full-time employment were followed up for 12 months.

At the end of the study period, 41 (30%) patients were in open employment. Of these, the vast majority (71%) were patients of the teams provided with motivational training, despite the fact that all participants expressed a similar desire to work at baseline.

Logistic regression analysis taking account of clustering by care coordinators and adjusted for gender, ethnicity, educational attainment, employment history and clinical status confirmed the superiority of IPS plus motivational interviewing versus IPS alone, showing that patients from the intervention teams were 4.3 times more likely to obtain employment than those from the IPS only teams.

“It is also worth noting that community conditions are unlikely to account for the better outcomes in the intervention teams because deprivation and unemployment were lower in the areas served by the control teams”, Craig and co-authors remark.

The team concludes that “providing clinical staff with specific training in techniques to address patients’ (and their own) motivational conflicts may enhance patients’ chances of moving towards competitive employment.”

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