Study protocol: A multisite trial of Work-Related Cognitive behavioral therapy for unemployed persons with social anxiety.

This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.

Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot trial.

We designed and pilot-tested a group-based, work-related cognitive-behavioral therapy (WCBT) for unemployed individuals with social anxiety disorder (SAD). WCBT, delivered in a vocational service setting by vocational service professionals, aims to reduce social anxiety and enable individuals to seek, obtain, and retain employment. We compared WCBT to a vocational services as usual control condition (VSAU). Participants were unemployed, homeless, largely African American, vocational service-seeking adults with SAD (N = 58), randomized to receive either eight sessions of WCBT plus VSAU or VSAU alone and followed three months post-treatment. Multilevel modeling revealed significantly greater reductions in social anxiety, general anxiety, depression, and functional impairment for WCBT compared to VSAU. Coefficients for job search activity and self-efficacy indicated greater increases for WCBT. Hours worked per week in the follow-up period did not differ between the groups, but small sample size and challenges associated with measuring work hours may have contributed to this finding. Overall, the results of this study suggest that unemployed persons with SAD can be effectively treated with specialized work-related CBT administered by vocational service professionals. Future testing of WCBT with a larger sample, a longer follow-up period, and adequate power to assess employment outcomes is warranted.

Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder.

OBJECTIVE: The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. METHODS: Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. RESULTS: After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. CONCLUSIONS: Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.