Evaluating social cognitive remediation for labour participation in severe mental illness: insights from a small-scale randomised controlled trial

Abstract

Background Employment rates remain critically low among individuals with severe mental illness. Although social cognition explains a significant portion of the variance in functional outcomes, research into social cognitive interventions has remained scarce. Aims To evaluate the impact of a social cognitive remediation (SCR) programme on functional and psychological outcomes over a 6-month post-intervention period. Method This randomised controlled trial was conducted across three sheltered employment centres in France (2020–2024; ClinicalTrials.gov protocol record: 2019-A00124-53). We evaluated the efficacy of a 12-week SCR programme versus an active control with respect to the ratio of hours effectively worked versus those expected at 6 months post treatment (primary outcome). Secondary outcomes included patient-reported measures of self-esteem, internalised stigma, recovery and anxiety. Intention-to-treat and per-protocol effects were estimated using targeted minimum loss-based estimation, with attrition accounted for through inverse probability of censoring weights. Results Of the 105 randomised participants (SCR: n = 53; control: n = 52; mean age: 35.6 [s.d. = 8.8] years; 71% male), 39 dropped out, yielding a per-protocol sample of 33 participants per arm. Attrition was 28% immediately after the intervention and 37% at 6-month follow-up. SCR was associated with a 6.5% increase in the ratio of hours worked versus those expected in the intention-to-treat analysis and a 3.6% increase in the per-protocol analysis (both P < 0.05). SCR also reduced internalised stigma at 6 months post treatment (P < 0.03). Conclusions Our findings suggest that a 3-month SCR programme improves employment maintenance and reduces internalised stigma in individuals with severe mental illness. Future research should use larger samples and improve retention to confirm these findings.