ArticlesEffect of cognitive-behavioural training on job-finding among long-term unemployed people
Introduction
People attribute events, particularly successes and failures, to causes, whether they are real or imagined.1 Such causal attributions may be classified in several dimensions, such as internality (due to oneself or to external factors), stability, pervasiveness, and controllability.2 These dimensions can be used to measure, by questionnaire,3 or content analysis,4 an individual's characteristic attributional style, which correlates with susceptibility to clinical depression5 and physical illness,6 risk of relapse in depression,7 low motivation and poor achievement in education and athletics,8 job satisfaction,9 and sales performance.10, 11 Individuals who typically attribute their failures to internal, stable, and global factors, and their successes to external, temporary, and specific causes, are most vulnerable to poor persistence, impaired performance, and depression.12 Clinically, cognitive-behavioural therapy (CBT) can modify attributional style,7 and can have beneficial effects in depression13 and other psychiatric disorders.14
Unemployment is associated with personal, financial, and social restrictions, which can affect psychological health.15 The proportion of unemployed people who score above the cut-off point for “psychiatric caseness” on the general health questionnaire (GHQ)16 is typically 60%, compared with 20% among employed groups.17 Long-term unemployment typically brings further difficulties, such as psychological changes that can prevent re-employment.18 Reduced self-esteem, self-efficacy, and expectations of success all decrease the likelihood of a successful outcome in job-seeking, or may reduce the motivation to seek work at all. Many long-term unemployed people cease to believe in their ability to regain employment.19 The personal cost of unemployment can, therefore, be substantial. There are also, of course, substantial costs to society.
There is a clear need for interventions to assist unemployed people to reduce the negative psychological impacts of unemployment and to help them back into work. However, little psychological assistance is given. Most re-employment programmes aim to clarify job goals, to provide job-seeking or job-related skills, or to resocialise unemployed people to the work environment. There have been few empirically assessed interventions, and those assessed so far have proved to be of little use.20 Three studies that described psychological interventions, however, have reported encouraging results. A programme to improve self-efficacy in job-seeking led to higher rates of re-employment; job-search behaviour was the major mediator through which high self-efficacy was converted into re-employment.19 A social-support and problem-solving intervention resulted in increases in quantity and quality of re-employment, but no difference in job-seeking behaviour.21 Expressive writing by job-seekers about the thoughts and feelings surrounding job loss increased re-employment success, but did not change job-seeking behaviour.22 To date, however, no psychological intervention derived from an empirically validated psychotherapy technique has been formally investigated.
Our occupational training programme, based on the principles of CBT (table 1), aims to help people identify and modify their attributional style. We assessed the effectiveness of the programme in a group of long-term unemployed professional people, who were likely to experience repeated failure in job-finding. We compared the effects on mental health, job-seeking activities, and success in job-finding with those of a social-support programme in a similar control group. The primary outcome measure of the study was obtaining full-time employment.
Section snippets
Methods
Professional people of standard occupational classification23 groups 1, 2, 3, and 7 (managerial, administrative, professional, technical, and sales) who had been unemployed for longer than 12 months were recruited via newspaper advertisements, mail shots, the UK Employment Service, and a major out-placement company (Sanders & Sidney). Calculations to ascertain the sample size needed for sufficient statistical power were based on the endpoint of change in attributional style (effect size
Results
A score on the GHQ of 5 or above is taken to indicate “psychiatric caseness”. At entry to the trial 80 (59%) of CBT-assigned participants and 59 (54%) control-assigned participants scored 5 or higher (p=0·42). The overall proportion (57%) is similar to that in previous reports on unemployed people.17 After training, the proportion scoring 5 or higher on the GHQ was significantly reduced in both the CBT group (to 29 [21%], p<0·001) and the control group (to 25 [23%], p<0·001), but again the
Discussion
Our results show that the principles of CBT can be applied in disciplines other than psychiatry, in which they were first developed. There were greater improvements in the CBT than in the control group on several measures of mental health, though the controls also improved (figure 2). Participation in the CBT programme produced substantial changes in job-finding, a good measure of real-life performance. Compared with participants assigned to the social-support programme, almost three times as
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