Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders

Thanh P. Le, Michael F. Green, Jonathan K. Wynn, Julio E. Iglesias, Richard L. Franco, Alex Kopelowicz, Robert S. Kern

Research output: Contribution to journalArticlepeer-review


Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks – two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) – in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (total R2 = 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.

Original languageEnglish
Pages (from-to)149-155
Number of pages7
JournalSchizophrenia Research
StatePublished - Dec 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023


This study was supported by the National Institute of Mental Health ( R21 MH110753 ; RSK – Principal Investigator). TPL is supported by an institutional training grant from the National Institutes of Health ( T32 MH122395 ). The funding sources were not involved in study design, collection, analysis and interpretation of data, or writing of the manuscript.

FundersFunder number
National Institutes of HealthT32 MH122395
National Institute of Mental HealthR21 MH110753


    • Effort valuation
    • Employment
    • Individual Placement and Support
    • Motivation
    • Schizophrenia
    • Work


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