Efficacy of Online Goal Management Training for Age-Associated Executive Impairment

Abstract Goal Management Training® (GMT) is a standardized cognitive rehabilitation program that enhances individuals’ awareness of executive function impairments and trains them to regularly monitor and manage their goals. In-person GMT is well-validated among numerous subpopulations, including people experiencing age-related cognitive impairment or acquired brain injury, and people with psychiatric disorders. The goal of this study was to evaluate the efficacy and usability of online GMT relative to computerized “brain training” in a registered randomized controlled trial (protocol NCT03602768 at Trials.gov). Both interventions were administered in a self-paced format, with background therapist support provided for GMT. Primary outcomes were measured as self-reported executive impairment on standardized measures (the Dysexecutive Questionnaire and the Cognitive Failures Questionnaire) at pre-, immediate post-, and 6 weeks post-intervention. 62 older adults without psychiatric or neurological diagnoses completed the trial (online GMT: n = 37, age[mean] = 69 years; computerized brain training: n = 25, age[mean] = 64 years; both groups: 76% female). Improvements on the primary outcomes were observed post-intervention and were maintained at follow-up. GMT and computerized brain training groups could not be differentiated statistically, possibly due to restriction of range in the outcome measures at baseline. Additionally, the self-paced format prolonged the intervention beyond the recommended duration, which may have diluted efficacy. GMT was well-received, with participants reporting frequent use of the trained metacognitive strategies. Future studies will examine online GMT’s effectiveness in samples with documented executive impairment and with additional supports to promote engagement for this virtual program.

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Goal Management Training of Executive Functions in Patients with Spina Bifida: A Randomized Controlled Trial

Journal of the International Neuropsychological Society ◽

10.1017/s1355617713000209 ◽

2013 ◽

Vol 19 (6) ◽

pp. 672-685 ◽

Cited By ~ 24

Author(s):

Jan Stubberud ◽

Donna Langenbahn ◽

Brian Levine ◽

Johan Stanghelle ◽

Anne-Kristine Schanke

Keyword(s):

Randomized Controlled Trial ◽

Executive Functioning ◽

Controlled Trial ◽

Real Life ◽

Management Training ◽

Post Intervention ◽

Neuropsychological Measures ◽

Goal Management ◽

Randomized Controlled ◽

Goal Management Training

AbstractExecutive dysfunction causes significant real-life disability for patients with spina bifida (SB). However, no previous research has been directed toward the amelioration of executive functioning deficits amongst persons with SB. Goal Management Training (GMT) is a compensatory cognitive rehabilitation approach, addressing underlying deficits in sustained attention to improve executive function. GMT has received empirical support in studies of other patient groups. The purpose of the present study was to determine the efficacy of GMT in treating subjects with SB, using inpatient intervention periods. We hypothesized post-intervention changes in scores on neuropsychological measures to reflect improved attentional control, including sustained attention and inhibitory control. Thirty-eight adult subjects with SB were included in this randomized controlled trial. Inclusion was based upon the presence of executive functioning complaints. Experimental subjects (n = 24) received 21 hr of GMT, with efficacy of GMT being compared to results of subjects in a wait-list condition (n = 14). All subjects were assessed at baseline, post-intervention, and at 6-month follow-up. Findings indicated superior effects of GMT on domain-specific neuropsychological measures and on a functional “real-life” measure, all lasting at least 6 months post-treatment. These results show that deficits in executive functioning can be ameliorated in patients with congenital brain dysfunction. (JINS, 2013, 19, 1–14)

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A randomized controlled trial on errorless learning in goal management training: study rationale and protocol

BMC Neurology ◽

10.1186/1471-2377-13-64 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 18

Author(s):

Dirk Bertens ◽

Luciano Fasotti ◽

Danielle HE Boelen ◽

Roy PC Kessels

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Management Training ◽

Errorless Learning ◽

Training Study ◽

Goal Management ◽

Randomized Controlled ◽

Goal Management Training

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Correction: paediatric goal management training in patients with acquired brain injury: study protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-029273corr1 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029273corr1

Keyword(s):

Brain Injury ◽

Randomised Controlled Trial ◽

Study Protocol ◽

Controlled Trial ◽

Acquired Brain Injury ◽

Management Training ◽

Goal Management ◽

Randomised Controlled ◽

Goal Management Training

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Rehabilitation of Executive Functions in Patients with Chronic Acquired Brain Injury with Goal Management Training, External Cuing, and Emotional Regulation: A Randomized Controlled Trial

Journal of the International Neuropsychological Society ◽

10.1017/s1355617715001344 ◽

2016 ◽

Vol 22 (4) ◽

pp. 436-452 ◽

Cited By ~ 31

Author(s):

Sveinung Tornås ◽

Marianne Løvstad ◽

Anne-Kristin Solbakk ◽

Jonathan Evans ◽

Tor Endestad ◽

...

Keyword(s):

Executive Functioning ◽

Neuropsychological Tests ◽

Daily Life ◽

Controlled Trial ◽

Acquired Brain Injury ◽

Executive Dysfunction ◽

Management Training ◽

Goal Management ◽

Randomized Controlled ◽

Goal Management Training

AbstractExecutive dysfunction is a common consequence of acquired brain injury (ABI), causing significant disability in daily life. This randomized controlled trial investigated the efficacy of Goal Management TrainingTM(GMT) in improving executive functioning in patients with chronic ABI. Seventy patients with a verified ABI and executive dysfunction were randomly allocated to GMT (n=33) or a psycho-educative active control condition, Brain Health Workshop (BHW) (n=37). In addition, all participants received external cueing by text messages. Neuropsychological tests and self-reported questionnaires of executive functioning were administered pre-intervention, immediately after intervention, and at 6 months follow-up. Assessors were blinded to group allocation. Questionnaire measures indicated significant improvement of everyday executive functioning in the GMT group, with effects lasting at least 6 months post-treatment. Both groups improved on the majority of the applied neuropsychological tests. However, improved performance on tests demanding executive attention was most prominent in the GMT group. The results indicate that GMT combined with external cueing is an effective metacognitive strategy training method, ameliorating executive dysfunction in daily life for patients with chronic ABI. The strongest effects were seen on self-report measures of executive functions 6 months post-treatment, suggesting that strategies learned in GMT were applied and consolidated in everyday life after the end of training. Furthermore, these findings show that executive dysfunction can be improved years after the ABI. (JINS, 2016,22, 436–452)

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Paediatric goal management training in patients with acquired brain injury: study protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-029273 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029273

Author(s):

Ruth Elizabeth Hypher ◽

Anne Elisabeth Brandt ◽

Kari Risnes ◽

Torstein Baade Rø ◽

Eva Skovlund ◽

...

Keyword(s):

Executive Function ◽

Brain Injury ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Acquired Brain Injury ◽

Executive Dysfunction ◽

Management Training ◽

Goal Management ◽

Randomised Controlled ◽

Goal Management Training

IntroductionCompromised integrity of the brain due to paediatric acquired brain injury (pABI) has been associated with cognitive impairment, particularly executive dysfunction, in addition to somatic and emotional symptoms and reduced everyday function. Goal Management Training (GMT) is a cognitive rehabilitation intervention for improving executive function (EF) that has received empirical support in studies of adults with ABI. The purpose of the present study is to determine the efficacy of a recently developed paediatric version of GMT (pGMT) for children and adolescents with ABI and reported executive dysfunction.Methods and analysisThis study protocol describes a parallel randomised controlled trial including allocation concealment and assessor blinding. Eighty survivors after pABI, aged 10–17 years at the time of intervention, will be recruited. Participants will be randomly allocated to either pGMT (n=40) or a psychoeducative control intervention (n=40; paediatric Brain Health Workshop). Both interventions consist of seven group sessions for participants and parents, followed by external cueing and telephone counselling. The study also includes involvement of teachers. Assessments will be performed at baseline, immediately postintervention and at 6 months’ follow-up. Primary outcome measure will be changes in daily life EF as reported by parents (The Behavior Rating Inventory of Executive Function). Secondary outcomes include other assessments of EF (neuropsychological tests and questionnaires). Furthermore, we aim to assess generalisation effects of pGMT on other cognitive functions, as well as emotional, behavioural, adaptive and family function, academic performance, fatigue and quality of life.Ethics and disseminationResults from this study will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals, in addition to presentations at scientific conferences. The study will be conducted in accordance with the Helsinki declaration and the Ethical Research Involving Children (ChildWatch International and Unicef). In accordance to Good Clinical Practice our study includes safety and quality monitoring guarantees in compliance with research ethics and safety. The trial will be reported in accordance with the Consolidated Standards of Reporting Trials 2010 statement and Standard Protocol Items for Reporting in Trials recommendations, in addition to being registered at ClinicalTrials.gov. The study has been approved by the Regional Committees for Medical and Health Research Ethics Norway (2017/772).Trial registration numberNCT03215342.

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Goal Management Training and Computerized Cognitive Training in Depression—a 2-Year Follow-Up of a Randomized Controlled Trial

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.737518 ◽

2021 ◽

Vol 12 ◽

Author(s):

Bjørn Ingulfsvann Hagen ◽

Jan Stubberud

Keyword(s):

Depressive Symptoms ◽

Daily Life ◽

Controlled Trial ◽

Management Training ◽

Computerized Cognitive Training ◽

Goal Management ◽

Randomized Controlled ◽

Goal Management Training

Objective: Information on the long-term effects of cognitive remediation (CR) in major depressive disorder (MDD) is lacking. The present study reports 2-year follow-up data from a previously published randomized controlled trial (RCT) from our research group, comparing Goal Management Training (GMT), a strategy-based CR intervention, to drill-and-practice computerized cognitive training (CCT). In previous work, we found comparable improvements in executive function (EF), in addition to reductions in depressive symptoms, following both GMT and CCT at 6-month follow-up.Methods: Forty-two participants of the RCT, all diagnosed with MDD, were invited to complete rating-scales pertaining daily-life EF, rumination, and depressive symptoms. Explorative analyses compared the 2-year follow-up with previously published baseline and 6-month follow-up data, using non-parametric statistics. Similarly, GMT and CCT were compared at the 2-year follow-up, and completers were compared with non-completers.Results: Twenty participants completed the study. Overall, completers (n = 20) and non-completers (n = 22) were similar. There were no significant differences between GMT (n = 11) and CCT (n = 9) for any outcome 2 years post-treatment. Reduction compared to baseline in depressive symptoms and rumination, but not in daily-life EFs, emerged for GMT only.Conclusions: Findings suggest long-term improvements in mental health following GMT, while improvements in everyday EFs might require additional treatment or maintenance to sustain. Caution is warranted in the interpretation due to the small sample size and high attrition rates.

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Do Old Errors Always Lead to New Truths? A Randomized Controlled Trial of Errorless Goal Management Training in Brain-Injured Patients

Journal of the International Neuropsychological Society ◽

10.1017/s1355617715000764 ◽

2015 ◽

Vol 21 (8) ◽

pp. 639-649 ◽

Cited By ~ 21

Author(s):

Dirk Bertens ◽

Roy P.C. Kessels ◽

Eleonora Fiorenzato ◽

Danielle H. E. Boelen ◽

Luciano Fasotti

Keyword(s):

Cognitive Rehabilitation ◽

Goal Attainment ◽

Outcome Measure ◽

Controlled Trial ◽

Management Training ◽

Goal Management ◽

Randomized Controlled ◽

Brain Injured ◽

Injured Patients ◽

Everyday Task

AbstractBoth errorless learning (EL) and Goal Management Training (GMT) have been shown effective cognitive rehabilitation methods aimed at optimizing the performance on everyday skills after brain injury. We examine whether a combination of EL and GMT is superior to traditional GMT for training complex daily tasks in brain-injured patients with executive dysfunction. This was an assessor-blinded randomized controlled trial conducted in 67 patients with executive impairments due to brain injury of non-progressive nature (minimal post-onset time: 3 months), referred for outpatient rehabilitation. Individually selected everyday tasks were trained using 8 sessions of an experimental combination of EL and GMT or via conventional GMT, which follows a trial-and-error approach. Primary outcome measure was everyday task performance assessed after treatment compared to baseline. Goal attainment scaling, rated by both trainers and patients, was used as secondary outcome measure. EL-GMT improved everyday task performance significantly more than conventional GMT (adjusted difference 15.43, 95% confidence interval [CI] [4.52, 26.35]; Cohen’s d=0.74). Goal attainment, as scored by the trainers, was significantly higher after EL-GMT compared to conventional GMT (mean difference 7.34, 95% CI [2.99, 11.68]; Cohen’s d=0.87). The patients’ goal attainment scores did not differ between the two treatment arms (mean difference 3.51, 95% CI [−1.41, 8.44]). Our study is the first to show that preventing the occurrence of errors during executive strategy training enhances the acquisition of everyday activities. A combined EL-GMT intervention is a valuable contribution to cognitive rehabilitation in clinical practice. (JINS, 2015, 21, 639–649)

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