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

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.

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

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.

An Exploratory Investigation of Goal Management Training in Adults With ADHD: Improvements in Inhibition and Everyday Functioning

Background: Adults with attention deficit/hyperactivity disorder (ADHD) are predominantly treated with medication. However, there is also a need for effective, psychologically based interventions. As ADHD is strongly associated with reduced inhibitory control, cognitive remediation approaches should be efficient. Goal management training (GMT) aims at enhancing inhibitory control and has shown positive effects on inhibitory control in non-ADHD patient groups. The aim of the current study was to explore whether GMT would specifically enhance inhibitory control in adults with ADHD, and if such an enhancement would lead to secondary improvements in self-reported everyday functioning.Methods: Twenty-one participants with ADHD (mean age: 39.05 years [SD 11.93]) completed the intervention and assessments pre-, post- and 6 months after the intervention. Measures included neuropsychological tests and self-report questionnaires pertaining to cognitive- and executive functioning, emotion regulation, quality of life, and ADHD symptoms.Results: Compared to baseline, the participants showed enhanced inhibitory control on performance-based measures at post-assessment and 6-month follow-up. The participants also reported increased productivity and reduced cognitive difficulties in everyday life at both assessments post-treatment, as well as improvements in aspects of emotion regulation and a reduction in the severity of core ADHD-symptoms at 6-month follow-up.Conclusion: Our exploratory study showed that GMT seems to specifically improve one of the core executive dysfunctions in ADHD, namely inhibitory control, with a positive effect lasting at least 6 months post-treatment. The adults with ADHD also reported improved self-regulation in their everyday life after completing GMT, providing strong arguments for further investigations of GMT as a treatment option for this group of adults.Clinical Trial Registration: The study is registered under ISRCTN.com (ISRCTN91988877; https://doi.org/10.1186/ISRCTN91988877).

Action for better brain health among people living with HIV: protocol for a randomized controlled trial

Background Lifestyle changes can protect or improve brain health in older adults. However, sustained lifestyle change is difficult for everyone and may be more difficult for those with executive dysfunction, including some people living with HIV. Thus, the key question is how we can improve adherence to the most promising interventions among people living with HIV experiencing cognitive difficulties. Goal management training is a cognitive rehabilitation program that targets executive dysfunction by teaching goal-directed behaviour and self-management. It is a promising means to improve adherence to lifestyle interventions. Objective To estimate the extent to which goal management training before a healthy lifestyle program is associated with greater adherence to health recommendations, achievement of health-related goals, and better brain health and health outcomes compared to the healthy lifestyle program alone among people living with HIV. Methods Brain Health Now cohort participants with cognitive difficulties or are not aging successfully are eligible. All participants will be given health resources, a health coach, a goal-setting digital application, and access to an online goal-setting workshop. The intervention group will participate in nine 2-h goal management training sessions and then will enter the healthy lifestyle program. Control participants will enter the healthy lifestyle program directly. A total sample of 100 participants will participate for 12 months. The main outcome is adherence to the healthy lifestyle program, defined as the number of weeks where physical activity adherence targets were met (150 min per week, measured with an activity monitor). Weekly social activities will be captured via self-report with confidential photo validation. We will send weekly health state reports to the participants. Downstream outcomes include cognitive ability, health-related quality of life, mobility, vascular risk profile, and social network size. We will analyze the data using a linear regression model. Discussion This project is the first to test whether goal management training can augment adherence to health recommendations among individuals with cognitive difficulties. If successful, behavioural interventions such as goal management training could be implemented as an adjunct to lifestyle interventions in other clinical populations. Trial registration: This trial was registered on clinicaltrials.gov (NCT04345484) on April 14, 2020, https://clinicaltrials.gov/ct2/show/NCT04345484?term=NCT04345484&draw=2&rank=1.

Development of Goal Management Training+ (GMT+) for methamphetamine use disorder through collaborative design: A process description

Background Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes including earlier drop out and relapse. However, current treatments for MUD do not address executive functions. Goal Management Training (GMT) is an evidence-based cognitive remediation program for executive dysfunction but required modifications to enhance its relevance and application within addiction treatment settings. This study aimed to 1) tailor GMT to the key cognitive deficits and typical treatment duration of MUD; 2) explore consumers (people with MUD) engagement with the revised program; 3) implement a protocol of the program with consumers; and 4) present the manualised standard administration to clinical service providers. Methods We followed the Medical Research Council Complex Interventions Framework and employed an evidence- and person-based intervention development process. We used a four-phased approach and collaborated with neuropsychology experts, design researchers in healthcare, consumers with MUD, and clinical service providers. Each aim was addressed in a separate study phase; including content refinement and review with neuropsychology experts (phase 1), intervention design and collaboration with consumers (phase 2), prototype development and review with consumers (phase 3), and final program modifications and review with clinical stakeholders (phase 4). Results Findings from phase 1 indicated support for targeting four cognitive processes (attention, impulse control, goal setting, and decision-making). Key feedback included the need to help habitualise program strategies and guide consumers in applying them in emotionally salient situations. Findings from phases 2 and 3 indicated consumer support for the program strategies and materials but highlighted the need to further enhance the personal relevance of specific content and journal activities. Findings from phase 4 provided overall clinical support for the revised program but indicated an opportunity to minimise unintended effects. We present the intervention materials for the revised program, Goal Management Training+ (GMT+), in line with TIDieR guidelines. Conclusions GMT+ targets tailored cognitive processes, includes reimagined materials and activities, and is sensitive to the clinical needs of people with MUD. Our intervention development process was important for informing the training components, design and intervention materials, and indicating initial acceptability prior to conducting a clinical trial.

Goal management training for adults with ADHD – clients’ experiences with a group-based intervention

Background There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD. Method We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework. Results Our analysis identified three main themes. The participants’ starting point captured the participants’ motivation and expectations prior to treatment. The ambiguity of the group – the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - “I am not alone”; The personal cost of participating in the group - “At times it was a hot mess”; and The group supported the learning experience - “We worked with it together”). The group promoted positive change – How the group affected the participants’ everyday lives consisted of two sub-themes (Managing ADHD in daily life - “It’s much easier to handle everyday life”, and Personal growth - “Gaining new perspectives”). Conclusion The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one’s focus. This study expands existing knowledge by exploring clients’ experiences of participating in group-based interventions for ADHD and shows how the group format provided participants with more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.

Development of a Program based on Goal Management Training for Adolescents with Executive Dysfunctions Complaints

This study aimed to develop a program based on Goal Management Training (GMT) and to investigate its effectiveness on executive functions, through formal instruments and an ecological task. Participants were 25 adolescents with complaints of executive dysfunctions. They underwent neuropsychological assessment of working memory, inhibitory control, cognitive flexibility, planning, and intellectual ability. Participants also took part in a cooking activity and were evaluated for errors per action, of omission, activity performance time, recipe consultation. After, they were randomly allocated to an active control group (CG), which underwent psychoeducation sessions, and an experimental group (EG), stimulated through GMT in eight sessions. Then participants underwent another assessment and follow-up after 4 weeks. In post-intervention analyses, results showed an improvement in executive functions in EG, in the working memory measurement and time of the ecological activity (g = 1.78 and .93, respectively), IQ (g = −1.01), reasoning (g = −.89), flexibility (g = −1.21), and inhibition (g = −3.11). In follow-up evaluation, large-size effects were observed on flexibility (g = −2.95), inhibition (g = −5.78) and execution time of the ecological activity (g = .98). Significant interactions between assessment Time x Group revealed EG gains in IQ, scores in reasoning and flexibility. EG also had longer execution time in flexibility and inhibition tests. That is, EG had greater scores and probably was less impulsive in these tests. Furthermore, EG decreased the number of verifications and the time in the ecological task, that is, had a more efficient performance. Results suggest the intervention can be as instrument to promote executive function.