A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes

Abstract

Background Executive functioning is essential to daily life and severely impaired in schizophrenia and psychosis risk syndromes. Goal Management Training (GMT) is a theoretically founded, empirically supported, metacognitive strategy training program designed to improve executive functioning. Methods A randomized controlled parallel group trial compared GMT with treatment as usual among 81 participants (GMT, n = 39 versus Wait List Controls, n = 42) recruited from an early intervention for psychosis setting. Computer generated random allocation was performed by someone independent from the study team and raters post-intervention were unaware of allocation. The primary objective was to assess the impact of GMT administered in small groups for 5 weeks on executive functioning. The secondary objective was to explore the potential of the intervention in influencing daily life functioning and clinical symptoms. Results GMT improved self-reported executive functioning, measured with the Behavior Rating Inventory of Executive Function – Adult version (BRIEF-A), significantly more than treatment as usual. A linear mixed model for repeated measures, including all partial data according to the principle of intention to treat, showed a significant group x time interaction effect assessed immediately after intervention (post-test) and 6 months after intervention (follow-up), F = 8.40, p .005, r .37. Improvement occurred in both groups in objective executive functioning as measured by neuropsychological tests, functional capacity, daily life functioning and symptoms of psychosis rated by clinicians. Self-reported clinical symptoms measured with the Symptoms Check List (SCL-10) improved significantly more after GMT than after treatment as usual, F = 5.78, p .019, r .29. Two participants withdrew due to strenuous testing and one due to adverse effects. Conclusions GMT had clinically reliable and lasting effects on subjective executive function. The intervention is a valuable addition to available treatment with considerable gains at low cost. Trial registration Registered at clinicaltrials.gov NCT03048695 09/02/2017.

Moderators of metacognitive strategy training for executive functioning in early schizophrenia and psychosis risk

“…We did not find support for our hypothesis that opportunities for practicing GMT strategies in sufficiently demanding everyday situations represented by living independently or participating in work or school would improve the effect of GMT. One reason for this may be that the focus in GMT is on individual goals which may include other situations than housework, work, or school ( Haugen et al, 2022 ; Krasny-Pacini et al, 2014 ). Some participants raised concerns about not having opportunities to practice skills, so GMT therapists could advise on alternative situations.…”

“…Participants were independently randomized to GMT (n = 39) or Treatment-As-Usual (TAU; n = 42). See Haugen et al (2022) for details on assessments and intervention. Assessments were collected by a clinical psychologist or psychiatric nurse under supervision from specialists in neuropsychology and psychiatry.…”

“…Degrees of freedom are listed for each effect in Table 3 . Sample size was calculated for the primary endpoint of the RCT, which was to estimate the efficacy of GMT compared to treatment as usual ( Haugen et al, 2022 ). Because of the exploratory nature of this study, no power calculations were performed for the measures in this study.…”

“…In a recent randomized, controlled trial GMT was effective in improving self-reported executive functioning in young people with early schizophrenia spectrum disorders or psychosis risk syndromes ( Haugen et al, 2022 ). The improvement was a clinically reliable change for most participants and remained significant when clinical symptoms were controlled for.…”

Effects of Goal Management Training on self-efficacy, self-esteem, and quality of life for persons with schizophrenia spectrum disorders

“…GMT is a meta-cognitive strategy training CR program that targets attentional control and problem-solving and has been shown to improve goal-directed behavior in persons with neurological or mental disorders and executive dysfunction ( Stamenova and Levine, 2018 ). Our group recently conducted an RCT with GMT for individuals with recently diagnosed schizophrenia spectrum disorders or psychosis risk syndromes and found that the intervention improved subjective executive functioning in everyday situations, which was the primary outcome of the trial, and reduced symptoms of anxiety and depression ( Haugen et al, 2022 ). However, the effects of GMT on well-being (e.g., self-esteem, self-efficacy, quality of life) in the context of schizophrenia remain to be investigated.…”