Use It or Lose It? A 5-Year Follow-up Study of Goal Management Training in Patients with Acquired Brain Injury

Tornås, Sveinung; Løvstad, Marianne; Solbakk, Anne‐Kristin; Schanke, Anne‐Kristine; Stubberud, Jan

doi:10.1017/s1355617719000626

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…Further, results suggest that these improvements are specific to GMT, and as such provide preliminary support of strategy-based CR being more effective in producing longterm improvements in mental health. Changes in perceived everyday EF did not sustain over the course of years in the present study, like previous evaluations of long-term effects following GMT (15). Concurrently, our findings align with previous research failing to find evidence of different longterm effectiveness between treatments (10,11).…”

Section: Discussionsupporting

confidence: 88%

“…Overall, these findings align with a recent meta-analysis including various neurocognitive disorders concluding that GMT is moderately effective in improving EFs and aspects of mental health (14). Nevertheless, only one study has reported follow-up analyses more than 2 years following GMT (15). Here, our research group found that improvements following GMT in EF and quality of life at 6-months follow-up, were no longer present at 5-years follow-up (15)(16)(17).…”

Section: Introductionsupporting

confidence: 90%

“…Nevertheless, only one study has reported follow-up analyses more than 2 years following GMT (15). Here, our research group found that improvements following GMT in EF and quality of life at 6-months follow-up, were no longer present at 5-years follow-up (15)(16)(17). In a similar vein, the lack of long-term follow-up studies is a limitation in the current literature on CR in MDD and likely represents an obstacle for clinical implementation (7,9).…”

Section: Introductionmentioning

confidence: 99%

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

Hagen

Stubberud

2021

Front. Psychiatry

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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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Section: Discussionsupporting

confidence: 88%

Section: Introductionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

Hagen

Stubberud

2021

Front. Psychiatry

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“…The standardized manual ensures fidelity and allows for efficient training of clinicians. Future studies should assess maintenance of strategies learnt during GMT [ 115 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Future research should also include objective functional measures (e.g., school performance) and combinations of assessment levels to further clarify the indexed constructs. Finally, future research may consider examining treatment dose (e.g., number of sessions and total treatment time) and the potential effects of “booster sessions” [ 91 ].…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial

Brandt

Finnanger

Hypher

et al. 2021

BMC Med

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Background Impaired executive functions (EFs, i.e., purposeful, goal-directed behaviour) cause significant disability after paediatric acquired brain injury (pABI) warranting efficient interventions. Goal Management Training (GMT) is a metacognitive protocol proven effective for executive dysfunction in adults. This pre-registered, blinded, parallel-randomized controlled trial evaluated efficacy of a paediatric adaptation (pGMT) compared to a psychoeducative control (paediatric Brain Health Workshop, pBHW) to improve EF. Methods Children aged 10 to 17 years with pABI (e.g., traumatic brain injury, brain tumour), ≥ 1 year post-onset or ended treatment, with parent-reported EF complaints were eligible. Participants were randomized (computer-algorithm) to either group-based pGMT (n = 38) or pBHW (n = 38). The active control was tailored to keep non-specific factors constant. Thus, both treatments comprised of 7 sessions at hospitals over 3 consecutive weeks, followed by 4 weeks of telephone counselling of participants, parents, and teachers. Parent-reported daily life EF, assessed by the questionnaire Behavior Rating Inventory of Executive Function (BRIEF; Behavioral Regulation Index (BRI) and Metacognition Index (MI)), were co-primary outcomes 6 months post-intervention. Secondary outcomes included neuropsychological tests and a complex naturalistic task (Children’s Cooking Task). Results Seventy-three participants (96%) completed allocated interventions and 71 (93%) attended the 6-month follow-up. The results demonstrated no significant difference in effectiveness for the two interventions on parent-reported EF: For BRIEFBRI, mean (SD) raw score for pGMT was 42.7 (8.8) and 38.3 (9.3) for pBHW. Estimated difference was − 2.3 (95% CI − 5.1 to 0.6). For BRIEFMI, the corresponding results were 80.9 (20.4) for GMT and 75.5 (19.3) for pBHW. Estimated difference was − 1.4 (95% CI −8.5 to 5.8). In performance-based tests, pGMT was associated with improved inhibition and executive attention, while pBHW was associated with fewer errors in the naturalistic task. Conclusions In pABI, metacognitive training (pGMT) did not demonstrate additional effectiveness on parent-reported daily life EF at 6-month follow-up, when compared to a psychoeducative control. Both interventions were well-tolerated and demonstrated distinct improvements at different EF assessment levels. To conclude on pGMT efficacy, larger studies are needed, including further investigation of appropriate assessment levels and possible differences in effect related to treatment duration, developmental factors, and injury characteristics. Trial registration ClinicalTrials.gov, NCT0321534211, 11 July 2017

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Use It or Lose It? A 5-Year Follow-up Study of Goal Management Training in Patients with Acquired Brain Injury

Cited by 12 publications

References 17 publications

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

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

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

Rehabilitation of executive function in chronic paediatric brain injury: a randomized controlled trial

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