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

• Published in: BMC psychiatry Vol. 22; no. 1; pp. 575 - 17
• Main Authors: Haugen, Ingvild, Stubberud, Jan, Haug, Elisabeth, McGurk, Susan R, Hovik, Kjell Tore, Ueland, Torill, Øie, Merete Glenne
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.08.2022; BioMed Central; BMC
• Subjects: Activities of daily living; Adult; Care and treatment; Clinical trials; Cognition & reasoning; Cognition disorders; Cognitive Behavioral Therapy; Cognitive impairment; Cognitive remediation; Cognitive therapy; Complications and side effects; Early intervention; Executive Function; Executive function (Psychology); Goals; Health aspects; Humans; Intervention; Management training; Mental disorders; Metacognition; Methods; Neuropsychology; Occupational therapy; Psychiatry; Psychosis; Psychotic Disorders; Questionnaires; Real-world function; Risk factors; Schizophrenia; Syndrome; Testing; Treatment Outcome; Norway; Psychosis; Early intervention; Executive function; Real-world function; Cognitive remediation; Cognitive impairment
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-022-04197-3

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. 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. 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. 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. Registered at clinicaltrials.gov NCT03048695 09/02/2017.