Jan Stubberud

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

Executive 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 Training (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.

Emotional health and coping in spina bifida after goal management training: a randomized controlled trial.

OBJECTIVE Executive function impairments are common after spina bifida (SB) and potentially have a detrimental effect on the individuals emotional health and coping. Goal management training (GMT) is a cognitive rehabilitation method for improving executive function. The purpose of this study was to determine the efficacy of GMT on aspects of perceived emotional health and coping in individuals with SB. METHOD 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 with results of subjects in a wait-list condition (n = 14). Four self-report questionnaires assessing emotional health and coping were utilized as outcome measures. All subjects were assessed at baseline, postintervention, and at 6-month follow-up. RESULTS Findings indicated positive effects of GMT relative to the control group on measures of emotional health. Of note, the GMT group showed significant improvement, compared with control subjects, on a self-report inventory of depressive and anxiety symptoms after training, lasting at least 6 months posttreatment. Furthermore, both groups showed improvements after training on mental health components of health-related quality of life. Finally, the GMT group showed a significant increase in task-focused coping and a decrease in avoidant coping after training compared with pretreatment baseline assessment scores. CONCLUSIONS Overall, findings indicate that by us a compensatory intervention to manage executive dysfunction, effective and lasting benefits can be achieved with regard to aspects of perceived emotional health and coping.

Goal Management Training improves everyday executive functioning for persons with spina bifida: Self-and informant reports six months post-training

Executive dysfunction accounts for significant disability for many patients with spina bifida (SB), thus indicating the need for effective interventions aimed at improving executive functioning in this population. Goal Management Training™ (GMT) is a cognitive rehabilitation approach that targets disorganised behaviour resulting from executive dysfunction, and has received empirical support in studies of other patient groups. The purpose of this study was to determine if GMT would lead to perceived improved executive functioning in the daily lives of patients with SB, as evidenced by reduced report of dysexecutive problems in daily life on self- and informant questionnaires. Thirty-eight adults with SB were included in this randomised controlled trial (RCT). Inclusion was based upon the presence of executive functioning complaints. Experimental subjects (n = 24) received 21 hours 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 six-month follow-up. Self-report measures indicated that the GMT groups everyday executive functioning improved significantly after training, lasting at least 6 months post-treatment. There were no significant effects on informant-report questionnaires. Overall, these findings indicate that executive difficulties in everyday life can be ameliorated for individuals with congenital brain dysfunction.

Problematic psychosocial adaptation and executive dysfunction in women and men with myelomeningocele

Purpose: Myelomeningocele (MMC) is caused by incomplete neural tube development, affecting physical, cognitive and adaptive functioning. The aim of this study was to characterize women and men with problematic psychosocial adaptation with respect to cognitive functions and psychological symptoms. It was expected that cognitive functions, especially the executive functions, were mostly impaired. In addition, the clinical history, the neurological and the psychological functioning was investigated. Method: Twelve participants (six men, six women; age range 24–41 years) with MMC were recruited from TRS National Resource Centre for Rare Disorders. Inclusion criteria were (1) uncompleted upper secondary school, (2) unemployment and (3) lack of social relationships. The participants underwent a systematic clinical history, a clinical neurological examination, a neuropsychological assessment and questionnaires regarding cognitive and psychological functioning. Results: All participants had major neurological deficits and most of them had hydrocephalus and Chiari-II malformation. Cognitive deficits were present in a range of domains, especially the executive functions. The neuropsychological findings showed no obvious difference between men and women. Symptoms of psychopathology were more pronounced in women. The men were less capable to structure daily living. Conclusions: The neuropsychological findings disclosed that the executive functions were most impaired. Future research should be directed towards cognitive rehabilitation. Implications for Rehabilitation It is conceivable that executive deficits in patients with myelomeningocele are decisive for problematic psychosocial adaptation. Cognitive rehabilitation should be considered for neuropsychological impairments to improve psychosocial functioning and quality of life. Gender differences in psychological functioning are evident.

Goal Management Training Combined With External Cuing as a Means to Improve Emotional Regulation, Psychological Functioning, and Quality of Life in Patients With Acquired Brain Injury: A Randomized Controlled Trial

OBJECTIVE To investigate whether goal management training (GMT) expanded to include external cuing and an emotional regulation module is associated with improved emotional regulation, psychological functioning, and quality of life (QOL) after chronic acquired brain injury (ABI). DESIGN Randomized controlled trial with blinded outcome assessment at baseline, posttraining, and 6-month follow-up. SETTING Outpatient. PARTICIPANTS Persons with ABI and executive dysfunction (N=70; 64% traumatic brain injury; 52% men; mean age ± SD, 43±13y; mean time since injury ± SD, 8.1±9.4y). INTERVENTION Eight sessions of GMT in groups, including a new module addressing emotional regulation, and external cuing. A psychoeducative control condition (Brain Health Workshop) was matched on amount of training, therapist contact, and homework. MAIN OUTCOME MEASURES Emotional regulation was assessed with the Brain Injury Rehabilitation Trust Regulation of Emotions Questionnaire, the Emotional Control subscale and the Emotion Regulation factor (Behavior Rating Inventory of Executive Function-Adult Version), and the Positive and Negative Affect subscales from the Dysexecutive Questionnaire. Secondary outcome measures included psychological distress (Hopkins Symptom Checklist-25) and QOL (Quality of Life After Brain Injury Scale). RESULTS Findings indicated beneficial effects of GMT on emotional regulation skills in everyday life and in QOL 6 months posttreatment. No intervention effects on measures of psychological distress were registered. CONCLUSIONS GMT is a promising intervention for improving emotional regulation after ABI, even in the chronic phase. More research using objective measures of emotional regulation is needed to investigate the efficacy of this type of training.

Behavior Rating Inventory of Executive Function Adult Version in Patients with Neurological and Neuropsychiatric Conditions: Symptom Levels and Relationship to Emotional Distress.

OBJECTIVES The present study explored the level of self-and informant reported executive functioning in daily living using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) in a large sample comprising healthy adults and patient cohorts with neurological and neuropsychiatric disorders. The relationship to neuropsychological test performance and self-reported emotional distress was explored, as well as the applicability of U.S. normative data. METHODS Scores on the self- and informant reported BRIEF-A are presented, along with scores on standardized cognitive tests, and on rating scales of self-reported emotional distress in a Norwegian healthy comparison group (n=115), patients with severe traumatic brain injury (n=125), focal frontal lobe damage (n=29), focal cerebellar lesion (n=24), Parkinsons disease (n=42), attention deficit hyperactivity disorder (n=34), type II bipolar disorder (n=21), and borderline personality disorder (n=18). RESULTS Strong associations were observed between the BRIEF-A and emotional distress in both the healthy group and in neurological groups, while no or weak relationships with IQ and performance-based tests of executive function were seen. The relationship between BRIEF-A and emotional distress was weaker in the neuropsychiatric patient groups, despite high symptom load in both domains. Healthy participants tended to have BRIEF-A scores 1/2-3/4 SD below the U.S. normative mean of T score=50. CONCLUSIONS The study demonstrates the need to interpret BRIEF-A results within a broad differential diagnostic context, where measures of psychological distress are included in addition to neuropsychological tests. Uncertainty about the appropriateness of U.S. normative data in non-U.S. countries adds to the need for interpretive caution. (JINS, 2016, 22, 682-694).

Psychosocial adaptation and cognitive functioning in young male adults with myelomeningocele

Background Myelomeningocele (MMC) is a multifaceted condition with complex neurological and neuropsychological sequelae mainly due to the MMC itself, hydrocephalus and Arnold-Chiari malformation (ACM). Quality of life and social functioning are known to be impaired in this patient group. Little is known about how clinical history, neurological findings and cognitive functioning influence psychosocial adaptation for young male adults. The aim of this pilot study is to investigate the relationship between these factors and psychosocial functioning. It is hypothesised that cognitive functions, especially executive functions, are of major importance for psychosocial adaptation.

Living with spina bifida: neurological and neuropsychological functioning in adults with severely impaired psychosocial adaptation

Background Spina Bifida (SB) is a birth defect caused by incomplete neural tube development, affecting physical, cognitive, and adaptive function. Findings from our previous study indicated that the visual-spatial and executive functions were especially important for psychosocial adaptation in young males. The aim of this study was to describe and examine a group of patients with severely impaired psychosocial adaptation, and to find out if there were gender specific differences with regard to clinical history, neurological and neuropsychological functioning.

S82. GOAL MANAGEMENT TRAINING OF EXECUTIVE FUNCTIONS FOR PATIENTS WITH SCHIZOPHRENIA OR HIGH RISK OF SCHIZOPHRENIA: BASELINE CHARACTERISTICS AND PRELIMINARY RESULTS FROM AN RCT

Abstract Background About 85% of patients with schizophrenia have cognitive impairments, executive functions being particularly affected. Executive dysfunctions are important predictors of functional outcomes. Unlike psychotic symptoms, cognitive deficits do not improve during periods of remission and change only minimally with antipsychotic medications. Thus, effective interventions aimed at improving executive functions in this population are needed. One of the most validated interventions for executive dysfunction is Goal Management Training (GMT). GMT is a compensatory intervention that relies on metacognitive strategies for improving participants’ ability to organize and achieve goals in everyday life. GMT has received empirical support in studies of other populations, such as people with neurological conditions and in healthy elderly. To our knowledge no previous studies have investigated the effect of group-based GMT in patients with schizophrenia spectrum disorders or with high risk of schizophrenia. Thus, this is the main objective of the study. Baseline characteristis and preliminary results from the first patients will be presented. Methods Participants (16–67 years, males and females, IQ >70) with executive dysfunction, will be recruited among patients referred for treatment at Innlandet Hospital Trust in Norway from 2017 to 2020. The study aims to include patients treated for psychotic disorder for less than 5 years and new patients who either have symptoms that meet the DSM-IV criteria for a diagnosis of broad schizophrenia spectrum disorder or who are considered at high risk of psychosis. We aim to recruit one hundred participants for the current randomized controlled trial (RCT), with efficacy of GMT (n = 50) being compared with results of subjects in a wait-list condition (WL, n = 50). Measurements include self-report of executive function, emotional health, and social- and everyday function. Informant reports of executive function will also be collected. Furthermore, neuropsychological tests designed specifically to measure areas of executive function will be utilized, as well as role-playing tasks thought to have good ecological validity. Symptoms of psychosis will also be assessed. GMT will be administered in 9 (twice weekly) x 2 hour sessions in accordance with the GMT research protocol. A general linear model with repeated measures analysis of variance (RM ANOVA) will be used to examine differential group treatment effects. A 2 x 3 mixed-design will be applied, with Group (GMT, WL) as between-subjects factor, and Session (baseline [T1], post-intervention [T2], and 6 months follow-up [T3]) as within-subjects factor. Interpretation of the strength of experimental effects will be provided with effect size statistics. Results Baseline characteristics and preliminary results from the first participants will be presented. Discussion Based on findings from previous GMT-studies, we hypothesize that post-intervention changes will be reflected in improved scores on self-reported and/or objective measures of executive functions (particularly in the areas of planning and attentional control) compared to patients in WL. We also expect that GMT participants will improve their goal attainment in everyday life and social functioning after the intervention. Additionally, we expect post-intervention changes to be reflected in improved scores on measures of emotional health.

Theory of mind in spina bifida: Relationship with intellectual and executive functioning

This article investigates emotion recognition ability, a central aspect of Theory of Mind (ToM), in a group of individuals with spina bifida myelomeningocele (SBM) experiencing executive function deficits, and examine associations between emotion recognition, and intellectual and executive functioning. A total of 38 adult subjects with SBM were included in this study, participating in a randomized controlled trial evaluating the effects of a cognitive rehabilitation intervention for executive dysfunction. Reading the Mind in the Eyes Test (RMET) was used as a measure of emotion recognition, and neuropsychological tests and questionnaires were utilized as executive function measures. One third of the participants performed poorer on the emotion recognition task compared to normative data. Emotion recognition may represent an area being affected in adults with SBM, and it is related to verbal IQ. Findings also suggest that executive functions and emotion recognition ability in adults with SBM are independent.