Goal Management TrainingTM is an evidence-based executive functioning treatment program.
In this article, you’ll learn the steps to Goal Management Training, how to use the principles in your practice, and how to get trained.
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What is Goal Management Training?
Goal Management Training (GMT) is an executive functioning treatment program for people with traumatic brain injuries and other conditions impacting cognition.
It was developed by psychologists Brian Levine, Tom Manly, and Ian Robertson and is based on a tried and true executive functioning treatment framework.
In GMT and similar programs, patients learn to stop, evaluate, and then change their behaviors to achieve their goals:
How executive functioning treatment works:
The Goal Management Training Program consists of 9 weekly sessions that are 1-2 hours each. It can be done one-on-one or in small or medium-sized groups.
GMT also has a more flexible program for those who can’t do the standard 9-week course.
Visit the Goal Management Training website for more details.
What Does The Research Say?
The research says it works!
A meta-analysis found that Goal Management Training helped patients make small to moderate improvements in executive functioning. These improvements were often maintained at follow-up. Plus, the gains generalized to iADLS (Stamenova, V., & Levine, B., 2019).
That said, the improvements were similar to other cognitive rehabilitation programs for executive functioning. Like GMT, these programs teach a step-by-step approach to problem-solving and becoming more aware of cognitive deficits.
Other effective executive functioning treatments include Goal Plan Do Review, Problem Solving Therapy, and Time Pressure Management (Cicerone et al, 2022; Kennedy et al, 2008).
In The Adult Speech Therapy Roadmap, we teach a framework for treating executive functioning deficits in adult speech therapy patients.
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Who Is Goal Management Training For?
Goal Management Training treats executive dysfunction in acquired brain injury, normal aging, and even ADHD.
To do GMT, patients need to be aware of their cognitive deficits, so it’s best suited for mild to moderate impairments.
This means it isn’t appropriate for severe deficits in awareness, memory, or executive functioning (Stamenova, V., & Levine, B., 2019). Use TEACH-M with these patients instead.
Goal Management Training Steps
Goal Management Training has basic 5 stages (Levine et al, 2000).
Throughout the program, patients internalize these 5 stages. They do this via education, discussion, practicing GMT in-session, and homework assignments to generalize GMT into real life.
Here are the steps to GMT:
- STOP
- The patient pauses to become aware of what they’re doing (and what they want to be doing).
- “What am I doing?”
- Define
- The patient identifies what the main task (their goal) is.
- List
- The patient lists the steps to accomplish the main task/their goal.
- Learn
- The patient reviews and learns the steps to do the main task/their goal.
- Then they do the task!
- Check
- Throughout the task, they self-monitor.
- “Am I doing what I planned to do?”
- They check if the outcome matches their goal.
Participants also learn other supportive strategies during GMT. These include mindfulness exercises to improve attention and a practice called STOP-RELAX-REFOCUS to get back on track (Cicerone et al, 2022).
Goal Management Training Examples
Here’s an example of how you might use the 5 steps of Goal Management Training with a speech therapy task. It illustrates how to use a strategy (in this case, the 5 steps) to improve executive functioning.
To administer Goal Management Training, you need to be certified (learn how below).
Remember how executive functioning treatment works: You help the patient become more aware so that they gain control over their behavior. Then you help them make and follow a step-by-step plan to accomplish a goal.
Download our free Executive Functioning Worksheets for more help.
The Goal. Your patient’s goal is to fill in a weekly medication box.
The Problem. During treatment, your patient becomes distracted internally (stops to talk about other topics) and externally (stops when they hear or see something out the window).
- STOP
- The patient is distracted by someone walking by the window and stops filling the medication box.
- You give a cue. “I notice that you aren’t filling the pill box.”
- The patient stops and asks himself, “What am I doing right now? I’m looking out the window.”
- Define the main task
- You: “What’s your goal right now?”
- Patient: “To fill my medicine box”
- List the steps
- You: “What are the steps to filling out your medicine box?”
- Patient: “First, I need to line up the bottles. Then, I need to follow the instructions on one of the bottles. Then I need to do that with the next bottle. Then repeat that until there are no more bottles.”
- Learn the steps
- You: “Repeat those steps aloud a few times to help you be successful.”
- The patient repeats the steps aloud.
- The patient fills the medicine box. You offer cues as needed. For example, you cue him to write down the steps and say them aloud as he works.
- Check
- You: “Let’s look over the medicine box and check if you filled it correctly.”
- You and the patient check the box for accuracy.
GMT Training
Licensed healthcare providers, including speech-language pathologists, can train for and administer Goal Management Training.
To administer GMT, you need to be certified and buy the toolkit.
GMT Certification
- Online training
- Training takes 6 hours, plus 60-90 minutes of live Q&A
- Continuing education units: Eligible for psychologists, social workers, and occupational therapists. Not eligible for ASHA CEUs at this time
- Price: Training & certification is $200 (Canadian dollar)
Learn more on the GMT website.
GMT Toolkit
Once certified, you’ll need to purchase the Goal Management Training Toolkit (~$600 CAD) plus a workbook for every patient you treat with GMT.
GMT Toolkit includes:
- Training manual (with slides, printable materials, evaluation forms, audio mindfulness exercises)
- 10 GMT workbooks for your patients (with worksheets)
- 1-year subscription to the GMT Therapist Community
More Executive Functioning Help
The Adult Speech Therapy Roadmap teaches you a framework for assessing and treating executive dysfunction. Now eligible for 1.55 ASHA CEUs!
References
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- Cicerone, K. D., Dams-O’Connor, K., Eberle, R., Fraas, M., Ganci, K., Langenbahn, D., Shapiro-Rosenbaum, A., Tate, R. L., Trexler, L. E., & American Congress Of Rehabilitation Medicine. (2022). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition: Translating evidence-based recommendations into practice.
- Kennedy, M. R., Coelho, C., Turkstra, L., Ylvisaker, M., Moore Sohlberg, M., Yorkston, K., Chiou, H. H., & Kan, P. F. (2008). Intervention for executive functions after traumatic brain injury: a systematic review, meta-analysis and clinical recommendations. Neuropsychological rehabilitation, 18(3), 257–299. https://doi.org/10.1080/09602010701748644
- Levine, B., Robertson, I. H., Clare, L., Carter, G., Hong, J., Wilson, B. A., Duncan, J., & Stuss, D. T. (2000). Rehabilitation of executive functioning: an experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society: JINS, 6(3), 299–312. https://doi.org/10.1017/s1355617700633052
- Levine, B., Schweizer, T. A., O’Connor, C., Turner, G., Gillingham, S., Stuss, D. T., Manly, T., & Robertson, I. H. (2011). Rehabilitation of executive functioning in patients with frontal lobe brain damage with goal management training. Frontiers in human neuroscience, 5, 9. https://doi.org/10.3389/fnhum.2011.00009
- Stamenova, V., & Levine, B. (2019). Effectiveness of goal management training® in improving executive functions: A meta-analysis. Neuropsychological rehabilitation, 29(10), 1569–1599. https://doi.org/10.1080/09602011.2018.1438294