Objectives
Goal Management Training® (GMT) is a standardized compensatory cognitive rehabilitation intervention that relies on metacognitive strategies for improving executive functioning (EF) in daily life. In a previous randomized controlled trial (RCT) (1), patients with acquired brain injury (ABI) received either 16 hours of GMT or 16 hours of a psycho-educative active control condition; Brain Health Workshop (BHW). 

Goal Management Training came out as the superior intervention for improving self-reported EF, with effects lasting 6-months post-treatment. The aim of the present study was to determine 5-years outcome following GMT, hypothesizing that GMT would still be associated with improved EF in everyday living.

Methods
The 5-year follow-up examined EF in daily life with the Behavior Rating Inventory of Executive Function (BRIEF-A),.Of the 67 participants at 6-months follow-up, 49 (GMT n=20; BHW n =29) returned questionnaires (46% female, age 45.8 ± 10.9 years). 

Changes related to EF in daily life (BRIEF-A) were assessed at pre-treatment (T1), post-treatment (T2), 6- months follow-up (T3), and 5-year follow-up (T4). As such, data were analyzed using a 2 X 4 mixed-design ANOVA that treated group (GMT, BHW) as a between-subjects factor, and Time (T1, T2, T3, T4) as a within-subjects factor. Significance level was set to p ≤..01

Results
There were no significant group differences with regard to age, sex, years of education, and IQ. A significant main effect of time was seen for all three BRIEF-A indexes, and a significant time-by-group interaction for the BRI-index. Post-hoc analyses showed a significant increase in BRI symptoms for the GMT-group from T3 (M = 54.1, SD = 11.9) to T4 (M = 60.4, SD = 13.2; t(20) = - 2.31, p = 0.031), that was not present for the BHW-group. In the GMT-group paired-samples t-tests showed a significant reduction in self-reported executive problems for all BRIEF-A indexes from T1 to T3, but then resumed to baseline levels at T4.

Conclusions
Preliminary data from 49 patients receiving either GMT or an unspecific psychoeducational service indicated that the significant GMT-related improvements on perceived EF in everyday life that were observed at 6-months follow-up, were no longer present after 5 years. These findings indicate the importance of long-term follow-up of clinical interventions as part of evidence-based recommendations. 
Furthermore, the findings might suggest a need to explore the effect of “booster” sessions at regular intervals post-treatment to maintain potential treatment gains.

References
1). Tornås, S., Løvstad, M., Solbakk, A-K., Evans, J., Endestad, T., Hol, P.K:, Schanke, A-K. & Stubberud, J. (2016). Rehabilitation of executive functions in patients with chronic acquired brain injury with Goal Management Training, external cuing and emotional regulation: A randomized controlled trial. Journal of the International Neuropsychological Society, 22 (4), 1–17. doi:10.1017/S1355617715001344

Goal Management Training in patients with acquired brain injury – a 5-year follow-up study: Be reminded to use it or lose it