Goal Management Training

GMT is a neuroscience-based therapy designed to improve executive functions. Executive functions are a set of skills that allow you to step back, organize priorities and strategies, move through steps systematically, and complete tasks you set out to do. In GMT, you’ll learn to identify and stick to behaviors that support executive functions. When you do that, you’ll be more effective at working towards immediate goals throughout your day, and less likely to be pulled away by emotions and distractions.

This therapy was originally designed to help individuals with acquired brain injuries restore their capacity to live happy and productive lives. Research has found GMT to be helpful for individuals with a variety of conditions that can compromise executive function, including multiple sclerosis, spina bifida, substance dependence, and executive dysfunction that can occur in some adults with aging. Recent research has also found GMT to be helpful for adults with ADHD.

With your GMT therapist, you’ll practise exercises specifically designed using neuroscientific insights on how people organize thoughts and behaviors during tasks. You’ll learn about present-mindedness, absentmindedness, being on autopilot, how to check-in and focus, how to organize a big job into smaller do-able tasks, and how to do all of this, on the fly, while functioning throughout your day.

In GMT, you’ll work with a therapist to complete a series of 9 modules designed to strengthen your executive functioning skills. You’ll learn how to overcome challenges you may be experiencing in day-to-day situations, like planning an activity, getting started, staying focused, completing the task, and not getting pulled away by your emotions. These are the executive function skills that individuals with ADHD often struggle to implement effectively. Improving your executive functioning can help you overcome the challenges and frustrations that come with being easily distracted, acting impulsively, procrastinating, or not following through on tasks. 

We recommend GMT as a therapy option for adults with ADHD whose goal is to improve their executive functioning skills. The format of GMT is quite structured and focused; it’s not intended to address other behavioral or emotional concerns you may have that go beyond ADHD. For instance, a person who has ADHD along with depression or an anxiety disorder might be better served by a more flexible intervention, such as Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT). Likewise, a person whose goal is to adapt to their life circumstances and manage their ADHD with accommodations and goal attainment directed by S.M.A.R.T. goals (i.e., Specific, Measurable, Achievable, Relevant, and Timely), rather than directly improving their executive functioning skills, might be better served by ADHD coaching.

Yes! The effectiveness of GMT has been tested in peer-reviewed, scientific studies. A research summary found statistical evidence for a range of improvements in executive functioning skills across 19 peer-reviewed studies. The participants in these studies had executive functioning challenges stemming from various medical conditions, such as acquired brain injuries, substance dependence disorders, multiple sclerosis, and spina bifida. GMT was also helpful for older adults who were healthy but experiencing problems with executive functioning. The summary of research findings appears in this article: Stamenova, V., & Levine, B. (2018). Effectiveness of goal management training® in improving executive functions: A meta-analysis. Neuropsychological Rehabilitation.

Yes. GMT has been shown to be effective in improving the executive functioning of adults with ADHD. The evidence has been published in 4 peer-reviewed studies:

Hanssen, K. T., Brevik, E. J., Småstuen, M. C., & Stubberud, J. (2023). Improvement of anxiety in ADHD following goal-focused cognitive remediation: A randomized controlled trial. Frontiers in Psychology, 14, 1212502

In de Braek, D. M., Dijkstra, J. B., Ponds, R. W., & Jolles, J. (2017). Goal management training in adults with ADHD: An intervention study. Journal of Attention Disorders, 21(13), 1130-1137.

Jensen, D. A., Halmøy, A., Stubberud, J., Haavik, J., Lundervold, A. J., & Sørensen, L. (2021). An exploratory investigation of goal management training in adults with ADHD: Improvements in inhibition and everyday functioning. Frontiers in Psychology, 12, 659480.

Jensen, D. A., Lundervold, A. J., Stubberud, J., Halmøy, A., Haavik, J., & Sørensen, L. (2022). Goal management training improves executive control in adults with ADHD: An open trial employing attention network theory to examine effects on attention. BMC psychology, 10(1), 207.

Yes. In fact, integrated treatments for ADHD are recommended. In ADHD, inattention and impulsivity can happen when core executive functioning skills are compromised. The effects of weak executive functions can be far-reaching, making daily living, working, and being attentive in relationships really hard. With so many ADHD symptoms affecting so much, the gold standard in ADHD treatment is typically a combination of interventions. So you might combine GMT with medication treatment, and with accommodations at school or work. Medication can help boost focus by making naturally occurring neurochemicals in the brain more available to sustain focus across the day. Accommodations at work or school, like extra time to complete tasks or having a quiet place to work, can further support focus and persistence. A therapy like GMT can help you learn new habits of reacting to day-to-day situations in more adaptive ways. 

Neuroscience research has consistently found a neurodiverse pattern of brain chemistry and circuitry in ADHD. These features underlie the executive function differences you might experience as inattentiveness and/or hyperactive behavior. We also know that the human brain changes continually throughout life. In fact, our brains change every time we learn something new, whether it’s a fact or a skill. The more practice we have in learning something new, the more solid the brain changes becomes. This finding also applies to our executive functions. Consequently, GMT is delivered as a structured series of steps designed to strengthen and consolidate executive functioning skills through practice. You could think of GMT as a course in which you learn basic skills, practise them, then move on to more advanced skills and practise those until you and your brain make changes that result in improved executive functioning. The changes you learn about making in GMT therapy sessions, and the practice you do on your own between sessions, will transfer to how you approach tasks at work or school, and in family and social settings.

Yes. We see clients across Ontario through secure video sessions. You must be physically present in Ontario for all therapy sessions.

GMT is an effective treatment for adults. The minimum age for GMT is usually 18 years. Benefits derived from the program can extend across the lifespan. Adults 50+ who are concerned about executive function may find GMT especially helpful.

The cost of a 50-minute GMT session with a therapist is $200 to $280, depending on the clinician providing the service.

GMT at Possibilities is provided by non-medical health professionals, such as psychologists and clinicians in supervised training with psychologists. As such, these services are not covered by OHIP. Since GMT falls under Psychology Services at Possibilities, it may be covered by some insurance plans. We encourage you to ask your insurance provider about coverage for GMT as a Psychological Service.

GMT has 9 sessions in total. These are booked every week, for 9 weeks.

Yes! You do not need a doctor’s referral to start GMT at Possibilities.