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= Goal Management Training (GMT) = Goal Management Training (GMT) is one of the rehabilitation programs which is designed to mitigate the symptoms of executive dysfunction. It is applied for a board range of clients because executive function could be damaged by various kinds of causes such as traumatic brain injury (TBI), stroke, schizophrenia, ADHD, multiple sclerosis(MS), spina bifida (SB) and aging.

Theory
Human behavior is said to be controlled by goal lists and sub goals constructed in response to environment and situations. Therefore,it can be said that people need to pay attention to and focus on their goals in their daily lives. The theory of GMT intervention can be obtained from the hypothesis that the sustained attention system supports executive function so sustained attention keeps individual’s goals in mind and prevents them from being obscured. In other words, compromised sustained attention can cause distracted behavior and leads to impaired executive functions because mental or environmental triggers might displace an individual's higher goals, resulting in distracted behavior. Therefore, it is suggested that the situations which behavioral goals are neglected may have to be modified to treat impaired executive function.

Purpose and effect
The primary purpose of GMT is patients become able to stop their actions to consider what they are doing, define their goals and review their behavior. It is said that this program also can educate clients in terms of gaining self-awareness, self-monitoring skills and controlling their ability to do daily living activities.

The idea of GMT is mainly consists of education, narrative structure, mindfulness and task practices. Education provides patients with insight into their condition and narrative structure can be useful to identify their individual outcomes. The program can include mindfulness practice to improve a patients’ skill in focusing on the present state of their mind to monitor their goals. Also, some reports showed that it is effective to introduce patients’ own real-life tasks as the part of the rehabilitation programs. GMT is recommended as a clinical practice and there is convincing evidence supporting its effect.

History and research
GMT was introduced by Ian Robertson in 1996 at the Medical Research Council (MRC) of Cambridge University, in the UK, and was based on Duncan’s (1986) theory of disorganization of behavior after frontal lobe damage. Since then, some published reports have showed some evidence that it can be effective. Firstly, research by Lavine et al. (2000) included the experiment to verify the effect for patients with traumatic brain injury (TBI) and observed a case study of a postencephalitic patient. There are a substantial number of reports where GMT has been applied for a variety of clients and in a recent study, Vessela & Brian Lavine (2018) conducted a meta-analysis to show the effectiveness of GMT.

Older adults
Executive function deficit can be showed as the first cognitive impairment for aging. Susan A.H. et al. (2007) investigated the effectiveness of neuropsychological intervention including GMT for older adults with cognitive dysfunction. The participants showed better management of their executive errors and less anxiety than the control group.

Traumatic Brain Injury (TBI)
Lavine (2011) compared the intervention for brain injured people with executive dysfunctions between an expanded version of GMT and alternative intervention. Outcome data indicated specific positive effects of GMT on the sustained attention during some tasks and tests. The outcome of a modified GMT module for severe TBI participants was observed by Grant et al. (2012) and they showed that GMT can help people with TBI to improve their actions in their financial management. A combination of Errorless Learning and GMT for brain-injured people with executive dysfunction were examined by Bertens D et al. (2015)

Schizophrenia
Levaux et al. (2012) assessed the effect of a modified version of GMT for a person with schizophrenia. It was reported that after the intervention, improvement in planning and mental preparation tasks was revealed. Besides, self-esteem also improved and the positive effect was generalized into schizophrenic patients' everyday tasks.

Multiple sclerosis (MS)
Richard & Nadine Marie (2013) described that GMT can be an effective approach for executive dysfunction and self-regulation deficit in people with MS. In this research, two studies were examined and compared showing an improvement in executive function in MS patients with a range of disease severity and with effects remaining visible. The results suggested GMT can be an effective intervention for executive function deficit in people with MS.

Attention deficit hyperactivities disorder (ADHD)
The combination approach of GMT with psycho-education and counseling for adults with ADHD were observed by In de Break (2012). In this study, the result that combination intervention may have validity for people with ADHD was suggested.

Spina bifida (SB)
Stubberud et al. (2014) determined that GMT could be helpful to improve executive function in daily life for people with SB. The results showed a positive effect that participants with SB who took GMT training improved in terms of emotional health and task focused coping.

Procedure
GMT can be provided to patients as rehabilitation programs in several ways such as individual programs and group work sessions. Modified GMT is often used in clinical practices as well as classic ones. The contents might also be changed according to the clients’ circumstances on condition the basic principles of GMT are kept. In other words, GMT can be applied to clients’ individual tasks of Activities of Daily Livin g (ADL) and Instrumental Activities of Daily Living (IADL) such as shopping, cooking and making their daily schedule. In addition, it may be important to provide this program with errorless learning which can prevent the occurrence of errors during clients learning. Although clients with disorders of executive functioning are likely to make errors because of the lack of self-monitoring and sometimes working memory, errors may interfere with the correct and proper acquisition of the tasks though the GMT process. Therefore, the instruction sheet or power point slides which show the procedure clearly for clients is often introduced in the training and the process has five or six steps, “stop”, “define”, “list”, “learn”, “do it” and “check”. Specifically, in GMT, clients are trained to notice the current situation at first (“stop”) and then set the appropriate main goal (“define”). Then the lists of the things and choices which they should do are made and each of them considered (“list”, ”learn”). In the final step, the outcomes of clients' selected behavior should be reviewed ("do it", "check"). In the event of mistakes, the specific step of the procedure is repeated. In addition, currently there is a program toolkit available published by Baycrest (Lavine, Manly & Robertson, 2012). It consists of GMT toolkits containing a trainer’s manual, client workbooks and the program slides.