Development of Goal Management Training+ for Methamphetamine Use Disorder Through Collaborative Design

Abstract

BackgroundMethamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes including earlier drop out and relapse. However, current treatments for MUD do not address executive functions. Goal Management Training (GMT) is an evidence-based cognitive remediation program for executive dysfunction, although required modifications to enhance its relevance and application within addiction treatment settings. This study aimed to (1) tailor GMT to the key cognitive deficits and typical treatment duration of MUD; (2) explore consumers' (people with MUD) engagement with the revised program; (3) implement a prototype of the program with consumers; and (4) present the manualized standard administration to clinical service providers.MethodsWe followed the Medical Research Council Complex Interventions Framework and employed an evidence- and person-based intervention development process. We used a four-phased approach and collaborated with neuropsychology experts, design researchers in healthcare, consumers with MUD, and clinical service providers. Each aim was addressed in a separate study phase; including content refinement and review with neuropsychology experts (phase 1), intervention design and collaboration with consumers (phase 2), prototype development and review with consumers (phase 3), and final program modifications and review with clinical stakeholders (phase 4).ResultsFindings from phase 1 indicated support for targeting four cognitive processes (attention, impulse control, goal setting, and decision-making). Key feedback included the need to help habitualize cognitive strategies and to guide consumers in applying these strategies in emotionally salient situations. Findings from phases 2 and 3 indicated consumer support for the program strategies and materials but highlighted the need to further enhance the personal relevance of specific content and journal activities. Findings from phase 4 provided clinicians support for the revised program but indicated an opportunity to minimize unintended effects. We present the intervention materials for the final revised program, Goal Management Training+ (GMT+), in line with TIDieR guidelines.ConclusionsGMT+ targets key cognitive processes and is sensitive to the clinical needs of people with MUD. Our intervention development process was important for informing the active ingredients and materials for GMT+, and indicated initial consumer and provider acceptability prior to conducting a clinical trial.

Cognitive training and remediation interventions for substance use disorders: a Delphi consensus study

“…The current consensus may provide a roadmap for future participatory research involving researchers, clinicians and members of the community with lived experiences of substance use disorders, as well as their carers [72, 73]. The selected items could guide and facilitate co‐production efforts that integrate the experts‐based knowledge with consumers and families’ goals, needs and preferences and thus contribute to development of more meaningful, tailored and feasible cognitive training and remediation interventions [74, 75]. Although cognitive training and remediation paradigms can sometimes be lengthy and repetitive, co‐design approaches, together with gamification and adaptive difficulty settings for software‐based tools, relating training/remediation approaches to therapeutic goals and employing trained therapists and a peer‐support work‐force who are skilled in building rapport and engagement may overcome feasibility challenges [76].…”

Protocol for a cluster randomised crossover pilot trial of Goal Management Training+ (GMT+) for methamphetamine use disorder

“…Some activities require GMT + skills during completion (four per week), and other activities are designed to help participants to reflect on the consequences of applying GMT + skills throughout the day (three per week). Materials are further described in our paper outlining the collaborative redesign [ 27 ] and may be requested for research purposes by contacting the corresponding authors.…”

“…There are several strengths to our trial protocol. We have tailored the intervention to the specific needs of MUD and have an initial indication of acceptability, based on qualitative feedback from people with MUD and treatment providers during the intervention redevelopment stage [ 27 ]. We are employing an active control intervention, comparable to GMT + in time spent with facilitators, group-based format, and in the number and style of in-session group activities and between session journal activities.…”

“…However, its original materials were catered to people with greater cognitive deficits and different demographics and lifestyles than people with MUD. To adapt GMT to the needs of people with MUD and treatment providers, we conducted a re-development process using input from these end-users within a co-design approach [ 27 ]. The modified program, GMT + , includes four weekly modules focussing on different executive functions that are typically impaired in MUD, including attention, inhibition, goal setting (working memory), and decision-making [ 14 , [28] , [29] , [30] ].…”