Executive Function Skills Training

Executive functions are functions that alert (or "cue") the rest of your cognitive processes that they need to perform a task at a particular moment. If you need to focus on something, listen, look, move, remember, make a plan, solve a problem, read, write, calculate, etc. it is your executive functions that tell you that you have to do that.

Your executive functions look at a situation and determine, "How do I get this task done? What other parts of the brain have to be involved with getting this task done?"

Executive functions also coordinate and regulate all those cognitive functions so that the task is done efficiently and well. In other words, executive functions are a set of functions that allow you to self-manage so that you can achieve a goal.

• What are some executive functions?
  • Research suggests that there are 33 separate executive functions. A person can have problems with a few, many, or most executive functions, or just may not know when to use them.
    
    Executive functions/skills include:
    • Focusing and sustaining attention without getting distracted
    • Shifting your attention to something else when you need to
    • Controlling your behavior and not "acting without thinking"
    • Controlling when to show emotion and how much emotion to show
    • Getting yourself started in doing an activity or task
    • Putting as much energy and effort into a task or activity as you need to
    • Being aware of your thoughts, feelings and actions
    • Watching yourself to make sure your actions are getting desired results
    • Changing your actions if they are not helping you reach your goal
    • Figuring out the best order in which to do things
    • Controlling the speed of your actions and the volume/speed of your speech
    • Being aware of how much time has passed and how long a task will take
    • Holding new information in mind briefly without "forgetting" it
    • Using strategies to remember new information later
    • Accessing information from your memory to use it when needed
    • Forming a plan to do a task
    • Breaking long tasks into smaller, manageable parts
    • Keeping your belongings organized so that you have what you need to get the job done
    • Knowing what the consequences of your words and actions are likely to be
    • Knowing what you want
    • Thinking deeply for an extended period of time to understand events in your life
    
    
• What activities will I do in Executive Function Training?
  • Executive Function Training always begins with an in-depth evaluation of your current executive functioning. Through the use of a questionnaire, all areas of executive functioning will be explored. Based on what your specific executive functioning problems are found to be, Executive Function Training will help teach you:
  • Modeling of effective executive skills (by trainer or others)
  • Use of role play to practice new behaviors
  • Use of visualization, mnemonic devices or other mental “tricks" for remembering what needs to be done
  • Use of commercially available tools for remembering to do tasks, prioritizing tasks, scheduling tasks, and staying organized
  • Use of games to motivate you to do tasks even when your motivation or energy are low
  • Journaling to help you learn to monitor how you do on meeting your goals throughout the day (including the goal of improving your executive functioning!)
  • Teaching and practicing mindfulness techniques (including meditation)
  • Teaching or reinforcing study skills
  • Teaching methods of how to “think through" a problem to come up with a solution
  • Using deep breathing, relaxation, self-talk, etc. to control your feelings (including anxiety during test-taking)
  • Processing speed training to help you think and work more quickly, or to slow down and be more careful through speeded, rhythmic drills
  • Possible additional assessment techniques to measure other areas of cognitive or emotional functioning if it is believed that problems may exist in those areas that are keeping you from using executive functioning skills that you already have
  • Addressing factors at home, school or work that may be keeping you from using executive functioning skills that you already have
  • MOST IMPORTANTLY: You will learn, through training and practice, how to ask yourself certain questions in order to recognize the need to use your executive skills in a given situation and which skills you need to use.
  
  
• I have ADHD and take medication for it. Would I still benefit from Executive Function Training?
  • ADHD is an executive functioning disorder that effects a specific set of executive functions, specifically focusing and sustaining attention, shifting attention to something else when necessary, and inhibiting/stopping behaviors when necessary. Some people with ADHD only have problems with those executive functions, while their other executive functions work well. However, often people with ADHD have other executive functioning problems in addition to attention and impulse control problems.
    
    ADHD medications work very well in improving focus and inhibition. However, they do not address other executive functioning problems such as disorganization, “forgetfulness," poor awareness of time, forming and following a plan of action, procrastinating, difficulty understanding what you read, and difficulty knowing how to study. Although improving your attention/impulse control alone can cause minor improvements in some of those other areas, real change will only occur through learning, practicing, and ultimately, using new executive skills until you can do them easily and automatically.
    
    A strong body of research tells us that for most people, the best treatment for ADHD is a combination of medicine and behavioral/psychological treatments that include skills training to address other executive functioning difficulties you may have.
  
  
• I already attend cognitive-behavioral psychotherapy. Would I still benefit from Executive Function Training?
  • All mental disorders (including depression, anxiety disorders, obsessive-compulsive disorder, bipolar disorder, PTSD, etc.) and behavioral disorders (including oppositional-defiant disorder, eating disorders, anger-control disorders, etc.) involve some kind of executive function problems. For example, a depressed person can have poor attention, difficulties with emotional control, difficulty “getting going" with tasks, and difficulty sustaining energy and motivation through tasks. Someone with obsessive-compulsive disorder likely has difficulty shifting their attention, thoughts, and behaviors. Oppositional-defiant children may have poor social problem-solving skills and lack of awareness of the consequences of their actions.
    
    If you are in cognitive-behavioral psychotherapy, chances are your therapist is already working with you on the executive functioning issues involved with your particular diagnosis. In such cases, Executive Function Training can reinforce the work you do in psychotherapy while also addressing any additional executive functioning difficulties you might have that are not directly related to your diagnosis.
  
  
• How long will Executive Function Skills Training take?
  • Change always takes longer than we would like! Change also requires commitment by you (and by your family if you are a child or teen) to come to your appointments, practice techniques between sessions, and implement new techniques and routines correctly and consistently.
    
    If you are not sure if you are ready to make that commitment, you may make an appointment with the Executive Function trainer to get answers to all your questions and concerns regarding Executive Function training.
    
    If you feel you are ready to make that commitment to Executive Function Training, the timeline and procedures of treatment are as follows:
    • The Executive Function questionnaire should be completed by you (and a separate one by a parent if you are under 18 years of age).
    • An initial appointment to gather information about you, including what your Executive Functioning needs are. Your responses to the Executive Function questionnaire(s) will be reviewed with you, and a treatment plan will be formed to address your identified Executive Functioning training needs.
    • Approximately eight more weekly sessions will be used to teach and practice new executive functioning skills. In between these appointments you will be expected to practice the techniques in your day-to-day life, implement changes to your routines at home and at school/work (your Executive Function Trainer will help with this, including through consultation with teachers). You will also be expected to keep track of your progress daily in a journal which will help you review the previous week with your trainer at appointments.
    • If more than eight appointments will be needed to address the treatment plan devised in the first session, a new plan for additional sessions may be negotiated
    • In one last session, we will review your progress and terminate treatment
    • There are three additional sessions for follow-up, review, and/or re-evaluation for possible additional treatment at 3 months, 6 months, and one year after termination of Executive Function Therapy.