Pilot Study of Let’s Get Organized: A Group Intervention for Improving Time Management

Method

This intervention study had a pretest–posttest design with 3-mo follow-up.

Results

Seventy-five participants consented to participate in the study and were included in the baseline data collection. Twenty participants dropped out of the study and were lost to postintervention data collection. No significant differences were found for any baseline measure between the participants who stayed in the study and the 20 who dropped out. The remaining 55 participants attended a mean of 8.1 of the 10 sessions (median = 9, range = 3–10). Most were women (n = 34), and ages ranged from 20 to 62 yr. A majority of the participants (n = 39) had a neurodevelopmental disorder, many of them in combination with a mental disorder, and six participants had only a mental disorder (Table 1). At the 3-mo follow-up, another 22 had dropped out, leaving 33 participants available for follow-up.

Participants improved their scores on all three ATMS–S subscales from preintervention to postintervention (p < .001). At 3-mo follow-up, they showed continued improvement in organization and planning but no significant change in time management or regulation of emotions (Table 2). For executive functioning, measured by the WCPA–SE, participants showed significant improvement in the number of correctly entered appointments (p < .001) and the number of rules followed (p = .034). No significant change occurred in the total time used to complete the task or in the number of strategies used (Table 3). The number of activities performed, measured with the SDO–13, increased significantly from 7.3 to 8.3 (p = .001) from pre- to postintervention. In addition, mean satisfaction with activities increased from 54.9 to 61.1 (p < .001), and mean global satisfaction improved from 3.2 to 2.8 (p = .007; lower scores indicate greater satisfaction; Table 4).

Discussion

The results of this study indicate that participants improved their time management skills, were more satisfied with their daily occupations, and to some extent also improved in executive functioning after participating in Part 1 of the LGO–S intervention. In the ATMS–S measurement at 3 mo postintervention, the improvements were maintained. These are promising results, indicating that the content of LGO–S was relevant to the performance of daily occupations in this group.

The SDO–13 results showed that the participants experienced increased satisfaction with their daily occupations and a small but significant increase in the number of daily occupations performed. These are interesting results, opening the possibility that LGO–S might have an impact on activity performance and on satisfaction in engaging in daily occupations. Given that people with neurodevelopmental and mental disorders often have difficulties with occupational balance, the possible impact of LGO–S on occupational balance needs to be explored in further studies.

The WCPA–SE results were mixed. A significant improvement was noted in the number of correctly entered appointments. This change might be directly related to LGO–S, which reinforces filling in appointments and other important information in an appointment book in each session. The number of rules followed and the number of strategies used increased only slightly, which might not be clinically significant, although the results for the number of rules did reach statistical significance. The number of rules followed was high already before the intervention, with a median of 5, so there was not much room for improvement. The fact that most participants managed to keep track of all the rules while carrying out the test might indicate that Level I was too easy and that use of the WCPA–SE at Level II might have been more sensitive to change and thus a better fit for this population.

All participants reported problems with time management in daily life, and the underlying reason involved a range of diagnoses. For people with ADHD, promising results from an earlier study suggest that systematic training using metacognitive therapy has an effect in enhancing time management and organizational skills (Solanto et al., 2010), and similar findings were presented in a review by Langberg et al. (2008). Our results are in line with these earlier studies. Langberg et al. noted difficulties in drawing conclusions about the evidence because the instruments used in the reviewed studies had not been evaluated. In our study, all instruments had been evaluated for psychometric properties.

Our study further indicated that the LGO–S intervention has potential benefit for people with other mental disorders, such as affective or schizophrenic disorder. Our results are similar to those of an earlier study by Edgelow and Krupa (2011) in which the Action Over Inertia (AOI) intervention increased engagement in time use in people with severe mental disorders. Although LGO–S and AOI have different main focuses (time management vs. time use), they overlap regarding the use of time awareness as a modality for intervention planning. Further research could show whether a group intervention such as LGO–S might be a complement to individual interventions such as AOI (Krupa et al., 2010). The finding that people with ASD can improve in time management, organization, and planning when participating in a structured group intervention has, to our knowledge, not been shown before and needs to be investigated and confirmed in further studies.

The LGO intervention has similarities to metacognitive therapy (Solanto et al., 2010) in focusing on time- and task-management topics (e.g., scheduling, prioritizing, learning new strategies), but LGO adds an occupational therapy perspective of skill mastery such as using real tools (e.g., appointment books), regulating emotions, learning that mistakes are integral to the process, and performing homework tasks. This perspective is more in line with the cognitive adaptation training evaluated by Fredrick et al. (2015), who reported that cognitive adaptation training that incorporates environmental support such as signs and checklists helps people overcome the cognitive deficits of schizophrenia and improves cognition more than other treatment methods.

An interesting result in the present LGO–S study is that the intervention may have improved participants’ regulation of emotions. This is of special interest because a relationship between an unrealistic understanding of time and difficulties with emotion regulation has been shown in people with ADHD (Maedgen & Carlson, 2000; Shaw et al., 2014). Identifying emotions is included in LGO–S at the beginning of each session; clients are asked to review an emotion sheet and answer the question “How are you feeling the most right now?” This stage has been shown to give clients an outlet for reflection and to help in the transition from the emotions of the day to the task at hand (White et al., 2007). It is possible that the study participants learned to identify and choose to use adaptive strategies to down-regulate negative emotions and maintain positive ones in a way that was useful not only for those with ADHD but also for those with mental disorders.

A limitation of this study is the pre–post design, which provides weak evidence to support the effect of an intervention. The findings were similar to the first pre–post study in the United States (White, 2007). This study had a larger sample, and evaluated instruments were used. The promising results support the planning of a randomized controlled study of the LGO–S intervention.

Another limitation is the high dropout rate (27%), which affects the reliability and generalizability of the results. Some participants may have dropped out because their symptoms became more acute, and there may have been other factors making them less able to engage in an intervention like LGO–S. If so, our results might be slightly too positive. It should be noted, however, that not all of the remaining participants completed all sessions. A high dropout rate is unfortunately not unusual in clinical research with people with mental or neurodevelopmental disorders, and our attrition rate was similar to the rates in other studies (Edgelow & Krupa, 2011; Solanto et al., 2010). High attrition must be taken into account when interpreting the results and planning future studies.

Implications for Occupational Therapy Practice

The results of this study have the following implications for occupational therapy practice:

Conclusion

This pilot study provides promising results indicating that LGO–S can improve time management, organization and planning, emotional regulation, executive functioning, and satisfaction with daily occupations in people with mental or neurodevelopmental disorders. These findings need to be confirmed in further studies. Other topics for further study are to evaluate Part 2 of LGO–S and the original LGO intervention with 20 sessions.