Manual for Executive Plus/STEP: Problem Solving Training and Emotional Regulation Training

In this manual, we provide detailed instructions for training people with brain injuries in problem solving and in emotional regulation. The manual is a result of our conducting randomized controlled trials on the Executive Plus and Short-term Executive Plus (STEP) programs, funding for which was provided by the National Institute on Disability and Rehabilitation Research and by the Centers for Disease Control and Prevention.

Results of the STEP RCT were recently published in the journal Archives of Physical Medicine and Rehabilitation (Cantor J, Ashman T, Dams-O'Connor K, Dijkers MP, Gordon W, et al. Evaluation of the STEP intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimization. Arch Phys Med Rehabil 2014; 95; 1-9). In the RCT, we found that STEP improved executive functioning and problem solving in program participants, who all were residing in the community, who had traumatic brain injuries (TBIs) from mild to severe, and most of whom were many years post injury. The results of the second program, Executive Plus, are currently being prepared for publication.

While the manual provides brief descriptions of the Executive Plus and STEP programs, the intent is not to create a manual for the programs in their entirety, but instead to focus on two of the assumed “active ingredients”, which are common to both programs: problem solving and emotional regulation.

The information provided in the manual is intended primarily as a support for current providers of services to people with brain injuries. It is not intended for relative novices to the clinical treatment of the psychosocial sequelae of brain injury. We assume that the person who will be responsible for potentially developing and implementing a program using the materials in the manual has in-depth training and substantial clinical expertise in treating brain injury, with a focus on the cognitive and emotional/behavioral consequences.

This manual is organized into seven sections:

  • Overview of Executive Plus and STEP
  • Problem Solving Clinical Manual
  • Problem Solving Workbook
  • Emotional Regulation Clinical Manual
  • Emotional Regulation Workbook
  • Appendix I: Background to Executive Plus and STEP
  • Appendix II: Reprint: Gordon, W.A., Cantor, J., Ashman, T., & Brown, M. (2006). Treatment of post-TBI executive dysfunction: application of theory to clinical practice. Journal of Head Trauma Rehabilitation, 21, 156-167.

If you are interested in obtaining a PDF version of the manual, please contact Dr. Wayne Gordon, Director of the BIRC-MS (wayne.gordon@mountsinai.org).