Training patients in Time Pressure Management, a cognitive strategy for mental slowness.

PURPOSE: To provide clinical practitioners with a framework for teaching patients Time Pressure Management, a cognitive strategy that aims to reduce disabilities arising from mental slowness due to acquired brain injury. Time Pressure Management provides patients with compensatory strategies to deal with time pressure in daily life. Application of the training in clinical practice is illustrated using two case examples from a randomized controlled trial on the effectiveness of Time Pressure Management for patients with stroke. RATIONALE: The Time Pressure Management approach is based on Michon's task analysis, describing levels of decision-making in complex cognitive tasks. Decisions with little or no time pressure are not impaired by mental slowness. Therefore, patients should try to transfer actions from situations with high time pressure to situations where the preserved decision levels with little or no time pressure can work. THEORY INTO PRACTICE: Several factors are required to teach patients to use Time Pressure Management. First, sufficient awareness is needed to recognize that there is a deficit and behavioural change is necessary. Sufficient awareness is also required to recognize and anticipate time pressure situations and to realize that the strategy is helpful and might also be useful in new and more difficult circumstances. Second, adequate motivation is needed to learn the strategy. And finally, the training should be adjusted to the patient's individual learning abilities and cognitive skills.