The MultiContext Treatment Approach

A Metacognitive Strategy Approach to Optimizing Cognitive Function

The MultiContext Approach

The MultiContext (MC) Approach provides a framework for promoting strategy use and self-monitoring across everyday activities. It was developed to provide occupational therapists with guidelines to help people who experience cognitive lapses or symptoms that interfere with daily life. The MC approach focuses on enhancing self-awareness of cognitive performance or helping people recognize that the same error patterns may be interfering with successful performance across different activities & situations.

At the same time, it helps people use cognitive strategies to manage, regulate or control cognitive performance errors. The MC approach integrates metacognitive skills and cognitive strategy intervention methods and draws upon literature on learning, transfer and generalization (see selected publications).

The MC approach can be classified as a metacognitive strategy intervention due to its focus on self-awareness, self-monitoring, and self-regulatory skills. Metacognitive strategy training is recommended as a Practice Standard for deficits in executive functioning following brain injury. (Cicerone et al., 2011)

Below is an outline of the Key Aspects of the MC approach. Activities within each session are embedded within a metacognitive framework; at the same time, the treatment program is structured horizontally to enhance transfer of learning. Mediation or guided questions are used to empower a person generate their own strategies or solutions for challenges (see VIDEO BELOW). 


Strategy Training beyond a specific task: Focus on Metacognitive Skills

•Error Detection
•Error Correction
•Strategy Generation


Key aspects of the MC Approach include: 

  • Focus on developing, generating, selecting, or using strategies to cope with and manage cognitive performance challenges.

  • Functionally relevant or meaningful activities

  • Horizontal Continuum — Wide range of activities with similar characteristics and demands to promote repeated practice of strategy. There is a focus on transfer/generalization or explicitly helping clients make connections across activity experiences

  • Metacognitive Framework and use of mediation or guided questions to promote executive function.

  • Focus on increasing cognitive self-efficacy

Goals of the MC Approach include:

  • Enhancing understanding of cognitive strengths and weaknesses

  • Increasing ability to anticipate, detect or correct errors and spontaneously self-check or monitor cognitive performance

  • Helping people effectively use cognitive strategies to:

- Encode, process and integrate information needed for learning, remembering and successful task completion

- Self-manage cognitive lapses, performance errors or cognitively challenging activities

- Transfer strategy use across activities 

- Generalize strategies to everyday life or novel situations


Who is the MC Approach used with?

  • The MC approach was initially developed for adults with cognitive impairments as a result of neurological disorders such as stroke, traumatic brain injury, brain tumor, Multiple Sclerosis, Parkinson's Disease and Mild Cognitive Impairment (MCI).  

  • The principles of the MC approach are general and have also been applied to populations with executive function deficits including schizophrenia, ADHD and learning disability.


See selected publications


VIDEO: A Simulation of 2 MC Treatment Sessions