4.1. Limitations
The primary limitation of this study is the small sample size, which limits statistical analysis and the generalizability of findings. While both groups demonstrated post-intervention gains and appear statistically comparable, it is unknown whether differences may be detectable in a larger sample. While statistically non-significant, it is notable that the conventional care group received more hours of group instruction compared to the experimental group, who had more frequent absences and scheduling conflicts. It is unknown whether this negatively impacted experimental group outcomes. Additional training on the interventions during other treatment sessions at SHARE or elsewhere was not tracked nor was the completion of homework and frequency of use of the interventions outside of group sessions. Therefore, group differences and the potential impact of those differences is unknown. The impact of the psychological conditions (This study was conducted in a real-world clinical setting during the COVID-19 global pandemic, which required some participants to receive a hybrid program including interventions delivered via a telehealth platform in addition to in-person care. While half of the participants in each group received hybrid care, the exact number of in-person versus virtual group therapy sessions was not considered in the analysis. Furthermore, the efficacy of telehealth delivery of the Executive Plus/STEP protocol in comparison to in-person care has not been robustly studied, and therefore, the extent to which varied service delivery methods influenced outcomes is unknown.