Objective: To examine the effects of a Time Pressure Management (TPM) strategy taught to stroke patients with mental slowness, compared with the effects of care as usual. Design: Randomized controlled trial with outcome assessments conducted at baseline, at the end of treatment (at 5-10wk), and at 3 months. Setting: Eight Dutch rehabilitation centers. Participants: Stroke patients (N=37; mean age +/- SD 51.5 +/- 9.7y) in rehabilitation programs who had a mean Barthel score SD at baseline of 19.6 +/- 1.1. Intervention: Ten hours of treatment teaching patients a TPM strategy to compensate for mental slowness in real-life tasks. Main Outcome Measures: Mental Slowness Observation Test and Mental Slowness Questionnaire. Results: Patients were randomly assigned to the experimental treatment (n=20) and to care as Usual (n=17). After 10 hours of treatment, both groups showed a significant decline in number of complaints on the Mental Slowness Questionnaire. This decline was still present at 3 months. At 3 months, the Mental Slowness Observation Test revealed significantly higher increases in speed of performance of the TPM group in comparison with the care-as-usual group (t=-2.7, P=.01). Conclusions: Although the TPM group and the care-as-usual group both showed fewer complaints after a 3-month follow-up period, only the TPM group showed improved speed of performance on everyday tasks. Use of TPM treatment therefore is recommended when treating stroke patients with mental slowness.