Welcome to Hacking Your ADHD.
I'm your host William Curb, and I have ADHD On this podcast.
I dig in the tools, tactics, and best practices to help
you work with your ADHD Brain.
Today I'm joined by Skye Waterson, for our research recap series.
In this series, we take a look at single research paper, dive into what
the paper says, how it's conducted, and try and find any practical takeaways.
In this episode, we're going to be discussing a paper
called Improvement of Anxiety.
ADHD
following goal-focused cognitive remediation, a
randomized controlled trial.
And this is a study that investigates goal-focused interventions and then looks
if they can improve executive function and emotional wellbeing for adults with ADHD.
Not too much to it there, so let's get into it.
Yeah, let's do it.
So this paper is from Norway, and really what they were looking for
was what, whether having a particular kind of intervention for ADHD,
particularly goal-focused intervention.
We'll get into what that means in a second.
Whether it was going to help with ADHD symptoms and associated
symptoms like anxiety, for example.
over and above your standard support and your standard treatment, which given
that it's still probably the beginning of the year when this is coming out,
is pro, is very useful for people who, might have set some goals of their own
or struggle with ADHD and goal setting.
'cause I know a lot of people do.
yeah.
And it's also, but there is some like interesting caveats to when we're like
looking at this paper too 'cause of looking at who they had as participants
being very focused on be people that are motivated to do this kind of thing.
So that's, I was like, this is, I understand 'cause you want to
have people complete the study.
But then
Yeah
how effective is is that, factor alone going to be enough to.
Yeah.
So there are a few, how do this, like limitations that we'll talk about,
but do we wanna start by just saying, what is goal management training?
Because for a lot of people, goals are just a thing that you set.
They're not a thing that you train.
So do you wanna take us through what this is?
Yeah.
So for their goal management training procedure, they had a, structure of eight
weekly, sessions where they're, these had these, 45 minute periods where they're
going through and participants are losing learning strategies for setting goals.
They have things like, stop, which I wrote this one down 'cause I
was like, how, does this work?
Stop is a technique with the stop state split.
And it is a technique to break that mental circuit where you're in auto mode.
So you stop, you're acti what you're doing and then you figure out what state
you're in, to combat that goal loss idea.
And then you.
If it's the task is feeling overwhelming, you can split the
task into smaller parts and figure out how to do that kind of thing.
but yeah, so a lot of this, goal management training is about teaching
how to set goals and then how to follow through with that goal
Yeah.
And it's interesting.
So what they're really trying to do here is they're trying to support your working
memory by splitting things in half.
They're trying to, avoid that reactive dopamine seeking.
Attention switching that we can do when we are like halfway through a task and then
we suddenly wake up, if you will, and we find ourself halfway through a third task.
they're trying to keep you in the zone and keep you focused, which I
think a lot of ADHD interventions are doing, in, in multiple different ways.
What they, and to your point then the people that they mentioned
and the people that they actually.
Asked if they wanted to do this study were people who were diagnosed with ADHD.
So we are looking at people who are specifically diagnosed, but they had
said that they were motivated, which is a very loaded word in the ADHD world to
work on executive problems to increase.
Coping in everyday life.
So they were not doing this against their will, if you will.
and I get that.
if I, one of the things I always ask people who I work with is, do you want
to learn new systems, try new things?
Are you comfortable reaching out if you need help?
All of those kinds of things.
You're not really gonna get any results if you don't, but it's different from
our purely pharmacological interventions.
Yeah, and it's, I mean, I think it's an incredibly important point
because yeah, you don't get change happening unless you want the change.
But
there's different levels of I want to change, but I don't know how versus I
want to change and I'm just gonna go
Yeah.
Yeah, and it's interesting to note, and I think it, this will come up
later that both groups, so the people who got randomly assigned to the.
Goal management system and the people who just got assigned to talking to
your psychiatrist, talking to your gp.
Both of those people, were motivated to work on their executive problems.
and then additionally we should also talk about the gas, the goal.
Attainment scaling, procedure that they used in conjunction
with the goal management training.
although they were, they had different, it was interesting 'cause they had
different, results on who finished what.
and but gas was also then, so the goal attainment scaling, sorry, I, reading
through the paper and seeing like I'm.
They used a lot of the, acronyms and I had to go back over and over again to
be trying to remember what they were.
But yeah, goal attainment
Yeah.
If you don't know if you're listening, we have like papers and highlighters
and all kinds of things in front of us to make this make sense.
yeah, I have my notes here where it's like, this is what
this is because otherwise.
It's way too complicated.
But the, uh, goal attainment, was participants, attending four
individual 45 minute sessions.
So this is like biweekly.
And then they could set as many goals as they wanted in the session,
although that averaged out to be 1.6.
So some people were setting a lot, a lot of people were not.
and.
They were varying from, you know, getting outta bed before like 9:00 AM or, you
know, practicing the stop technique from the goal management training.
And then each goal was measured on a scale of, to track the progression where it's
like just, it's a five point scale, but going from negative two to positive two.
And then, that's just a, it was a method to measure the progress
they were making on their goals.
Yeah.
Yeah, definitely.
Definitely.
And I think it's an interesting one when we talk about the GMT process
itself and stating your goal.
Some of this I would say.
Yep, that's really helpful.
Others.
If I'm being honest and I'm looking at the research into ADHD, I
wouldn't use in my own work, for example, some of the processes.
How did you feel about the actual GMT method that they were testing?
I felt,
especially with the fact that we had motivated people, like this was a
lot, of a lot of, uh, intervention.
Like they're meeting quite frequently, for eight weeks.
So it's, it's a long term thing and so.
I don't know if the particulars of what they were doing were the most
important thing, rather than they were keeping goal setting top of mind
Is the
and like what you want to do.
Yeah.
And so when I was like, okay, yeah, you have these,
workbooks that you're learning about, absent and minus and automatic
pilot and these mental slipups where you're doing the wrong thing.
To the biggest thing they saw was a reduction in anxiety, and
that's what this looked like.
It would be, for me, it would be more of an anxiety program
rather than a specific ADHD
Yeah.
And that was, I think the true, the thing because yes to cut to the end
and then discuss it a little bit more.
What they found was that people who were struggling with ADHD, symptoms who did
this, didn't have much of a difference in terms of their executive functioning.
Compared to the treatment as usual method.
So this intervention didn't improve ADHD symptoms significantly.
it was anxiety that it improved instead.
Yeah, and I can definitely see why.
and there's no question that's great.
We reducing anxiety is, you know, that in itself can have, effects
on your executive function, having less anxiety, worrying about things.
It's great.
Uh, but again, it was just like, yeah, that kind of seemed what they were.
Unintentionally aiming at, like they weren't, I didn't see anything
specific that was like, oh, this is going to help with executive function.
think that's one of the problems with, some of the.
System improvements that we use.
if you type into, if you ask Chad ut for example, how to support ADHD, it
will give you a lot of support for emotional support, but not so much
for actual executive functioning.
'cause I think it's just a more complicated, less known problem.
Like for example, when I was looking at the mental blackboard,
they talked about this idea of.
Limited capacity in your working memory.
AKA, you have a mental blackboard and you can't put a lot of
stuff on it Totally makes sense.
Really good.
What do we do instead?
That bit seemed, at least from what I'm getting here to be missing and that
like we use the prioritization filter.
We've talked about this on this podcast before, I'm sure, but it's that idea
of, breaking things down and how it works and how to filter it, and.
I feel like mechanically, if you are trying to support executive functioning,
you need more mechanics that are gonna work for the a d ADHD brain.
Yeah.
Yeah, it's not just 'cause Yeah.
breaking down tasks is a fantastic way to get more stuff done and figure
out what you need to prioritize.
But that alone can't be your solution.
'cause it can become, breaking down tasks and also become overwhelming when you're
like, oh man, that was not one task.
That's 50 tasks.
hundred percent.
A hundred percent.
Actually I should probably at this point, just I'll give you the link again.
will, if you want and people can get the prioritization filter for
free to do it so you guys aren't left wondering what to do next.
But, Yeah, I agree.
I think it's, great and then it's overwhelming.
That was maybe the one thing that I found really interesting was how much this
helped with anxiety, because it made me wonder what the anxiety was about.
Yeah, because often.
I find a lot of people with ADHD treat their ADHD through anxiety
because, I just need to get stuff done.
If I feel anxious about it, I'm going to get to it.
But it's a bad way to treat your ADHD and it's leads to like it.
That's a big factor in burnout is being just like, oh, I'm
just running on anxiety.
Like I can't.
because yeah, if I'm, I'm my, I, I have my task manager in my head, so I can't
stop thinking about it because if I stop thinking about it, I'm gonna forget.
So learning techniques to be like, oh, I'm not gonna keep everything in
my head, would reduce anxiety, but it might not necessarily increase
the amount of stuff you're getting
Yeah.
Yeah, exactly.
And I think that's maybe the complicated part of this conversation is, these people
were very, motivated to support their life and their executive functioning,
and they were motivated enough to do a multi-step process that went over a
lot of periods and was quite intense.
In the end, I'm not completely, I know everybody's, systems improved
with accountability, but it did feel like there was a little bit
missing from the mechanics of the support that was available to help
them actually reach that goal.
I think that was the piece that I felt the most, sorry for people at the end.
Going well, they feel less anxious and they feel a little bit better, but there's
probably a piece missing where they're still like, I'm gonna feel a little
bit more overwhelmed soon once this very intense accountability drops off.
Yeah, it would be really interesting to then have another follow up.
So they have this like initial eight week and that another one after
they're not doing any interventions.
What has stuck, what has, did it help in the long term rather than just while
it was going, while it was happening?
in terms of what we can take away from this, I think we can say that
that support, that accountability, that intervention does have
a, shifts and it does help.
and, and also that, it is good doing these kinds of stop reflect, what am I doing?
What am I doing next in terms of improving anxiety?
Yeah.
And if you are dealing with anxiety, yeah, definitely try out these techniques.
'cause it's something that we have data that says, yeah, this helps,
but you just need to actually do
Yeah.
Yeah, 100%.