1 00:00:05,596 --> 00:00:07,176 Welcome to Hacking Your ADHD. 2 00:00:07,286 --> 00:00:10,936 I'm your host William Curb, and I have ADHD On this podcast. 3 00:00:10,936 --> 00:00:13,246 I dig in the tools, tactics, and best practices to help 4 00:00:13,246 --> 00:00:14,956 you work with your ADHD Brain. 5 00:00:15,496 --> 00:00:18,946 Today I'm joined by Skye Waterson, for our research recap series. 6 00:00:19,306 --> 00:00:21,736 In this series, we take a look at single research paper, dive into what 7 00:00:21,736 --> 00:00:25,456 the paper says, how it's conducted, and try and find any practical takeaways. 8 00:00:25,876 --> 00:00:27,526 In this episode, we're going to be discussing a paper 9 00:00:27,526 --> 00:00:29,476 called Improvement of Anxiety. 10 00:00:29,586 --> 00:00:29,836 ADHD 11 00:00:31,891 --> 00:00:34,891 following goal-focused cognitive remediation, a 12 00:00:34,891 --> 00:00:36,271 randomized controlled trial. 13 00:00:36,991 --> 00:00:41,131 And this is a study that investigates goal-focused interventions and then looks 14 00:00:41,131 --> 00:00:45,431 if they can improve executive function and emotional wellbeing for adults with ADHD. 15 00:00:46,801 --> 00:00:48,901 Not too much to it there, so let's get into it. 16 00:00:49,201 --> 00:00:50,531 Yeah, let's do it. 17 00:00:50,951 --> 00:00:56,051 So this paper is from Norway, and really what they were looking for 18 00:00:56,081 --> 00:01:02,641 was what, whether having a particular kind of intervention for ADHD, 19 00:01:02,831 --> 00:01:05,021 particularly goal-focused intervention. 20 00:01:05,021 --> 00:01:06,821 We'll get into what that means in a second. 21 00:01:07,451 --> 00:01:11,531 Whether it was going to help with ADHD symptoms and associated 22 00:01:11,531 --> 00:01:13,571 symptoms like anxiety, for example. 23 00:01:15,301 --> 00:01:20,791 over and above your standard support and your standard treatment, which given 24 00:01:20,791 --> 00:01:24,181 that it's still probably the beginning of the year when this is coming out, 25 00:01:24,571 --> 00:01:28,861 is pro, is very useful for people who, might have set some goals of their own 26 00:01:29,251 --> 00:01:31,321 or struggle with ADHD and goal setting. 27 00:01:31,351 --> 00:01:32,166 'cause I know a lot of people do. 28 00:01:33,066 --> 00:01:33,486 yeah. 29 00:01:33,546 --> 00:01:39,546 And it's also, but there is some like interesting caveats to when we're like 30 00:01:39,546 --> 00:01:44,286 looking at this paper too 'cause of looking at who they had as participants 31 00:01:44,796 --> 00:01:48,246 being very focused on be people that are motivated to do this kind of thing. 32 00:01:48,246 --> 00:01:52,236 So that's, I was like, this is, I understand 'cause you want to 33 00:01:52,236 --> 00:01:53,976 have people complete the study. 34 00:01:56,181 --> 00:01:56,961 But then 35 00:01:57,556 --> 00:01:57,846 Yeah 36 00:01:58,331 --> 00:02:03,881 how effective is is that, factor alone going to be enough to. 37 00:02:04,631 --> 00:02:04,961 Yeah. 38 00:02:05,201 --> 00:02:11,111 So there are a few, how do this, like limitations that we'll talk about, 39 00:02:11,111 --> 00:02:14,861 but do we wanna start by just saying, what is goal management training? 40 00:02:14,891 --> 00:02:18,041 Because for a lot of people, goals are just a thing that you set. 41 00:02:18,071 --> 00:02:19,571 They're not a thing that you train. 42 00:02:19,571 --> 00:02:22,421 So do you wanna take us through what this is? 43 00:02:23,771 --> 00:02:24,011 Yeah. 44 00:02:24,011 --> 00:02:30,011 So for their goal management training procedure, they had a, structure of eight 45 00:02:30,071 --> 00:02:37,421 weekly, sessions where they're, these had these, 45 minute periods where they're 46 00:02:37,421 --> 00:02:41,681 going through and participants are losing learning strategies for setting goals. 47 00:02:41,681 --> 00:02:46,601 They have things like, stop, which I wrote this one down 'cause I 48 00:02:46,601 --> 00:02:48,131 was like, how, does this work? 49 00:02:50,531 --> 00:02:54,101 Stop is a technique with the stop state split. 50 00:02:54,821 --> 00:03:00,671 And it is a technique to break that mental circuit where you're in auto mode. 51 00:03:01,151 --> 00:03:07,391 So you stop, you're acti what you're doing and then you figure out what state 52 00:03:07,391 --> 00:03:11,201 you're in, to combat that goal loss idea. 53 00:03:11,201 --> 00:03:11,741 And then you. 54 00:03:13,481 --> 00:03:17,471 If it's the task is feeling overwhelming, you can split the 55 00:03:17,471 --> 00:03:19,721 task into smaller parts and figure out how to do that kind of thing. 56 00:03:20,921 --> 00:03:25,031 but yeah, so a lot of this, goal management training is about teaching 57 00:03:25,601 --> 00:03:27,881 how to set goals and then how to follow through with that goal 58 00:03:28,181 --> 00:03:28,601 Yeah. 59 00:03:28,691 --> 00:03:29,141 Yeah. 60 00:03:29,591 --> 00:03:30,431 And it's interesting. 61 00:03:30,431 --> 00:03:33,761 So what they're really trying to do here is they're trying to support your working 62 00:03:33,761 --> 00:03:36,011 memory by splitting things in half. 63 00:03:36,371 --> 00:03:40,586 They're trying to, avoid that reactive dopamine seeking. 64 00:03:41,381 --> 00:03:45,671 Attention switching that we can do when we are like halfway through a task and then 65 00:03:45,671 --> 00:03:49,361 we suddenly wake up, if you will, and we find ourself halfway through a third task. 66 00:03:50,141 --> 00:03:54,191 they're trying to keep you in the zone and keep you focused, which I 67 00:03:54,191 --> 00:04:00,881 think a lot of ADHD interventions are doing, in, in multiple different ways. 68 00:04:01,841 --> 00:04:06,401 What they, and to your point then the people that they mentioned 69 00:04:06,401 --> 00:04:07,751 and the people that they actually. 70 00:04:08,231 --> 00:04:12,811 Asked if they wanted to do this study were people who were diagnosed with ADHD. 71 00:04:13,331 --> 00:04:17,801 So we are looking at people who are specifically diagnosed, but they had 72 00:04:17,801 --> 00:04:24,731 said that they were motivated, which is a very loaded word in the ADHD world to 73 00:04:24,791 --> 00:04:27,336 work on executive problems to increase. 74 00:04:28,061 --> 00:04:29,411 Coping in everyday life. 75 00:04:29,411 --> 00:04:33,611 So they were not doing this against their will, if you will. 76 00:04:34,571 --> 00:04:35,321 and I get that. 77 00:04:35,651 --> 00:04:40,451 if I, one of the things I always ask people who I work with is, do you want 78 00:04:40,451 --> 00:04:43,451 to learn new systems, try new things? 79 00:04:43,451 --> 00:04:45,521 Are you comfortable reaching out if you need help? 80 00:04:45,521 --> 00:04:46,661 All of those kinds of things. 81 00:04:46,661 --> 00:04:52,211 You're not really gonna get any results if you don't, but it's different from 82 00:04:52,211 --> 00:04:55,481 our purely pharmacological interventions. 83 00:04:56,621 --> 00:05:00,431 Yeah, and it's, I mean, I think it's an incredibly important point 84 00:05:00,431 --> 00:05:04,871 because yeah, you don't get change happening unless you want the change. 85 00:05:05,441 --> 00:05:05,891 But 86 00:05:06,491 --> 00:05:11,621 there's different levels of I want to change, but I don't know how versus I 87 00:05:11,621 --> 00:05:13,271 want to change and I'm just gonna go 88 00:05:13,571 --> 00:05:13,886 Yeah. 89 00:05:14,036 --> 00:05:17,426 Yeah, and it's interesting to note, and I think it, this will come up 90 00:05:17,426 --> 00:05:22,321 later that both groups, so the people who got randomly assigned to the. 91 00:05:22,976 --> 00:05:27,836 Goal management system and the people who just got assigned to talking to 92 00:05:27,836 --> 00:05:30,236 your psychiatrist, talking to your gp. 93 00:05:30,566 --> 00:05:36,536 Both of those people, were motivated to work on their executive problems. 94 00:05:40,213 --> 00:05:46,663 and then additionally we should also talk about the gas, the goal. 95 00:05:47,413 --> 00:05:50,773 Attainment scaling, procedure that they used in conjunction 96 00:05:50,773 --> 00:05:54,613 with the goal management training. 97 00:05:55,483 --> 00:05:58,423 although they were, they had different, it was interesting 'cause they had 98 00:05:58,423 --> 00:06:01,063 different, results on who finished what. 99 00:06:02,023 --> 00:06:09,703 and but gas was also then, so the goal attainment scaling, sorry, I, reading 100 00:06:09,703 --> 00:06:11,633 through the paper and seeing like I'm. 101 00:06:13,123 --> 00:06:17,863 They used a lot of the, acronyms and I had to go back over and over again to 102 00:06:17,863 --> 00:06:20,083 be trying to remember what they were. 103 00:06:20,083 --> 00:06:21,133 But yeah, goal attainment 104 00:06:21,538 --> 00:06:21,778 Yeah. 105 00:06:21,778 --> 00:06:26,038 If you don't know if you're listening, we have like papers and highlighters 106 00:06:26,038 --> 00:06:28,213 and all kinds of things in front of us to make this make sense. 107 00:06:30,103 --> 00:06:32,113 yeah, I have my notes here where it's like, this is what 108 00:06:32,143 --> 00:06:33,823 this is because otherwise. 109 00:06:34,753 --> 00:06:36,253 It's way too complicated. 110 00:06:36,253 --> 00:06:41,143 But the, uh, goal attainment, was participants, attending four 111 00:06:41,143 --> 00:06:42,823 individual 45 minute sessions. 112 00:06:42,823 --> 00:06:43,933 So this is like biweekly. 113 00:06:43,933 --> 00:06:47,413 And then they could set as many goals as they wanted in the session, 114 00:06:47,443 --> 00:06:50,263 although that averaged out to be 1.6. 115 00:06:50,563 --> 00:06:53,983 So some people were setting a lot, a lot of people were not. 116 00:06:55,003 --> 00:06:55,093 and. 117 00:06:56,578 --> 00:07:00,928 They were varying from, you know, getting outta bed before like 9:00 AM or, you 118 00:07:00,928 --> 00:07:04,108 know, practicing the stop technique from the goal management training. 119 00:07:04,648 --> 00:07:10,528 And then each goal was measured on a scale of, to track the progression where it's 120 00:07:10,528 --> 00:07:14,698 like just, it's a five point scale, but going from negative two to positive two. 121 00:07:15,178 --> 00:07:20,908 And then, that's just a, it was a method to measure the progress 122 00:07:20,908 --> 00:07:22,198 they were making on their goals. 123 00:07:22,243 --> 00:07:22,498 Yeah. 124 00:07:22,963 --> 00:07:24,253 Yeah, definitely. 125 00:07:24,823 --> 00:07:25,423 Definitely. 126 00:07:25,423 --> 00:07:31,003 And I think it's an interesting one when we talk about the GMT process 127 00:07:31,003 --> 00:07:33,463 itself and stating your goal. 128 00:07:34,003 --> 00:07:36,493 Some of this I would say. 129 00:07:36,493 --> 00:07:38,143 Yep, that's really helpful. 130 00:07:38,563 --> 00:07:39,223 Others. 131 00:07:39,223 --> 00:07:44,713 If I'm being honest and I'm looking at the research into ADHD, I 132 00:07:44,713 --> 00:07:49,153 wouldn't use in my own work, for example, some of the processes. 133 00:07:49,423 --> 00:07:53,503 How did you feel about the actual GMT method that they were testing? 134 00:07:54,103 --> 00:07:55,123 I felt, 135 00:07:55,723 --> 00:07:59,263 especially with the fact that we had motivated people, like this was a 136 00:07:59,263 --> 00:08:04,126 lot, of a lot of, uh, intervention. 137 00:08:04,276 --> 00:08:09,706 Like they're meeting quite frequently, for eight weeks. 138 00:08:09,706 --> 00:08:12,616 So it's, it's a long term thing and so. 139 00:08:14,956 --> 00:08:18,766 I don't know if the particulars of what they were doing were the most 140 00:08:18,766 --> 00:08:23,791 important thing, rather than they were keeping goal setting top of mind 141 00:08:24,091 --> 00:08:24,421 Is the 142 00:08:24,466 --> 00:08:25,876 and like what you want to do. 143 00:08:26,236 --> 00:08:26,746 Yeah. 144 00:08:27,586 --> 00:08:30,406 And so when I was like, okay, yeah, you have these, 145 00:08:34,126 --> 00:08:37,006 workbooks that you're learning about, absent and minus and automatic 146 00:08:37,006 --> 00:08:40,366 pilot and these mental slipups where you're doing the wrong thing. 147 00:08:41,946 --> 00:08:46,416 To the biggest thing they saw was a reduction in anxiety, and 148 00:08:46,446 --> 00:08:48,216 that's what this looked like. 149 00:08:48,216 --> 00:08:50,886 It would be, for me, it would be more of an anxiety program 150 00:08:50,886 --> 00:08:53,736 rather than a specific ADHD 151 00:08:54,036 --> 00:08:54,606 Yeah. 152 00:08:54,666 --> 00:08:55,236 Yeah. 153 00:08:55,296 --> 00:08:58,896 And that was, I think the true, the thing because yes to cut to the end 154 00:08:59,196 --> 00:09:01,116 and then discuss it a little bit more. 155 00:09:01,326 --> 00:09:09,126 What they found was that people who were struggling with ADHD, symptoms who did 156 00:09:09,126 --> 00:09:14,916 this, didn't have much of a difference in terms of their executive functioning. 157 00:09:15,501 --> 00:09:18,681 Compared to the treatment as usual method. 158 00:09:18,711 --> 00:09:24,981 So this intervention didn't improve ADHD symptoms significantly. 159 00:09:26,301 --> 00:09:29,511 it was anxiety that it improved instead. 160 00:09:30,111 --> 00:09:33,291 Yeah, and I can definitely see why. 161 00:09:33,771 --> 00:09:35,631 and there's no question that's great. 162 00:09:35,871 --> 00:09:42,051 We reducing anxiety is, you know, that in itself can have, effects 163 00:09:42,051 --> 00:09:45,291 on your executive function, having less anxiety, worrying about things. 164 00:09:46,281 --> 00:09:46,821 It's great. 165 00:09:46,941 --> 00:09:50,661 Uh, but again, it was just like, yeah, that kind of seemed what they were. 166 00:09:51,426 --> 00:09:55,626 Unintentionally aiming at, like they weren't, I didn't see anything 167 00:09:55,626 --> 00:09:58,401 specific that was like, oh, this is going to help with executive function. 168 00:09:58,701 --> 00:10:03,861 think that's one of the problems with, some of the. 169 00:10:05,166 --> 00:10:07,836 System improvements that we use. 170 00:10:07,986 --> 00:10:12,696 if you type into, if you ask Chad ut for example, how to support ADHD, it 171 00:10:12,696 --> 00:10:16,326 will give you a lot of support for emotional support, but not so much 172 00:10:16,326 --> 00:10:17,946 for actual executive functioning. 173 00:10:17,976 --> 00:10:22,266 'cause I think it's just a more complicated, less known problem. 174 00:10:22,656 --> 00:10:26,346 Like for example, when I was looking at the mental blackboard, 175 00:10:26,766 --> 00:10:28,626 they talked about this idea of. 176 00:10:29,061 --> 00:10:31,791 Limited capacity in your working memory. 177 00:10:31,791 --> 00:10:34,671 AKA, you have a mental blackboard and you can't put a lot of 178 00:10:34,671 --> 00:10:37,101 stuff on it Totally makes sense. 179 00:10:37,221 --> 00:10:38,061 Really good. 180 00:10:38,631 --> 00:10:40,251 What do we do instead? 181 00:10:40,611 --> 00:10:47,421 That bit seemed, at least from what I'm getting here to be missing and that 182 00:10:47,481 --> 00:10:49,971 like we use the prioritization filter. 183 00:10:49,971 --> 00:10:53,901 We've talked about this on this podcast before, I'm sure, but it's that idea 184 00:10:53,901 --> 00:10:57,531 of, breaking things down and how it works and how to filter it, and. 185 00:10:58,296 --> 00:11:04,266 I feel like mechanically, if you are trying to support executive functioning, 186 00:11:04,356 --> 00:11:08,406 you need more mechanics that are gonna work for the a d ADHD brain. 187 00:11:08,706 --> 00:11:08,961 Yeah. 188 00:11:10,371 --> 00:11:12,441 Yeah, it's not just 'cause Yeah. 189 00:11:13,431 --> 00:11:16,791 breaking down tasks is a fantastic way to get more stuff done and figure 190 00:11:16,791 --> 00:11:17,871 out what you need to prioritize. 191 00:11:17,991 --> 00:11:21,591 But that alone can't be your solution. 192 00:11:22,041 --> 00:11:26,991 'cause it can become, breaking down tasks and also become overwhelming when you're 193 00:11:26,991 --> 00:11:28,731 like, oh man, that was not one task. 194 00:11:28,761 --> 00:11:29,676 That's 50 tasks. 195 00:11:30,231 --> 00:11:31,056 hundred percent. 196 00:11:31,116 --> 00:11:31,926 A hundred percent. 197 00:11:31,926 --> 00:11:36,966 Actually I should probably at this point, just I'll give you the link again. 198 00:11:37,356 --> 00:11:41,016 will, if you want and people can get the prioritization filter for 199 00:11:41,016 --> 00:11:45,546 free to do it so you guys aren't left wondering what to do next. 200 00:11:45,551 --> 00:11:48,591 But, Yeah, I agree. 201 00:11:48,591 --> 00:11:51,411 I think it's, great and then it's overwhelming. 202 00:11:51,591 --> 00:11:56,331 That was maybe the one thing that I found really interesting was how much this 203 00:11:56,331 --> 00:12:01,101 helped with anxiety, because it made me wonder what the anxiety was about. 204 00:12:04,176 --> 00:12:05,136 Yeah, because often. 205 00:12:05,736 --> 00:12:11,016 I find a lot of people with ADHD treat their ADHD through anxiety 206 00:12:11,856 --> 00:12:15,966 because, I just need to get stuff done. 207 00:12:15,966 --> 00:12:17,856 If I feel anxious about it, I'm going to get to it. 208 00:12:19,386 --> 00:12:26,226 But it's a bad way to treat your ADHD and it's leads to like it. 209 00:12:26,226 --> 00:12:28,506 That's a big factor in burnout is being just like, oh, I'm 210 00:12:28,506 --> 00:12:29,556 just running on anxiety. 211 00:12:29,616 --> 00:12:30,306 Like I can't. 212 00:12:32,706 --> 00:12:36,846 because yeah, if I'm, I'm my, I, I have my task manager in my head, so I can't 213 00:12:36,846 --> 00:12:39,816 stop thinking about it because if I stop thinking about it, I'm gonna forget. 214 00:12:41,106 --> 00:12:44,376 So learning techniques to be like, oh, I'm not gonna keep everything in 215 00:12:44,376 --> 00:12:49,206 my head, would reduce anxiety, but it might not necessarily increase 216 00:12:49,206 --> 00:12:50,046 the amount of stuff you're getting 217 00:12:50,346 --> 00:12:50,706 Yeah. 218 00:12:50,766 --> 00:12:51,756 Yeah, exactly. 219 00:12:51,756 --> 00:12:58,026 And I think that's maybe the complicated part of this conversation is, these people 220 00:12:58,026 --> 00:13:01,926 were very, motivated to support their life and their executive functioning, 221 00:13:02,616 --> 00:13:07,866 and they were motivated enough to do a multi-step process that went over a 222 00:13:07,866 --> 00:13:09,471 lot of periods and was quite intense. 223 00:13:10,911 --> 00:13:15,861 In the end, I'm not completely, I know everybody's, systems improved 224 00:13:15,861 --> 00:13:19,341 with accountability, but it did feel like there was a little bit 225 00:13:19,341 --> 00:13:23,991 missing from the mechanics of the support that was available to help 226 00:13:23,991 --> 00:13:25,611 them actually reach that goal. 227 00:13:25,851 --> 00:13:29,856 I think that was the piece that I felt the most, sorry for people at the end. 228 00:13:30,936 --> 00:13:33,906 Going well, they feel less anxious and they feel a little bit better, but there's 229 00:13:33,936 --> 00:13:37,596 probably a piece missing where they're still like, I'm gonna feel a little 230 00:13:37,596 --> 00:13:41,616 bit more overwhelmed soon once this very intense accountability drops off. 231 00:13:42,216 --> 00:13:45,306 Yeah, it would be really interesting to then have another follow up. 232 00:13:45,786 --> 00:13:49,236 So they have this like initial eight week and that another one after 233 00:13:49,296 --> 00:13:50,946 they're not doing any interventions. 234 00:13:51,516 --> 00:13:55,836 What has stuck, what has, did it help in the long term rather than just while 235 00:13:55,836 --> 00:13:57,216 it was going, while it was happening? 236 00:13:58,746 --> 00:14:01,626 in terms of what we can take away from this, I think we can say that 237 00:14:02,526 --> 00:14:06,546 that support, that accountability, that intervention does have 238 00:14:06,546 --> 00:14:09,276 a, shifts and it does help. 239 00:14:10,116 --> 00:14:16,566 and, and also that, it is good doing these kinds of stop reflect, what am I doing? 240 00:14:16,566 --> 00:14:19,896 What am I doing next in terms of improving anxiety? 241 00:14:21,021 --> 00:14:21,291 Yeah. 242 00:14:21,351 --> 00:14:24,951 And if you are dealing with anxiety, yeah, definitely try out these techniques. 243 00:14:24,951 --> 00:14:29,031 'cause it's something that we have data that says, yeah, this helps, 244 00:14:29,031 --> 00:14:30,501 but you just need to actually do 245 00:14:30,516 --> 00:14:30,801 Yeah. 246 00:14:31,026 --> 00:14:32,196 Yeah, 100%.