Research Recap with Skye: Anxiety and Goals
Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into 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 a single research paper, dive into what it says, how it was conducted, and try to find any practical takeaways.
In this episode, we're going to be discussing a paper called "Improvement of Anxiety and ADHD following goal-focused cognitive remediation: a randomized controlled trial." This study investigates goal-focused interventions and looks at whether they can improve executive function and emotional well-being for adults with ADHD. There’s not too much to the intro, so let's get into it.
If you'd life to follow along on the show notes page you can find that at https://HackingYourADHD.com/282
https://tinyurl.com/56rvt9fr - Unconventional Organisation Affiliate link
https://tinyurl.com/y835cnrk - YouTube
https://www.patreon.com/HackingYourADHD - Patreon
William Curb: Welcome to Hacking Your ADHD. I'm your host, William Curb, and I have ADHD. On this podcast, I dig into 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 a single research paper, dive into what it says, how it was conducted, and try to find any practical takeaways.
In this episode, we're going to be discussing a paper called "Improvement of Anxiety and ADHD following goal-focused cognitive remediation: a randomized controlled trial." This study investigates goal-focused interventions and looks at whether they can improve executive function and emotional well-being for adults with ADHD. There’s not too much to the intro, so let's get into it.
Skye Waterson: Yeah, let's do it. This paper is from Norway, and they were looking at whether a particular kind of goal-focused intervention would help with ADHD symptoms and associated symptoms like anxiety. They wanted to see if it offered benefits over and above standard support and treatment. Given that this is coming out at the beginning of the year, it’s very useful for people who might have set goals of their own but struggle with ADHD and goal setting—because I know a lot of people do.
William Curb: Yeah. There are also some interesting caveats to consider when looking at this paper, specifically regarding the participants. They were very focused on people who were motivated to do this kind of thing. I understand why—you want people to complete the study—but I wonder how effective that factor alone is.
Skye Waterson: Yeah. There are a few limitations we’ll talk about, but should we start by defining "Goal Management Training" (GMT)? For a lot of people, goals are just things you set, not something you train for. Do you want to take us through what this is?
William Curb: Yeah. For their GMT procedure, they had a structure of eight weekly sessions. These were 45-minute periods where participants learned strategies for setting goals. They used a technique called "STOP," which involves the "stop-state-split." It’s a technique to break the mental circuit when you’re in "auto-mode." You stop what you’re doing and figure out what state you’re in to combat the idea of "goal loss." If a task feels overwhelming, you split it into smaller parts. A lot of this training is about teaching how to set goals and then how to follow through.
Skye Waterson: Exactly. They’re trying to support your working memory by splitting things in half. They’re trying to avoid that reactive, dopamine-seeking attention switching we do when we’re halfway through a task and suddenly "wake up" to find ourselves halfway through a third, unrelated task.
They’re trying to keep you in the zone, which many ADHD interventions attempt in different ways. To your point, the participants were all diagnosed with ADHD and explicitly said they were motivated to work on executive problems to increase coping in everyday life. They were not doing this against their will. I always ask the people I work with if they want to learn new systems; you aren't going to get results if you don't. But this is very different from purely pharmacological interventions.
William Curb: It’s an incredibly important point. You don't get change unless you want it. But there are different levels of "wanting to change," ranging from "I don't know how" to "I'm just going to go for it."
Skye Waterson: It’s interesting to note that both groups—the people randomly assigned to the goal management system and the "treatment as usual" group (who talked to their psychiatrist or GP)—were motivated to work on their executive problems.
We should also talk about the GAS (Goal Attainment Scaling) procedure used in conjunction with the GMT. It was interesting because they had different results regarding who finished what.
William Curb: They used a lot of acronyms; I had to go back over them repeatedly to remember what they were. For Goal Attainment Scaling, participants attended four individual 45-minute sessions biweekly. They could set as many goals as they wanted, though it averaged out to 1.6 per session. Goals ranged from getting out of bed before 9:00 AM to practicing the "STOP" technique. Each goal was tracked on a five-point scale from -2 to +2 to measure progress.
Skye Waterson: I think it's an interesting process. Regarding the GMT method itself, some of it is really helpful, but looking at other ADHD research, there are some processes I wouldn't use in my own work. How did you feel about the actual GMT method they were testing?
William Curb: I felt that, especially since the participants were already motivated, this was a very intense intervention. They were meeting frequently for eight weeks. I don't know if the particulars of what they were doing were as important as the fact that they were keeping goal setting top of mind.
The biggest thing they saw was a reduction in anxiety. To me, it looked more like an anxiety program than a specific ADHD intervention.
Skye Waterson: Yeah, and that was the truth of it. To cut to the end, they found that while the participants struggled with ADHD symptoms, this intervention didn't provide much difference in executive functioning compared to standard treatment. It didn't improve ADHD symptoms significantly; it improved anxiety instead.
William Curb: I can see why. Reducing anxiety is great and can have positive effects on executive function, but it seemed like they were unintentionally aiming at anxiety. I didn't see anything specific that was clearly going to help with executive function mechanics.
Skye Waterson: I think that’s a problem with some of the system improvements we use. If you ask an AI how to support ADHD, it gives you a lot of emotional support but not much for actual executive functioning. It's a more complicated, less-known problem.
For example, they talked about the "mental blackboard" and the limited capacity of working memory. That makes total sense, but the "what do we do instead" bit seemed to be missing. If you want to support executive functioning, you need mechanics that work for the ADHD brain.
William Curb: Right. Breaking down tasks is fantastic, but that alone can’t be the solution. It can even become overwhelming when you realize one task is actually 50 tasks.
Skye Waterson: A hundred percent. I agree—it’s great until it’s overwhelming. One thing I found really interesting was how much this helped with anxiety, because it made me wonder what that anxiety was originally about.
William Curb: Often, people with ADHD "treat" their ADHD through anxiety. They think, "If I feel anxious about it, I'll finally do it." But that leads to burnout. If I keep my task manager in my head, I can't stop thinking about it because I'm afraid I'll forget. Learning techniques to get things out of your head reduces anxiety, but it might not necessarily increase your output.
Skye Waterson: Exactly. These people were motivated enough to do an intense, multi-step process. While everyone's systems improve with accountability, it felt like there was something missing mechanically to help them actually reach their goals. I felt for the participants at the end; they feel less anxious now, but they might feel overwhelmed again once that intense accountability drops off.
William Curb: It would be interesting to see a follow-up. They had the initial eight weeks, but what happens when there are no interventions? Did anything stick in the long term?
Skye Waterson: In terms of takeaways, we can say that support, accountability, and intervention do help. It is good to practice techniques like "stop and reflect" to improve anxiety.
William Curb: Yeah. And if you are dealing with anxiety, definitely try these techniques. We have data that says they help—you just have to actually do them.