Research Recap with Skye: Anxiety and Goals

Summary

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Hacking Your ADHD - "Research Recap with Skye: Anxiety and Goals"

Host: William Curb
Guest: Skye Waterson
Date: March 27, 2026

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Episode Overview

In this Research Recap episode, host William Curb teams up with Skye Waterson to examine a Norwegian randomized controlled trial entitled “Improvement of Anxiety in ADHD following Goal Focused Cognitive Remediation.” The conversation centers on the study’s focus: whether a structured, goal-focused intervention can improve executive function and emotional well-being—especially anxiety—for adults with ADHD. The hosts analyze the methodology, results, and real-world implications, and discuss the broader challenges of managing goals and anxiety with ADHD.

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Key Discussion Points & Insights

1. The Study & Its Purpose

[01:05-01:49]

• The trial compared a specialized Goal Management Training (GMT) intervention to standard ADHD support (treatment as usual).
• The hosts frame this as especially relevant for listeners with ADHD who struggle with goal setting—timely for the start of the year.

Quote:

“This is a study that investigates goal focused interventions and then looks if they can improve executive function and emotional well-being for adults with ADHD.”
— William Curb [01:36]

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2. Who Studied, Who Participated?

[01:49-06:38]

• Participants were adults officially diagnosed with ADHD, all self-described as motivated to improve executive functioning—something the hosts emphasize as a critical (and limiting) factor in interpreting the results.
• Both study groups (GMT & standard treatment) were highly motivated, which may not represent the broader ADHD community.

Quote:

“They were not doing this against their will, if you will.”
— Skye Waterson [05:24]

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3. What is Goal Management Training (GMT)?

[03:02-08:54]

• GMT consisted of eight weekly sessions (45 minutes each), teaching strategies like the “STOP” technique:
  • S = Stop the current activity
  • T = Take notice of your state
  • O = Observe what you’re doing
  • P = Proceed with intention
• Focus was on breaking tasks into smaller components and becoming mindful, helping prevent distraction and “goal loss.”
• The research also used Goal Attainment Scaling (GAS): biweekly 45-min sessions where participants set and tracked individualized goals on a -2 to +2 scale.

Quote:

“A lot of this goal management training is about teaching how to set goals and then how to follow through with that goal setting.”
— William Curb [04:23]

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4. Limitations of the Study

[02:33-08:54]

• Participation bias: Only highly motivated individuals joined—raising questions about generalizability.
• The intensity and accountability of weekly sessions may be more important than the specific content.

Quote:

“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.”
— William Curb [08:54]

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5. Results: Anxiety vs. Executive Function

[09:27-12:08]

• The main, somewhat surprising finding: The goal-focused intervention didn’t significantly improve executive function compared to standard treatment.
• However, GMT notably reduced anxiety among the ADHD participants—a significant benefit, but not the targeted outcome.

Quote:

“What they found was... this intervention didn’t improve ADHD symptoms significantly. It was anxiety that it improved instead.”
— Skye Waterson [09:54]

• This anxiety reduction led to reflection on the relationship between anxiety and ADHD, with both hosts noting many people manage ADHD-related productivity issues by leveraging anxious energy—often at a cost.

Quote:

“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.’”
— William Curb [13:04]

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6. Mechanics of Executive Dysfunction: More Needed

[10:58-12:29]

• Available interventions and online advice often focus on emotional support rather than actionable mechanics for executive functioning.
• Breaking tasks down and prioritization are helpful, but not always sufficient and sometimes overwhelming.

Quote:

“Mechanically, if you’re trying to support executive functioning, you need more mechanics that are going to work for the ADHD brain.”
— Skye Waterson [12:08]

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7. Reflections, Takeaways & Practical Implications

[14:32-15:30]

• Strong accountability and regular support were likely driving benefits, but there may be a tough transition when those supports end.
• The hosts advocate adopting these strategies for anxiety management and self-reflection, while emphasizing the need for more robust executive function supports.

Quote:

“I think we can say that, like, that support, that accountability... does help. And also that it is good doing these kinds of stuff. Reflect. What am I doing? What am I doing next in terms of improving anxiety?”
— Skye Waterson [14:57]

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Notable Quotes & Memorable Moments

• “You don’t get change happening unless you want the change.”
  — William Curb [05:56]

• “Breaking down tasks is a fantastic way to get more stuff done... but that alone can’t be your solution.”
  — William Curb [12:08]

• “Learning techniques to be like, ‘Oh, I’m not going to keep everything in my head,’ would reduce anxiety, but it might not necessarily increase the amount of stuff you’re getting done.”
  — William Curb [13:41]

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Timestamps for Key Segments

• [01:05] — Introduction to the study and episode theme
• [03:02] — Explanation of Goal Management Training (GMT)
• [07:01] — Overview of Goal Attainment Scaling (GAS)
• [09:27] — Discussion of main study findings and implications
• [12:08] — Limitations of current approaches to executive functioning
• [14:32] — Takeaways and practical application for listeners

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Conclusion

William and Skye provide an accessible yet critical review of research on goal-focused interventions for ADHD, emphasizing both hope and realism. While goal management techniques and accountability frameworks seem to reduce anxiety for motivated adults with ADHD, the evidence for improvements in executive function remains thin. The hosts encourage listeners to reflect, try out anxiety management strategies, and look for actionable mechanics to support real executive function challenges.

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Resources Mentioned

• Unconventional Organization – Free resources and strategies for ADHD
• (For prioritization tools, listeners are promised a link from Skye, referencing her “prioritization filter.”)

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Transcript

[A]

Hi, I'm Katie Duke and I've been a nurse for over 20 years. Listen, I used to think that I was my most stylish in my 20s, but honestly, style and confidence only get better with age. And that is why I love figs. These scrubs are beautiful, comfortable, and they are built to last. They're not those boxy, scratchy uniforms that we all started out in. No, no, no. These fit perfectly, they feel amazing, and the quality is just wow. My favorite color, burgundy. It's chic, it's timeless, and it's even the same color as my apartment because I'm kind of obsessed with it. And I love adding custom embroidery to make my scrubs as personal as my style. And since I work in telehealth, my embroidered figs even double as my ID badge. It's never too late to reinvent yourself or your scrubs. Get 15% off your first order at wearfigs.com with the code FIGSRX. That's wherefigs.com code FIGSRX for 15% off your first order.

[B]

Welcome to Hacking youg 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 frame. Today I'm joined by Sky Waterson for our Research Recap series. In this series, we take a look at a single research paper, dive into what the page paper says, how it was conducted, and try and find any practical takeaways. In this episode, we're going to be discussing a paper called Improvement of Anxiety in ADHD following Goal Focused Cognitive Remediation, a randomized control trial. And this is a study that investigates goal focused interventions and then looks if they can improve executive function and emotional well being for adults with adhd. Not too much to it there. So let's get into it.

[C]

Yeah, let's do it. So this paper is from Norway and really what they were looking for was 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 very useful for people who might have set some goals of their own or struggle with ADHD and goal setting. Because I know a lot of people do.

[B]

Yeah. And it's also. But there is some, like, interesting caveats to when we're looking at this paper too because of, like, looking at who they had as participants, being very focused on people that are motivated to do this kind of thing. So that's. I was like, this is. I understand, because you want to have people complete the study. But then.

[C]

Yeah.

[B]

How effective is like, is that factor alone going to be enough?

[C]

Yeah, 100%. Yeah. So there are a few limitations that we'll talk about. But do we want to 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 want to take us through what this is?

[B]

Yeah. So for their goal management training procedure, they had a structure of like eight weekly sessions where they're, you know, these have 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 because I was like, how does this work? Stop is a technique with the stop state split. And it is a technique to kind of break that mental circuit where you're in auto mode. So you kind of like stop your activity, what you're doing, and then you kind of figure out what state you're in to kind of combat that goal loss idea. And then you, if the task is feeling overwhelming, you can like split the task into smaller parts and figure out how. So. 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 setting.

[C]

Yeah, 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, you know, avoid that reactive dopamine seeking attention switching that we can do when we are sort of like halfway through a task and then we suddenly wake up, if you will, and we find ourselves 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, 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, 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.

[B]

Yes.

[C]

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 I mean, 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 going to get any results if you don't. But it's different from our purely pharmacological interventions.

[B]

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 going to go for it.

[C]

Yeah, yeah. And. And it's interesting to note, and I think 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.

[B]

So. 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 because they had different results on like who finished what.

[A]

Yes.

[B]

And so, but GAS was also then. So the goal attainment scaling. Sorry, I. Reading through the paper and seeing like, oh my God, they used a lot of the acronyms and I had to go back over and over again to try to remember what they were. But yeah, goal attainment scaling.

[C]

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.

[B]

Yeah, I have my notes here where this is what this is, because otherwise it's way too complicated. But the goal attainment was pretty. Participants attending four individual 45 minute sessions. So this is like bi weekly. 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 out of bed before, like 9:00am or, you know, practicing the stop technique from the goal management training. And then each goal was measured on a scale of, you know, 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. It was a method to measure the progress they were making on their goals.

[C]

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, 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?

[B]

I felt especially with the fact that we had motivated people like this was a lot, you know, of a lot of 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.

[C]

Yeah.

[B]

Is the accountability what you want to do?

[C]

Yeah, yeah.

[B]

And so when I was like, okay, you have these, you know, workbooks that you're learning about absent mindness and automatic pilot, these mental slip ups where you're doing the wrong thing, you know, to get. The biggest thing they saw was a reduction in anxiety. And that's kind of what this looked like. It would be, for me, it would be more of an anxiety program rather than a specific ADHD program.

[C]

Yeah, yeah. And that was, I think, the tr. The thing because. Yes. To, 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.

[B]

Yeah, and I can definitely see what I mean. And there's no question that's great.

[C]

Yes.

[B]

Reducing anxiety is, you know, that in itself can have, you know, effects on your executive function. Having less anxiety, worrying about things, it's great. 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.

[C]

I think that's one of the problems with some of the system improvements that we use. Like if you type in, if you ask ChatGPT, 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 because I think it's just a more complicated, lesser known problem. Like, for example, when I was looking at the mental black board, 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, you know, breaking things down and how it works and how to filter it. And I feel like mechanically, if you're trying to support executive functioning, you need more mechanics that are going to work for the ADHD brain.

[B]

Yeah, yeah. It's not just because. 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.

[C]

Yes.

[B]

Because it can become. Breaking down tasks can also become overwhelming when you're like, oh man, that was not one task. That's 50 tasks.

[C]

100%. 100%. 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, 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.

[B]

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.

[C]

Okay.

[B]

But it's a bad way to treat your adhd and it leads to like, that's a big factor in burnout is being just like, oh, I'm just running on anxiety. I can't because yeah, 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 going to forget.

[C]

Yeah, yeah.

[B]

So learning techniques to be like, oh, I'm not going to keep everything in my head would reduce anxiety, but it might not necessarily increase the amount of stuff you're getting done.

[C]

Yeah, yeah, exactly. And I think that's maybe the complicated part of this conversation is, you know, these people were very, 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, you know, going, well, I feel less anxious and they feel

[B]

a little bit better.

[C]

But there's probably a piece missing where they're still like, I'm going to feel a little bit more overwhelmed soon once this very intense accountability drops off.

[B]

Yeah. It'd be really interesting to then have another follow up. So they have this, like, initial eight week and another one after. They're not doing any interventions.

[C]

Yeah.

[B]

What has stuck? What has. Did it help in the long term rather than just while it was going, while it was happening?

[C]

Yeah. But, you know, in terms of what we can take away from this, I think we can say that, like, that support, that accountability. That intervention does have shifts and it does help. And also that, you know, it is good doing these kinds of stuff. Reflect. What am I doing? What am I doing next in terms of improving anxiety?

[B]

Yeah. And if you are dealing with anxiety. Yeah. Definitely try out these techniques because it's something that we have data. Yeah, this helps, but you just need to actually do it.

[C]

Yeah. Yeah, 100%. Hello. So you were just listening to a research recap. I'm Skye Waterson of Unconventional Organization. If you like that, there's lots more. More information about ADHD and support for you@unconventional organization.com you can go ahead and check that out. Lots of free resources, lots of strategies, and if you want to join our programs, you can do that as well. And we'll see you there. Unconventional Organization.

[A]

Hi, I'm Katie Duke, and I've been a nurse for over 20 years. Listen, I used to think that I was my most stylish in my 20s, but honestly, style and confidence only get better with age. And that is why I love figs. These scrubs are beautiful, comfortable, and they are built to last. They're not those boxy, scratchy uniforms that we all started out in. No, no, no. These fit perfectly. They feel amazing, and the quality is just, wow. My favorite color, burgundy. It's chic, it's timeless, and it's even the same color as my apartment because I'm kind of obsessed with it. And I love adding custom embroidery to make my scrubs as personal as my style. And since I work in telehealth, my embroidered figs even double as my ID badge. It's never too late to reinvent yourself or your scrubs. Get 15% off your first order. @wearfigs.com with the code FIGS RX. That's wherefigs.com code FIGSRX for 15% off your first order.