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tl;dr: Executive dysfunction is common and can make uni intolerable.  The successor to this project is open to all. Sign up to be an accountability partner now, or tell us in the comments what's needed.

 

I (Gavin) keep meeting young people who struggle enormously with university. I now personally know 9 EAs who suffered lasting mental health problems they associate with uni, or who are currently thinking of dropping out. (This is about 5% of all EAs I have spoken to intimately.) 4% of EAs taking the 2019 Survey reported “Some college, no degree”. 3% of EAs in the 2020 SSC survey reported having less than an associate degree as their completed education.

There's nothing inherently wrong with dropping out: uni isn't for everyone. But we (Damon and Gavin) think this implies a few problems:

  1. Some EAs are on suboptimal trajectories because of poor fit with uni / other mental health problems.
     
  2. There's a shortage of in-community coaching and mentorship, particularly for people with these problems / less obvious potential.
     
  3. Dropping out entails shame or trauma - even though dropping out isn’t a strong disqualifier in many careers, including EA careers. Prospective suffering makes (1) much worse.
     
  4. The above, and lack of attention to the above, harm community morale, even among those who don’t themselves have these problems.
     

Some people aren’t constituted to sit through college, or doubt the emotional cost-benefit ratio in their case. Some could make it through with less trauma, given a bit of help. So we’re doing something for people who struggle in these ways. 

Gavin’s hunch was that executive dysfunction was the major neglected factor (distinct from well-known conditions like anxiety, depression, or scrupulosity). Damon (a professional therapist) came on board to dig into what that actually means, and we designed a survey to test the hunch. We did some small things on our small exploratory grant and have ideas for how to scale up.


What is executive dysfunction?

First things first; “executive dysfunction” is not a diagnosis. Executive functions are what govern our ability to plan actions, take those actions, maintain focus on them, adapt to changes, and more subtle steps between. 


ADHD is a diagnosis that points to a cluster of common struggles with executive function: working memory, impulse control, and self monitoring. But there are plenty of other diagnoses that can impact one or more of those eight, and of course even things like lack of sleep, hunger, being irritated, disruptive environments, and other stressors can affect them. 

So in general when we talk about executive dysfunction what we’re really pointing at is a symptom we witness when someone isn’t able to act on their desires, or on things they think they should do, or on things they think they should desire. 

Which brings up the more philosophical question; what does it mean to “fail to act” on a desire? Does someone “have executive dysfunction” if they struggle to complete something they don’t want to do, but feel they have to? What about what they “want to want” to do, but don’t find interesting, even while they can still work on passion projects without issue? Or is it only executive dysfunction if they can’t bring themselves to work on something they feel a strong desire to do, in which case what does “strong desire” mean?

All this makes the question of whether someone struggles with executive dysfunction ill-posed. The better question is “in what domains or in what types of circumstances does someone struggle with executive dysfunction,” followed by narrowing down to which of their executive functions are the chokepoint. Organization? Task initiation? Emotional control?

(I’m also not a fan of “emotional control” as a phrase, as it implies something like stifling or dampening or wrestling with your emotions. This might accurately describe the feeling for some people, but integrating emotions in a healthy way doesn’t have to feel like any of that)

With this more precise understanding, the possible interventions also become more clear. Organization and planning skills can be learned, as can self-awareness and emotional integration. Multitasking and working memory, meanwhile, are harder to improve, and so reducing distractions by adjusting the environment might be more effective.

But most importantly, the question of whether the task is tied to a “want” or a “want to want” or a “should” can itself guide people to better understanding whether their struggle is one that is worth resolving at all, as compared to one that isn’t worth the costs compared to other actions or paths. Many people have pushed through some difficult job or university degree and were glad they did; others regret time wasted and emotional suffering endured for a goal that didn’t end up mattering to them.

Which is why executive dysfunction should not be treated by default as a difficulty that needs to be overcome. Instead it can also be a signal from one or more of your parts that the path you’re on is not the right one for you, and that you might benefit from searching for other, better roads, or even goals.

Along with depression and anxiety, additional factors can exacerbate executive dysfunction, such as perfectionism. The idea that anything tried must succeed, or be done perfectly, often leads to a feeling of dread or hopelessness at the prospect of even starting a task. This is particularly exacerbated by OCD.

Which leads to a general theory of treatment that includes things like exploring motivations and dissolving “shoulds” as a first step before taking for granted that failure to do something is about the person rather than the thing they’re trying to do. 

Once that’s done, only then is it useful to focus on strategies for breaking tasks down into simpler versions of themselves, finding tools and contexts for improving focus and accountability, and generally working around that colorful circle up there as much as possible to improve all the ways executive functions might be disrupted. For example, since past difficulties can exacerbate this sense of predicted suffering or failure, it’s also important to focus on small, achievable steps that are more likely to succeed and thus increase predictability of success.

[The above refers to the parts model of the self, and to the therapeutic idea of systematically replacing the concept "should" with less normative framings. A lot of people find these helpful, but they're not consensus views and they don't work for everyone.]

You can read more about Damon's research on Procedural Executive Function here.

Survey

Here’s the survey we sent out. We sent it to the EA Corner Discord and to a few other places students go.

Survey results

Since it selects for people struggling, the survey can’t answer how large the problem is. But we got 74 responses, which is more than enough of a constituency anyway. 


We really should have separated out procrastination from executive dysfunction. But a (suitably weakened) version of the hunch is confirmed. 

 


Themes in "What has helped before?"

Accountability: Deadlines, Accountability Partner/Group, Academic mentorship, rapid feedback loops, Bets with friends, Friends/partner, studying in the library, housemates, coworking

Productivity: Boss as a service, Beeminder, Focusmate, website blockers (Freedom), productivity gamification apps, habit trackers, Apple watch, tracking work time, Pomodoros, Routines/structure/weekly planning

Psychology: Therapy, finding purpose, following personal interest, social support (friends), self-care/love/acceptance, accepting own difficulties, EA Mindset, journalling, Meditation, anxiety reduction techniques, gamifying tasks, gap year, CBT techniques

Medication: Ritalin, Caffeine, Antidepressants, ADHD medication, Adrafinil, SSRIs, Adderall

Themes in "What do you need?"


After asking them a freetext question about what would help, we also asked:


Since a large minority of people mentioned this without being primed, and a large majority thought it could work for them after being prompted, we decided to go ahead and pair people up. (No particular evidence base for this, it just makes sense.)

Accountability partners

You can sign up to be paired with an accountability partner here. (If you already filled out the survey, check your email.)
 

What we’re doing about it

  • DONE: Survey of people struggling (n=74)
  • DONE: Interviews with excellent dropouts (3 out of 5 done, posts forthcoming)
  • DONE: Invited survey respondents to be accountability partners
  • TODO: pilot of executive dysfunction coaching
  • TODO: evaluate the peer accountability pilot
  • TODO: work out what other help to provide (see below)

 

Possible larger programmes

1. Free Support Booking: we book external support for people we identify 

We use the survey to identify people, then contact them and find out what kind of
support they need (e.g. therapy; a tutor for their subject; life coach; career coach). Then we book a few sessions for them - say 10 and so ~$600 per mentee.
(Booking for them sidesteps the executive dysfunction.)

After that, recruitment via word of mouth.

Pros: no adverse selection, minimal coaching iatrogenics, low time investment
Cons: unfair, small-scale / money intensive, no community signalling or belief correction

 

2. Identify a few great EA coach candidates and pay for their training

We’ve met 3 people interested in becoming a part-time EA coach. With help from our advisors, we should be able to identify more and test them out. Then pay them to take proper courses. Let them reach out to people who opted in on the survey, at subsidised rates.

Pros: useful for everyone, not just the struggling. Low iatrogenics.
Cons: Not as targeted
 

Thoughts welcome.

Concerns

  • Iatrogenics. It would be bad to nudge people into dropping out if that’s not actually what’s best for them. And it’s incredibly hard to know what’s best for them.
    Mitigation: mental health professionals and other people who know how to back off.
     
  • Adverse selection. An earlier version of this aimed for unconditional support, but this would quickly get swamped.
     
  • Perverse expansion of EA into a mini society. Do we even want to replace general mental health professionals / student support with community stuff?
    Mitigation: We’re not replacing anything, we’re supplementing.
     
  • Perverse retention. Part of the problem is about retention: not losing people from the community just because they’re unlucky. But there should be graceful routes for people to decide EA isn’t for them too. A non-EA mental health worker is one of these routes.
    Mitigation: But EA support people can easily do it too, by just not being naive fanatics.
     
  • Scope creep. No single project can take on all of community mental health. Even “student health” is too big. But the temptation will be to include more things as time goes on.
    Mitigation: we just handle people struggling with uni, and just the executive function bit
     
  • I’ve mostly been focussing on undergrads, but others think PhDs are a good shout. We're not going to exclude them.
     

How do I get involved?

  • If you’re struggling at uni, the survey is still open or you can sign up for accountability now.
  • If you have ideas, comment below!
  • If you want to fund this, get in touch. (The only cost currently is Damon’s time, which Gavin views as a bargain for the sanity checking and risk mitigation alone.)

 

Thanks to Carolin Basilowski for analysis and Howie Lempel, Aaron Gertler, Nora Ammann, Linh Chi Nguyen, Quinn Dougherty, and Chana Messinger for comments.


 

Comments26
Sorted by Click to highlight new comments since: Today at 4:42 AM

What a great goal, and the early steps you've made here feel like address many of my concerns. I think it's great you did an initial survey and will be doing a pilot of executive function coaching - as I read, I had the thought that I have no idea how easy it is to do executive function coaching well, or how easy it is to make things a lot worse, so piloting it seems exactly right. 

With love and support for the project, I'll note a couple remaining concerns:

Minipoint about price: I have never paid for things in the realm of {coaching, therapy, tutoring} that were <= $60 an hour. As a tutor I have charged both 1/3 of that and an order of magnitude more than that. Do you feel confident those things will be available at that price, or is the difference in money there not very important?

First concern: Helping with perverse retention

Perverse retention. Part of the problem is about retention: not losing people from the community just because they’re unlucky. But there should be graceful routes for people to decide EA isn’t for them too. A non-EA mental health worker is one of these routes.
Mitigation: But EA support people can easily do it too, by just not being naive fanatics.

I'm not sure what role not being a naive fanatic (or the linked post, the importance of taking care of one's self) is playing here. Is the idea that thoughtful EA support people will float the hypothesis "maybe EA is not for you?" when appropriate? 

The concerns about perverse retention seem like:

  1. People won't leave EA even if they should because that's where their mental and financial support is coming from
  2. People won't leave EA even if they should because their support person is an EA and they're so nice and great and you don't want to disappoint them
  3. People won't leave EA even if they should because their support person is trying to do everything to keep them there
  4. But then also, if I were an EA support person, while I would be totally comfortable suggesting that EA isn't the right choice, I would feel in a weird position if someone still wanted my time. I would probably want to give that time! But I would have signed up because I want to support people who either share my values or I think are likely to make the world better or because I want my community to be a good community. Helping other lovely people is good, but not what I signed up for.

So I'm not sure which of these the mitigation addresses, and I don't really know how to mitigate any of these, except that 3 is very bad and hopefully no one like that will end up being a support person, and 1 and 2 can maybe be mitigated by gentle support?

Second concern: Parts Model

Which is why executive dysfunction should not be treated by default as a difficulty that needs to be overcome. Instead it can also be a signal from one or more of your parts that the path you’re on is not the right one for you, and that you might benefit from searching for other, better roads, or even goals.

This reads to me as this parts model being uncontroversial, real, and the right way to think about one's self, without any flagging that this Off-Road experiment is taking a very particular view on the matter. Maybe this post is that flag? It does spend the first half laying out its view on how to help and why that's the right intervention point for Off-Road, so maybe I'm totally off base here, but while "executive function is the right intervention" felt like it got labelled as a hypothesis and explained, this parts thing didn't. Is it so uncontroversially true (and a useful lens) that it doesn't need to be flagged? Is this cordoning off a certain section of the space and other people should do non-parts-based work, or is this an attractor in the space of trying to help? 

A therapist friend of mine says that IFS done badly can be extremely harmful (probably not a concern here since "therapy" won't be the main dynamic) and a CFAR person we know thinks that thinking of yourself in parts is one of the more potentially dangerous things CFAR teaches.

But also parts of it seem very commonsensical, and certainly lots of people find it useful. (I find it semi-useful, and also worry it gives people a superweapon with which to describe me in ways I can't push back on).

Anyway, I bumped on it.

Potential worries: people will update too strongly that this is the consensus or universal view, or that help of a different kind will be harder to find because the lacuna won't be obvious.

Third concern: Getting rid of shoulds

I don't have a ton of evidence in this area, and (everyone - 1)  I know who has read Replacing Guilt has liked it (including me, though I don't seem to have liked it as much as other people), so there's a lot of reason to dismiss what I'm saying here. Also, there are elements of Nate's thinking that I have incorporated into my own life and my teaching of high school students for years, including before I read his work; there was a synchrony of thinking. 

Nonetheless, getting rid of shoulds entirely feels like a very strong intervention and I have some Chesterton's fence intuitions about it. I also personally don't really like the idea of EA being a place where moral obligations don't matter, seems like it takes away a really beautiful and core element, though the proof will be in the pudding if the world is made better that way. 

So a project that again seems framed as general help having this particular view without maybe a big flag saying where it stands (again, could be this post, but I suspect would need to be a bigger flag than that) worries me.

Same worries as above: people will update too strongly that this is the consensus or universal view, or that help of a different kind will be harder to find because the lacuna won't be obvious.

Conclusion:

None of this makes me think the project is bad or net negative, and I erred on the side of stating rather than non-stating concerns, so take them under wing if they're useful and not if they're not. Fwiw, the first one is the biggest concern to me.

Gavin covers the rest of it, so to talk about the "parts" thing; in this context I'm using it more as a semantic handle on what it means to have internal conflict, and not explicitly as an IFS thing. Psychotherapists have been talking about individuals as being made up of "parts" from the very beginning (Freud's Id, Ego, Superego) and  with all due respect to our mutual CFAR friend, if there's any other way to describe and interface with the experience of internal conflict as well, I have yet to hear it :) 

In other words, I've written "a signal from one or more of your parts" as basically equivalent to "a signal that you aren't fully convinced." I think the latter is lower-resolution way of saying the former, but could be convinced it's better if people largely expect the coaching to center around IFS-type things.

As for "shoulds," I think we can get rid of the way they exist as harmful things without eliminating what you call "moral obligations,"  which I agree are good things (and sort of important to the "Altruist" part of Effective Altruism!). Basically I consider the two phrases to be pointing at very different phenomena in general; I think "shoulds" comes from an external source, even if it's been internalized, while moral obligations are the result of internal generators, and aren't the sort of thing that would respond to the sorts of questions and interventions that  tend to dissolve shoulds.

The thing about parts not being necessarily about IFS specifically should have occurred to me, thank you!

Thanks Chana! I appreciate you thinking hard about this, and hope it'll make us more careful and good.

Price. My EA coach is $60 an hour (with student discount), which is my only datum. Happy to amend given more data.

Retention. Yeah, you capture what I was thinking about with (3): not being a naive optimiser, not squeezing as many people into EA as you can despite their misery and lack of fit. The self-care link is pointing at the same vague spirit: don't routinely crush feelings (in that case, your own). Both my and Damon's instincts run pretty heavily against indoctrination, so we should be able to spot it in others. I don't think we'll set any policy about continuing to help people after they leave EA, that's clearly a matter of conscience n context. 

I take (1) and (2) pretty seriously, but Free Support Booking, the current leading idea, is designed to mitigate them ~completely: the idea is we book "external" (non-EA) support people. I just forgot to say this at any point. Only trouble is the money.

Parts. I'll let Damon respond in full, but my take is: I don't think that sentence is meant as a strong claim nor mission statement. Parts stuff is a mental model: often useful, always extremely unclear metaphysically. Taken metaphorically ("as if I had several subagents, several utility functions, internal conflict"), it seems fine. We haven't designed the coaching yet, but it won't involve intense IFS or whatnot. 

I find it hard to think about the baseline risk of all psychological intervention (all intervention), which is what I take your concerned friends to be denoting. Going to a standard psychodynamic therapist seems similarly risky to me (i.e. not very).

Shoulds. Happy to flag it. (I personally get a lot out of shoulds, so we're not the anti-should movement.)

Thank you! This makes sense to me.

Signup seems broken because the Doodle no longer works. I would like to sign up as an accountability partner, purely as holding someone else to account, I don't think I need someone else to hold me to account (for now at least). PM me for my email.

Thanks: you can apply here.

I've edited the post to link to the successor project.

Here’s the survey we sent out. We sent it to the EA Corner Discord and to a few other places students go.

 

  • Which other places did you send this out? 
  • Did you capture data on who these students were (e.g. which regions / universities / subject of study etc.) and their level of involvement in EA (e.g. time spent on EA / events attended / decisions taken)?

We sent it to student groups and to a few extremely well-connected people we know through ESPR. 

We got the universities incidentally, from the .edu and .ac.uk email addresses. No involvement question,  self-definition is fine for now.

I think many people should drop out of collage and don't, and I think this very much happens due to social pressure and "committing to people that I'll graduate". I'm adding this as a concern (the opposite of yours where you expect social pressure will CAUSE people to drop out)

 

(this is just a side point. The project sounds great)

Some should, some shouldn't and I find it hard to tell who is what.

Just wanted to say "great job" in doing your research, finding collaborators, and getting the support to carry forward the work!

Point someone raised offline: The above talks as if executive dysfunction or school suffering is an EA problem, or disproportionately represented in EA. Neither are true.

The explanation is, I find myself automatically thinking in terms of multipliers (helping someone who could do great thing vs helping someone else) and then the whole project is quietly conditioning on that. I notice that I really don't want to do this automatically.

Offer this for graduates and early career (EA) professionals as well? 

This seems potentially quite useful not only for students but also for early career professionals - especially those who don't (yet) have a team nor a good manager or mentor to work with (e.g. people doing independent AI alignment research funded by EA Funds) - as well as graduates who are currently planning their career. Career planning is one of the hardest things to do in general, and probably even more difficult for people with executive dysfunction due to lack of deadlines and accountability, lots of uncertainty and rabbit holes to get lost in, others pushing you in different directions like parents who don't understand what you're doing and keep asking you why you don't want to become a doctor, lawyer or other "decent jobs" in their opinion etc. 

Do you think it makes sense to try out working with that group as well? Maybe even minimal infrastructure such as a well-moderated peer support group for early career professionals with executive dysfunction or ADHD would be helpful, even if you don't do much more than that. 

I run the EA coworking discord server and was curious if you would be open to collaboration opportunities. At the moment, there seems to be at least one person on the coworking server every other day if not every day. Here's the link to the EA coworking server: https://discord.gg/5FGY4PyEcT

Possibilities:

  • having regular coworking sessions on the EA coworking server
  • matching people on the EA coworking server to be accountability buddies
  • having daily check-ins on the server
  • hosting events about executive dysfunction / productivity

Let me know what you think!

Sounds good to me

I am really happy that someone is doing this, and I would have loved to take part in this when I was in uni! 

That however gets me thinking: Isn't this something that should be open to non-students as well? I am part of the EA group on Focusmate (for me a real life / job saver), which seems to include a lot of non-students, and I know for a fact that I could still really benefit from having an accountability partner that shares some of my values. Is the plan to test this with students and later see whether this could work for others as well? Or is the focus just on students because that is generally where we see executive dysfunction? Or because it is the group most interesting for community building? 

Completely fair. A fully scaled and suitably ambitious version of Off Road would indeed address this. But this is a pilot, and scope creep is fatal even for mature projects.

Reason I focussed on students is because that's what the examples I met were and because it's a relatively high leverage point in their lives.

I'm looking for people to help build it up; I've found someone to do the matching (and the accountability idea is free besides that) already, so we can scale that to nonstudents.

(See also) https://forum.effectivealtruism.org/posts/8ekqxkowckzEKu3uG/off-road-support-for-eas-struggling-at-uni?commentId=3G3GppqrwZSxeDBgP

Makes sense and I will definitely keep an eye on whether you guys make something available for everyone! :) 

I'm coaching EAs now and would be happy to talk to you about "2. Identify a few great EA coach candidates and pay for their training". I have a sliding scale and offer discounts for full-time students. You can DM me at dave.coaching@pm.me

More info about me on  EA Mental Health Navigator and LinkedIn.

Hi Dave, emailing you now :)

Wonderful work! I have nothing I can offer other than encouragement as this defiantly seems worth researching!

I don't have much to add or say about this, other than that I love it and support it! Please keep on doing this!

Is this still live? And if it is, is it expanded or still just for college students?

A successor project is live here, takes all comers.

Ah cool, thanks. Would probably include that at the top of the post for others who may be interested.

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