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What Is Executive Dysfunction?

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Anxiety, Depression, Mental Health

Here, experts break down everything you need to know about this mental health struggle, from what it is to how to manage it on your own or with a pro.

Do you ever feel like your brain just isn’t doing what it’s, err, supposed to? Maybe you stare at your calendar for minutes only to still struggle with planning your day. Or perhaps you have difficulty regulating your behavior; some days you blurt things out during Zoom meetings, while at other times, you’re quiet to the point that your boss might think your head is in the clouds.

These scenarios are examples of a real phenomenon known as executive dysfunction, and it can happen to anyone. Individuals experiencing executive dysfunction often struggle with planning, problem-solving, organization, and time management — and it’s typically a clue that something larger is going on (anything from depression, ADHD, and other mental health challenges to COVID-19). Ahead, everything you need to know (and then some) about executive dysfunction, what it is, how it works, who it affects, and what to do about it, according to mental health experts.

What Is Executive Function?

In order to understand executive dysfunction, you must first understand executive function. “Generally, [executive function] is a term that refers to a global set of skills related to how people operate in day-to-day life,” explains clinical psychologist Alfiee Breland-Noble, Ph.D., founder of AAKOMA Project, a nonprofit dedicated to mental health care and research. “The American Psychological Association describes executive functions as ‘higher-level cognitive processes,'” which include planning, decision making, and goal pursuit, among others.

“Overall, healthy executive function helps us independently manage daily life and maintain relationships,” adds board-certified neurologist Paul Wright, M.D., senior vice president and system chair of the Neuroscience Institute at Nuvance Health, a not-for-profit health system. “[It] involves behavioral, cognitive, and emotional skills that help us focus, plan, organize, and remember to manage time and practice self-control.”

Say a deadline is unexpectedly moved up at work. Ideally, you find yourself easily able to adapt to the circumstances and brainstorm ways to reprioritize tasks to get the project done ASAP. Such flexible thinking and adaptability are just two of many healthy executive functions.

That being said, this optimal, healthy functioning can ebb and flow throughout your day. “Executive functioning is ‘online’ throughout a person’s waking hours,” explains clinical psychologist Forrest Talley, Ph.D. As a result, sometimes you — and these cognitive processes — might be on autopilot. “Because each of us has spent a lifetime with the type of executive functioning that is ‘normal’ for each of us, it feels just that…normal,” says Talley. However, at other times, you might not excel at, for example, focus or time management. Some of that is just a result of being human. “We can all occasionally be forgetful, have trouble concentrating, and regulating our emotions for various reasons including dehydration, hunger, and sleep deprivation,” says Dr. Wright. But (!) if you find yourself struggling with organizing, planning, problem-solving, and regulating your behavior on the regular, you might be experiencing executive dysfunction.

What Is Executive Dysfunction?

It’s simply the opposite of executive function: Executive dysfunction is when one or more of the aforementioned skills is not working as efficiently as possible, according to communication pathologist and cognitive neuroscientist Caroline Leaf, Ph.D. More specifically, the APA defines executive dysfunction as “impairment in the ability to think abstractly; plan; solve problems; synthesize information; or start, continue, and stop complex behavior.”

Sound familiar? Nearly everyone experiences some level of executive dysfunction from time to time, particularly while emotionally or physically compromised, according to the experts. (To quote Hannah Montana, “everyone makes mistakes, everyone has those days.”)

“Maybe you didn’t get enough sleep, have a hangover, are distracted by financial distress, the illness of a loved one…On these days, we have a hard time concentrating, motivation is harder to find than Sasquatch, planning takes more effort, and emotions get the best of us,” explains Talley. “Don’t jump to conclusions and assume that you are suffering from this malady. Odds are you’re just having a bad day or a tough week.”

That being said, if executive dysfunction seems to happen a lot, then then it may be time to check in with a mental health professional, as a larger issue might be causing these problems, he says.

So, What Causes Executive Dysfunction?

“The list of potential sources of diminished executive function is very long, but common culprits include ADHD, depression, anxiety disorders, severe grief, traumatic brain injury, alcohol, and drug addiction,” says Talley. Leaf echoes this list, adding “learning disabilities to dementia, autism, brain tumors, and extreme unmanaged thoughts and toxic stress” can all cause you to develop executive dysfunction as well.

And while you can technically suffer solely from executive dysfunction (think: those first few overwhelming weeks of the pandemic), it’s more likely to be associated with neurologic disorders (e.g. traumatic brain injury) as well as mood disorders or psychiatric conditions (e.g. ADHD), according to a review article in Continuum. Meaning, executive dysfunction is often considered a symptom of what is usually a larger issue.

Case in point? COVID-19, which is believed to cause some executive dysfunction. A small study from February 2021 found that 81 percent of patients experienced cognitive impairment while recovering from prolonged COVID-19 hospitalization. Those who haven’t had severe coronavirus are also at risk for dysfunction. “We’ve noticed more people experienced problems with executive function skills during the COVID-19 pandemic because they felt anxious, nervous, and frustrated,” says Dr. Wright. (See also: The Potential Mental Health Effects of COVID-19 You Need to Know About)

So, how can you determine if you’re experiencing executive dysfunction? Here are a few telltale signs, according to Dr. Wright:

  • Regularly getting distracted during meetings and conversations
  • Struggling to manage emotions or deal with frustrations
  • Forgetting to do things that have been near-automatic (paying bills, performing basic work tasks without a great deal of effort, etc.)
  • Experiencing general memory loss; poorer than normal levels of forgetfulness
  • Feeling easily overwhelmed by tasks (especially if you’ve been doing those tasks successfully over the past year)
  • Experiencing decreased ability to plan and organize your day-to-day life
  • Struggling to follow step-by-step instructions, or feeling you can’t problem solve
  • Wasting time; generally struggling with time management
  • Overindulging on dessert or junk food due to less self-restraint

How Is Executive Dysfunction Diagnosed and Treated?

Executive dysfunction is not an official medical diagnosis recognized by the Diagnostic and Statistical Manual of Mental Disorder, the catalog of psychological conditions widely used by clinicians to diagnose patients. It does, however, have “a shared meaning and standard of recognition among mental health professionals and educators,” says Breland-Noble. Meaning, if things have been “not quite right” for a while, seeking out a practitioner (e.g. psychiatrist, psychologist) is a good idea, as they can help you get to the root of any executive dysfunction and then, hopefully, address the problem.

Once executive dysfunction is diagnosed by a qualified professional, there are plenty of treatment options available. The key, however, is identification and proactive treatment. If it goes unchecked for a long time, such extended dysfunction “could lead to depressive and anxiety symptoms as well as low self-esteem over time,” according to board-certified psychiatrist Leela Magavi, M.D. So, yes, anxiety can cause executive dysfunction but executive dysfunction can also cause anxiety — an unfortunate cycle. (Related: What Is High-Functioning Anxiety?)

The good news? “Executive functions can return and improve on different levels, which I found clinically with my patients and in my research, whether the person was battling with a TBI, learning disability, autism, severe trauma, or early-stage dementia,” says Dr. Leaf. “With appropriate mind-management practices, my patients, as well as the subjects in my research, were able to significantly improve their executive functioning over time, regardless of [their] past.” (Related: Simple Strategies to Improve Brain Health)

Tools for Managing Executive Dysfunction

Limit screen time. “Limiting screen time and maintaining familiar routines inclusive of mindfulness activities and exercise — as much as possible — could improve focus and motivation,” says Dr. Magavi.

Try therapy. Breland-Noble and Dr. Magavi both cite cognitive behavioral therapy, a form of psychotherapy, as an excellent method for treating executive dysfunction. CBT typically focuses on changing particularly unhelpful or faulty thought and behavioral patterns so that you can “learn better ways of coping” with your psychological challenges and become “more efficient” in everyday life, according to the APA. In other words, CBT directly targets executive functions (e.g. organizing and planning, coping with distractions, adapting thoughts to circumstances, etc.) “to help someone adjust their behaviors around an accepted set of circumstances,” explains Breland-Noble.

Exercise sleep hygiene. As sleep plays a huge role in executive function for everyone, it’s imperative to have proactive sleep hygiene, says Dr. Magavi. That includes things such as not working from your bedroom (since doing so can affect sleep quality), and getting into a routine of going to bed and waking up at the same times daily. (BTW, did you know that sleeping with socks might also help you catch those Z’s?)

Set up a focused workspace. Keep your workspace cool, bright, clean, and organized — all of which helps improve focus, says Dr. Magavi. “Writing down top goals for the day and then crossing these out could also help individuals keep track of tasks.” Sounds simple enough, but for those struggling with executive dysfunction, just remembering to make a to-do list can be challenging. (Related: I’ve Worked from Home for 5 Years — Here’s How I Stay Productive and Curb Anxiety)

Build on your success. Even small successes release dopamine, which can positively reinforce healthy behavior and focus, says Dr. Magavi. On the flip side, low levels of dopamine and norepinephrine can lead to attention deficits. “So any activity that increases these levels could boost focus.” For example, when you’re feeling overwhelmed, give yourself a 30-second task, be it folding one pair of jeans, washing a dish, or writing just one sentence. Celebrate achieving that small assignment, and see if you feel motivated to continue.

For the full article with links in SHAPE click here.

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Anxiety, Depression, Mental Health