Picking apart what's possible with ADHD
March 16, 2022 6:54 AM Subscribe
I'm beginning my journey to understand ADHD and how it has impacted my life. I believe it is possible to use CBT to increase focus and decrease impulsivity, but to what extent is it worth it, or a good idea? How much should I try to "train" myself to pay more attention, vs accept myself the way I am and create support structures, vs wait for the medicine to kick in?
I am 36. I suspected I might have ADHD based on conversations with my family. I got a diagnosis from a medical professional last month and I am currently dialing in a medication under my PCP's supervision. My therapist is great at CBT and talk therapy but admits having little experience with ADHD.
I just finished the book "Taking Charge of Adult ADHD," based on the author's interview on the Ologies podcast. It was a fantastic book and I highly recommend it (with grains of salt, of course). The book had many useful suggestions for how to understand and work with your ADHD to thrive - just what I want.
Some techniques I can use are supports, for instance "When you have a random idea you want to look up on Wikipedia during work, write it down and look it up during your break."
Other techniques are about behavioral change, like "If you think of something to look up on Wikipedia, remind yourself of your goal (keeping your job), decide to ignore the distraction, and continue on."
I've done a lot of both over the years, so I know they are possible, but I also know how much effort they can be, and how overwhelming. I spent my teens and 20s believing the way my brain worked was broken, and carried a lot of guilt over not being able to fix it. And, I built rigid structures to support correct behavior (schedules, lists, charts, etc) that turned into an insurmountable mountain of self-imposed responsibility. It was totally out of balance with what is required, realistic, or rewarding. I don't want to do that again. But, I do want to use my new knowledge of ADHD to set healthy goals and improve my life.
That's why I was hoping to hear how other folks have found this balance, especially if you were only diagnosed with ADHD later in life, like me.
And I'm also curious to what extent the third option is the most useful - that once I get a medication that works for me, I'll simply find much of my issues with these things melt away. That's what I've heard before - so maybe I should try to do nothing different at all.
I am 36. I suspected I might have ADHD based on conversations with my family. I got a diagnosis from a medical professional last month and I am currently dialing in a medication under my PCP's supervision. My therapist is great at CBT and talk therapy but admits having little experience with ADHD.
I just finished the book "Taking Charge of Adult ADHD," based on the author's interview on the Ologies podcast. It was a fantastic book and I highly recommend it (with grains of salt, of course). The book had many useful suggestions for how to understand and work with your ADHD to thrive - just what I want.
Some techniques I can use are supports, for instance "When you have a random idea you want to look up on Wikipedia during work, write it down and look it up during your break."
Other techniques are about behavioral change, like "If you think of something to look up on Wikipedia, remind yourself of your goal (keeping your job), decide to ignore the distraction, and continue on."
I've done a lot of both over the years, so I know they are possible, but I also know how much effort they can be, and how overwhelming. I spent my teens and 20s believing the way my brain worked was broken, and carried a lot of guilt over not being able to fix it. And, I built rigid structures to support correct behavior (schedules, lists, charts, etc) that turned into an insurmountable mountain of self-imposed responsibility. It was totally out of balance with what is required, realistic, or rewarding. I don't want to do that again. But, I do want to use my new knowledge of ADHD to set healthy goals and improve my life.
That's why I was hoping to hear how other folks have found this balance, especially if you were only diagnosed with ADHD later in life, like me.
And I'm also curious to what extent the third option is the most useful - that once I get a medication that works for me, I'll simply find much of my issues with these things melt away. That's what I've heard before - so maybe I should try to do nothing different at all.
For me medication is a game changer, and makes strategies like you’re talking about so natural that they’re really not even strategies. I am skeptical of the benefits of CBT for ADHD in general and even more skeptical of the benefits of embarking on CBT for ADHD with a practitioner who has little experience with ADHD. I would recommend asking for a referral to someone who does have expertise.
posted by Kriesa at 8:24 AM on March 16, 2022 [1 favorite]
posted by Kriesa at 8:24 AM on March 16, 2022 [1 favorite]
There are some great resources for adult ADHD on the web.
Black Girl Lost Keys is a great website and Twitter feed, including helpful merch like pill-organizing water bottles.
ADHD Alien is a series of comics that explores the ADHD experience. Tremendously validating!
posted by SaharaRose at 9:17 AM on March 16, 2022 [1 favorite]
Black Girl Lost Keys is a great website and Twitter feed, including helpful merch like pill-organizing water bottles.
ADHD Alien is a series of comics that explores the ADHD experience. Tremendously validating!
posted by SaharaRose at 9:17 AM on March 16, 2022 [1 favorite]
CBT can be helpful to unpack the sometimes deeply-ingrained negative self-talk that can come with existing with ADHD. A stat I've read often is that ADHD researchers estimate that by the age of 12, children with ADHD "get 20,000 more negative messages about themselves than other kids their age" I don't have a link to the actual study, so caveats, but it seems more than plausible. Someone without a diagnosis is going to internalize that negative feedback.
But yeah, medication is what is going to make this work possible. In regards to resources, check out How to ADHD on YouTube--Super informative, engaging videos.
posted by Maude_the_destroyer at 9:44 AM on March 16, 2022 [2 favorites]
But yeah, medication is what is going to make this work possible. In regards to resources, check out How to ADHD on YouTube--Super informative, engaging videos.
posted by Maude_the_destroyer at 9:44 AM on March 16, 2022 [2 favorites]
From my research it looks like that, in the studies they've done so far, CBT combined with medication leads to better outcomes (in terms of self-reported and observed ADHD symptoms) than either medication or therapy alone. Basically, though medication is good at improving the physical symptoms of ADHD, it doesn't, on its own, affect the lifetime of habits, coping strategies, and underlying beliefs that you have built up over the years as a person with untreated/unsupported ADHD. And, inversely, only trying to fix your habits can be limited by the physical effects of ADHD (as you have found).
The guilt and shame you describe is so, so common, and exactly the kind of thing that a therapist should be able to help you with. There are therapists who specialize in ADHD, or maybe if your current therapist is willing, you could learn more about it together. If you're in a situation where you CAN get theraputic help, why not do so? You've been trying so hard without the proper support for so long--don't deny yourself that help and support now.
posted by radiogreentea at 10:45 AM on March 16, 2022 [3 favorites]
The guilt and shame you describe is so, so common, and exactly the kind of thing that a therapist should be able to help you with. There are therapists who specialize in ADHD, or maybe if your current therapist is willing, you could learn more about it together. If you're in a situation where you CAN get theraputic help, why not do so? You've been trying so hard without the proper support for so long--don't deny yourself that help and support now.
posted by radiogreentea at 10:45 AM on March 16, 2022 [3 favorites]
CBT is not generally regarded as a useful or even necessarily safe modality for ADHD. I would proceed with caution and consider other therapeutic approaches to get what you need.
posted by Bottlecap at 1:59 PM on March 16, 2022 [1 favorite]
posted by Bottlecap at 1:59 PM on March 16, 2022 [1 favorite]
Best answer: I really relate to this struggle. I was fairly recently diagnosed. I think so many of my habitual patterns of thinking and behaviour are adaptations, some more or less helpful. For example, I do have a habit of writing stuff down - but I write down too much and get overwhelmed. I feel like I have to do something immediately or I will forget it (often true). I think it's unhelpful to think up a system of rules and immediately expect yourself to do all of them. (I read that book as well, and while interesting, I haven't found his whole thing about trying to create a rule to pause before doing something in any way helpful).
I read (listened to 1/3) of another book talking about habit change (called Unwinding Anxiety), which emphasized that you shouldn't try to just will yourself to change habits. It recommended spending a long time just noticing the habits occurring. Once you have noticed them and figured out how they work, you can decide what to change and how to change them. He also talks about how trying to will yourself out of it is basically pointless - he says you should try to reset the reward value of carrying out the habit or addiction by mindfully paying attention to how you feel before and after, all without actually trying to change it. This makes sense to me - I have similarly spent so much time beating myself up over checklists, and lists, and rules, and schedules, and it's not helpful.
You only have so much mental brainpower, and have to decide how to use it that will best help you. That might be changing a habit or pattern of behaviour, or it might not be worth doing so. I think you have to try to find a very simple, potentially impactful place to start that is accomplishable. For me, I think that's just "notice when I've gone off task" - still very much a work in progress. Noticing is hard enough in itself - once you've worked on that, maybe you'll be in a better position to make decisions about it. I don't think you have to do anything more than noticing to start with.
I also have tried to set times where I have to try, and times when I don't. I'm trying to make the morning my "work chores" time where I do all the horrible tasks I hate (responding to emails and juggling various things). But then, for the rest of the day, I don't have to try to compel my brain to work in a way it is not used to, and just do things the way that I have adapted to do them (trying to make modifications around the edges).
I also think that you need to see the adaptations you've created as skills and gifts in themselves. Like probably a lot of ADHD-ers, I can pull together a project at the last minute like no one's business. However, I tend to tell myself that that's a bad thing and I'm horrible for doing so. Sometimes, you just have to lean in to the procrastination - productively procrastinating on one thing until you just have to do the other. It's stressful, but it's much less stressful if you stop beating yourself up for doing things the "wrong way".
This podcast - Something Shiny - is generally great and had two great episodes on doing things the "right way". Episode 007: Isn’t there a right way of doing things?, and Episode 008: Are we designed to procrastinate?. I would listen to the whole thing though - I found it much more compassionate and realistic than that book. It's by two therapists who themselves have ADHD.
This was long and scattered (surprise surprise). Basically, I think you should give yourself a break and be as kind to yourself as possible. I don't think you should spend any time right now trying to train yourself to focus more. Easier said than done - but I would not let prescriptive "rules" that you guilt yourself into continue to be your primary means of motivating yourself. Guilt builds up because it's the only way some of us have to do things - it takes a long time to break that down. Just forgiving yourself and trying to think more kindly of yourself might increase the amount of cognitive power you have available by reducing the emotional burden. I would just try noticing the thinking habit of guilting yourself and how it feels, before even trying to change that - let alone trying to compel yourself to focus.
I hope you are able to use the diagnosis to improve things for yourself. Certainly has for me - medication but also understanding how my brain works. After much therapy, the conclusion is just that I need to try to be kind to myself and feel my feelings or whatever - and I think that is correct as an approach.
posted by lookoutbelow at 6:07 PM on March 16, 2022 [8 favorites]
I read (listened to 1/3) of another book talking about habit change (called Unwinding Anxiety), which emphasized that you shouldn't try to just will yourself to change habits. It recommended spending a long time just noticing the habits occurring. Once you have noticed them and figured out how they work, you can decide what to change and how to change them. He also talks about how trying to will yourself out of it is basically pointless - he says you should try to reset the reward value of carrying out the habit or addiction by mindfully paying attention to how you feel before and after, all without actually trying to change it. This makes sense to me - I have similarly spent so much time beating myself up over checklists, and lists, and rules, and schedules, and it's not helpful.
You only have so much mental brainpower, and have to decide how to use it that will best help you. That might be changing a habit or pattern of behaviour, or it might not be worth doing so. I think you have to try to find a very simple, potentially impactful place to start that is accomplishable. For me, I think that's just "notice when I've gone off task" - still very much a work in progress. Noticing is hard enough in itself - once you've worked on that, maybe you'll be in a better position to make decisions about it. I don't think you have to do anything more than noticing to start with.
I also have tried to set times where I have to try, and times when I don't. I'm trying to make the morning my "work chores" time where I do all the horrible tasks I hate (responding to emails and juggling various things). But then, for the rest of the day, I don't have to try to compel my brain to work in a way it is not used to, and just do things the way that I have adapted to do them (trying to make modifications around the edges).
I also think that you need to see the adaptations you've created as skills and gifts in themselves. Like probably a lot of ADHD-ers, I can pull together a project at the last minute like no one's business. However, I tend to tell myself that that's a bad thing and I'm horrible for doing so. Sometimes, you just have to lean in to the procrastination - productively procrastinating on one thing until you just have to do the other. It's stressful, but it's much less stressful if you stop beating yourself up for doing things the "wrong way".
This podcast - Something Shiny - is generally great and had two great episodes on doing things the "right way". Episode 007: Isn’t there a right way of doing things?, and Episode 008: Are we designed to procrastinate?. I would listen to the whole thing though - I found it much more compassionate and realistic than that book. It's by two therapists who themselves have ADHD.
This was long and scattered (surprise surprise). Basically, I think you should give yourself a break and be as kind to yourself as possible. I don't think you should spend any time right now trying to train yourself to focus more. Easier said than done - but I would not let prescriptive "rules" that you guilt yourself into continue to be your primary means of motivating yourself. Guilt builds up because it's the only way some of us have to do things - it takes a long time to break that down. Just forgiving yourself and trying to think more kindly of yourself might increase the amount of cognitive power you have available by reducing the emotional burden. I would just try noticing the thinking habit of guilting yourself and how it feels, before even trying to change that - let alone trying to compel yourself to focus.
I hope you are able to use the diagnosis to improve things for yourself. Certainly has for me - medication but also understanding how my brain works. After much therapy, the conclusion is just that I need to try to be kind to myself and feel my feelings or whatever - and I think that is correct as an approach.
posted by lookoutbelow at 6:07 PM on March 16, 2022 [8 favorites]
Response by poster: you should try to reset the reward value of carrying out the habit or addiction by mindfully paying attention to how you feel before and after, all without actually trying to change it.
Thank you, lookoutbelow - your whole comment was really helpful. I've noted it down in my journal, especially the above line.
posted by rebent at 5:15 AM on March 17, 2022 [1 favorite]
Thank you, lookoutbelow - your whole comment was really helpful. I've noted it down in my journal, especially the above line.
posted by rebent at 5:15 AM on March 17, 2022 [1 favorite]
I think it's possible to train yourself in useful actions/ behaviors more than paying attention, which is a general term for a group of behaviors that are really difficult with attention deficit. I was diagnosed really late, and have so many adaptive behaviors, like having several keys hidden outdoors. I am unable to take medication, but moderate coffee is helpful. i find it helpful to define the areas that are most problematic. Once of them is leaving the house; it's made worse by social anxiety, which has gotten worse during Covid. When I am leaving, I repeat a list Laptop, Wallet, Mobile, Meds, Glasses, Coffee, Lunch and I still forget my phone more often than I want to say. But it helps a great deal. I rely very heavily on Keep, Calendar, and written lists. I often write a grocery list, then take a picture with my phone, so there's a 98% chance I will have a list at the store. I park near the cart corral near the exit door of any grocery. I take a picture of the locator sign in a big parking lot. Technology makes it a lot easier to manage.
Tons of people have attention deficits, and clearly it has advantages in some areas. I notice things other people don't. I have a vivid imagination. I used to do tech support, and my ability to switch gears for a phone call is impressive. Maximize what this does for you, work on adaptations to live in the modern world. Don't let anyone shame you.
posted by theora55 at 9:26 AM on March 17, 2022
Tons of people have attention deficits, and clearly it has advantages in some areas. I notice things other people don't. I have a vivid imagination. I used to do tech support, and my ability to switch gears for a phone call is impressive. Maximize what this does for you, work on adaptations to live in the modern world. Don't let anyone shame you.
posted by theora55 at 9:26 AM on March 17, 2022
This thread is closed to new comments.
I have ADHD, but I'm 65 and amphetamines are a bit risky. I also am ASD, with a tendency to hyperfocus in a way that makes ADHD look like a picnic. I've become afraid of it. That hyperfocus can last for months! (which was the Big Clue to my ASD).
But hey, now hear this! FINISHING something is the biggest reward! BELIEVE IT! FEEL IT!
Congratulate yourself, pat yourself on the back, and treat yourself. THAT honestly can do much to help you.
posted by Goofyy at 7:06 AM on March 16, 2022 [2 favorites]