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Ordering from a Large Menu

“Psychological treatment may play a critical role in the management of adults with ADHD who are motivated and developmentally ready to acquire new skills as symptoms remit.” (J. of Att. Dis. 2008; 11(6) 642-651) — from the Journal of Attention Disorders.

This may not be news to you, but not everyone with ADHD accepts that taking medicine is usually not enough to meet our needs. This is especially important for adults who didn’t have a diagnosis until years after developing self-defeating habits. Research suggests that medicine can level the playing field and increase the likelihood of benefitting from psychotherapy and other resources.

You should ask yourself if you are living well with your ADHD, if you are satisfied with your marriage, if you are having the success you desire in your career, if you have a healthy lifestyle, if you have satisfying relationships with friends, if you manage your emotional life competently, if you seldom make mindless mistakes in your work, if you are getting things done efficiently and on time, and if you are attaining your goals and living your dream. If professional help could make your life easier and more satisfying, why deny yourself the help?

I don’t know about you, but I can be defensive about these things. I’m competent and should be able to manage my life without help, right? I can tell you this for sure: I never would have gotten my book published without the help of fellow author Melissa Orlov, editor Dave Carew, and the many friends and colleagues who believed, perhaps more than I, that my goal was attainable. I learned that I could finish a project that would take two years from beginning to end. I don’t think I ever completed a project that required more than a two-week commitment! The simple truth is that we are human, and any non-defensive individual can benefit from others who are willing and able to help.

There are many available resources for helping adults with ADHD to function more effectively in their daily lives. My professional colleagues include psychotherapists, neuropsychologists, psychiatrists, professional organizers, ADHD coaches, executive coaches, psychological examiners, career counselors, meditation teachers, a neurodevelopment optometrist, and educational consultants. While you probably don’t need all of these resources, it can help to know that the menu of helpers is big.

A few ADHD professionals serving adults have helped me start a network of providers in Middle Tennessee. We welcome inquiries from other professionals in the area who may want to join in our efforts. Coordination among the various professional services not only can help our clients, but can help us learn from each other.

The Self-Criticism Habit

ADHD symptoms are one thing; habitual behaviors that form around those symptoms are another. The secondary problem of habits may be worse than the primary problem of having ADHD.

All people are prone to habits that are driven by their emotional or cognitive styles. For example, many anxious people habitually avoid situations that make them feel anxious. Surfing the internet can distract an anxious person from dreaded future events. It has an obvious short-term benefit, but an undesirable long-term consequence. Practicing avoidance is not a productive way of coping. The underlying discomfort is the primary anxiety, but the secondary anxiety is more debilitating — i.e., being anxious about becoming anxious. The avoidance habit has a guaranteed reward: immediate anxiety reduction. 

One of the most common behavioral habits I have observed in adults with ADHD is harsh self-criticism. Expecting (or being expected) to deal with life challenges the same way non-ADHD peers do is half the problem. Expecting criticism from others is the other half. Clients tell me that criticizing themselves is like a preemptive strike that keeps judgment from others at bay. 

My clients often don’t even notice how much they criticize themselves until I point it out. Their self-dialogue is like the white noise of a fan running in the background.  Tendencies are harmless unless you don’t see them, or you mistake them for “who you are” rather than “what you’re doing.” You don’t need to change who you are just to change what you’re doing.

The best way to deal with habits that don’t serve you is to develop new habits that will. Don’t think you have to overhaul yourself in the new year. Commit to action that is consistent with your values and then do this when the wheels come off the tracks: (1) put them back on the tracks, and (2) do it without judgment. They will come off again; you can count on it. Practice repeating these two steps as often and as many times as needed. It is like practicing meditation, returning your attention to the present as often and as much as needed.

Zen practice in real time can be better than practicing on a meditation cushion. On the cushion you repeatedly return to the present moment by redirecting your attention to your breath, to your body, to sounds in the present moment, or to a mantra. In “everyday Zen,” you repeatedly return your attention to the task at hand, and without adding the judgment. Cultivate this new habit, and have a Happy New Year!

Love is NOT All You Need

It’s hard to believe that John Lennon’s life ended 37 years ago, on December 8, 1980. As brilliant and creative as he was, he was wrong about one thing: Love is not all you need.

If you want to have a successful relationship, you need empathy, willingness, acceptance, mindfulness, flexibility, understanding, humility, respect, fondness, commitment, and friendship. You can develop effective partnership skills, but trying to change your partner is disrespectful. Skillful partnering is more useful than holding onto selfish notions of an ideal mate.

Love is not all you need. Insisting on unconditional love from your partner is unreasonable. There are important conditions in a skillful partnership, like honesty and respect. They are building blocks for the “house” you are constructing. The more competent you are in building your house, the more content you will be in it.

Love is not all you need. Knowing how to navigate conflicts is essential. Conflicts are normal, but trying to win an argument is harmful. Winning an argument creates a loser, and a sound relationship does not have a loser. What you fight about is less important than how you treat your partner, and trying to be understood is less effective than trying to understand.

Love is not all you need. You need to stop doing harm with your avoidance of conflict. Ignoring your partner’s complaint conveys to her that her needs are unimportant to you. Extinguish all harsh criticism and expressions of contempt. Criticism and name-calling only separate you from your partner. Criticism points the finger of blame, whereas presenting a complaint points toward your own emotional experience and is less likely to provoke your partner.

John Lennon sang, “It’s easy…all you need is love.” Becoming a competent partner is not easy, and love is not enough.

Don’t Laugh at Me

What should you do when your ADHD symptoms are a source of amusement for people you love? I often hear about this challenge in my support group and on web-based forums. Your loved ones may adore you and find you lovable, like a puppy, and may unwittingly be hurting your feelings.

“We’re just playing with you,” they might say…like your uncle who would tickle you until it hurt and ignore your plea for him to stop. He was just playing.

If you tell a friend that he is hurting your feelings, he may reply that you’re just being sensitive, thereby reframing his insensitivity as your problem. If you react to his response with defensiveness, you risk reinforcing his perspective—proving him right—and so you may tend to shut down instead. Then you feel the deep loneliness that many adults with ADHD experience. 

In truth, you may be more sensitive than some of your friends. Many adults with ADHD experience a sense of alienation after years of being misunderstood and mislabeled. That is why I chose to make “Who You Are and Who You’re Not” the first chapter in Living Well with ADHD. Others may have characterized you in ways that don’t accurately portray who you are. You are not your ADHD symptoms, nor the labels that may have been ascribed to you, and you are not defined by what others think of you. Others may believe that their portrait of you is a mirror, but their painting is impressioniam—a distorted image of you.

Chapter seven in my book is, “ADHD is Funny…And It’s Not.” Disabled people can be funny, like anyone, but a disability is not funny. Who would laugh at someone for using a walker? You wouldn’t say to him, “You look like an old man.” To someone with ADHD, saying “you may not remember” is more sensitive than laughing at him for forgetting. When I was a twenty-something, I recall someone remarking, in front of peers, that my eyeglass lenses were thick as a coke bottle. I told him that my vision problem was not funny.

Accepting your neurological difference is essential to living well. Your wish for others to be more sensitive is reasonable, but first, you must be clear about the essence of who you are so you can live with confidence. It is a bonus when others understand you, but not mandatory for your wellbeing. You need not rely on others to validate you. You have already have value…you can’t get it from others, and you don’t have to earn it. Living your values demonstrates who you are.

So, here is what you can say when your ADHD symptoms are a source of amusement for a friend: “I don’t think you intended to hurt me, but it would be unfair to you if I kept my hurt feelings to myself. Our relationship is important to me.”

The Art of Indecision

I was asked recently if it is typical for adults with ADHD to have difficulty making a decision and committing to it. I don’t know if there is any research supporting my opinion, but I believe it is true. It is consistent with my observations.

If ADHD is defined by inhibition difficulties, it makes sense that we would have trouble, not only with inhibiting attention and impulses, but with inhibiting attention to a stream of thoughts flooding our brains. Selectively focusing attention requires inhibiting attention to everything swirling around us and inside us. What we call attention “deficit” disorder may be an attention “surplus” disorder!

Here is one example of superfluous mental activity: Do I really want to accept this job offer, or am I just desperate to stop spinning about my career? Am I just settling if I take the job. Will I regret it? The thought of making the wrong decision makes me anxious. Did I over-sell myself in the other interview? What if I take the more challenging job and can’t perform as expected? What if I choose a job without being absolutely certain, and realize later that I’ve made a terrible mistake? What will I do if I make a bad decision? My anxiety is out the roof.

The director of an anxiety disorders clinic defined obsessive worry as “trying to control the future by thinking about it.” Adding more cognitive activity means more anxiety, not less, and the extra anxiety can immobilize us. 

Meditation is one way to reduce anxiety that rises from spinning thoughts. Less superfluous mental activity means more clarity. Medicine also helps inhibit attention so you can remain mindfully focused on the task at hand.

Ambivalence is not abnormal. We cannot eliminate uncertainty in life, but we can learn how to tolerate it better. Our most difficult decisions in life are ones we must make with insufficient data. Wishing to know more, to be more certain, is just wishing. 

“He prefers the security of known misery to the misery of unfamiliar insecurity.” ― Sheldon B. Kopp, If You Meet the Buddha on the Road, Kill Him: The Pilgrimage Of Psychotherapy Patients

‘Tis the Season for Emotional Chaos

Are you dreading the holidays or looking forward to them? For many reasons, holidays can create extraordinary stress.

I remember my mother’s annual holiday efforts, decorating the house and preparing food for a Christmas gathering for her three siblings, their spouses, and the children. I was fond of them all and looked forward to seeing them. But they seemed different when they were all together. After an evening meal, the grownups would sit in the family room, occasionally breaking the silence with a comment. No one openly disagreed with anyone, although I don’t believe they were sincerely in lockstep with one another. Sometimes they focused on the television instead of each another. They always departed earlier than our other friends would have. While cleaning up afterward, my mom — who loved entertaining friends — would complain that no one seemed to enjoy the event and would vow never to host it again. She repeated the routine for years…including the vow.

In a friend’s family, two elderly brothers — his wife’s uncles — normally refused to attend events where both were invited. My friend insisted that both come to his house for Thanksgiving, believing that he could facilitate some kind of reconciliation. He sat them next to one another at the dining room table. For his generosity, he got to observe their pettiness and rude behavior firsthand during the holiday meal.

Other families have far worse stories of nasty fights after excessive indulgence and early departures with hurt feelings.

Here are ten tips for preventing emotional chaos during holidays:

  1. If you don’t want to host an event, then don’t. If you invite a rude person, expect rude behavior. 
  2. Be realistic and accept that your ideal might not be realized. 
  3.  When hosting an event, start preparing early so you can be relaxed and flexible when guests arrive. If you’re at ease, they will be too.
  4. Give kindness, even to those who may not be kind to you. A gift is not a trade; don’t expect anything in return.
  5. Be yourself, and be that same self to everyone. Reacting to a difficult person by being difficult is constructing another self. 
  6. Remember that disagreeable people wouldn’t cause suffering if they didn’t suffer in some way.
  7. Old grudges are just bad memories. Stop rationalizing that you are better than someone you don’t get along with.
  8. Don’t fret about negative emotions, or you will double your discomfort. Embrace your uncomfortable feelings; don’t compound them.
  9. Abandon thoughts that bubble up from inense feelings. They are distortions.
  10. Holiday events are therapeutic opportunities. The more challenging they are, the more you can learn about your emotional self.

For great holiday entertainment, watch “The Family Stone,” a story about a family’s emotional chaos during a holiday reunion of adult children. Sarah Jessica Parker won an Academy Award for her performance. 

Look Before You Leap

When you were a kid, did you ever walk to the end of a diving board and stop to contemplate whether to jump, flip, or dive, and then ponder how cold the water might be? Did the impatient kids waiting in line behind you yell, “Just jump!” If so, they restored your awareness of them, and you probably took action. You jumped.

One strategy for activating is to jump into a task before your distracting self-talk gets in the way. Like jumping into a pool, you can circumvent superfluous thoughts by leaping into action. Jumping can be a useful strategy, but if you are jumping only to stop the swirling mental activity, you might begin ironing your socks when you should be paying your bills.

Wanting to get out of your head so you can get something done is noble. But leaping indiscriminately just to escape feeling overwhelmed can send you down the wrong trail. The cost of investing your undivided attention in an unimportant task gets you further behind on an important task. Then you are right back to feeling overwhelmed and immobilized.

What would happen if you jumped back before jumping forward? What if you paused to consider all the tasks competing for your attention, identify the ones that must get done today, decide where to start, and consider how much available time you have? Open awareness is a kind of soft and expansive attention that allows the mental space to conceptualize and prioritize, and where you are mindful of the big picture, the calendar, the clock, the task list, other people, and the future.

Adults with ADHD prefer acting over planning, and we’d rather have our attention locked in on something—even a daydream—than sit patiently in an open state of awareness. Working efficiently requires access to both states of awareness, selective attention and open awareness, and for intentionally directing our attention between them. 

Getting mindlessly stuck in selective attention (some call it “hyper-focus”), is why we ask, “Where did the time go?” Estimating how long a task will take, and tracking time as you work, are important for living well with ADHD.

Okay…enough time on this blog…next item…check phone messages before my first client arrives. 

More About Buying Emotion Thoughts

Robert Wright, author of Why Buddhism is True, describes experiments that demonstrate how feelings are influenced by stories we have been told, or the stories we tell ourselves. In one of them, wine experts were unaware that the same Bordeaux was in two different bottles. One of them had a premium label, and the other was labeled as a table wine. Forty out of fifty-two subjects chose the former as the better wine.

In a similar study, several wines were used, and prices were attached to all of them. Only two bottles had the same wine, one that was priced at $90 and another priced at $10. As you might guess, the $90 bottle was chosen as the better of the two. What is most striking is the effect of the apparent “story lines” on their brain activity, as measured by brain scans. When subjects drank wine from the $90 bottle, researchers observed more activity in the medial orbitofrontal cortex than in the brains of those drinking the $10 bottle. That part of the brain is associated with the experience of pleasure.

Negative story lines affect us too. In the second chapter of Living Well with ADHD, I compare washing one dish to cleaning the kitchen. Washing a dish does not require thought about how messy the kitchen is, estimation of how long the dreaded task will take, or consideration of how much worse it is to wash pots and pans than plates. Awfulizing about a task makes it unpleasant, whereas, interrupting the negative meaning-making helps us activate. If no one is making you wash the dishes…like my parents made me…you don’t have to commit to washing a second dish after the first…but you probably will.

Just knowing that activating is one of the greatest and most understated challenges for adults with ADHD can help us “jump,” as some ADHD experts call activating. Jumping into a task, before we have had time to consider the stories our brains want us to believe, can help us turn that corner. In time, the old stories get disproven and the task demystified. We can’t fake it and just make ourselves believe that the task is pleasant, but with practice, we can learn to notice the automatic thoughts that otherwise are like white noise. They are there, buzzing around us, whether we see them or not. If we don’t notice them, they do more harm than if we see then for what they are…just mental activity…extra thoughts that are not useful. You don’t need the extra head on top of your head.

Adults with ADHD were once children with ADHD. Many of them were bullied, ridiculed, criticized, shamed, suspended, expelled from school, compared negatively to their siblings, or humiliated in front of their classmates. While the actual risk of harm may be less in adulthood, the conditioned brain may still anticipate harm and remain vigilant and easily aroused. The arousal can take the form of fear or rage and may lead to striking out, withdrawing, or being defensive. The primary arousal cannot be controlled simply by will or changed immediately.

What can you do if you can’t prevent or extinguish an uncomfortable feeling? You can get up close to it where you can examine it and know it as a sensation. You can watch the thought that arises from it and observe it as mental activity. If you pause before responding to an emotion-driven thought, then you have a better chance to observe it as an event. To borrow from the millennial generation’s vocabulary, “It’s a thing.”

I’m not suggesting that humans are nothing but conditioned lab rats, but only that our brains form mental habits around traumatic events. If we habitually believe that our feelings and thoughts are the same as reality, we will be enslaved by our feelings and distorted perceptions. Our actions will be driven by a desire to resolve the discomfort rather than stay the course and attain our goals. Staying the course usually requires willingness to tolerate discomfort.

Psychologists have a name for buying thoughts as truths. They call it cognitive fusion. Meditation teachers call it attachment.

You don’t have to buy the “story lines” (thoughts) that your emotionally flooded brain is trying to sell. To pause and suspend belief in them is to maintain an open and wise mind.

Mindless in the Magnificent Mile

If anyone reading this blog found my eyeglasses at the CIBC Theater in Chicago during the October 6 evening performance of “Hamilton,” please let me know how I can retrieve them. I was fumbling as the play was ending, trying to get my ticket to fit in the case with the glasses so I would have a memento to keep. I should have just bought a t-shirt, the cost of which was the same as my return trip to the theater. 

George Washington opened the door for me when I returned…seriously! He directed me to the stage door entrance, and the office where lost and found items are conveniently kept. Thanks George. I still believe my glasses are under seat D318. 

I’m grateful for the driver who waited for me while I searched for the stage door. I had already paid and said goodbye, thinking I would be on Monroe Street for a while. I might have been left by Lyft. 

Thanks to the Southwest Airlines employee who printed another boarding pass for me while my wife and daughter boarded with the B group. I found mine in my suitcase when I got home. 

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