This episode is sponsored by CURE Hydration. You know that moment for me, it’s around like 2 or 3pm when my ADHD brain just decides we’re done for the day. We’re done here. The afternoon slump hits, the lights go off upstairs and suddenly answering an email or doing basically anything feels like climbing a mountain. That’s when I reach for Cure Energy. It’s a clean plant based energy drink mix made with 100 milligrams of natural caffeine and electrolytes. So I get the focus and hydration boost I need without jitters, without a crash and without that like I drink battery acid vi that some of the energy drinks have. The peach tea and acai berry flavors are my current go tos. Crisp, refreshing and they don’t taste fake, y’. All. They don’t taste fake. I’ll drink one before recording a session or when I need to get help through like that afternoon drag. And honestly, I. I drink it anytime. My brain just needs to cooperate. What’s wild is that Cure Energy is only 25 calories and has zero added sugar. It actually helps me stay hydrated while giving me energy. Okay, I love coffee, but coffee could never. Staying hydrated isn’t just about water. You also need electrolytes. And that’s why I love CUR Cure. It’s clean, it tastes great and it actually works. And remember, Cure is FSA HSA approved, which is amazing. You can use that money to pay for cure and for I have ADHD listeners, you can get 20% off your first order@curehydration.com I have ADHD with the code I have ADHD. And if you do get a post purchase survey, make sure to tell them that you heard about CURE right here on the podcast. It really helps to support the show. Don’t just drink more, upgrade it right with cure. Welcome to the I have ADHD podcast where it’s all about education, encouragement and coaching for adults with adhd. I’m your host Kristen Carter and I have adhd. Let’s chat about the frustrations, humor and challenges of adulting relationships, working and achieving with this neurodevelopmental disorder disorder. I’ll help you understand your unique brain, unlock your potential and move from point A to point B. Hey, what’s up? This is Kristen Carter and you are listening to the I have ADHD podcast. I am medicated, I am caffeinated and I am ready to roll. Today on the show, I have the privilege of interviewing a straight up superstar in the world of ADHD. Dr. Russell Ramsey Russell Ramsey is a licensed psycholog and associate professor of clinical psychology in psychiatry at the University of Pennsylvania Perelman School of Medicine. He co founded and still serves as the co director of Penn Medicine’s Adult Attention Deficit Hyperactivity Disorder Treatment and research program. Dr. Ramsey is the author of several books, including Rethinking Adult Helping Clients Turn Intentions into Actions, which I found to be absolutely fascinating. He’s lectured internationally on various issues related to adult adhd, as well as the principles of cognitive behavioral therapy, and he’s here with us today to share his expertise. Dr. Ramsey, welcome. Thank you. I am caffeinated too. No, I’m happy to be here. Thank you. Ready to roll, I assume. I love it. Well, I have so many questions for you. I am a huge fan, as I said, but I think what my listeners want to know most is are you a Philly sports fan? Do you love the Philadelphia Eagles? Do you cry yourself to sleep every night now that they’re out of the playoffs? I am a Philly sports fan. I grew up around the area and now working at Penn and half jokingly part of the reason so many. There’s such a rich mental health history in Philadelphia. And it’s no surprise that Philadelphia was the home of cognitive behavioral therapy that deals with negative thinking based on all the unfortunate sports outcomes with our many teams over the years. So it was a very good population to test those theories out upon. Isn’t that the truth? That is like the best answer that you could have ever given. I have Philly sports in my blood. It’s just been passed down to me from generation to generation. And it is not an easy life to live. It is not easy being an Eagles fan. It’s not easy being a Phillies fan. It’s just. It is what it is. That’s what it is. I wouldn’t have it any other way. Very right, Exactly. Fan base. I love it. And not forget the Philadelphia Union. Oh my goodness. An ex soccer player too. Oh my word. Yes. Actually, I’ve been to a union game and it is so much fun. So much fun. Okay. So I’m so glad that you’re here with us. Thank you so much for being here. And I would love for you to just tell us a little bit bit about what you do with adults with ADHD at UPenn. What is it that you do there? All right. There’s several facets to our program. The first is a comprehensive diagnostic evaluation, particularly for individuals who aren’t sure if they have adhd. So being able to come in and just do a thorough evaluation. And we provide a feedback session and report with our full evaluation and either sorting through and identifying ADHD or people coming in with attention problems and saying, this doesn’t sound like adhd. You have attention problems, but for something else. So that’s sort of the entry point. Then in terms of treatment, there’s like, not like there are three arms of treatment. There’s the psychiatry, the medication side, which currently overseen by Dr. Shazia Savol, previously Dr. Tony Rostane, who has since moved on and is chair of psychiatry at Cooper Health in Camden, New Jersey. Colleague Lisa Tuttle, an ADHD coach, oversees the mindful Self management group. We call it a class. It’s not like a group therapy, like what are we going to talk about today? But it’s every session devoted to a different facet of executive functions. And then there’s the individual cognitive behavioral therapy, overseen by yours truly, Again, very focused on executive functions, which are central to adhd, but also a wider array of issues that are common for adults with adhd. So for the lay listener who might not be aware of what cognitive behavioral therapy is, would you give us just kind of like a definition that might be easily understandable for us? Cognitive behavioral therapy is a form of talk therapy. You sit in a room and you’re talking with somebody else. The emphasis is on, well, both the cognitions or how we think about things or interpretations and the role they play in behavior change. And even though it’s not in the title, also the emotional management. Now that’s sort of like a braided cord of things. But the cognitions are useful starting point, since we’re philly centric today. The father of cognitive therapy, Dr. Aaron Beck, who passed away this past November at the age of 100, and the center for Cognitive Therapy, he developed it as a psychotherapy for depression, noticing that the thoughts and cognitions of patients with depression were very often excessively negative, pessimistic. Now, sometimes negative thoughts can be accurate, but he noticed that often they were distorted or incomplete. And so that this negative bias was a feature of depression. And that by looking at and assessing one’s thoughts and considering alternatives and any downstream effects on options and feelings, a lot of people could make a lot of improvements in their mood. In an all too brief nutshell, cognitive behavioral therapy focuses on how you interpret things, looking at alternatives and how these alternatives can help with functioning. This has been studied for adults with ADHD, and you’ve used it for the last 20 years plus, right. With adults with ADHD. So what outcomes are you seeing? Well, we and other groups you Safran, Susan Spritz at Harvard, Mary Cilanto formerly at Mount Sinai, Alexandra Phillipson in Germany, Susan Young in the uk. I know I’m forgetting somebody. Laura Nowson, John Mitchell have done a lot of work. So across these different groups, cognitive behavioral therapy or the initial CBT seemed like a good approach to adapt to adhd. Now you don’t think yourself into having adhd, Right. But living with ADHD can lead to real world frustrations that can affect your mindset and then maybe over generalize where you start avoiding things out of concern about understandable concern about potential frustrations from adhd. So in general, different groups and different qualities of. Studies have found that cognitive behavioral therapy adapted for adhd. There’s a lot of good CBT out there, but it’s the CBT plus the understanding of ADHD and the executive functions which dealing with them are an important facet of any CBT program for adhd. We found that it is a highly effective psychosocial treatment, often in combination with medications. Even though there have been some studies looking at adults with ADHD going through CBT without medications and finding that there are some gains in both cohorts. That is so interesting because I think that there are a lot of people out there wondering, okay, in addition to medication, what else do I do? And so how does someone find a cognitive behavioral therapist? Is it as easy as like a simple Google search? Is there something like a specific keyword? Is it CBT for adhd? Or how does a listener find a cognitive behavioral therapist that would be able to adapt the CBT for their adhd? That’s an important question and still an important limitation in the field. There’s not like a central clearinghouse. There are many ways to find good cognitive behavioral therapists. The association of Behavioral and Cognitive Therapies and the Academy of Cognitive Behavioral Therapy both have find a therapist features. But that doesn’t necessarily mean there’ll be an ADHD expertise. But that’s a starting point. Yes. A Google search of CBT for adult adhd. Yeah, very often what happens is one of the adult ADHD programs ours, Harvard Stuart Universities, there’s several of them. And then it’s sort of a six degrees of separation. Let me contact Ramsey at Penn and see if he knows of anybody in Pittsburgh or in Ohio or I know Russell Barkley has gotten people asking, so reaching out to experts in adult adhd, even if they don’t do, even if they don’t do therapy or CBT is a way to sort of hone in on and get referrals. But yeah, it is a limitation that there’s not like a central clearinghouse yet. So listener who is entrepreneurial and go ahead and create a database for that. Right. That would be amazing. So now that we’re in the age of zoom and everything can be essentially done over zoom, is CBT something that can be held over zoom? And forgive my ignorance, I don’t know if like somebody in Pennsylvania is allowed to work with somebody in Ohio. Is that, you know, permitted. Right. A psychologist is a licensed profession, healthcare profession, which means for me and the Commonwealth of Pennsylvania to call myself a psychologist legally. Right. I have to be licensed, which I am. I’m also licensed in New Jersey. Now during the pandemic a lot of states loosen those restrictions to allow cross state because there may be a student attending the University of Pennsylvania, but who is from Florida. Right. Now most states, not everyone, but most loosened their restrictions to say you could see existing clients who lived out of, you know, depending on the state that they were in. So therapy happens wherever the client is sitting. So some of these restrictions are being tightened up again. Now within psychology there is what’s called psypact and it’s a consortium of states and I am credentialed through psypact. So my home state is Pennsylvania. It’s the home license that I’m credentialed under. Right. And so once I got credentialed through psypact, there is at current count, I think 26 states and the District of Columbia that say. And it’s like a driver’s license, your license in Pennsylvania so you can drive in our state, you have to follow our state rules. Okay. But they allow for remote treatment. So there is a people who are credentialed under psypact now more information than you need. My department that I work under only once has seen clients from Pennsylvania and New Jersey. So I have that limitation just within my employer. But I think this is part of a movement probably for a national licensure so that with remote therapy, not going away anywhere soon. So it’s a very long winded answer. So like a lot of answers in my field, it depends. And not every state is part of psypact. So it. But for me, well, it’s P S Y PACT and it’s initials for psychology. I don’t know what. Yeah, no, I like, I’m really glad I asked you because I’m sure the listeners will be curious and I’m going to try to link these. And by me, I mean my team will link this in the. In the show notes as well, because I wonder if they have some sort of database where people could search. Well, they do. And if you do psypact map, you can see which states are already in psypact and also those that have legislation going through that may in the future be part of it. Yeah. And just as an aside, ADHD coaching currently is not a licensed profession, so even before the pandemic, they were able to do cross state services. Yes. Okay, so that is such a perfect segue into like the meat of the conversation that I want to get to today. Because as an ADHD coach myself, I work with my clients so much on thought distortions. And I would love for you to give us a kind of an explanation of thought distortions and what common thought distortions you see across the board for adhd, because I think this is absolutely fascinating. And I. You can see here, I have your book here, two different highlighter colors. This is not. I would not call it an ADHD friendly read. This is like a classic clinical manual. But I have gone through it. This is my second time now. And I found it to be really, really helpful just in my own understanding of myself, but also in working with my clients. And thought distortions are just such a huge component of the ADHD experience. So can you talk to us a little bit about that? This goes back to Dr. Beck. So cognitive distortions was a term he and probably others developed. And it could be thinking errors, maladaptive thoughts, and sometimes people talk about the negative wording used, but it had a place in its time and it’s just stayed. But what it reflects is we all have automatic thoughts. That’s the first thought that goes through our mind. When that’s like a common question. What thought went through your mind when you thought about doing this podcast? And it was like, oh, boy, I hope I do a good job. I hope the questions are easy. I hope I know what I’m about talking, talking about, whatever the case may be. Those are automatic thoughts. And these are part of a stream of thinking and sense making that we all do. And a lot of them are ephemeral. They just go through. And yeah, we’re already rolling. I’m not thinking about that anymore. But there can be things like, did I explain sidepact well? And I wonder if I messed up, and I wonder if somebody’s gonna somehow misunderstand what I said. Now, that is possible, but it also might be distorted because I’m doing Mind reading. Other people are going to misinterpret what I said. Discounting the positive. No, I’m giving a lot of information and people can look it up and find out for themselves. I don’t have to explain everything chapter and verse. So it shows how sometimes we’ll have a thought that is incomplete. Or it may be possible, but I’m adding in information. Well, people are going to misunderstand what I said. That is possible. But do I know that for sure? And it would be more of an issue if I sort of stop the podcast. I can’t do this. I’m going to quit. Or I can’t sleep tonight because I’m grinding over it. That’s when it becomes problematic and gets in the way of our functioning, maybe unnecessarily so. And so with the distortion, we can find. All right, there are some categories of distortion now, they’re overlapping. It can fall more in one category, but it gives a tool with which we can identify. You know, I’m doing mind reading or fortune telling or catastrophizing mind reading. I’m assuming what somebody else is thinking or that they’re going to judge me. Negative fortune telling. This is going to cause problems in the future. Discounting the positive. You know what, maybe you made some mistakes, but you gave some good information. And that by reevaluating the thought now we can have negative thoughts. I failed the midterm. And that can be an accurate thought. Right? And we can make mistakes. But then if, like a student who failed the midterm says, I don’t belong in college, there’s no use studying for the final. That’s where it becomes problematic insofar as well, now you’re basing future behavior or avoidance based on your assumption from what at first was an accurate thought. And that’s like a second level of automatic thought. So it’s just becoming more versed with, all right, how am I making sense of the situation? And is there another way to look at it that keeps more options open, even if my first pass at it is accurate? And so with adhd, very often, I mean, these could be thoughts about ourselves and mistakes, I think tied in with the executive functions. This is even thoughts about what we’re planning to do. So some of the common thoughts and these draw on the classic distortions. Some that we often see are comparative thinking. I’m not doing this as well as other people. And again, there could be a grain of truth. Choose some of these. But comparative thinking is basing our own sense of self about how well or poorly we size up against other people and we are notoriously bad comparers. We can come up with a Frankenstein’s monster of I don’t make as much money as that person. I’m not as good shape as that person. That person’s lawn is better than mine. Discounting the positive and magnifying the negative. Huge is another big one. Huge. Now this one doesn’t exactly fall within the classic distortion list, but based on some of our research, perfectionism in one of our studies emerged as the number one endorsed distortion using the Inventory of Cognitive Distortions, which really surprised me because I would have thought magnification and minimization magnifying the negative and minimization minimizing the positive. But I had some hunches about why that was the case later, just based on clinical experience. It goes beyond the data, so it’s not firm. But another one deals with the emotions of I make the conjecture in the book that you mentioned about the main emotional issue in ADHD is managing discomfort. The ugh feeling when we have to start a task even if we know we have to do it, even if we know we can do it. But nobody in their right mind is ever in the mood to do work or homework or exercise. So we usually go, I know I should work out now, this would be a good time. But I’m not in the mood. And I think a form of all or nothing thinking that comes up there is I have to be totally discomfort free and in the mood to do something before I can do it. And if we wait for that, we’re going to be waiting a long time. And some of us do wait a very long time. Well, you know what? Because I think the thought is and and it’s sneakily convincing. Well, I’ll put this off till later when I am in the mood to do it or I do have enough energy or I have better focus, but then that time never really comes. And that could be a distorted positive thought. That’s what I was just going to ask you. Is that kind of a maladaptive positive? Positive thoughts or distortions? Laura Nelson, John Mitchell, who I bragged on earlier, and a couple other of their colleagues, they developed the ADHD Cognition Scale and it’s very research based and really it’s seven distorted positive thoughts. I know this usually sucks me in, but I’ll just do it for a minute. Waiting until the last minute is a big part of who I am, or there are some others and it’s a published study and we use it on our program with permission. But Laura and John did a paper a couple years ago where they talked about this before they had the scale, and they called it incautious optimism, which I thought was a great term. But they’re also known as permission giving beliefs, justifications to do something that may ultimately be self defeating, but we’re convincing ourself in that moment. Yeah, and it’s really interesting. I used to do this a lot where I would lay in bed at night and kind of review all of the things I didn’t do that day and really beat myself up for it. But then I would fantasize about tomorrow. Well, tomorrow is going to be different. And it was totally that fantasy of, you know, that maladaptive positive thinking of like, well, I know I was this person today, but tomorrow, without making any changes, I’m going to be a completely different human. And what I found as I kind of reflect back on that is that would give me enough dopamine, that would give me enough like a little bit of a boost where I could go to sleep and like kind of put a little bow on my day. Like, today was awful, but tomorrow’s going to be amazing. Tie a pretty bow around my day, go to sleep, but then wake up and not have made any changes in the interim. And so then I’m just repeating the negative patterns rather than making any sustainable changes toward, you know, positive behavior change. Right, right. And you know what? Actually some of the research, and it wasn’t specific to adhd, focusing on problematic positive thinking is that sometimes, like what you described as putting the happy bow on the day, and it came from research on weight loss, they actually found that the thoughts, the images of achieving weight loss became more in reinforcing and a distraction rather than, okay, tomorrow I’m going to get to the gym. And there might be things like the getting ready to get ready or thinking about doing it, maybe ordering exercise outfits, signing up for the gym, but not ever really going and, well, I’ll start next week or whatever, but not ever moving it forward. The positive thoughts became more reinforcing and part of an avoidant pattern, which we also see in PhD. The getting ready to get ready, it becomes part of a, an avoidant script. The cognitive modification doesn’t mean we challenge negative thoughts with positive thoughts, but it is with adaptive thoughts. And part of like the cognitive behavioral therapy with ADHD and the cognitive piece it jives with the executive function is coming up with realistic plans. What’s realistic for me to start tomorrow and do at least for a Little bit. And what are some other things? When do I switch to something else? And when do I take breaks so that we can both give ourselves credit for what we have done, even if maybe it’s not as much as we thought. And also to set realistic expectations to increase the likelihood that we’ll get engaged. And maybe part of. And I don’t know this specifically, but when you were coming up with the fantasy for the next day, if it would be, okay, I’m going to finish this project, finish that project, which may be unrealistic, but I’m going to come up on an adaptive. I just want to work on this for 30 minutes. Right, right. And I will open up my phone right now and set a reminder to do that before I fall asleep. Right. So it’s like even taking a step of, like, let me create some space to do that as well. Right, right. Or, or, okay, the first step, tomorrow morning, after I, you know, go through my morning routine and have breakfast, I’m going to sit down and plan the day and make sure, you know, and realistic plans and what I’ve said and people get sick of me saying it. Everybody with ADHD knows this. Yeah. There are no trade secrets in terms of the coping strategies, but it’s the implementation issue. How do we put it into play and personalize it? Because one person, they might say, yo, 15 minutes is all I can do. And that’s the increment. Somebody else says, yeah, I don’t care what that tomato machine tells me, I need to do 45 minutes. I love that you said that there are no trade secrets. And the way that I say this all the time is like, listen, you don’t need me for tips and tricks. You already know them. Or they’re very easily Googleable. Like, what’s the best app for productivity? I don’t know. Go Google it. Like, we don’t. That’s not why somebody engages a coach or a therapist. It’s more like, how can I make this mine? How can I tolerate the discomfort of doing what I don’t have to do? How can I learn how to stop bedazzling my planner and making it pretty and actually follow what it says that I’m supposed to do? And that’s that. What did you call it? Like, the problematic positive thinking and the getting ready to get, get ready. I noticed that a ton with people, like, planning their schedules and like finding the right planner. And maybe if I do it this way, if I do it in whiteboard and it’s like, it doesn’t actually matter. Stop trying to put jewels and bows and sparkles on it. Like just figure out something easy that works for you. Right. Well. And you know what? Things like that. We used to call it pseudo efficiency. We’re busy and we’re getting something done, but it’s not moving it forward. So it’s like the student working on a paper who has to cite at least three sources and they download 50 PDFs from the library and it’s like, wow, I was really productive. And it feels good and it is sort of like a self medication. And I get it, we can all fall into this for sure. But at some point it’s, you know, it’s sort of avoiding the actual writing. Yeah, these are things that we can catch and see how it’s positive and it is productive, but we have to cut it off. It’s sort of a point of diminishing returns. And now a word from our sponsor. Hey, Kristin here. I’m the host of this podcast, an ADHD expert and a certified life coach who’s helped hundreds of adults with ADHD understand their unique brains and make real changes in their lives. If you’re not sure what a life coach is, let me tell you. A life coach coach is someone who helps you achieve your goals. Like a personal trainer for your life, a life coach is a guide who holds your hand along the way as you take baby step after baby step to accomplish the things that you want to accomplish. A good life coach is a trained expert who knows how to look at situations, all situations, with non judgmental neutrality and offer you solutions that you probably never even considered before. If you’re being treated for your ADHD and maybe even you’ve done some work in therapy and you want to add to your scaffolding of support, you’ve got to join my group coaching program, Focused. Focused is where functional adults with ADHD surround each other with encouragement and support. And I lead the way with innovative and creative solutions to help you fully accept yourself, understand your ADHD and create the life that you’ve always wanted to create, even with ADHD. Go to ihaveadhd.com focused to join and I hope to see you in our community today. Okay, so you mentioned pseudo efficiency. I would love for you to describe what you call as procrastivity. Did you coin that term? First of all, I did not. I did not. And I always, I was about to like hand you a bouquet of flowers, an award, a tiara. That’s an awesome. Well, I will still wear that. And no, no, I Actually learned about it from a client. Amazing. And it is pretty much what pseudo efficiency. It sort of has co opted and it’s gotten associated with my name. So. But I’m working with a client on that who talked about, okay, I had this report due for Monday, but all weekend I mowed the lawn, caught up on housework, paid bills, and then Sunday night I’m rushing to finish it. And I said, you know what, you were going around doing all these productive things and feeling good, but really it was probably subtly avoiding the other thing. He goes, yeah, my roommates, they call that procrastivity. And that was the first time I ever heard it. And I looked it up at least as much as you can trust Urban Dictionary first appearance was around 2010. Wow. Okay, so. But really what procrastivity is and within procrastination literature, maybe not using that term, but it’s known as productive procrastination and it is a way of salvaging a day on the procrastination continuum. Right. Like you go, okay, I’m not going to work on taxes this weekend. At least let me take care of these other things. So it’s better than nothing. But how, you know, I’ve sort of defined it and maybe drawing on Urban Dictionary, but it’s avoiding a higher priority, more time sensitive task by doing something else that is productive. And maybe you had already procrastinated on that is productive and needs to be done, but actually is self defeating because it’s getting in the way of the higher priority task. And probably, and this is a true example, I’m not sure if the best example, but it’s the most illustrative, working with a student who had to run a lab, meeting a journal club type of thing and describe a study. And she had this study, but came home and instead of reading the study and preparing her talk, said I’ve got to bake a cake and spent a couple hours baking a cake and then I’ll get to this thing. When she was reviewing it with me later, she said, not only did it get in the way of me being adequately prepared for the lab meeting, I’m diabetic, I can’t eat the cake. So she just did it to did it, you don’t have to eat the cake, but it was sort of like I did it and it’s not like I was giving it to somebody for a birthday, I just did it to do it and then I can’t even enjoy it right. So it wasn’t like I even really reaped Anything from that, but it was just how strong the aversion to things can be. And that will sort of do other stuff now. Anybody can do this. It’s not just for adhd, but it seemed just to capture something for me. And working with a lot of people with adhd, this sort of sneaky procrastination, it’s almost like the Trojan horse. Like it’s this gift, but then all of a sudden the negativity runs out later when you go, yeah, the kitchen is clean, but I’m not prepared for the midterm 100%. And then from there, if you’re clients or anything like me, then there is a shame spiral attached to that. So then there’s a lot of self judgment, you know, beating myself up. I can’t believe this happened again. I’m never gonna learn. This is now. I’m never gonna move forward. There’s just all of that guilt and shame that goes along with just kind of getting that awareness of like, okay, here we are again. Right, right, well. And you know what? Drawing from that, just briefly, one of the things that got me thinking in seeing a lot of procrastinator and living it many times. No, but I figured, well, what is it about like in this case for the person baking the cake, she probably had other times to do it. What was it about that compared with the lab preparation or that young man who taught me procrastivity, all the other chores he was doing as opposed to writing the report that he had to do. And it’s just sort of a reverse engineering. And are there ways we can hack that and sort of repurpose them for the higher priority task? And generally it seems to be the tasks that we escape to tend to be more hands on manual, more immediately actionable, like baking a cake, unloading a dishwasher, mowing the lawn, rather than something that’s more intellectually challenging. And even among say homework tasks, there’s probably like a rock, paper, scissors algorithm where writing is harder than reading, reading is harder than a problem set. And again, this could be individualized. There tends to be probably a clearer onboarding sequence of steps for mowing the lawn. A recipe to make a cake. Yeah, I know how to get started. I know unloading, you know, unloading the dishwasher as opposed to writing a report, even though we’ve written reports before, there’s a degree of uncertainty like this one’s going to be a little different. I’m going to have to think and write and change things. And writing for college students, ADHD or not is the number one task for procrastination. We are not wired to write. We have to learn to write speech. We have a universal grammar. We have a natural speech instinct. And we’re going to learn the language in which the context in which we’re immersed. But writing has to be drilled. We have to learn it. So it’s not a natural human behavior. There’s probably with the procrastivity test, the escape test, a clearer sense of progress and maintenance of gains, and also probably a clearer endpoint. The cake is done, the dishes are unloaded. I have something to show for it as opposed to, okay, I’m going to have to go back to the report and do another draft. Or I got part of my taxes done and I’m still not sure they’re right and I don’t want to get audited. So there’s uncertainty in there. So there’s just things that we can do in CBT or coaching or anywhere to try to. Even if it’s stuff, again, that we all know. All right, the first thing I’m going to do with working on the report, let me open up the document on my screen. Now, that’s not doing anything productive yet, but we just exponentially increased the likelihood that we’ll take the next step, which is very similar to exposure steps for dealing with anxiety and other. Would you say that just gaining the awareness around these maladaptive behaviors, like this procrastivity tendency. Have you seen in your work that the awareness a lot of times is enough to kind of like, not necessarily snap someone out of it, but give them almost an alternative? Because when you don’t even know that you’re doing it, there’s no alternative. But when you are able to watch yourself think and you’re able to notice these things come up for you, and it’s just kind of the same old stuff that comes up over and over. What I found for me and my clients is that we are then able to make different choices. Because all of a sudden another option is presented. I don’t have to bake the cake because I notice what my brain is offering to me is like, well, we could bake a cake. And then it’s like, oh, I see what you’re doing there. Like, very cute. But no. Right. I think that having that alternate, having the framework is a precondition. For some people, that might be enough where they go, okay, once I have the framework, I can see plan B and I just doubled my options rather than just going through this route, like, make the Cake. Make the cake. For some people, they go, okay, I can see I could do something else. But I’m still not doing it because I want to do this or whatever the case may be. So I think it is a precondition. But I think this is where some of the other coping strategies, like I said, the reverse engineering of some of the facets of the components of Procrastinate are helpful. And some of the other executive functioning workarounds, maybe having that framework. And I think the framework is also an inhibitory intervention like let me pause. Yes. And developmentally, some of the work by Russ Barkley, the ability to inhibit and stop responding to the environment, that is like one of the first executive functions to emerge. Because in that pause, and there’s a great quote that I forget who said it, when you press a pause button on a machine, it stops. But when you press the pause button on humans, we start. And the whole notion that if we pause and we’re going through this program and say, you know what? Now I can act with intention. If I keep doing this, I know how this movie ends, but I want to end up over here. And then there’s the other executive functions. All right, how do I sequence my behaviors to achieve that goal and all these other things? So I think the framework is helpful and it can start that conversation of the cake baker. What’s getting in the way of me working on the report right now? I don’t feel like doing it. I’m worried it’s not going to be any good. I have it, you know, it’s a dense research article. Well, let me at least read the abstract, the introduction and the conclusion. And let me see again. Strategy we all know, start with a small step, baby stepping, whatever you want to call it, we all know it. But now we’re adding an implementation step and there’s a whole research on specific implementation strategies drawing on some of that research that I mentioned before about when people going through weight loss. If the idea of losing weights more reinforcing than actually doing it. How do we break things down and use the environment as a cue for. Okay, if I can do this, if I can open up the article on my screen, then I can at least read the introduction. And now once we’re engaged, there’s no guarantee we could stop then, but an object in motion tends to stay in motion. So we just exponentially increase the likelihood of follow through. I love it. I have a question about something. I’m not going to use the right term because I don’t have it. Written down. But essentially it’s a math equation that we ADHDers do, like a cost benefit analysis. Oh, right, right. Okay. And so I would love for you to explain that, but like, in the context of. Let me just open up my computer and read the introduction and conclusion. I was already doing that cost benefit analysis as you were saying that of like, well, that’s not going to be worth it. And it’s so interesting that my brain just automatically went to that place of like, well, that sounds harder than any benefit that it’s going to give to me. So can you talk to us about and use the term that you use? Because I know it’s not cost benefit analysis, but what is that? There were two things in the book. One was behavioral investment theory, but the other was implementation strategy, the effects, then why statement. And that’s an implementation. And it draws on the research, Peter Gallwitzer and the team there. But pretty much what it is. Yeah, it was the behavioral investment theory and behavioral investment theory. So that comes from evolutionary psychology in a way. And what it is, is, is we make these. And this is everybody. But probably even more so with adhd, we make these quick calculations and whatever we’re doing, and it’s like a behavioral loan officer, do I approve this loan? Because this is going to take time, effort and energy. And is this worth it? And this is why people struggle with so much with exercise. There was a Harvard biologist who in the past year did a book about his own struggles with exercise to say, from an evolutionary standpoint, this doesn’t make sense. We should be conserving energy, taking in a lot of calories. Thank you. But in, in the, in that. In parts of our brain that sort of. This will be. Won’t be exactly biologically correct. But sort of do this with behavioral investment theory. That doesn’t make sense. No. Store up energy and, you know, early humans were not like doing triathlon cardio. Yeah, yeah. I mean, to survive. They were. No, no. But. But it’s sort of like that’s what we’re bumping up against. And things like now, if you add in like that example, a lot of folks with ADHD might have personal histories with things where they go, hey, my past history with sitting down to work on the paper is like, you know, Steve, the late Steve Kopp said, twice as hard for half as much. Yeah, this is going to be grueling. This is going to be painful. I’m not sure if I’m going to get anything done. And the couple seconds I took to use those Words, these are like emotional, probably non verbal impressions that we’re getting that gut level. Ugh. That I call it feel it all over my body and it’s self protection. Yeah, yeah. So that, that sort of. So that’s what we’re battling against. And that’s why I say that managing discomfort is the, is the core emotional task in dealing with adhd. The aversion to the learned aversion, if you will. So anyway, the behavioral investment theory says we make these quick non conscious calculations. Is this going to be worth the time, effort and energy and a lot of times and especially for delayed gains. And this is what the executive functions allow us to do. And it is, you know, I’m going to do something that’s not going to pay off now, it’s going to pay off later. And maybe there’s even going to be a short term cost like exercise. I’m going to get sweaty and yucky and not be in that much better shape at the end of this. But if I do this for a week, for a month, whatever. And that is a uniquely human trait of being able to take on some short term hits, working on homework when I don’t feel like doing it, to be able to pass the class, to get the degree, to do whatever next. So recognizing that and then a lot of the strategy, a lot of the executive function workarounds are exactly that. Because using some of the definitions about of executive functions, the ability to set a goal, arrange and organize a plan, sustain it over time to achieve that delayed outcome without immediate enough payoff. And we want the goal that is executive functioning. And I’ve probably written this many times, people have heard me before, get be sick of me saying it. But in a feedback session with a gentleman who just completed his evaluation and I was using that example of the executive functions to help give a framework for adhd. And as an aside, going back to framework, I think that’s why the executive functioning model is so valuable for adhd. Because rather than working harder and harder to pay attention or not be impulsive or not procrastinate, it helps us break it down into actionable steps and give a model for oh, I gave into my ugh feeling or I set too big of a first step. Now we have a changeable behavior. But going back to the gentleman, what he said, like when I used that executive functioning definition, he slapped his knee and he said that’s it. My boss always tells me if he needs it from me in 10 minutes, I can deliver it in five. But if I have A week. It takes me a month. 100. Because 10 minutes is diffusing a bomb. Okay, now all in hyper focus, whatever we want to call it. Emotions. Okay. I’m writing is like the night before the exam. A week. No way. Okay, this is important. Let me break it down. This will be good. All the rational reasons for doing it. We know it. But I don’t have to do it now, right? Okay. I didn’t do it Monday. Well, I got Tuesday. I got the weekend, which is accurate. And if we do it, that’s fine. But we ended up putting it off in the increment at a time until it’s like, yikes. Anyway. So huge, huge, huge. So that behavioral investment theory, it’s realizing that there’s going to be a lot of things we don’t feel like doing in the short term. But that’s like our prefrontal cortex and executive functions and other networks, they help us see the long range and breaking it down and all the coping strategies for adhd, but knowing it’s going to be going against that visceral, often emotional facet. And that’s why the emotional regulation, which is an executive function, is an important piece of managing ADHD and tied in with how we think about things and trying to reframe. Okay, I don’t have to do the whole thing. Let me give this at least 15 minutes. And 15 minutes, the reframing time. 900 seconds. That doesn’t sound as bad. Or 15 minutes. Hey, a commercial break for a football game after the exercise between the touchdown, extra point and kickoff. I mean, it’s probably not 15 minutes, but something close to it to say, I could do it for that long, but that just feels different. And that’s the power of reframing sometimes, too. Yeah. I had a client once, like, put off doing her dishes forever. Forever. Forever, forever. And I said, why don’t you just time yourself, see how long it takes. Yep, seven minutes. She would procrastinate all day long, but doing the dishes, like, she had hard data then to say, like, oh, it takes me seven minutes. And so then you can look like the next day when you’re looking at the dish and you’re like, I don’t feel like doing the dishes. You’re like, well, it takes seven minutes. Like, I can give it seven minutes. Let’s just do that. It just. It changes everything. Oh, yeah. And reframing time, I think, like in that manner, or changing minutes to seconds, even in the early days before portable wristwatches or anything like that, where you know, 10 minutes. We didn’t know people would use things like behaviors where people had this sense of it, I’ll be with you in the milking of a cow. And for like a very agrarian people knew, okay, I know how long that means. And there’s actually one theory of time perception that says we sort of, sort of calibrate time by how long things take in the image environment and that’s how we get this visceral sense of how long things. That’s wild. Wow. I don’t want to take too much of your time, but as we wrap up here, I would love for you to just share your thoughts about that visceral feeling of discomfort. Why is it so hard for us ADHDers to tolerate that ugh, discomfort feeling? What is that about? Why does it seem harder for us than for the general population? Part of the emotional regulation piece of the or the executive functions is that it is different from a mood or anxiety disorder. It is the same sort of emotional reaction, a stress aversion reaction. Nobody likes doing homework, nobody likes unloading the dishwasher. So anybody’s going to have emotional reactions. The thing with ADHD with part of the self regulatory framework is it’s harder to down regulate upset emotions. They stay out there and upset longer and maybe felt stronger and it takes longer for them to wind down naturally. So it’s harder to downregulate. And on the other side, the emotional regulation and motivation is the ability to generate an emotion about a task in the absence of immediate consequence. It doesn’t mean you have to look forward to studying for the midterm, but just sort of like feel enough like studying just to get it out of the way, including to remove the aversion. So that would be sort of upregulating. How do we modify our feelings to be able to like the person you were working with to get started even working on the, on the dishwasher. And that’s from the regulation standpoint. And also why is it maybe felt stronger? Because people probably have a personal history. Nothing’s really emotionally neutral for folks with adhd. So even unloading the dishwasher it’s sort of like, well, this is going to be tough and maybe I won’t get it done and then I’m going to get criticisms. And so, oh, why, why did you only empty the top rack and not the bottom one? And maybe it’s a well meaning question, but over time, and this goes to some of the accurate negative thoughts of having disappointments and frustrations and the fact that you know what? I spent twice as long as anybody else writing my paper and I still failed or had to do it over or whatever the case may be. And I think it’s, along with Steve Copps, twice as hard, yell adult ADHD twice as hard for half as much. I always go back to that early. One of the earliest self help books on adhd. You mean I’m not stupid, lazy or crazy? Because I think that’s the attribution, the cognitions, if you will. But there’s also an emotional component to that of I’ve done this before, I know I can do it, but I’m not sure if I will get myself to do it at this point. And even if I do get myself started, will I be able to finish it? Will it do any good? So there’s a lot of landmines with a lot of things. And I’ve used the analogy of it’s like food poisoning. You have a food that presumably you ordered and wanted to have and somehow it’s tainted. So you have an aversive, a nauseated reaction to a nauseous reaction to it and your body’s doing what it has to do to expel the toxin. Well, if we use that, not literally, but that analogy of things that are supposed to be good for us, like school and learning and being able to write and maybe we are good at. You’re such a good writer when you do it, or you’re so smart and you don’t try so much or if you can only work harder or whatever the case may be, or you’re a really good athlete, but you have a failing grade in this class. You’re ineligible for this week’s game. Right. All these things can lead to and thinking about going away to college. Oh, great, I get to do more school. That, ugh, feeling that visceral again, emotions. And what are emotions? They help. These are signals about, you know, interpretations from the environment and they are adaptive. The capacity to feel anxiety, that’s adaptive to have to avoid danger. You know, feeling pain, not an emotion. But if we didn’t have the capacity for pain, we get burned, cut, and whatever. So emotions are helpful and they give us information and maybe based on our past experience. So that’s why treatment with adhd, coaching, whatever it is, medications too also directly and indirectly deal with the emotional side and sort of changing our emotional relationship with a lot of tasks that we now want to master or at least have more efficacy for, including the ones that we know we can do and maybe get a little more Consistent at being able to engage and follow through on. It’ll never be perfect. None of us will be just trying to change the ratio. Where I make the point in the book that the main cognitive theme that we’re going for is greater self trust for coping with adhd. And that’s just based on my conjecture, it’s not research based yet. I would absolutely love to have you back sometime in the near future to spend a whole hour talking about self trust because I really see that so predominantly with my clients of like, I know that I’m smart, but I just, I don’t believe that I am going to take the action required to accomplish this. And so I just am not going to try because I’ve failed so many times and I know how failure feels. It does not feel good. So it’s essentially failing ahead of time where it’s like, I’m not even gonna bother to try. But so much of our lack of willingness to like go for it is completely understandable. But there’s a, there’s just such, there’s a void when it comes to self trust. So maybe that’s like one of the more insidious things about adhd. We’re not our grades, we’re not our job. But pardon the double negative, these aren’t nothing we might have selected to pursue. So in that way it sort of gets at how we define ourselves. And again, it could be somebody who says, I like painting but I don’t get around to it or athletics or other things. So it sort of does get to how somebody defines themselves too. But yeah, happy to come back future convos. I love it. Thank you so much for your time, for sharing all of your infinite wisdom. I know this is going to be so, so valuable. Thank you for your book and the work that you just do for us adults with adhd. I just appreciate you. Thank you very much. Appreciate that. A few years ago I went looking for help. I wanted to find someone to teach me how to feel better about myself and to help me improve my organization, productivity, time management, emotional regulation, you know, all the things that we adults with ADHD struggle with. I couldn’t find anything. So I researched and I studied and I hired coaches and I figured it out. Then I created Focused for you. Focused is my monthly coaching membership where I teach educated professional adults how to accept their ADHD brain and hijack their ability to get stuff done. Hundreds of people from all over the world are already benefiting from this program and I’m confident that you will too go to. Ihaveadhd.com focused for all the details.
