WISE MIND FOR THE DISTRACTED MIND: EMOTION REGULATION SKILLS FOR ADHD

Emotions and Adult ADHD

Emotion regulation is getting more attention in research and clinical circles as a significant dynamic in the lives of ADHD adults, with more voices advocating for changes to the DSM criteria for ADHD to include emotion regulation deficits as a marker for ADHD.  We will post more resources on these voices in later blogs, for the research nerds among us. Like me.

The DBT tools can help you mitigate ADHD symptoms related to emotion regulation. Speaking from experience, and anecdotal reports from my patients who are undergoing a more robust DBT-informed treatment in our Wise Mind for the Distracted Mind program, these are quite helpful to reshape your relationship with your emotions.

One important foundation for emotion regulation is knowing that your emotions are natural and help you in many ways:

1. They help you with survival;
2. They help you get things done;
3. And they help you to connect in relationships. 

And when we suffer from neurobiological irregularities interacting with a long history of negative social interactions, loads of invalidation, and criticism, we are likely to feel the turbulence of impulsivity and internalize invalidation that feeds low self-efficacy, we may find our emotions running our lives. When your emotions are running your life, you tend to follow easy choices that lead to a hard life. ADHD adults are often daunted by frequent episodes of dysphoria related to rejection sensitivity. This in turn contributes to low efficacy and a tendency to give up on goals and health.  When your emotions are running your life, you may turn to alcohol, tobacco, or other diversions that offer temporary soothing, by way of avoidance, while exacerbating dysphoria and multiplying long-term difficulties. Emotion regulation can be achieved through mindfulness and intentional emotion regulation skills, patiently practiced daily, with relentless compassion and commitment to yourself.

Emotion Regulation Skills

MASTERY

Do something every day that improves your sense of competence. You can do this by doing what is difficult and mundane. Much of daily life is quotidian. As such, there is much of basic life that is important and apparently devoid of discernable dopamine discharges. You know what you need to do and you know what you want to do, but you don’t do either. Later, you will learn opposite action skills to help you to activate the attention and emotion you need to get things done and become more skillful with mastery activities.

Start with making a list, and scheduling commonly suggested in ADHD mitigation literature. Review your list at the start of your day and complete one, two, or three of the tasks listed. When cultivating mastery, don’t minimize the importance of tasks such as hygiene, exercise, or washing the dishes in the sink, drying them, and putting them away. Also, be sure to attend appointments to which you committed. When my patients make it to our DBT skills training group, we reflect on how attending this group each week is an act of mastery. It’s important to give yourself credit for a job well done and to even invite others if this will help reinforce your habits and energize you to continue in mastery until they become second nature. What therapists call generalized.

Every time you engage in an act of mastery you are acting on your environment. You’re exerting your influence on your immediate world and life.  It is an act of self-regulation. As you engage in at least one daily mastery activity it is important to:

1. Schedule the event. This increases the likelihood that you will in fact engage in the task. Will you do this as 9:00 AM, or 12:00 PM.  Whether doing the dishes or folding the laundry. Put on your planner for a specific time.
2. Do something challenging. It isn’t important whether it is challenging to others, or if you think “this should be an easy part of adulting,” let go of that limiting comparison. If getting the dishes done and put away or folding laundry is difficult for you, start it and complete it. And notice your incremental daily growth, and revel in your accomplishment. You’re building your skills.
3. “Plan for success, not failure” (Linehan, 2015).  Meaning, balance challenge with possibility. Do the dishes, rather than make the whole house spotless.  Go for a twenty-minute walk rather than a thirty-minute run, especially if you haven’t been conditioning. If you try to do more than is possible, you may face setbacks that will feel like failures and discourage you from your mission to lead a more effective life.

PLEASANT EVENTS

It is important for us ADHD adults to have pleasant experiences each day.  Positive emotions are part of life if you let them be, and they help you to cultivate resilience against the inevitable stressors and hassles of life.  If you’re chronically focused on all the things that are going wrong, positive events can help you break that habit of chronic negative meditation on limitations and failures known as rumination.

I recommend that you make a list and schedule pleasant activities.  Again, keep in mind to set for yourself pleasant events and activities that are accessible to you in the context of your real and daily life.  These events can be as simple as brewing a pot of coffee and lingering in the pleasure of the aroma rising into your nostrils. Watch a comedian on the Internet to have a few laughs.  Learn a joke to tell.  For example, my current joke I’ve learned to tell my step-kids goes like this: 

“Q: How does a pig clean its feet?

A: With Ham Sanitizer.”

As bad a dad joke as that is, it makes the kids laugh and gives me a moment of shared hilarity, giving me some fun, connection, and a positive memory to share with the kids for years to come.

Some of us ADHD-ers tend to feel frequent frustrations and futility when it comes to thinking of ways to make life better. Allow me to gently warn you to not get mired in any of those sticky automatic thoughts of why bother or nothing ever works or, I don’t have time for fun. You have nothing to lose in practice, and everything to gain by putting yourself at risk for increasing your emotion regulation and improving your quality of life.

As you engage in positive events, allow yourself to feel fun, joy, and enthusiasm without thinking about how or when these will come to an end, and without doubting whether you are deserving of these good things. In all things DBT, we start with mindfulness, and what and how tools help you notice when your mind turns from a stance of open and energetic willingness toward closed and controlling willfulness. If you become distracted by habitual negative thoughts, refocus your attention back to the positive aspects and emotions of what is ensuing. Let fun be fun. Let joy be joy. Be mindful of the good and the positive.

OPPOSITE ACTION

Sometimes your emotions are disproportionate to situations, and you may be tempted to overreact. Opposite action, also called opposite-to-emotion action, is used to counter hyperarousal, such as when you feel intense anger that interferes with effective actions, in which case to practice opposite action you slow your movements, slow your breath, and soften your face to counter the anger. These incongruent postures and movements slow anger, in this example.

If you’re feeling overly anxious about attending an important appointment, rather than giving in to the temptation to avoid it, you approach and go to the appointment, even though you may not feel like it.  In the case of anxiety, not only will diaphragmatic breathing help you decrease anxiety as you decrease carbon dioxide in your body, but adopting a confident stance, literally, Stand up straight. Pull your shoulders back. Lift your head. Repeat as needed as you head to the appointment and continue throughout the appointment. As you allow yourself to fully participate in these opposite action processes you will be at risk for wise mind pride and improved integrity and congruence.

Opposite action can also help you to generate the emotional energy you need to start and complete tasks that are typically difficult for ADHD adults.  Looping back to our opening remarks about engaging in mastery skills that are dull to the ADHD brain, opposite action is very helpful to start, and even complete mastery tasks.   

Returning to our dishes example from above, you may see the dishes staring you in the face, and intellectually you know you feel better if you get these done and yet you don’t feel like starting. Observing thoughts such as, “Why can’t I just get it together,” or “This shouldn’t be so hard, what’s wrong with me,”  don’t get trapped in the analysis paralysis and just spin your mental wheels thinking about what’s not getting done. Opposite action gets you embodied and action-oriented.  For many of my clients getting the body moving gets the emotions moving and specifically with the dishes, they stand up on their feet, take a ready stance, bringing their body to bear upon generating the minimally sufficient energy to get at it. This is initiation. Move to the sink with an attentive posture. Roll up your sleeves, if needed. And begin washing your dishes, either by hand or by loading them into the dishwasher. When you feel like quitting, don’t. This same strategy has been useful to start paying bills, discussing bills with spouses or starting homework. Standing briefly, and doing a few arm circles can serve to activate you, and as you sit for these mundane mental tasks, try sitting upright to increase attentiveness and the likelihood that you will carry through on these tasks.

We can say so much more about opposite action skills but let’s leave with A few important summary points about opposite actions.  To engage in opposite action:

1. Practice mindfulness, observing and describing, to notice if your emotions match the situation with a wise mind perspective;
2. Engage in breathing to ground and to counter, anxiety, anger, and fear, as needed;
3. Change your postures to counter present emotions or to activate needed emotions;
4. Change your facial expression to deepen congruence with desired emotions;
5. Start over as often as you need to, exercising flexible and determined willingness.

MOVING ON WITH SKILLFULNESS

Keep in mind that change is a process.  These proposed skills don’t work as a one-off. Put up a few sticky notes around your home to remind you to practice these emotion regulation skills and commit each day to being as skillful as you can be. keep in mind that you’re doing your best, even as you continue to do better. Be mindful out there and practice, practice, practice.   

Bibliography and Consulted Works

Brown, T. E. (2005). Attention deficit disorder: the unfocused mind in children and adults. New Haven: Yale University Press.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Publications.

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York: Guilford Publications.

Philipsen, A., Graf, E., Tebartz van Elst, L., Jans, T., Warnke, A., Hesslinger, B., et. al. (2010). Evaluation of the efficacy and effectiveness of a structured disorder tailored psychotherapy in ADHD in adults: study protocol of a randomized controlled multicentre trial. Attention deficit and hyperactivity disorders, 2(4), 203–212. https://doi.org/10.1007/s12402-010-0046-7

Spradlin, S. E. (2003). Don’t let your emotions run your life: How dialectical behavior therapy can put you in control. Oakland: New Harbinger Publications.

Note: Dialectical Behavior Therapy (DBT) was developed by Dr. Marsha Linehan and her colleagues at the University of Washington, which was originally found to be an effective therapy for Borderline Personality Disorder (BPD) and has since been adapted to address other human struggles with emotional and attentional regulation.