So hi everyone.

Welcome back to another episode of the ADHD Women's Wellbeing Podcast.

I am here today just to bring back some of the more insightful, interesting podcast episodes from 2025.

Maybe when you've got a bit more time over this festive break, you're able to just kind of digest and reflect on these episodes.

And today is no different.

We have Dr. Russell Ramsey, and he is a clinical psychologist specialist specializing in adult ADHD and anxiety and is the co founder and co director of the University of Pennsylvania's Adult ADHD Treatment and Research Program.

And he's also authored six books all related to adhd.

He really is an expert in this field.

And in this clip you will hear back from our podcast episode earlier on in the year, how ADHD and anxiety are deeply interconnected.

We hear this all the time, and with ADHD creating that uncertainty that often triggers the anxiety.

And he also helps us break down CBT strategies that are neuroaffirming that are specifically for adhd, that work, I guess, similarly to exposure therapy for anxiety.

We also talk about techniques such as emotional labeling and distant self talk that help reduce this catastrophizing and ruminating and help us regulate this overactive nervous system that so many of us have.

I really hope that today's clip helps you, wherever you are, with whatever you're doing right now at this period of time, because not everyone finds this festive season easy.

I know it can be very overwhelming and overstimulating and can also be quite triggering being around different family members, especially when you're navigating something new like an ADHD discovery.

So I'm sending you love and I hope that today's episode helps you take care.

How much do you think anxiety plays a part in ADHD?

I'll be a little cheeky.

I'll say 100%.

And just like ADHD plays 100% role, they go together.

And that was one of the things doing the workbook and what attracted me when I was asked to do it was looking at that connection.

Because of the coexisting conditions, anxiety and depression are generally first and second, with anxiety landing first more often.

So it's the most common and in some ways it makes sense.

Now, starting with the anxiety side.

And let's situate it.

You know, our emotions are adaptive, they're helpful.

And so anxiety at its core, most people say, well, it's the perception of threat or danger or risk, which is still very true.

The unchained dog down the street that doesn't look Too friendly.

It helps us orient, it signals us and it helps keep us safe even if it's uncomfortable sometimes and we can get overly anxious.

There's also been work research on anxiety looking at another factor, the intolerance of uncertainty, the non zero risk that goes into day to day life.

And on the other side, in thinking about why ADHD and anxiety are so often connected.

ADHD is an uncertainty generator by definition.

Like working with a lot of people, they'll say I know exactly what I need to do, I just don't know if I'll do it when I have to do it.

I have a plan, but will I follow the plan?

And other facets that raise a degree of uncertainty and the feeling of anxiety, including.

I think I've done everything, I think I've remembered everything, but I've had the experience before of walking into the meeting and that's the day I was expected to present.

I thought I was presenting next week or I get to the show and I forgot the ticket or whatever it may be.

So there is a lived history of that uncertainty.

ADHD or the anxiety ADHD connection and recently there's actually some preliminary research showing that connection in adults with adhd.

So that's my somewhat long winded explanation about why this goes along goes together and in some ways though looking at at least the non medical treatments, I'm certain I'm a psychologist but I'm certainly not anti medication at all.

It can be very helpful and one of the ironies sometimes is we think about the stimulant medications and highly effective for ADHD and stimulants like caffeine.

You would think sometimes and some people have this side effect, oh, it helps my attention but it revs me up too much, it makes me too anxious.

But more often when people respond they say yeah, I'm taking this stimulant but I'm also less anxious because I'm more for lack of better, for least reliable in keeping up with my day to day.

So even the stimulant, it would seem counterintuitive but, but the anxiety, if the anxiety is predominantly coming from adhd, well then you know, as you're managing things better and feeling more confident, you know, the emotions will settle in a little bit more too.

And the nice thing about the CBT side, many of the, the interventions, the ways we have of.

Using the coping strategies for ADHD and my line for that, there's no trade secrets about what works.

Kate, I'm going to tell you, nobody else knows this.

Using a planner can be helpful.

And for procrastination, you need to start earlier.

Again, ADHD is a performance problem, not a knowledge problem.

But with many of the strategies for.

Okay, how do you use the planner?

How do you break down a task?

Get started earlier.

These are, I would say, equivalent to what we would call the exposure based treatments for anxiety.

Facing the fear.

Okay, you're afraid of dogs.

If you want to, let's get this very docile dog and get used to, you know, petting that or even a toy dog.

And then we'll work up to you owning a dog.

And here with anxiety, it's an adhd, it would be.

Let's get used to using the planner.

Let's get used to the things that periodically you'll forget to add something, but we can bounce back things like that.

So.

And again, going back to the ADHD anxiety connection.

Anxiety is our alarm system.

So especially if somebody's gone undiagnosed until adulthood and all the signaling, okay, there's a difficult assignment in school, a presentation at work.

Alarm bells, alarm bells, alarm bells.

Almost like I use the analogy to understand the emotions, the feelings that go along with adhd.

Yes, the same emotions, feelings that we all have, but how their experience or how they can come on and how they build up differently.

The example of food poisoning.

What happens with food poisoning?

We eat a food presumably that we want to enjoy and maybe we historically enjoy, we're looking forward to it, and it's somehow tainted.

And what happens?

We feel nauseated.

Our body kicks in to say, I have to get rid of.

I'm anthropomorphizing here, but getting rid of the toxin, however that happens, we feel lousy as it happens, so we recover the next time we're presented with the food, Even if we're 100% mentally, our logical part of brain knows I saw it prepared, I know it's not tainted.

The automatic emotional system goes, yeah, this is the same as last time.

What happened?

We feel nauseated.

It takes a while to get over it.

And that I think resonates in terms of, you know, adults with ADHD doing homework.

Even if somebody says, the last paper I submitted I got highest marks in the class, but the one before that I had to take an incomplete or I had to hand it in late.

And so I don't know, it's a gamble, I don't know what's coming up next.

So the anxiety is a signal, but it becomes overly sensitive over time.

And cognitive behavioral therapy gets a bad reputation for.

Oh, it doesn't Care about emotions.

And maybe some of that was the early phases, looking at the cognitions, emphasizing that which was novel at the time.

But you know, our thoughts, our feelings and behaviors.

I like the phrase they create a braided cord.

They're all happening.

But also sometimes what I'll ask people is what was it like being in your skin?

Now, that could be a thought, but often it's a feeling.

And often, sometimes our thoughts were putting words on feelings.

And so in, in the cbt, now we're talking about anxiety.

It's asking, all right, this feeling, the sensation of anxiety you're having right now, what is it signaling you?

How is it trying to help you, even if it's misguided at the time?

Maybe I'm telling myself that I'm going to do lousy on the assignment before I even started it.

Okay, this is based on past things, but how do you want to approach this now?

And it's also.

The toleration of discomfort.

Can I have this sensation?

As I'm still preparing to work on the assignment, prepare my presentation.

The thing that's causing the anxiety, this is the exposure based side.

And you know how I describe this?

We're trying to change your relationship with your emotions, understanding it, understanding how the alarm might be, trying to help you.

Anybody who's ever had a smoke alarm in their kitchen that gets set off when a pot boils over or something like that, the alarm goes off and it's annoying, even though you know it's not.

There's not a fire.

But that's what alarm systems do.

They're overly sensitive and our emotions are there to help us.

So, you know, having that relationship with your emotions.

Questioning, all right, why am I feeling this now?

Now it could be I'm anxious because I'm going to be around a family member who's very critical of me and I want to be on guard for that.

That.

And I think this is a really aside, but I think this is adjacent to the anxiety discussion.

It's something I cover in the book too.

Rejection sensitivity, which is another form like in, I guess we could say the social anxiety realm.

And again, it makes sense.

It's based on very real experiences of.

I have been rejective actively.

We don't want to hang with you anymore.

Or passively.

Huh.

I wonder why I haven't been included in the group text for a while.

Yeah.

So, you know, it, it covers a lot of things, but that relationship with the emotions and you know, within the, the CBT for adult ADHD framework, even jumping back to something you said before.

The self mistrust.

My whole.

My.

My previous book Rethinking Adult ADHD was about the cognitive piece and the thoughts and beliefs and that's my.

It still needs to be tested.

But my conjecture about the main cognitive theme in adult ADHD is I know I can do it but I don't trust that I can do it when and where I need to do it.

And on the.

The emotional side it's the toleration of discomfort.

Can I feel some anxiety, understand where it's coming from.

But I can hold it as I engage and get started in the task.

And usually and this draws on the exposure based therapies for anxiety.

Once we're engaged we usually start to feel better.

Okay.

I'm starting to work on the assignment and hopefully that's also where our strengths come through.

I'm actually a good writer.

When I start the assignment or this presentation I'm looking forward to presenting this and my numbers are good or any other facets.

But that's, you know, how, you know, we get through to the other side.

Yeah.

I mean like you sort of saying the procrastination is a form of anxiety.

It's.

I'm going to just put this off because I'm still not trusting myself.

I'm not.

I know that I'm capable but can I actually sit down and get started?

When we.

We think of a sort of a more extreme form of the anxiety of the hyper vigilance.

Our nervous systems being ramped up feeling the sensations in our body and I know I'm going to speak from a personal perspective that catastrophizing is a really big part of my anxiety.

It's exhausting living like that with your nervous system constantly on hypervigilant alerts and how can we maybe if we're sort of seeing our.

The catastrophizing is like a flashing sort of 10 or red.

Bring it down to maybe like a seven or a six.

That feels relatively manageable in our nervous systems.

Right.

One is there's several things.

One is a reminder that feelings always change.

If you do nothing, feelings will change.

I was reading a book on managing emotions and it was an expert in panic attacks, panic disorder, who said I've never seen a panic attack in my life.

It's my expertise but by the time the person gets in front of me it ends.

So it feels like it never ends, but it does now I know when you're in the middle of it that's.

Thanks a lot.

It's sort of like in the middle of a bad storm and you're driving.

Oh, you'll eventually get home.

Yeah, it's great.

But right now I need help.

As simple as it sounds, even labeling the anxiety or labeling the feeling, whatever it might be, and including some sort of.

It's called labeling with granularity.

Some sort of specific.

This is my catastrophizing.

This is my awful izing.

This is my.

I hate writing anxiety and procrastination.

I think it does a couple things.

One, and this is underrated, but the pause.

We don't stop feeling.

But I'm going to stop feeling for a moment, the pause and think about what word do I want to put this.

Putting it through the language system.

Not that we're trying to.

Oh, don't feel.

No, it's to be with it.

But there's actually research.

That the simple act of labeling the feeling reduces amygdala firing in the brain and that labeling with granularity.

I think an example I heard about this was in Germany.

They have.

I don't know what the German term, but slap in the face anger.

Not that you would slap somebody, but it's.

It.

It puts a personal bent on it.

That again is slowing things down.

This also ties in with.

I found this to be a very useful portable coping strategy that's very consistent with cognitive behavioral therapy.

It's not specific to adhd, but many clients find it helpful.

And after I introduce it, they say, you know what?

I do that myself.

It is called Distanced Self Talk.

It was developed by a researcher at the University of Michigan, Ethan Cross, with a K, K, R O S S and he has a book out a few years ago called Chatter.

Distance Self talk is talking to yourself by name or as you second or third person.

If we're doing I, that's immersive self talk.

I need to get over this catastrophic thinking.

I can't be feeling this way.

I have to make myself.

It's.

It would be like if I'm you, Kate, this is your catastrophic thinking.

You know, it's because you're in the situation and you know, actually saying the words.

Or it could be you saying you.

And that has been found to be helpful with emotional regulation generally getting to a more positive endpoint.

If this episode has been helpful for you and you're looking for more tools and more guidance, my brand new book, the ADHD Women's Wellbeing Toolkit is out now.

You can find it wherever you buy your books from.

You can also check out the audiobook if you do prefer to listen to me.

I have narrated it all myself.

Thank you.

Thank you so much for being here.

And I will see you for the next episode.