Welcome to the ADHD Women's Wellbeing Podcast.

I'm Kate Moore Youssef and I'm a wellbeing and lifestyle coach, EFT practitioner, mum to four kids and passionate about helping more women to understand and accept their amazing ADHD brains.

After speaking to many women just like me and probably you, I know there is a need for more health and lifestyle support for women newly diagnosed with adhd.

In these conversations, you'll learn from insightful guests, hear new findings, and discover powerful perspectives and lifestyle tools to enable you to live your most fulfilled, calm and purposeful life wherever you are on your ADHD journey.

Here's today's episode.

So I'm absolutely delighted to welcome Dr.

Russell Ramsey, talking to me at 6am his time.

He's in Pennsylvania and Dr.

Ramsey is a clinical psycholog specializing in adult ADHD and anxiety and he's also authored five books all related to adhd and he has one that's just been released recently and it's more of a workbook about ADHD and anxiety, which I'm really looking forward to hearing more about.

So, Dr.

Russell Ramsey, welcome to the podcast.

Kate, I'm thrilled to be here.

Thanks for inviting me.

We were just saying before we press record that we talk about anxiety a lot in the podcast.

It's always there under the surface, the nuances of it.

But actually we've never got into the nitty gritty of the specifics of how anxiety shows up alongside ADHD and how we can disentangle it all and understand how to help ourselves with our anxiety and thrive more with ADHD as a whole.

Because as we know that ADHD doesn't really go anywhere, but we can help ourselves using tools.

And I know you also specialize in cbt, which is really helpful, so perhaps we can just kind of like roll things back a little bit.

And when people know about their anxiety and then they know about their, they understand that it's ADHD related.

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 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.

I think I'm doing okay at work but there, oh, I forget what they call it in the UK here we might call it downsizing.

I forget.

I remember watching the British office, they would talk redundancies, redundancies.

I think it is so.

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 phrase, reliable in keeping up with my day to day.

So even the stimulant, it would seem counterintuitive 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 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 this is almost like my doctoral dissertation defense.

So no, but that's a long winded.

The connection between ADHD and anxiety and also how that understanding helps explain how some of the treatments work and how it can be a both and you can address both simultaneously.

It's not like let's do two sessions on ADHD and two sessions on anxiety.

No, I think how I view it, they come together.

Yeah, no, I totally agree.

And you know, what you were saying then resonated so deeply for me and I know will resonate deeply for a lot of the listeners is the lack of self trust and a lot of self doubt.

Because like you say, if we've been diagnosed especially for women, much later on in life we will have spent half our lives not trusting ourselves and having the evidence to prove that we do turn up to the airport and we've forgotten our boarding pass or we've got the wrong day or we miss our trains or like you say, we've, you know, we've got the, the wrong presentation on the wrong day and all sorts of things because we have the evidence to back it up.

But that was pre awareness, pre understanding.

So we had a story of we're not reliable, we're disorganized, we're always late, we can't do things the way normal adults do in inverted commas.

So it's really hard, isn't it?

Then we've got to use like therapeutic techniques such as CBT to break it down, unravel it all, and maybe rebuild our beliefs and the way we do things through the knowledge of actually, this is adhd.

This has not been my shortcomings.

It's not been me not trying.

It's not been me being lazy.

And I know that's been, you know, so to speak, a difficult pill to swallow for many people.

And it's really hard as well.

When we've had layers and layers of conditioning and belief systems building this up and people telling us, and the criticisms and the internal self criticism as well.

I can understand why the anxiety, even through the awareness of adhd, is probably the hardest thing to work through, which is why I wanted to talk about it today.

Right.

And emotions in general, that's one of the other facets of adhd.

And it's still not anywhere in the official criteria.

But emotional regulation is one of the executive functions.

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 they're 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 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.

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 as 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?

You know, when we, we think of a sort of 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.

And especially when you become a parent and you've got kids and all sorts of things can go on and it feels really hard to be able to kind of tame that down when again we can think.

I think we've got a really exceptional part of our ADHD anxiety where we're good at problem solving and health and safety threats and all things like that and we can be five steps ahead of someone else.

We can notice all the exits and the fire exits and all things like that.

But actually 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 the catastrophizing as like a flashing sort of 10 on a 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.

Yeah, 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.

Distant 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 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 as well as for task initiation, getting started on a task which goes back to something we were just talking about.

Very often it's now this is true of everybody, ADHD or not.

But like most things, it's even more relevant for folks with adhd.

The emotional regulation piece with procrastination for everybody.

Because we all procrastinate.

20%.

I think at least in the US sample, 20% of people in the population would describe themselves as problematic procrastinators.

And what is the cognition?

I usually hear of people when they talk about both their thoughts about the task that they're putting off and probably it relates to the feeling.

I'm just not in the mood to do it now, I'll be in the mood to do it later.

Even though it's usually a task that nobody in their right mind is ever in the mood to do.

Homework, US income taxes, chores, things like that.

But that's the justification there.

So the talking to yourself by you or his name.

And even if you're in a public place, you can't do it.

You just, you know, sub vocally just working your way through it.

These couple portable tasks, the labeling, the distant self talk, couple tools that we can use, like you said, it's not going to turn it down to zero.

You know, another way to think about the feelings, even including the unpleasant feelings and the unpleasant emotions like in that case anxiety.

But even sometimes the social emotions like guilt.

Because guilt, like other emotions, it's helpful that we have it, we need it.

It's like pain.

If we didn't experience pain, we'd be walking around with third degree sunburn, whatever.

And guilt is a social emotion.

The adaptive feature, it lets us know when we've made a mistake.

Oh, I never said thank you or I never sent the card for my sister brother's birthday, something like that.

But it should only be a mild twinge like oh, I've got to mail that card or the E card, I'm a Gen X or I still toggle between the two.

But sometimes it can be excessive.

So even if we're working it down to say this is a relatively minor offense.

I made it good, it's all good.

We probably don't want to totally eradicate it.

So even if we look at what percentage of this says something helpful about me.

Okay, I might lead first with my guilt feelings thinking I did something wrong.

But I might magnify that too much or sometimes go, oh, somebody walked in because they didn't bring their umbrella and it rained and they say, oh, I forgot my umbrella.

And we go, I'm sorry.

Well, why am I sorry?

It's like, well, I invited you over to my place on a rainy day and you forgot your.

And we catch it later and go, that wasn't my doing.

They were just sharing that they forgot their umbrella.

But we might even go, well, the very fact I have that.

What might be a positive sign?

Well, I take responsibility for myself or I'm worried.

I want to make sure I'm not any excessive people pleasing.

That would be turning the dial down.

But I care about other people and I'll take responsibility if I have done something.

And that actually draws from some of the work of David Burns, a very noted figure in cognitive behavioral therapy and his probably more recent update of his Feeling Good book called Feeling Great.

But it's a nice add on about even when we have these unpleasant emotions and we go, it misfired here.

But maybe it's coming from.

There's that residue that might be a positive thing even if it was misguided in the moment.

So it's another way to decatastrophize and not say, oh, I'm always guilty, what's my problem?

It's like, no, some of this will always be there because it's a positive part of my relationship in my palette of my emotions.

And you know, one other thing with the distance self talk.

And this is my hypothesis and it's from working with almost exclusively adults with adhd, in addition to everything else that's been shown, at least in lab based research associated with it.

I think another thing it does, yes, it makes us say it.

And I think especially for adults with adhd, we're speaking as though we're speaking to somebody else.

And what will most people say, especially with adhd, I can coach somebody else what to do, but I don't follow it myself.

So there's that we're saying it in that language.

And I think this probably goes beyond the data, putting it in you or by name, maybe drawing on our compassion for others, that if we were supporting somebody else so if we're doing that language, hopefully we're turning some of that, that compassion towards ourselves as we're talking ourselves through the task or through the feelings.

Totally.

I was going to say it sounds very much like the self compassion work and it has to come from our, you know, to ourselves first and you know, the same way we would show to, to someone else.

I really do believe that speaking out loud and saying our name like almost like jars us and we are listening and so I'm really delighted about that because that is something that I, I do and I coach clients about.

But what you're saying about guilt is a social emotion.

We've got people pleasing, there's obviously perfectionism.

There's so many different ways anxiety can show up that perhaps we're not even aware is our anxiety kind of like playing a role there.

And so breaking it all down and understanding and allowing ourselves to have that pause and say, okay, so what's this telling us?

What's this teaching us?

Where's this coming from?

It I guess removes all that noisy chatter and allows us to, I don't know if analyze is the right word, but be a little bit more strategic with the tools that we can then bring in.

Moving away from the psychologies just for a second.

I love using sort of supplements and I'm a big fan of medication.

If it works, that helps.

Something that helped me with Saffron.

I remember feeling very, very anxious at a certain time, not, not that long ago, about a year ago.

And I went into a holistic supplement shop where I got lots of supplements from.

And I said I'm borderline needing to go and have medication.

And I wanted to try something more holistic just before I did that.

And she showed me quite a lot of evidence to say that there'd been trials to say that Saffron had worked just as well as anti anxiety medication.

I thought, you know what, I'm going to give it a go.

I and it really did help.

It dialed that anxiety down, say it was from like an 8 or a 9 probably down to like a 5 or a 6.

And it helped me cope in those situations better than I probably would have coped without any of that.

Who knows if it was psychosomatic or not.

But I do take it and I take it most days.

So I think that it's amazing to have all these psychological tools, but I do think there's other ways, you know, like movement, meditation.

I'm interested from your perspective as a, as a psychologist who I know would rely on evidence and research.

How do you think this all blends in together?

You know what, I'm not as up to date on the Saffron, even though as you mentioned, I think I've heard people.

So my second book, it's like from 2010, so it's getting dated.

But it was a review, a book length review of non medication treatments for ADHD.

And going into some of the supplements, I'm never gonna tell somebody who says, you know what, I find it helpful, keep doing it.

There's also other things and I think you're on board in addition to everything you said before, exercise, sleep, overall good health practices as best we can.

But again, what's difficult for adhd, it's the organization of behavior across time to remember to do the exercises, to get to the class or to take the supplementations and the vitamins and to you know, get into bed and turn things off.

So I mean that's, that's the, the insidious nature, the paradox of ad.

Like people would say if I could do all the CBT stuff, I wouldn't need to come to see you, I'd be doing it on my own.

But my cute phrase about that, we all know the strategies, but there are the, the tactics for how do I implement this especially that are modified for ADHD including like whatever supplementation regime.

I'm all for having the things researched and you know, finding what's the best fit, how much works, how well for how long for, for who and in what situation.

Yeah, I think with ADHD the best part is that awareness.

It's that, oh, okay, now I understand what's going on from a neurobiological perspective.

We understand that our brains are operating differently, we've got different wiring and just to have that validation and awareness and the recognition and like you say, how exhausting and tiring it's been all our lives to be working, overcompensating, feeling like we're constantly on a hyper vigilant mode because we may forget something or do something differently or all of those things, but then once we've got that awareness, we can kind of separate what works for us.

You know, like you say, ADHD shows up and manifests so differently in such kind of nuanced detail that someone may just really, it may just work for them to go for a run every single morning and for them that's it.

And they, everything else kind of like they, they ticks along.

For me, I always remember my supplements because I put them in a place where, and I know, I feel really different if I don't take them.

And I know that I have to have water with me because for me if I feel any tiny bit of dehydrated, my emotional regulation, everything just my concentration just feels off.

I sort of quite finely tuned in my body like the symptoms and those alarm signals.

So it's, I guess it's knowing ourselves, isn't it?

Knowing what works for us and not feeling like we have to do everything.

And that again can breed the anxiety of oh my goodness, right, I need to do everything, every single last thing from a lifestyle perspective I have to tick off and I need to know everything about CBT and I need to know all these anti anxiety kind of tools and strategies.

Otherwise you know, it's like that all or nothing thinking.

Yeah, this is the personalization of it.

And like in the book, I recall what you just said there, the overwhelm, anxiety, it's, I'm overwhelmed by everything.

And that's part of what our working memory does.

It's to take these things and say, okay, I'm going to push that pile over here.

Here are the two things I'm going to do today and put it on a to do list or however you keep track of it.

But you know, working memory is one of these things implicated in ADHD in terms of okay, if I, if I push those things over there I'll forget them or if I try to hold two things I'll drop one.

One metaphorically and but this is the personalization and like you said, people ask me what are good jobs for somebody with adhd?

And in general, based on interview research it seems like active hands on things, project based like time limited beginning, middle, end, stop, something new.

But there could be somebody with all respect to the profession for some reason accounting is always the one that is used.

But there are people with ADHD who find accounting and the numbers as like a puzzle and that's mentally engaging.

Where somebody else goes, oh my gosh, the numbers.

I'm just seeing like the numbers of pie going in front of my eyes every day and I can't focus on it.

Again, this is the personalization of the treatment, the goals and what works.

And another thing you mentioned in there, sometimes people will come to me saying, you know what?

Sometimes I think I have obsessive compulsive disorder because when I get home my family wants to read or the pet goes to greet me but I go, wait, I have to take care of things.

I have to put my id, my keys, I have to put them here first because If I don't, I'll put them in my pocket, I'll set them in a drawer in the kitchen, and then tomorrow I'll go, oh my gosh, where are they?

And now that's certainly not obsessive compulsive disorder, but that's, that could also be like one of those somewhat unpleasant emotions where we go, hey, this is helping me that, excuse me, I'll be right back, let me do this.

And it's also, you know what, this, this goes back to the social emotions and rejection sensitivity, a lot of adhd.

And this gets at why guilt and shame are often brought up.

And oftentimes in situations where we go, you didn't do, you didn't hurt anybody, you didn't make a mistake with anybody.

So guilt seems like it.

I'm not telling you, oh, your feelings are wrong.

But it's like, it's interesting that you say guilt because nobody else was affected by what you did.

But it's because very often a lot of the experience of ADHD growing up, even before it was diagnosed, is very public facing in the classroom, in the workplace, in the family, with siblings getting the feedback, or even if the family, the coaches, the teachers are very understanding, we draw those conclusions to, oh, they must be so annoyed with me.

Or I know they're just being nice when they say they're not bothered by it or things like that.

So that's why emotions generally, but also those, those social emotions, you know, the other thing too, and this goes back to dealing with the emotions, is looking.

Sometimes emotions are layered.

It might start with anxiety, but there's also anger that's underneath and it's, it's, you know, magnifying a little bit the anxiety in there, you know, there.

And there could also be like maybe a percentage of guilt in there.

I shouldn't be feeling this way.

I should be able to blah, blah, blah.

So it's just we're complex creatures.

You know, the emotions, they're all there to be helpful and sometimes, often based on our past experiences, which is helpful.

But sometimes our current situation, the current context, they might be unhelpful to a degree because they're not matching up what our goals are for the situation.

Or there's residue from past experiences that may not be relevant here.

Yeah, it's very much noticing what our, I guess, how our anxiety presents and from a historic perspective, maybe having felt dismissed or invalidated or ridiculed by family members, something I can really relate to.

Even my husband, who bless him now, is a lot more Understanding by adhd, because he lives and breathes it in the house.

We've got kids with it.

I've got it hanging.

Pretty sure he's got it, and he is sure as well.

And his anxiety shows up in a very different way to mine.

Whereas I wouldn't have thought it was anxiety, but now we've kind of unpicked it and we recognize that it is where mine was a lot more kind of surface level.

Like, he could see straight away when I was overwhelmed, there was just too much on, or I had to juggle too many things, or there was a party to organize, and there was just so all these other components.

And he could see, like, how anxious I was getting.

And he, in the past, probably would belittle it a little bit and say, why are you so neurotic?

Stop worrying.

And these kind of, like, words with negative connotations that we've grown up.

So we then suppress our anxiety, which we now know makes it worse because it's internalized.

And it can come out in patterns like, you know, unhealthy behaviors like addiction or not sleeping properly, or it can come out in all sorts of ways.

Maybe ocd.

OCD as well.

And when women, I think, are diagnosed later on in life, it's almost like we go, okay, I can breathe a little bit now because none of this was a figment of my imagination.

This was real, and there is a reason for it, and it's true.

And I've had years of being dismissed and invalidated and ridiculed, and actually, it's okay for me to admit it and look at it and accept it.

And I think with your workbook, it's going to be very empowering for a lot of people to say, right, this is where I've been.

This is how, you know, it presents for me, and this is how I've lived my life.

And my coping mechanism has been to internalize it and suppress it.

But, you know, it's come out in migraines, it's come out in pain, it's come out in skin conditions, gut problems, all sorts of physical manifestations where we can now say, it doesn't have to be like that.

We're allowed to let it have its say.

Something that I do with my clients is almost giving, like, the anxiety or whatever the critical voice is, or whatever it is that we sort of see as a part of us and a bit of distance and almost kind of give it another word, another name and reflect back on it and say, you know, thank you for keeping me safe.

Thank you for being there all my life.

And I know that you've been there for a reason, but I'm wondering if maybe we don't need to.

You don't need to be there as much or thank you for giving me these warning signals.

But actually maybe I'm going to try a different perspective or a different way of thinking or, you know, this type of thing, which I think can be, you know, can be very helpful.

And going back to your book, I'm wondering, you know, you've written a lot of maybe more theoretical books and this is a lot more practical.

Were you noticing that people were ready to feel more empowered?

And now that they had the awareness of the ADHD, the adult ADHD, which perhaps 10, 15 years ago wasn't the case, they're now saying, actually we need strategies, we need tools to be able to work with this in our daily life.

Yes.

I mean, I think that's been one of the benefits of CBT and why it aligns so well with medications often because as one of the colleagues who also appear at the early stages of the development of CBT for adult ADHD said, the CBT picks up where the medications leave off and they align pretty well together.

And the things he said, even about the distant self talk, and even you mentioned talking to the feelings and things, and we could use the distant self talk to talk to adhd.

Okay, you pulled me away from the task right now, but I want to get back and at least finish Strong or finish 10 minutes and wrap it up rather than just leaving it go.

And this is taking some of the strategies that are out there and personalizing them from adhd, just like you were talking about personalizing.

One person might go for a run first thing in the morning.

Somebody else goes, no, I'm better at starting my morning this way.

And here's how I'll work in the exercise later.

But two points I wanted to make that you brought up, rightfully so, about women with adhd.

One is, you know, we're talking the anxiety.

Very often women later diagnosed with ADHD and seeking help saying, something's going on.

I can't keep up with everything.

I'm feeling anxious.

The anxiety and often the depression is what people are going to latch onto, because one, that's what.

And I'll just keep it to two professions, even though there's a wider array like psychologists and psychiatrists, we all get training in that.

That's like the common cold for the family doctor.

So we're going to catch that and say, well, it Must be anxiety or depression.

And sometimes women will go through treatment for that and get a little better.

Hey, I've got some tools for that.

But still the time management, the disorganization, the other features of ADHD are still there.

So it's like there's still that doubt.

Well, I had treatment.

Did I not do treatment well?

And it's not until the diagnosis that I've called the accurate diagnosis of ADHD the first cognitive intervention in cbt.

Because now there's this shift of now it makes sense.

There's a framework I have that's out there that this makes sense why I put things off.

Because historically this, that and the other thing, and the other thing about women is you mentioned perimenopause and menopause.

That's another game changer where including women who clearly do not have a history of ADHD may go through that phase of life and start feeling like they do.

And there's been some research.

Tom Brown, a world expert in adhd, K.

Neal Epperson, a former colleague at Penn, I think she's at University of Colorado now and still doing work on this, found that even using prescribed stimulants for ADHD could help women going through menopause dealing with the cognitive symptoms even if they didn't have a history of adhd.

Now that would be off label use.

But it's been researched and you can find the study.

But looking at how even if it doesn't fit a full pattern, a lifetime pattern of adhd, these sort of features can arise, you know, going through perimenopause and menopause.

So again, it could be another thing that gets dismissed.

Get over it, you'll get through it, It'll, you know, whatever.

But, oh, it's, it can be.

And just like menstrual cycle and adapting for that, it's, it's something that, you know, women with ADHD and going back to, you know, puberty and adolescence, totally.

And that's why we have to be so open minded about ADHD in women, because of the hormones involved.

And I'm really glad that you said this, that we can start thinking about it like this because it has to, things have to change a little bit.

It can't be so prescriptive.

And I kind of don't laugh, but it makes me chuckle that the way medication works for some people and doesn't work for other people with ADHD is so indicative of adhd because there's just so much we still don't understand and there's still so much Unknown.

And there's still so much like you say, this personalization how it just shows up slightly differently in each person, male, female, child, teen, you know, a woman going through perimenopause.

It's just so slightly different that each treatment plan and strat and the strategies just have to be personalized.

And I wonder if that kind of just shines a light on the fact that awareness and understanding from a personal perspective so vital because if we don't understand, like you say, so many people come to you with anxiety and depression but actually it's only when we get that diagnosis of the adhd, we're then able to really tackle it and understand how maybe time involves, you know, anxiety, the organizational side, the executive functioning, the mood, the emotional regulation.

We're then able to see it as a full package.

And sadly so many women have just gone under the radar and they haven't had the right treatment plans and medication and psychological help.

And this is why these conversations are so vital.

And you know, your book I think is going to be hugely helpful for so many people because they're then able to take, take control and you know, if they can't get that support post diagnosis and if the only support they are getting is a titration of medication which may or may not work, but then all these other things are still not kind of falling into place for them and we just need to keep working harder to have these conversations so there's more awareness and more understanding and more self compassion.

I would say.

No, I agree what they were saying about the personalization of treatment.

I mean part of this.

And before I want to give a shout out to two European colleagues at one, I think I mentioned to you before in our pre talk, Susan Young in the UK and Sandra Koi K O O I J in the Netherlands, they've done a lot of work advocating for women, you know, girls, teens, women with ADHD and everybody else with ADHD too.

But you know, tackling some of these issues, the other thing about the personalization, when we think about our human brain and more specifically the executive functions, because that's usually where even making the diagnosis sometimes, well, very often that's probably a better framework for being able to see ADHD because the attention problems, you'll hear this, you've probably heard this from people and maybe we've even uttered it.

Well, how can you say it's an attention problem when you can be so focused on this or that and it's not really that level of attention, it's the attention allocation.

Yeah, they're focused for an hour on that.

When they had planned to do a little here, a little there, a little there.

It's the allocation and difficulties directing attention.

But the executive functions, when we get down to the time management and not necessarily that we have to, it has to show up in a job or the classroom.

This could be around the house, our health, our taking care of our pets and scheduling their appointments, whatever we view as important in our life, being on top of it.

And the executive functions really one, they arose going back to the social element.

Early humans living in larger and larger groups of non genetically related humans where about like 100 people.

So very small communities that if you weren't doing your share or somehow were deemed inappropriate for the group, that was a death sentence.

So there was a selection pressure for these things.

But it's also about adapting to environments.

Now we humans have adapted to the earth.

Yeah, spoiler alert.

But bringing it back to the clinical work, well then different people are going to have different relationship environments, housing, cultural environments.

So that gets back to the personalization and just even our subtle different temperament differences.

You know, we were talking about whether you're a morning person or more of an evening person.

So, you know, that's that.

But that's part of the clinical work.

The work helping other people.

That.

There's a lot of overlap and there's some general strategies.

But that's the clinical task, the coaching task of taking the broad principles and tailoring them to the individual and the tweaks.

And that's part of the.

And I think in there the relationship with the helper, coach, therapist, somebody who gets it.

Hey, this makes sense.

No, it's.

I just offered this planner as a starting point.

It's got all the basics, but this is where we take that suggestion and we drill down and find what's most helpful for you or and be it how you sequence tasks in your day, there might be things you go after I do that I'm done.

Okay, let's put that at the end of the day and let's build in breaks and all those, all those other things.

I know I'm preaching to the choir right now, but the per.

That's the personalization of this.

Yeah, totally.

I mean coaching is I think so, so powerful and just to kind of this the overarching conversation that we're having, especially because this podcast is, you know, specifically more for women.

But there's a lot of men that listen to it so they can help their, their wives or partners.

But what I'm seeing So much.

Is this because as women, you know, you go back to the anthropology of living in a community that women have been conditioned that our executive functioning should be able to cope with all these moving parts and should be able to have children and keep a house and not forget things and cook dinner.

And now this expectation of women working, having careers and, and having ambition, all these different things.

Which is why I think ADHD is coming more to the forefront.

Because the pressures and the expectations that are on us are much, much greater and we have more.

Maybe our parents are living longer, our children are living at home for longer.

All these different things that I just want women to be able to kind of just hear and like let it land in their bodies that maybe this is a reason why ADHD is becoming a lot more prominent in women, is because it's harder to juggle life and our executive function can only withstand so much and our working memory and our time management because the overwhelm is very, very real.

So I just wanted to add that to the conversation because I think that's kind of like a common thread which I hear in all my clients.

I 100% agree.

And I think part of what we're talking about here with the emotions, and I might not have said it explicitly, we're normalizing them.

That's another thing, like including with social situations is as you're going into it, know what's coming and planning and even having coping reminders, like a coping card to remind yourself in the middle of the boat and hey, remember, this will be okay, it'll be over in whatever time.

Or here's the positive I want to focus on and even interpersonally, to the degree that we can, and I call this using our social capital or our influence.

It could be something like setting up a meeting with somebody.

And typically the meetings go for 45 minutes and if somebody goes, I'm losing my focus after 20 minutes, it might be making a counter proposal.

Is it okay if we set up a 20 minute meeting or, you know, if getting together with lunch for a friend or they say, hey, let's get this really nice dinner, four courses and you go, I'm going to have to be walking around after they bring the bread to the table.

It might be, hey, how about a quick lunch?

Or we get coffee and a dessert somewhere, Make a counter proposal that's still in line.

It's not like, oh, I can't see anybody.

Because that's another thing, people with ADHD might start withdrawing because I can't do this well and I can't keep up with the conversation and being able to make counter proposals for things that work well for them.

But also going back to where I started with this.

Just normalizing.

Yeah, anybody?

Our executive functioning, there's a limit where we have to stop and rest and normalizing that our emotions, the imperfection of our attention, including sometimes that is a sign.

And I tell my clients this.

A lot of times it's not procrastination.

It's saying, I need to recharge my battery I've put in.

But that can be the all or nothing that comes from the history of unrecognized adhd.

And, you know, one of the cognitive distortions is comparative thinking.

Well, it looks like everybody around me is still focused all day long, but if you actually watched everybody.

Oh, they're on their computer.

Yeah, they're probably on Amazon or something else too, and taking these little breaks or whatever else.

So sometimes individuals with ADHD may be holding themselves to an unrealistic standard because how they assume, you know, what's normal or typical or what they think they see everybody else doing, but they don't see.

Maybe the person at the other cubicle is taking a proper lunch break for an hour or goes out, they walk away.

And maybe they walk around the block for a break or something like that.

And that somebody with ADHD can do.

But sometimes there's that limit or the penalty they put on themselves.

I have to keep working.

Something like that.

Totally.

Definitely.

I think we put neurotypical people or other people on a bit of a pedestal and we kind of glorify, glamorize how they get things done.

And that's why I'm a huge fan of being vulnerable, being honest and admitting and say, yes, I have a cleaner.

I have help.

Someone does this for me if I'm doing like a party.

Yes, I went and got outside catering.

I didn't make all these salads.

Yeah, just these little things just to normalize and say, yeah, I go on holiday, but I'm really anxious about the packing and making sure I've got everything and I've got all the medication.

And yes, it looks like on social media that we're having a great time.

But actually I was really worried, anxious.

We had an argument, like all these things.

I just think it really, really helps.

Dr.

Russell Ramsey, I could talk to you for a very long time, and I just think that what you're doing is amazing.

Can you tell people where they can get your book and what it's called?

Right.

The title of the most recent book is the Adult ADHD and Anxiety Workbook.

I have a website, it's www.CPT Number4adhd.com.

So I have all the books.

I have other things.

You'd be sick of me by the time you're done with it.

So if you want the book, you can just go to the book section and get that.

Fantastic.

Thank you so much for your insights and your expertise.

And I know that I think this conversation will be very, very valuable and I would absolutely love to have you back on maybe for a round two where we can maybe talk about all the things that we didn't have time for because there were lots of other things I wanted to ask you.

And I'll make sure all the details are on the show notes as well so people get get in touch with you as well.

Okay.

This is a blast.

I'd be more than happy to come back.

I really hope you enjoyed this week's episode.

If you did and it resonated with you, I would absolutely love it if you could share on your platforms or maybe leave a review and a rating wherever you listen to your podcasts.

And please do check out my website, ADHD womenswellbeing.co.uk for lots of free resources and paid for workshops.

I'm uploading new things all the time and I would absolutely love to see you there.

Take care and see you for the next episode.