CHADD talk June 2013 Dr. Muggli

S M Techniques That Work

ADHD & Anxiety: Managing the Impact on Relationships

Laura A. Muggli, PsyD Licensed Clinical Psychologist www.lauramuggli.com

212-787-7771

June 3rd, 2013

Goals for Talk….

• Provide a practical foundation of the relationship between anxiety and ADHD.

• Learn how to better identify worry and an anxious thought.

• Discover how to build connected relationships.

• Learn strategies to better cope with ADHD & Anxiety.

2Laura A. Muggli, PsyD www.lauramuggli.com

212-787-7771

Prevalence of ADHD & Anxiety

• Research has noted that around 5%-15% of the childhood population will have an anxiety disorder.

• Between 15%-35% of children with ADHD will manifest significant anxiety.

• Some studies place the prevalence of anxiety disorders comorbid with ADHD as high as 50%.

• In adults the prevalence of an anxiety disorder co-occurring with ADHD is around 20%.


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Why Anxiety and ADHD?

• Often times individuals with ADHD struggle with decreased cognitive inhibition.

• Cognitive inhibition is vital to appropriate social behavior.

• A deficit in cognitive inhibition could lead to disrupted family and peer relationships that may lead to anxiety.

• As research has noted anxiety may increase later in life as more demands are put upon us as adults.


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Identifying Anxiety

• Anxiety is always about the future.

• An anxious thought or idea almost always begins with an ‘If/then’ statement or a ‘What if’?

• It is about things we may feel we have little control over to change, i.e. another person or an airplane landing safely.

• What about worry?


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Worry

• An anxious thought about the future that has not happened that we repeatedly think about.

• Most worries take on a catastrophic tone—we may believe that something bad is going to happen, and that starts to feel like a valid truth.

• Worry can be categorized as productive or non-productive. • Examples of productive worry: tests, gas in the car,

preparing for hurricanes…etc.• Examples of non-productive worry: worrying that the sky

will fall, other people’s behavior, past experiences…etc.


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How do Anxious Thoughts & Worry Impact our Relationships?

• It is difficult to be in the present in our relationships.

• We have trouble believing that relationships will work out.

• We project the potential for “bad” things happening in our relationships.

• We feel even more disorganized in our relationships when anxiety takes over our thoughts and our mind.


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Worry, ADHD & Relationships

• Past experiences of difficulty inhibiting inappropriate behavior may lead to anxiety about our behavior in the current or future relationships. Examples?

• Lack of awareness of how we are impacting others. Are we reading social cues accurately? For example, long-winded, tangential conversations.

• All of the above ADHD related difficulties can negatively impact the relationship which can lead us to feel more anxious.


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More on the Worry-ADHD Connection

• Anxiety may become worse later in life when behavior becomes more reliant on planning and control of cognitive processing.

• Additionally, cognition is disorganized in ADHD, which may lead to feelings of psychic anxiety, independent of external cues.

• The inattentive type may be more susceptible to anxiety and depression as they have a tendency to internalize problems.

• Anxiety may be present in ADHD as a means to regulate impulsivity and poor social behavior.


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Executive Functioning Impacts our Relationships

• Executive functioning relates to the ability to plan, prioritize, problem solve and engage in appropriate social behavior. Deficits in executive functioning may lead to:• Poor planning--thinking something may take 10 minutes

and it ends up taking 25 minutes which makes you late to dinner with your friend, colleague or partner.

• Lack of follow through on saying what your are going to do which can be very problematic in relationships.

• Not listening-spacing out which leads to miscommunication and problems in all types of relationships.


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The Third Party in the Relationship

• Electronic devices have become a part of our everyday lives.

• We are used to instant gratification with texting, twitter and Facebook and Instagram.

• As much as these devices such as the IPhone can be tremendously helpful for organizing our lives and managing our time they can also interfere with our ability to be present and communicate effectively.

• How many have had this experience?


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The Vicious Cycle of Avoidance

• Avoiding or escaping from experiences that bring on the “bad” thoughts and feelings.

• Avoiding or running from anxiety only provides temporary relief.

• Avoidance can lead to disconnection in relationships.• I avoid writing an e-mail because I want it to be “perfect”

never responding to my colleague which leads to them feeling like I may not want to talk to them. Has anyone else experienced anything like this?


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What Strategies can Help us Minimize Anxiety and Build More

Connected Relationships?


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What have we learned?

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• What is the prevalence of ADHD and anxiety?

• How do you identify an anxious thought?

• How does executive functioning impact our relationships?

• How does anxiety impact our relationships?

Laura A. Muggli, PsyD www.lauramuggli.com

212-787-7771

Strategies: Be the Observer

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• Try to look at your thoughts instead of from your thoughts.

• Observe the mind and all of the many types of thoughts, i.e., irrelevant thoughts, disordered thoughts, and helpful thoughts.

• Do not follow the thought. How many people have had this experience? Sometimes it is almost as if you are dragged by the thought and it becomes your identity.

• Buying a thought versus having a thought. For example, “I am anxious or I am having the feeling that I am anxious.”

Laura A. Muggli, PsyD www.lauramuggli.com

212-787-7771

The Mind-Train Exercise

• Now imagine you are standing on a bridge looking down at three train tracks carrying different things.

• The train track on the left carries sensations, perceptions, and emotions. It carries things like the sounds you hear; sweaty palms; the sadness you notice; and so forth.

• The middle train track carries only your thoughts: your evaluations, your predictions, your conceptualizations, and so on.

• The train track on the right carries your urges to act; your pull to avoid and look away; and your efforts to change the subject.


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Mindfulness

• The practice of mindfulness is getting in touch with your own experience moment to moment in a nonjudgmental accepting way.

• Take time to tune in—simply notice what you’re saying to yourself, without judgment.

• It is taking a ‘pause’ before you reach for food, the phone, someone else…etc. Even if you only pause for a minute, that could be enough time to reflect and decide whether the action you were about to take would be helpful.


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Practicing Mindfulness

• Slow down to be able to observe your thoughts and sensations.

• Now take a moment to bring your awareness to the tips of your fingers. Feel your fingers.

• Rub your fingers together. How do they feel? What is the sensation?

• Can you feel the indentations in your fingertips? Notice the feelings that come up and move on.

• Another simple exercise is drinking tea. Notice how the color of the tea changes as it steeps. How does the flavor change as you begin to take a sip and what feelings are now coming up for you?


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Challenging our Thoughts

• As mentioned previously, there is a difference between buying a thought versus having a thought.

• When I am having a thought I can create space and distance from it.

• This space that I can create between myself and the anxious thought allows me to make a more reality-based and realistic interpretation.


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Managing ADHD-Staying Organized

• Manage the disorganization with whatever works for you. i.e. a coach, therapist, IPhone, daily planner.

• Have daily check-ins with yourself.• Do one thing at a time as none of us are really good at

multi-tasking.• Overestimate how much time something will take so you

will not be late to a dinner or meeting.• What are some ideas you might have for staying

organized?


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Be Involved

• Look for ways to spend quality time with the people you care about. For example, a noisy bar is probably not the best place to enhance connection in our relationships.

• Ask your friend, colleague or partner what they would like to do. What is important to them?

• Share in the experience with your loved ones—Do something active. For example, go bowling if that is what you like to do or volunteer for a valued cause.


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Listen Actively

• Do not interrupt.• Do not think of what the person is going to say next or

what you are going to say next. • Ask questions.• Ask someone to repeat something if you spaced out—

they won’t be offended, I promise. They will be more offended that you forgot, which may make them feel like you do not care.


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Meditation

• Improves attention and our ability to be more of an observer in our own lives

• It can provide more clarity.• Can improve our ability to behave less impulsively in our

relationships as it helps us slow down and be less reactive.

• Use a mantra or guided mediation. A simple mantra is Let, Go. Silently repeat this mantra over and over again for several minutes.


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Meditation Exercise:

• Make sure you are seated comfortably.• Sit up straight-back against the chair.• Have your feet on the ground.• Rest your hands comfortably on your legs.• Close your eyes.• Count from 0-10 and back down from 10-0. Inhale and

say 0 and exhale and say 1. Do this for at least 5-10 minutes daily.• Another exercise is walking mediation which can be done

anywhere at anytime which is especially easy in New York City.


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Closing Remarks:

• Be easy with yourself. Have self-compassion!• It will take some time to use the above suggested tools

on a consistent basis.• Be patient. It takes time to learn a new skill. I am sure

you would not be hard on yourself if you were learning to play tennis for the first time. Right?

• Practice.• Let go of judgmental thoughts. • Take time every day to feel good about making even the

smallest change in your life. Every change we make counts.


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Resources and Citations:

• Get Out of Your Mind and Into Your Life by Stephen Hayes.

• The Mind Train Exercise is by Stephen Hayes in Get Out of Your Mind and Into Your Life.

• Mindfulness exercises of drinking tea and rubbing your fingertips are by Stephen Hayes in Get Out of Your Mind and Into Your Life.

• The Mindfulness & Acceptance Workbook for Anxiety by John P. Forsyth and Georg H. Eifert


212-787-7771

CHADD talk June 2013 Dr. Muggli

Health & Medicine

Transcript of CHADD talk June 2013 Dr. Muggli