Managing life with ADHD & how counselling can help

10 minute read

OK, so I’m not really sure where to start with this one. It feels like a gigantic topic to try to address in under 3,000 words. Plus I keep procrastinating… obviously, since I have ADHD too.

Firstly, I’m aiming this blog at those who have ADHD, or suspect that they have ADHD. It’s about what it feels like to have ADHD and how we can manage some of the typical difficulties that can arise for those of us with ADHD.

I’m not going to waste time explaining what ADHD is or what is going on in the brain, as I expect those of you with suspected or diagnosed ADHD have already researched it yourself. If not, I would really encourage you to do so. (Here is a link to ADDitude magazine, which has loads of information for a good starting point). It makes such a difference to understand why we struggle in the ways we do and how our brains work, and this can really help not only with addressing the issues that come up as a result of this, but also with managing the good old ADHD-shame that can be so crushing.

So I will just summarise the basics. ADHD is far from the stereotypical “naughty boy” label that it used to be seen as. There are different presentations, some people struggle more with the hyperactive side, others with the difficulties in focus, many struggle with both. In people who have been raised as female, ADHD is hugely under-diagnosed, due to the different presentation. Girls tend to be more likely to cope in school environments, but often go on to develop anxiety and depression as a result of the effort it takes them to do this.

Though it is still unclear exactly what causes ADHD, and there are different theories ranging from childhood trauma alone (quite a controversial theory), to a combination of genetic factors and environmental factors, we do know that dopamine levels tend to be significantly lower for those of us with ADHD (more info on this here). Dopamine is a neurotransmitter and is the reward chemical in the brain. This is important to understand when thinking about the issues we tend to face and in helping us to break away from the feelings of shame around feeling like we can’t “do life” the way others seem to.

Procrastination

Procrastination can be a massive problem for people with ADHD. It seems to me that there are broadly two approaches to working with procrastination. One is to accept that this is how you work and to recognise that you need a certain amount of stress before you can get the motivation to do a task. This is backed up by our understanding of ADHD and dopamine levels. Neurotypical people are starting from a higher level of dopamine, so when someone says “just get on with it!”, or other such spectacularly unhelpful advice, that is just how it works for them. They might not want to do a task, but they know it has to be done, so they just get on with it. For many of us neurodivergent folk, it is sadly not that simple.

It can feel like it is impossible to start a task that we are struggling with. Maybe it’s that big essay or report that’s due, or maybe it’s just getting out of bed. Either way, it is hard to describe just how much effort it takes.

So going back to the level of dopamine in the brain, if we need a certain level to get to the “activation point”, maybe we need a boost of adrenaline from the stress of being late, or not having the essay ready to hand in, before we can get to that point and actually start. So perhaps by accepting that this is how we work, we can reduce the level of shame and self-judgement and actually plan around working in this way. That way, we cut out a lot of unnecessary energy expenditure and don’t feel half as bad about ourselves.

The other approach is a little more structured and can vary depending on what works best for you. There’s an idea that can be referred to as “dopamine dripping” whereby we deliberately seek small releases of dopamine in a way that helps us to stay regulated, rather than having the highs and lows of big releases from activities that might not be supportive or helpful for us.

This might be from ticking off a small task, like making the bed or from listening to music, getting out into nature, or getting some exercise, even just for a few minutes. I know this might sound simplistic, but it really helps.

Many people also find that breaking tasks down into really small steps can help with this, as you can then tick off each step as you go, thereby generating a small release of dopamine. There are even apps that can support you with this.

Handling the highs and lows

Emotional dysregulation is one of the biggest issues reported by adults with ADHD, shown to be present in up to 70% of adults with ADHD (Shaw et al, 2014). What this means is that we can be flooded with a strong emotion, very quickly and without much, or any, conscious thought or warning. We can then really struggle to regulate that emotion and soothe ourselves. We can also find it extremely hard not to react from that place of heightened emotion, due to the difficulty we can have controlling our impulses.

I have been working as a counsellor for more than 10 years, so I notice that I feel some shame admitting that I too can struggle to regulate my emotions. This is partly due to my own internalised messages about how therapists “should” be and also due to having received the repeated message that I am “too sensitive” or “too emotional”. Sadly, I have no doubt that this will be familiar to many, if not all, of you.

So let’s try to be compassionate and gentle with ourselves about this. It is really hard and there is now good understanding of what is happening in the brain that makes it so hard.

OK so now we’ve laid aside the self-criticism (ish…), how do we work with this in a way that helps us to manage it?

Well, laying aside the self-criticism is actually a big part of how to manage emotional dysregulation. We are hard-wired to judge ourselves, but this makes it so much worse. So the first step is to try really hard to step back from the self-judgement. Then we can notice what we are feeling. It helps to label it. If you are someone who finds it hard to recognise and name their emotions, it might help to think of them in terms of 4 major categories - angry, frightened, happy and sad.

Once we have identified what we are feeling, we can spend a few moments just feeling it. Sounds easy but it actually takes a lot of practice. This is essentially a mindfulness practice and can be incredibly helpful. Try not to think about what you are feeling, just notice it in the body and allow it to be there.

You might well find by this point that the feeling is starting to recede. That might be all it takes. What we want to avoid is the ridiculously slippery slope of engaging with the thoughts that come up in response to whatever we are feeling.

When we are in the throws of such strong emotion, we can not think clearly, and we tend to find old, embedded patterns of thought coming up. For me, these are often thoughts around the belief of not being good enough.

If I engage with those negative thought patterns, I will have spiralled down into the rabbit hole of doom before I can catch myself. So it’s really important to notice those thoughts, and step back from them. If we can simply label them as thoughts, not facts, and allow ourselves to feel the sensations in the body, they will actually pass most of the time.

Many people find breathing techniques helpful to reduce the adrenaline level and calm the nervous system. A good basic technique is the 7/11 breathing exercise. Breathe in through the nose for a count of 7 and out through the mouth for a count of 11. It can be at any speed, as the important thing here is the ratio. The out breath is longer, thereby giving your parasympathetic nervous system the message that you are not at risk of danger, and helping to switch off the adrenaline release from the fight or flight system.

Other useful techniques include writing a reassuring note, having a particular picture or prompt on your homescreen, or keeping a journal to hand. I know out of sight is out of mind for most of us, so it needs to be somewhere you will see it. You could even use a piece of jewellery or clothing as an anchor to keep you grounded in reality. Questions like “is this a fact or a thought”, or prompts such as “breathe through it” can be helpful.

It sounds easy but I know that it is far from easy. Sometimes, we will all fall into that hole, but trust me, practice makes it easier, and it really does make a difference, a lot of the time.

Other factors that help are those basics of self-care. Eat good food, drink plenty of water, exercise, get outside, limit or reduce alcohol consumption, sleep (yeah I know, we’ll get to that shortly).

Hormonal cycles play a big part, and for those going through perimenopause or who are post-menopausal, well that’s a whole book in itself. We know that sex hormones have an impact on dopamine and seratonin, as well as adrenaline, so it is all a lot harder at various stages in the cycle. Go easy on yourself, speak to your GP or psychiatrist about support with this, and know that it is really, really hard and you are doing your best.

Hyperactive bodies and minds

The theory is that due to the low levels of dopamine, the brain is craving stimulation. This is often, not always, expressed through a lot of movement in the body and that characteristic “always on the go”, fast-talking, restless, fidgety presentation. What people often don’t realise is that it can also be a more inward kind of hyperactivity, associated with thinking and restlessness of mind.

This can make sleep an enormously difficult issue and lead to real trouble with staying focused on conversations or work. It can also make it a lot harder not to “overthink” pretty much everything. I don’t know if this is the typical experience for others, but my mind usually has at least 3 different thoughts simultaneously, plus a background song on repeat. This can obviously make it harder to focus and can feel exhausting.

Again, self-care is vital. The more tired or over-stimulated we are, the harder it is to find any kind of peace within the mind. Many people find medication really helpful with this, and that is certainly something worth discussing with your GP or psychiatrist.

Music can be a really useful tool here, as can exercise, or getting outside. It is another area where it can be so helpful to notice and be aware of our experience, so that we can try to avoid engaging with repetitive or unhelpful thought patterns.

Even something as simple as a deep breathing exercise can help to quieten things a little. The 7/11 breathing technique is a really helpful one (see Handling the highs and lows for how to do this).

Mindfulness can be an incredibly helpful approach, though many people with ADHD find it virtually impossible to sit still and practice mindfulness. You might like to try mindful movement as a very viable alternative.

In pursuit of sleep

Ah sleep... One of the most frustrating things about ADHD in my experience, is not the fact that sleep can be so elusive and unpredictable, but it’s how often you come across professionals telling you how important sleep is in managing ADHD…

Not everyone with ADHD struggles with sleep, but for those of us who do, it can be the difference between feeling like we are staying afloat in life and feeling like we are drowning. Sleep also impacts dopamine levels, so it’s no wonder that it makes it harder when we’re tired and burnt out.

I’m not going to patronise you by explaining sleep hygiene. We all know that screens are bad and regular routines are important for the regulation of sleep patterns. But we can be doing everything right and still find it really hard to have reliably good sleep.

The most helpful thing I have come across with this was advice from the Mindfulness app, Headspace, which said to remember that your body is at rest when you are lying down and to try to quiet the mind (ha ha), so that the mind is also at rest. This won’t give you the same quality of rest as sleep does, but it is still rest. There are loads of different resources available online for sleep meditations or other suggestions for ways to quiet the mind, such as sleep stories, white noise and breathing techniques (yet again, the 7/11 breathing exercise can be great here as it is a meditation which can soothe the mind, as well as a way of calming the body).

I know it’s really hard not to panic about how you’re going to get through the day, as you watch the hour hand getting nearer to the time when the alarm will go off, but if at all possible, try to breathe slowly, stay calm and reassure yourself that you are at least resting.

Some people find it helpful to try to sleep only for a certain period of time, then to get up and go somewhere else to read or watch TV, so that you don’t associate lying in bed with being wide awake. You can then come back to bed when you think you feel sleepy and try again.

Whatever the approach, the really important part is to stay calm. It’s not easy but the anxiety and panic just wear us out more.

Other ADHD struggles

ADHD is such a personal thing, that affects us all differently. It is not just a spectrum from left to right, it is multi-directional, with so many different elements possible, all at different levels. It is not possible to cover even half of them in this format, but I would really encourage you to read up on the specific issues that you struggle with and seek as much support as you can with managing them. We know that people with ADHD are more likely to struggle with organisation, sensitivity to rejection (or perceived rejection), addictions, disordered eating, social anxiety, burnout, sensory overload and relationship difficulties, let alone all the comorbidities such as anxiety and depression, which are so common.

How to maximise counselling with ADHD

Firstly, it’s really important that your therapist has a good understanding of ADHD. Unfortunately, not all counsellors have good knowledge of neurodivergence. I have found myself explaining to another therapist why I do think it is necessary to “label” myself, and explaining how ADHD impacts my life in so many ways. This felt discounting and could easily have fed into my sense of not being able to do life the way others can.

Many people with ADHD have been given incorrect diagnoses or simply been invalidated in their experience due to the professional not having an understanding of ADHD.

Don’t be afraid to ask your potential counsellor what experience and training they have had in working with ADHD.

In the sessions, it can be hard to focus, or to stay on track, so you might want to flag this up with your counsellor at the beginning and ask them to help you to stay on the planned topic, or at least point out if you have gone off in a different direction.

You might want to plan a grounding exercise with the therapist in case you find yourself feeling overwhelmed by the intensity of any emotions that might surface.

We are probably all aware of the fact that out of sight generally means gone forever for us. Clients often find it really helpful to take a notebook to sessions, so that they can jot down important points and things that they want to remember.

You might find it helpful to take a bit of time between finishing a session and going back to normal life. This can help to process the session and could be just sitting quietly in the car for a few minutes or taking yourself out for a walk if possible.

To sum up…

For so many of us, the most important thing to be working on is self-compassion. The shame and self-criticism are so in-built that we don’t always even notice how loud and active they are. It can feel like everyone else is managing their lives and we are never quite getting it right. People report not feeling like a “proper” adult, or a chronic sense of being an imposter, just waiting to be found out.

Lay down a strong foundation of self-care and allow yourself as much time and space as you can manage to top yourself up in any way that is supportive.

Above all, remember that we are doing our best and that the struggle is genuine and valid.

Get in touch to enquire about further support.