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If you are someone who lives with anxiety, then you understand the persistent and often self-defeating cycle of catastrophizing, what-ifs, and negative self-talk. If you add attention-deficit/hyperactivity disorder (ADHD) into the mix, these patterns are intensified because of the natural challenges with executive functioning skills that come with a neurodivergent brain. It’s just tougher to manage the strong emotions before they take over and leave you dysregulated and overwhelmed.
Despite misdiagnoses, ADHD differs significantly from anxiety. At its core, anxiety is an overestimation of a problem and an underestimation of the personal resources someone has to deal with it. While people with ADHD wrestle with organization, prioritization, productivity, working memory issues, and other executive-function challenges, those with anxiety struggle more with compulsive, obsessive, or perfectionistic behaviors; psychosomatic ailments; and debilitating specific phobias. Issues related to food, housing, or job insecurity; systemic racism; or trauma further intensify anxiety. With ADHD, the primary issues relate to focus, concentration, and impulse and emotional control. It’s primarily a condition of dysregulation. Anxiety reflects persistent distress, unease, or fear in situations (regardless of them being benign or dangerous) that have identifiable and clear triggers.
According to the Centers for Disease Control and Prevention, anxiety rates in adults range from 12.5 to 18 percent with the severity of symptoms differing by sociodemographic and geographic characteristics. For adults with ADHD, the co-occurrence of anxiety is considerably higher at 50 percent due to the combination of neurological patterns, executive functioning challenges, past histories of criticism, bullying, social and academic difficulties, and other adverse experiences. Ongoing concerns about “messing up again” amp up into persistent worry about the next time that you may (unwittingly) make another mistake or forget something important. It’s common to become overwhelmed beyond your coping capacity with ADHD, which makes anxiety more likely.
Nervousness, worry, and anxiety, while used interchangeably, are not the same things. Nervousness refers to an emotional experience that goes away once a skill has been mastered. Worry refers to how we think about something. Anxiety is our physiological response based on negative thoughts and distorted beliefs. We cannot eliminate anxiety: It’s a natural human response that’s evolved for survival. In our post-COVID world, anxiety has reached new levels—thriving due to greater health and socioeconomic concerns and increased social media usage.
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Without useful self-management strategies and tools to access the internal resources you need, anxious adults with ADHD tend to become agitated, panicked, or shut down. When people learn how to talk back to worried, negative thinking and rely on past successes for confident choices in the present, they learn how to tolerate the discomfort of uncertainty and take reasonable risks. They also accept the possibility of disappointment that anxiety is trying to avoid. This is how we develop the essential resilience that’s crucial for successful, satisfying lives.
Anxiety is a shape-shifter, and having ADHD along with it ratchets up our reactivity. Just when you think you’ve figured out how to deal with one issue, another one pops up. It’s like playing Whac-A-Mole. To avoid this frustration, you’ve got to step back and see how your anxiety operates and not react to the content. It’s the reaction to the worry, not getting rid of it, that makes the difference. Dismissing concerns (“This isn’t that big of a deal. You’ll be fine.”) doesn’t honor the reality of your worry. It will grow. Reassurance from others (“Don’t worry, everything will work out.”) also doesn’t provide a lasting solution because nobody can guarantee that. Instead, we want to slow things down and validate our concerns by saying, “You’re right to be scared. You’re not sure you can handle that. It’s natural to worry in that situation.” Then ask yourself: “What have I done in the past in a similar situation that could apply here?” This lets you acknowledge what is going on while identifying what can help you deal with it.
Here are five quick tips for managing your anxiety and reducing it:
- Settle the body, settle the mind. When you are anxious, the amygdala sends messages to your body to prepare for flight, fight, or freeze responses. This means that your digestion slows down, your muscles tighten, you may perspire or heat up, your heart races, etc. Blood flows away from your prefrontal cortex to your emotional and physiological centers so you can react quickly. You have to slow down this process and get your thinking brain back online. Breathing and changing your location are the best ways to shift things. Box, triangle, or alternate nostril breathing techniques all help you settle. Practice a breathing tool at least once a day when you are not stressed so you know what being centered feels like. This is one reason mindfulness meditation, yoga, Tai Chi, etc. are so valuable. You can detect when you are activated and know how to lower the volume on the noise.
- Name the worry and talk back to it. Reducing anxiety starts with clarifying and decreasing your worries. Worried thinking and environmental triggers can set off feelings of uncertainty and insecurity. When you name your worry, you gain perspective on what keeps it going. Identify your worry by thinking about what most concerns you right now. Worry says “Blah, blah, blah and you can’t handle it.” What could you say, based on past successes, that would counter that? Too often, people try to address multiple worries at the same time. Pick one worry, find a way to talk back to it by drawing on your coping abilities, and then write these statements down. When the noise related to this worry goes down, then you can pick another to work on. It’s one thing at a time here.
- Change your relationship to anxiety. Most people overidentify with anxiety. Actually anxiety is something that is happening to you based on worried thinking. It is not who you are any more than having ADHD defines who you are. You can change your relationship to anxiety by zooming out. Think like Sherlock Holmes and investigate anxiety like a puzzle. What are its triggers? When, where, and how does it show up? Validate your concerns without catastrophizing. It’s easy for people with ADHD to think very fast and transform a small issue into an insurmountable mountain. Keep your perspective by looking at the forest and not just the individual trees. This improves your ability to brainstorm solutions.
- Pivot from worst-case scenarios to best-case scenarios. When people are anxious, it’s easy to think about all of the things that could go wrong. The endless spiral of “What-ifs” leads to magnifying only negative outcomes. Instead of following this path, I encourage you to engage your curiosity and ask yourself, “What could go right?” What positive scenario might occur? What might you possibly enjoy in a situation that frightens you such as the office holiday party or an extended family dinner? Where anxiety shuts you down and predicts negative outcomes, curiosity about an alternative scenario opens you up to possibilities. Shift from “I’m worried about…” to “I wonder about…”
- Start small to build confidence. Anxiety is great at erasing memories of past successes. This is compounded for adults with ADHD and working memory challenges. Choose a small goal related to decreasing a worry that’s within reach and work on taking a small step first. What would you want to do if anxiety wasn’t there? If you can’t recall times when you took a risk and succeeded, ask a friend, family member, or colleague. Think about the strategies you used in that situation and how they can apply to something you are worried about now. Say to yourself: “I’m willing to feel unsure. I can grab onto my courage and try this.” This calms the anxious brain and fosters resilience. When you nurture your resilience, you diminish anxiety. Connect with what you like to do and people who care about you to build confidence and lower self-doubt. Resilience is the antidote to anxiety.
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