Clinical Psychologist: How To Overcome ADHD Overwhelm

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0:39Procrastination is one of my biggest problems. I'm so ashamed of my to-do list. It's as long as my forearm. I've tripped over a suitcase that was from a holiday months ago, so I'm desperate for some help. But I guess to start with, and this is super interesting, why do you think people with ADHD struggle with procrastination so much? Well, it's kind of a bigger point of why they struggle with initiating anything. So we know that task initiation can be difficult because it's part of our executive functioning, right? It's getting yourself organized to start something. It's finding the energy to start something.

1:21There's a lot of things that neurotypical people just get up and go. and sometimes that can be hard to even just get off the sofa to go and brush your teeth because that means you have to get off the sofa so it's that inertia that can be that we're almost like in stuckness stuck mode and you can't get going so if you don't have something that you have to do that is not even remotely interesting or fun or exciting or rewarding like emptying your suitcase why would you be bouncing off the sofa to do that there's very little dopamine in doing that then when we have an interest-based nervous system we want to do things that are exciting and fun and novel and give us a challenge and or it's an urgency like suddenly your partner is saying if you don't open that suitcase and empty it immediately I'm leaving you that's only that you have to or there's some negative consequence that will come and then the urgency kicks in and then the adrenaline kicks in and then you might be able to get off the sofa now I work a lot with It's helping people find motivation that isn't so adrenaline-fueled, that isn't so cortisol-based, because it's quite stressful if you leave everything to the last minute.

2:27And don't get me wrong, I'm still ADHD myself. I leave things to the last minute. It's kind of how it works. But when you learn to work with your nervous system, when you work with motivation that's kinder and more compassionate, you can learn to do this and kind of gamify it and play with it in a fun way so that the procrastination doesn't turn into a massive doom. and instead you can kind of, yeah, how can I make this more interesting in Game of Violence? I'm happy to get into more details about how you do that. Typically, I leave it until the next holiday comes around and then the urgency becomes now.

3:01Yeah. There's a contradiction though, right? Between like the impulsivity that we associate with ADHD, the wanting to do stuff now and the procrastination that stops us from being able to do stuff now. Yeah, absolutely. And that's a paradox that's weird, right? Like, why are you suddenly unable to stop yourself from doing something when you've not been able to get yourself going all day? Well, it's again coming back to interest. If you get an impulse, you want to do something, that's usually because it's a spark. Like something has sort of sparked and got triggered. Oh, wow, that sounds fun. Or I want to do that.

3:36Or you get a novel idea or something. So that's where you can then shift yourself out of the inertia quite quickly because you got the spark. you got something to get you going a bit of dopamine whereas that suitcase that's been there so long there's probably like part of the furniture by now you don't even see it anymore it blends into the background that has no dopamine that has no interest and it's just a threat like you must do this because otherwise I'm a failure of a human being who can't unpack my stuff and I'm can't do adulting and all the self-criticism that comes in like why can't I just empty the suitcase like normal people do.

4:12Do you recognize any of those kind of thoughts that come in? They're huge, yeah. It makes you truly believe that you're lazy. Yeah, and you're not. You've just got an interest-based nervous system that's wired differently to other people's. If we rewind just a tad, what's your speciality, your mission in the world of ADHD in general? So as a clinical psychologist, I work with mental health and the overlap between that and neurodivergence. And with my specialism having been perfectionism for like 15 years, I noticed that a lot of the things that comes with perfectionism, like people pleasing, stress, burnout, anxiety, low mood and depression when you feel like you really haven't measured up, all the way down to low self-esteem and low confidence, all of that was also possible to see in undiagnosed ADHD women.

5:05So I started seeing through my ongoing therapy clients that there was something that wasn't quite explaining why they had repeated cycles of burnout, repeated episodes of anxiety, and they felt misunderstood. There was something else that wasn't just about their mental health. So my mission really is to identify these women and help them find a way to approach themselves with more compassion and kindness and self-acceptance. because when we do that, we can actually unlock the things that we need to put in place in our lives to survive and live well with ADHD. And that's such a multi-pronged approach.

5:40There's so many things that we need to work on that is utterly overwhelming when you first start out. Oh no, I need to think about my sleep and my nutrition and my exercise. And this is a lot. So my mission is to really help people give themselves that permission to unlock those things, to work on those things, to make them non-negotiable, medicinal even. Because if you think, oh no, I don't need to prioritize this, I don't need to put myself first, you're not going to really look after your ADHD and the symptoms will be worse. So that's really what I'm trying to do. I'm really passionate about that compassion journey for those women and softening that self-criticism and shame that decades of not knowing that you are differently wired can do to you.

6:24Perfectionism is such an interesting topic. I feel like it's something I struggle with and it stops me from starting a lot of things and it can lead to procrastination. Is there a link that's deeper there between perfectionism and procrastination? Yes, there is. And you might not remember this, but first time I met you at the Neurodiversity in Business Conference a couple years ago, I asked a question about perfectionism because you were talking about anxiety and I was like, hang on a minute, there's definitely perfectionism underneath here. And at that point, I was, you know, quite new to your work and whatnot.

6:57So I think there is a strong link between procrastination and perfectionism. But it's really important to think about correlation and not causality. So just because you are a perfectionist doesn't mean you always procrastinate. And just because you procrastinate doesn't mean you are a perfectionist. They just, there's overlap right and often that is because procrastination for perfectionism procrastination for a perfectionist isn't about laziness it's about avoidance and often it's avoidance of fear fear of failure fear of not being good enough fear of being judged fear of other people noticing that you're not measuring up fear your own standards not being met fear of past memories even of hearing from other people, like parents, siblings, co-workers, peers in school, that it wasn't good enough.

7:50So it's not that you're trying to avoid something and procrastinating, starting that task because you are lazy. It's often because what if the end result isn't good enough? So I think of it as there are three stages where people really struggle when it comes to procrastination is getting started, continuing and finishing. And not everyone struggles with the same thing. I'm sure you've heard of the whole like 80 % or 95 % issue of we're nearly there and I just can't get it over the finish line. That's a very different type of procrastination to the one that is about starting and getting going. So it's really difficult to say exactly this is how perfectionism feeds the procrastination because it's so unique to what that individual's circumstances are really depends so what we do when we work with this in therapy or coaching you do a functional analysis you basically formulate what's going on looking at patterns what happens when you try to start something that's new or scary or you've not done this before are you worried about failing and then understanding what thoughts are going through your mind what do you notice you in your body how does that feel and what is your behavior like like Getting really aware of those avoidance patterns, noticing it as it's happening, that is really powerful.

9:09So I can't get people with ADHD to no longer ever procrastinate. What I can do is to help them notice when they're in the middle of that, noticing it as it's emerging, as it's happening, and then soften that with a compassionate voice saying, of course, I'm going to want to procrastinate that. This is really scary. I procrastinated looking at your questions for ages. And I even told you about that saying, wow, there's a lot of questions in that email. Let's see if I can break this down to myself. And I didn't procrastinate that because I was lazy. I procrastinated because it was scary. Does that make sense?

9:41Yeah, totally. Yeah, I feel like the optics of procrastination can look like laziness for someone who doesn't quite understand the complexities of what's going on inside their mind and what's causing that paralysis. yeah how do you think procrastination generally can look like from others partners bosses friends yeah and i think you you've said it there that it's it's often frowned upon it's often seen in a negative light because people don't realize the agony the analysis paralysis is happening on the inside they're just seeing the the output they're seeing the behavior not being done they're seeing the box not being ticked but if you're looking you know if you roll that back it's often to do with overwhelm it can be lack of clarity not knowing what I'm supposed to be doing and then not daring to ask for clarification so if we're thinking about something happening at work and your boss is at you because you've not done this thing but you don't even know what you're supposed to be doing and you're too scared to ask for clarification so the procrastination is not a simple thing and it's not everyone procrastinates in the same way but it's we need to look underneath to surface?

10:48What's going on here? What is the function of that avoidance? Usually that avoidance helps you to not face one fear that is bigger than another fear. So of course, you know you're going to be late or you know you're going to be questioned, but that is still less scary than the prospect of trying to do the thing and the thing doesn't work and you get laughed at or you have to face your own sort of incompetence. So it's very, very fear-based. That's why a lot of perfectionists are also anxious because they're anxious and worried about not being good enough about failing so yeah it's not an easy one to to answer anyone's listening he feels like oh i procrastinate loads well you might hear some aspects of what i'm saying on this episode that resonate and not others and that's okay everyone is very unique in how they procrastinate i feel like it's totally exhausting the overthinking that leads to the procrastination You said analysis paralysis.

11:45It's so all-consuming and so exhausting. But the person who you're with, your partner, your boss, your friend, whatever, they don't see that. So it must be really hard to explain why you could be potentially burnt out through the exhaustive process of overthinking. Whereas the optics of what you're actually doing might just be lying on the sofa, doom scrolling. And you have to explain to your partner, I'm so tired. but that can lead to conflict because your partner doesn't necessarily see that internal workload the analysis paralysis that you're describing yeah and i guess you need to name it to tame it so being more vocal about that um as someone who does couples therapy as well as individual therapy i see that a lot between partners that they need to name and make make the unconscious conscious so that what you see in your partner lying there on the sofa scrolling and you're like, why aren't they doing anything?

12:38Or sometimes partners tell me that they can see their spouse just literally standing, staring, and you're like, what are you doing? And they're just in that paralysis. They cannot physically move. And being able to name that as much as you can with a partner, hopefully your partner is supportive, and just to say, I'm actually really stuck. I don't know what I'm going to wear tomorrow. And being able to name that, knowing that a lot of us, ADHDers are verbal processors. So just having that sounding board. I do that with my husband all the time. He doesn't need to come up with any answers. Sometimes I just need to agonize out loud and to say, like I did getting here to the studio, which route do I take?

13:16And just having that acceptance and that compassion between the two partners that actually I need a bit of help with this, that's really difficult because that's vulnerable. To say, I'm really stuck. I need to probably sound this out. It's going to take five minutes. Can you help me with that? rather than seeing you lie down for three hours and do nothing and it leads to conflict, get ahead of that pain and say, I can see where this is going. I can see I'm going to agonize on this and go around in a doom spiral. Can you help me? And can we sound it out? It doesn't have to be more complicated than that.

13:51You save so much time and conflict and awareness. And if you are with a partner, I don't want to be like fatalistic here, but if you're a partner, with a partner you can't do that with, you need to consider what's going on in your relationship. If they're that unsupportive that they can't let you talk it through for five minutes, so you'll feel less agony inside you. And it's, again, making the invisible visible, sharing it with another person, and you feel less alone in having it as well. What's the emotional toll of someone who doesn't have a supportive partner, someone who really struggles with procrastination, perfectionism, to the point where they get exposed to so many comments, you're lazy, why can't you just start the task?

14:31What does that do to their self-esteem? I mean, it completely erodes it. I think that, you know, we know the statistic of receiving 20 ,000 negative comments by the age of 12. And we think about my community of women who are late diagnosed who didn't know they were ADHD, who got all these comments of you too much and you're not enough. That has been an internalized self-criticism. So we've taken the negative comments externally and brought them inwards. And we don't need people to be negative anymore. Even when everyone's positive, give you appraisals that are wonderful, that inner critical voice is so loud that that will trump anything that other people say.

15:08And yet we are seeking that external validation, constantly looking for that approval to feel good enough on the inside. But it's not going to be strong enough to override that inner critical voice unless you work with softening and soothing that voice with compassion. So it's an inside job that takes a long time. It's been laid down over often decades. So we can't then expect that to just go away. Sorry, if you listen to this podcast thinking if I listen to this episode, I'll magically be kind to myself. No, but you can start chipping away at it slowly, gradually doing little moments of checking in with yourself and just saying, well, no wonder that I'm really worried about that.

15:46No wonder I'm agonizing about how to get to the studio on time. Or no wonder I don't want to unpack my suitcase. So that phrase, no wonder that, is a really lovely little one just to say. You don't have to do anything else with what you find. It's just a little permission piece of compassion that, wow, this is really hard. It is hard for me. I'm differently wired. And I agonize over small decisions. You know, it's a known fact that we bring calm to the chaos. We can do extraordinary things under pressure. Some of my clients are working in the emergency services where they run towards danger, where everyone else is running away from it.

16:24We know we can bring calm to chaos, and so we will bring chaos to calm and utterly overthink what outfit you're going to wear for an ADSG Chatter podcast recording. I've not overthought the questions and the answers I'm going to give you today, but I agonized what I was going to wear. That's kind of how it is, right? we can sit in the complexity while we struggle with the simplicity. And that is a big thing to understand when you procrastinate. Oh, well, no wonder that I'm going to procrastinate this because I don't have clarity and it feels overwhelming. It's a long list and can I break it down somehow?

17:01I think you talk about turning the iceberg into ice cubes. How can I do that? How can I make it simpler? And then I'm less overwhelmed by it and I can start because then you can do, well, maybe can't even put it into crushed ice? Can I do one little ice chip and then, you know, take one sock out of that suitcase and that's it, done. And then eventually you chipped away at it and all those socks are emptied and you're done. So giving yourself the permission to do it differently to how other people do it. Maybe you can't ever in your life empty a suitcase all in one go. So be it. Can you chip away at it?

17:35Because if you're not approaching that with compassion and acceptance, you will battle against it and the suitcase will be there forever after haunting you laughing at you whereas you think actually i'm gonna do this my way my adhd way i'm gonna gamify it or i'm gonna listen to one song at a time i'm gonna empty as much as i can in my favorite song that's four minutes or whatever those kind of things so you can play with it and the acceptance piece is saying yeah okay other people don't need to do that and so be it that's fine so much good advice there and And it's so important, as you said, to take those ice cubes sometimes and have no shame if you need to really crush those down into crushed ice.

18:15Sending an email can be such a daunting task for me. And some days, and I have to give myself grace and say, just turning on my laptop is a piece of crushed ice sometimes. Opening up the web browser is another one. And eventually I get the momentum that gets me writing the email and clicking the send. many people are listening to this podcast after years and years of feeling misunderstood being called lazy and not understanding why and during that time maybe they've been diagnosed wrongly or rightly with an anxiety disorder depression can perfectionism procrastination can that cause anxiety and depression yes it can it's almost like two different cycles that are going on.

19:00So if you have perfectionist standards or very high standards, perfectionism isn't a clinical diagnosis as such. It's not a mental health diagnosis you can get from your therapist or doctor. It's an umbrella term that houses a lot of things sitting underneath it. Everything from disordered eating or eating disorders. It's very common in anorexia nervosa. Things like panic disorder, social anxiety. So all of the anxiety disorders can sit on that umbrella as well being fueled by perfectionism OCD and perfectionism strongly overlap so there's there's a lot of anxiety that is often about your nervous system your threat system is really on high alert looking out for danger that you're not going to be good enough you're going to fail and that can take various forms like having a panic attack before you're supposed to do something that requires a lot of performance because it might not be good enough right so I'm building that up or it might be social anxiety fueled by perfectionism where you feel like everyone's going to judge you and again you will never be good enough and people will laugh at you and you feel humiliated so perfectionism can fuel all of these different areas but it's not a diagnosis in itself it's what we call trans diagnostic running across those so if you think about it it's almost like one side of it is anxiety and the other one is depression so the anxiety is almost like the future-based bit where you think maybe you won't be good enough.

20:27What if I'll fail? What if, what if, what if? And that builds up into stress and pressure, obviously, in your nervous system. Whereas the depression side is, ah, I knew it. I failed. Nobody liked it. It wasn't good enough. I'll go home after here and agonize. He's nodding his head a lot, but he probably hated it. You know, that's the kind of the self-criticism and the shame that fuels the depressive side when you think it's a fact. I knew it. I didn't reach my standard. And that's how both anxiety and depression fit in with perfectionism because it depends on where it lies in time. And we know that those who have high levels of self-criticism and shame don't necessarily benefit to the same extent of, say, CBT, cognitive behavioral therapy, for depression or anxiety.

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22:32Just a note though, this code is only applicable on the web browser, not on the smartphone. Back to the show. You mentioned a fascinating theory off camera about the three circles of emotion. Could you elaborate again? Yeah. So in compassion-focused therapy, the founder of that theory, Paul Gilbert, he talks about three circles of emotion. And I think they are really important to know when you're thinking about why perfectionism happens, why we are high striving. So there's three parts that threat, drive and soothing. And the threat system, we need that for survival. That is where we feel a sense of adrenaline and cortisol.

23:10And that's where we protect ourselves from danger. is about safety, safety from harm. And for anyone who's listening who has ever had an experience of RSD, your threat system gets activated when someone says something and you think they hate me now. When you've made a mistake, when you've had a negative comment, your threat system comes on live. And that is the thing that can help you mobilize to take yourself into safety quite quickly. Need that to survive. Otherwise you would cross the street and be run over. Not good. We also have the drive system, which is a sense of joy, excitement, vitality.

23:46That's the thing that we get that we're in dopamine. We can get that sense of high. Too much of the drive might make you manic. Not enough of the drive might make you depressed. So a sweet spot there where you have enough dopamine, enough of that excitement. And lastly, the soothing system, which is where we feel a sense of being at ease, safe, at peace. It's our rest and digest. that's a parasympathetic nervous system where you feel like I'm calm and connected rest and digested now the really interesting thing with these three models is that imperfectionists we see the motivation for them striving for things getting the next accolade doing the next big achievement reaching the next goal is not driven by the drive system solely which is the system that gets us to do stuff and get things done.

24:35It is driven by threat-infused drive. So wanting to do something because otherwise you might feel bad about yourself or you might feel ashamed. So that's a threat coming in there. Or hitting the next goal, getting that next promotion, because otherwise you might worry that your parents are going to think you're not good enough. That's not the same as, I want this promotion because I can really see how much I would enjoy that next job and how much I would enjoy that role and the change I can make, that's driven by pure drive. And we know that when you do something that's driven by that threat-infused drive, the fear of failure, fear of success even, you're much more likely to go into burnout because you're pushing yourself beyond your limits and you're overdoing it and you're not listening to your body's signals that you need to slow down or stop because you just need to do the next thing which is very common in ADHD and perfectionism that you're constantly pursuing the next thing without getting any satisfaction for having hit that goal and at the end you have all the accolades but still feel empty on the inside.

25:39So there can be a fear of letting someone down, fear of being triggered like the pain of RSD can be a motivation. Yeah. What if you fear letting someone down but there's so many moving parts there's an overwhelm that stops you getting over the start line keeps you in procrastination can that create quite an internal turmoil for that person absolutely because that overwhelm means that you then don't take any action because you've already expended all your energy on being overwhelmed in you know burning calories in your mind by just obsessing and agonizing that you then don't have any energy left to do the action that means you're not making any progress and often we see that perfectionists are so keen on hitting a certain level that they then don't take actually the steps that makes them have progress it's all or nothing so if i can't do it perfectly then why not why bother you know my clients would say stuff like i can't meditate because once i've missed one day on headspace i've broken my run streak and then there's no point or if they can't meal plan for six weeks they won't plan what they're going to eat tomorrow because that's not, it's all or nothing.

26:49If I can't do it fully and perfectly and brilliant, then I won't try. What about the differences between autism and ADHD? Is there a difference in how perfectionism shows up in those two categories? Yeah, a little bit. But as we've discussed before as well, and you've had brilliant guests on the show talking about ADHD, there's such an overlap as well. There's obviously a lot of people who are autistic who are also ADHD and vice versa. But the autistic side of perfectionism is a lot about control and preventing anxiety, having certainty, wanting to feel like things are predictable. So then that type of perfectionism can be seen in anorexia, when someone is controlling their body weight or body size or food intake when everything else around them is unpredictable, that can give them a sense of calm and control.

27:39whereas the ADHD side of perfectionism can be much more about the RSD or having had so many comments in the past for being messy or being late and being everything but perfect actually that they then work really hard to try to keep that under wraps and not showing people what mess they are underneath it. I even actually, one of my most popular episodes I record on my own podcast is called You Can Be a Hot Mess and Still Be a Perfectionist because a lot of people say to me, but I'm not perfect, I'm terrible. like my house is a tip I I'm always late like how can I be a perfectionist when I'm clearly like chaos on legs and that's not what perfectionism is it's not about the end result it's about striving in the journey towards that that you never feel satisfied with what you've done and you would always question how could that have been better in a self-critical way not in a growth way um so yeah it's exhausting and then striving for perfect that way makes you vulnerable for burnout.

28:38I suppose the perfectionist might appear perfect or even productive from outsiders but internally their home like you said could be chaotic because it's too much to manage both their internal world and their outward appearance. Yeah especially for women who are late diagnosed when they become parents because before that they could maybe work really hard in a senior job and work extra hours to perfect emails or read things and perfecting their slides to make sure everything is neat and then they could do that but then we have kids then there's no rest on the weekend you can't just crash into your weekend because you've overworked in the week suddenly you have to something's got to go and then there's a lot more chaos kids bring mess they are not tidy creatures as i speak from experience um then that's where that equation no longer works and then you add perimenopause on top of that.

29:37So a woman who has kids who might also be neurodivergent, who's got a senior role, she's got high standards for how she should parent, how she should be at work, how she should be as a partner, and thinking, well, never mind, I also have to do my recycling and do my face to not get wrinkles. And all the pressures, the patriarchal pressure of perfection on women today, it is just a perfect storm, pun intended. And that leads then to burnout. out what's the cost of perfectionism if something's got to give what what do we see gives what's the cost sanity yeah inner peace um but also physically what we see as markers of especially women that i support that they've gone beyond their own body's boundaries is that everything from hair falling out to the gut being in disorder, skin issues, autoimmune conditions, all the things that we also know is related often with neurodivergence.

30:35When you are not respecting your body's natural resources for how much energy you've got to your disposal, if you use up all your spoons, to use spoon theory, you will pay the price for that. So there could be things like feeling really exhausted, having frequent inflammation in the body, frequent infections, picking up cold after cold because you're never resting properly. You're never getting a chance for your body to reset and recover and come back into the soothing. You're constantly operating in the threat and the drive to get more stuff done. As you said on your to-do list that is longer than you are, that's probably a perfectionistic part to that as well, is setting ourselves really unrealistic long to-do list that was just inhuman for us to even manage to complete them.