Attention Magazine October 2020

Create the Experience That Best Serves You

Emotional regulation challenges are common and pervasive with ADHD. These challenges include the more obvious experiences of emotional reactivity: those times when something was said or done that triggered off a spiral of emotion. This can range from the positive, in the form of heightened enthusiasm or attraction, or the negative familiar experience of hurt, shame, or rejection. Such emotional experiences can be helpful in motivating and engaging with others, but more often result in isolation and demotivation from tasks and engagement.

For the adult with ADHD, the emotional responses take on a life of their own, generating more feelings, ideas, and beliefs that usually have no connection with what has really happened, yet feel real. Experiences can also feel beyond the person’s control: they come without invitation and seem to take over their life. The cascade of emotions also creates other problems the person might not attribute to the initial emotional response, including how they shape their future.

Have you ever noticed that you resist committing to a future appointment, arrangement, or task? Do you feel concerned that you might not “feel” like doing that thing then? Often this is written off as simply avoidance, procrastination, or unwillingness to commit. These words simply describe what the other people around you see and assume. They don’t help you understand and in turn solve the problem. Another example of challenges with emotional regulation, it describes a combination of challenges with time projection (who we will be in the future) and the ability to choose and control emotional experience in the future. Challenges with motivation are deeply seated in emotional regulation and are a common area of challenge for people with ADHD.

Adults with ADHD consistently report challenges with emotional regulation, including significant difficulty in regulating and reframing emotional context. Whether in the present or projected into the future, their experience is that emotions are something that happens to them. Often interpreted as issues with impulse control, the greater issue is actually with the ability to hold and direct attention. To understand this, it is important first to understand the two stages of emotion.

The two stages of emotion

As for the root cause of challenges in emotional regulation, the issue appears to lie with inconsistent executive function. The self-regulation process has difficulties regulating emotional attention. If we consider that we first interact with the world via default mode network processing (DMN), this means we take in an external trigger or stimulus and immediately attempt to associate it with our experience or emotional memory. This is a vague but fast association which has evolved to give us the best “guess” as to what will happen next. Depending upon the past associations that are triggered by the external stimulus, we will either motivate towards, away from, or be indifferent to.

Then, if our self-regulation is acting as it should, our attention via the Task Positive Network (TPN) is activated, which allows us to focus on the detail and project into the future, thinking about what we could do to influence the outcome. At the same time our DMN turns down, quieting our emotional response while our attention (TPN) creates the new expectations of what will happen and then feeds it back to the DMN, which can change the way we feel about it.

This is an important process because it allows us to pause our immediate emotional reaction to explore the detail and other options with our attention network. It is how we can stop reacting emotionally in the moment and choose how we want to feel and then act in a situation. This means we can also choose how we will feel in the future by using attention to create the mindset that supports it. With ADHD, the challenges are about activating attention (TPN) when and to the extent needed. FMRI studies have shown that with ADHD, at times the TPN doesn’t activate as well as it should and the DMN doesn’t turn down as it should. This means the emotional response stays dominant, making it difficult to redirect emotions or feel that we can choose our emotions now or in the future.

The challenge with ADHD includes inconsistent activating of attention (TPN) and turning down emotion (DMN). This can result in reactive emotional responses dominating without the mediation of attention. This is also where the opportunity for behavior change can be found.

What can we change

To change from being emotionally reactive to directing how we feel, we need to find ways of activating attention. This includes establishing an emotional reference point, a practice of inhibition, and a processes for activating attention and directing emotion. Another way of thinking about these steps are priming, pausing, and projecting.

Priming refers to creating an emotional reference point to act as a stable foundation. Two useful approaches to priming are general and specific. With general positive emotional priming, the objective is to consciously conjure an image of yourself in your best emotional state. Ask yourself the following questions:

• How do you want to feel as you move through your day?
• How do you want to respond emotionally to any challenges or barriers?
• Create a mental image of yourself moving through your day feeling positive and in control.
• Create a mental image of yourself calming managing any conflict or problem.
• Choose when through the day you want to re-center yourself to this image (and create check points!).

Specific positive emotional priming takes the same ideas as general, but targets your emotional plan to an impending situation. This includes preparing for situations such as difficult conversations, receiving feedback, or really any interaction with the potential to become emotionally challenging. So before you engage in the situation:

• Choose who you want to be in this situation
• Choose what you need from the situation (not just want)
• Create a mental image of yourself in the situation being the better version of yourself

Pausing refers to interrupting the emotional cascade. This includes any strategy that delays reaction, such as behaviors like deep breathing, counting down, or simply leaving the space. Often this can be challenging with ADHD due to the speed at which the emotional cascade happens, and the inherent challenge with impulse control. To aid in this it is useful to note signals that you are beginning to struggle to maintain emotions. This could include self-awareness: your face is flushing, you’re experiencing shortness of breath, or even if you’re repeating the same question or statement with no resolution. Noticing how you begin to react can give you and your loved ones a cue for when to implement a pausing behavior.

Projecting refers to activating attention and directing emotion toward an objective. This means we need to be able to engage our attention (TPN) to “create” the emotion we need. Fortunately, once we understand the problem, this is not as hard as it sounds.

• Reinforce your ability to choose. For example, pick a future activity and ask yourself, “How will I choose to feel when that day/moment arrives?”
• Build the mental image. Stop and imagine all the positives related to the thing you want to do. Imagine the best version of yourself doing it. See yourself going through the motions of doing that thing and enjoying the benefits. Note how you are dressed, what you have with you, how the interactions will go, and what you will get from it.
• Defuse the negatives. Take any negatives that jump into your mind, stop and notice them, remind yourself that you get to choose what happens and how you feel about it, and instead create a mental solution. Then replace it with the positive mental image.

SOLVE: a helpful tool for emotional redirection

SOLVE is the acronym for a pausing and emotional redirecting tool I developed for the adult with ADHD. This device is particularly useful if you find yourself caught in ruminating about an issue. Here is how to SOLVE the emotional loop:

Stop: Tell yourself STOP! and move your body to change your perspective. If you are sitting down, stand and move to another place. If you are pacing, sit down with good posture and take a deep calming breath.

Objective List: List only what you know, not what you assume. This will activate your attention to detail rather than emotionally driven assumptions and fears. The resolution of this issue will present itself. Usually noting only what you know as a fact will show you how many gaps in knowledge really exist. Often resulting in a need to find more information or as likely that it is not worth it.

Verbalize: Verbally state the solution at which you have arrived. It is important to hear your own words and create a simple and direct solution to the issue. If it involves an action, state when the best time to deliver that action is.

Exit: Move to your next task. For example, if your rumination was interrupting your sleep, reset your sleep routine. If it was interrupting your work, reset and refocus on a new task.

Rinse and repeat! The emotionally driven thoughts are likely to return. This is okay. Just repeat the SOLVE steps; they will be quicker each time and the impact will be reduced each time you repeat the steps.

The key idea to remember is that emotions are first reactions and then we give them meaning. By consciously activating our attention to address the details, we can shape our emotional experience. It will take practice and some supporting systems such as the SOLVE acronym; however, it will improve your emotional control as you tend to your emotionally reactive cycles. In this way you can create the emotional experience that best serves you.

Jonathan Hassall, BN, ACC, is an ADHD and executive function coach and director of Connect ADHD Coaching, providing services internationally from Brisbane, Australia. His background includes nursing in psychiatric services and serving as an ADHD expert in the pharmacological industry. As an active member of national and international professional ADHD associations, he provides individual and group programs and speaks regularly to professionals, community, and industry. Hassall’s focus is to translate EF theory to ADHD coaching, helping individuals with ADHD find and accept their “neuronative” state, creating effective adaptation of environment and self.