Saturday, August 29, 2015

The Mindfulness Prescription for Adult ADHD

The third ADHD book I am reading is The Mindfulness Prescription for Adult ADHD by Lidia Zylowska.  The point of the book is pretty much given in the title.  The book reviews some research and gives some exercises for practicing mindfulness.  There's not a lot of research on using mindfulness for ADHD, but there's research on using mindfulness for the things ADHD affects, such as memory and concentration. It doesn't give a lot of time to explaining what ADHD is, but there are some parts about ADHD that resonate with me.
  • "You can have many ideas but likely have trouble focusing and prioritizing, since you may think everything is equally important.  You may feel paralyzed, not knowing where to begin, or you may sometimes impulsively start several projects at once.  You may have trouble initiating a task, staying on task, or transitioning out of a task."
  • ADHD is not really a deficit of attention.  It's a deficit of attention regulation.  
  • "I see many ADHD adults who are stressed and overwhelmed  They frequently feel behind and are constantly trying to catch up on what they need to do.  They often describe themselves as 'running on empty.'"
  • "In general, writing things down and posting them in a place you are likely to notice them is a great help.  However, leaving loose pieces of paper all around or having haphazard reminders in multiple places -- which adults with ADHD tend to do -- is not helpful."
One thing I thought was interesting, though it wasn't specifically about ADHD, was that people who had difficulty with anger were able to reduce their verbal and physical aggressive behavior with mindfulness.  They practiced focusing on the sensation on the soles of their feet instead of on whatever was making them angry.

Another study had some psychotherapists meditate just before a session, and others meditate at another time.  Patients had better outcomes when the therapist meditated just before the session.

People who habitually pay attention to certain things have larger brains in that area.

Mindfulness includes both formal and informal activities.  Formal is when you sit and meditate.  Informal is when you stop and be mindful during the course of the day.  Both formal and informal are needed for ADHD.  Formal trains you to be better at informal.

When you meditate, your mind will wander.  This is normal.  Don't judge yourself.  Just label it and move back to the present.  Labeling it means noting what is happening in your mind: worry, itching, thinking.   Say, "There is anger," rather than "I'm angry."

The book offers an 8 step plan, with several exercises for each step. It suggests spending about two weeks on each step before moving on to the next step.

Step 1: Become More Present: Attention and the Five Senses

Practice tuning into to each of the five senses separately, as if each is a different radio station.

Step 2: Focusing the Wandering Mind: Mindful Breathing

Practice awareness of breath: nostrils, chest, abdomen. If your mind wanders, just remind yourself of your intention and return to your breath.  You can count as you breathe, or use a word (such as "peace") or use a visualization, such as a wave of air going in and out.

Step 3: Direct and Anchor Your Awareness: Mindfulness of Sound, Breath, and Body

Set an intention to pay attention to a specific thing.  Pay attention to that.  Then set an intention to pay attention to a different thing.  For example, set a timer and spend 3 minutes focused on sound, 3 minutes focused on breath, 3 minutes focused on body sensation.  This exercise gives you practice being in the driver's seat of your attention.

Use sound, breath, and body to anchor you throughout your daily life.

Take a breath.
Observe sounds, breath, and body sensation.
Proceed.  Consider where your attention was, what your attention is, and choose what to do next.

Step 4: Listen to Your Body: Mindfulness of Body Sensations and Movement

Body scan: focus on each part of your body, one by one.  There are a number of things you can do at each place:
  • Relax
  • Tense and then relax
  • Move
  • Direct loving attention to that spot
  • Imagine breathing into that spot

They have a diagram of the body showing:
  • Sagittal plane - front to back
  • Coronal plane - left to right
  • Transverse - horizontal
This diagram reminds me of the Sphere of Protection in AODA practice.

Many people with ADHD are clumsy.

Practice mindful movement exercises.  Stand in one place, and practice mindfully swaying, stretching, standing on one foot, raiiing arms, swinging arms.

Walking meditation: while walking, focus on your feet.  You can think of each time you place your foot as representing being proactive and starting new things, or you can think of each time you left your foot as leaving things behind.

Spend 2 minutes standing still, 5 minutes shaking, 3-5 minutes dancing, a few minutes sitting or lying down.  This comes from Kundalini yoga, but in yoga, you usually do 10 minutes on each thing.  Prepare a CD or playlist that has an appropriate number of minutes of music to shake to and music to dance to.

Your facial expression and body posture reflect how you feel, ,but it also goes the other way.  Practice changing your facial expression and body posture to reflect the feelings you want to evoke.  Sit up straight if you want to be more assertive.   Practice the soft smile.

Do any activities that relax or loosen your body, such as aerobic exercise, massage, yoga, hot bath, sauna.

Using mindfulness to cope with pain: Notice the pain, and any thoughts associated with it.  Then focus on your breath or a part of your body that is not painful.  Keep switching between them.  Accept the pain.  Don't try to change it.

The same technique can be used for restlessness.  Notice the restlessness.  Notice the physical sensations and thoughts associated with it.  Switch between focus on the restlessness and focus on something else.  Use compassion.  For example, tell yourself, "I know restlessness can be unbearable because of ADHD."  Try things like going for a walk, moving a part of your body, or doodling, and be mindful how you feel before, during, and after these activities.

Notice your body throughout the day, including during transitions between walking, standing, sitting, and lying.

Step 5: Observe Your Mind: Mindfulness of Thoughts

Imagine your thoughts as clouds passing through a blue sky.  Observe them as they go by.  Notice the space between them -- the space where you can observe your thoughts from a distance.

Creativity comes from daydreaming.  Give your mind time to relax and roam.

Mind traps to watch out for: judging others, judging yourself, all or nothing thinking, blaming others, blaming yourself,  magnifying, minimizing, making assumptions, rigid adherence to rules, disregard for rules.  When you get into a mind trap, use the STOP practice.

Step 6: Manage Your Emotions: Mindfulness of Feelings

People with ADHD may be quick to emotional responses, or may push aside their emotions. Use the RAIN practice:


Explore the emotion.  Observe how it impacts your body.  Be kind and gentle with yourself.  Non-identify -- just watch it and learn from it.  End by recognizing your courage in being present with a difficult emotion.

Loving-kindness meditation: Starts with yourself and loved ones.  Eventually can move on to those we feel neutral about, those we dislike, and all beings.  Can say something like, "May you be happy,  may you be safe, may you be healthy and live with ease"   or "May I be happy, May I be free of suffering, may I be safe, may I be peaceful and at ease, may I find joy, may I be healthy and strong, may I accept myself as I am."

I was doing something like this when I was practicing regular mediation 2010-2012.  I don't think anyone told me to, it was just something I came up with on my own.

If you have trouble sending loving kindness to yourself, you could try thinking of yourself when you were a child, or thinking of how people who love you feel about you.

Before you can send loving kindness to people who have hurt you, you may need to sit with the hurt for a while.

Cultivate joy, gratitude, humor, and playfulness.

Step 7: Communicate Skillfully: Mindful Listening and Speaking

Use the STOP practice to make sure you are paying attention when someone is speaking, not talking too much, and not going off topic too much.

Marshall Rosenberg's nonviolent, compassionate communication:
  1. Observe: when....
  2. Express feelings evoked by observation:  I feel...
  3. Needs: I need...
  4. Request: I would like....
You also use this to express empathy, describe what another person feels, but leaving off step 4.

Mindful presence meditation: Instead of choosing to focus on a particular thing, observe yourself as you notice whatever arises: sound, body sensation, emotion, though.  End with loving kindness. This cultivates a flexible, receptive attention that you can use when interacting with people.

Step 8: Slow Down to Be More Effective: Mindful Decisions and Actions

Use the STOP practice to look at how you are dealing with tasks.  Are you interested? Bored? Procrastinating? Overwhelmed? Wanting to do something else? High or low energy? Motivated? Are you doing what you intended to be doing or something else?  If you notice an obstacle, such as avoidance or lack of interest, imagine you are looking directly at it and naming it, "There's avoidance."

If you are frazzled, calm yourself with the mountain meditation.  Imagine a mountain.  Think about how it has been standing there for millenia through all kinds of weather.  Imagine you are the mountain.  As you breathe, say "Breathing in, I see myself like a mountain.  Breathing out, I feel solid and strong."

Task sequence: choosing, starting, doing, finishing.  Be mindful of what you are doing at each stage.

"Many adults with ADHD report being overwhelmed by their choices and not knowing where to start."  That's me.

Acceptance Commitment Therapy: List the things that are important to you in life.  List long-term and short-term goals in each area.  Now look at the extent to which your day to day activities reflect what is important to you.

Meditation if you need help getting started: "Breathing in, I am like a tiger.  Breathing out, I am focused and ready to act."  You can say, "Jump tiger!"

Make lists, set priorities, break tasks into smaller step, focus on one thing at a time.  If you get distracted, go back to the thing you chose to focus on.  Watch and vary your pace.  Take breaks for a fixed amount of time, and return to task when time is up.  Give yourself external structure -- post-it notes, someone working with you.  Sometimes it helps to have someone working on their thing nearby while you work on your thing.  If you drop the ball, forgive yourself and pick it back up.

Be mindful of finishing.  Do you have a sense of completion before you are really done? Do you procrastinate more as you get near the end?

Savor how good it feels when you are truly finished.  Remember this and use it to motivate yourself the next time.  

To get out of hyperfocus, practice flexible focus.  Imagine a frog jumping from one lily pad to another.

Developing good habits: When you want to get into the habit of doing something, like leaving your keys in a certain spot or taking your vitamins, do it very mindfully.

Start sideways: if you are avoiding starting a task, just take a peek at it, dip your toe in.  I've done this with exercise -- tell  myself I'm going to do a small amount, but then find the ability to do more when I get started. 

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