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. 

Thursday, August 27, 2015

Just be

People are always arguing, giving advice, having opinions.  I want to be able to be with someone and just be.  I want people who can just sit and be satisfied with who I am right now, not try to change my mind or enlighten me.

Saturday, August 22, 2015

Queen of Distraction

Now I am reading The Queen of Distraction: How Women with ADHD Can Conquer Chaos, Find Focus, and Get More Done by Terry Matlen.  As with the other things I've read about ADHD, some things fits me and some don't.
  • It talks about have piles of paper all over your house, and not being able to find things in the piles.  I do have that problem.  However, other things mentioned in the chapter on clutter don't apply to me.  When I'm going out, such as to work, I don't have trouble with remembering and bringing with me the things I need, such as keys.  Also, the books says many women with ADHD have a disorganized kitchen, but that is not a problem for me.
  • It says that people with ADHD are drawn to books about how to de-clutter and get organized, but the books don't really work for us.  I think I'm not really drawn to the books, because I know they don't work.
  • One thing it suggests for de-cluttering is listen to your body.  Which aspect of the clutter makes you tense? Address that aspect of the clutter first.
  • It says "For many (but not all) women with ADHD, it's more enjoyable to do just about anything but cook."  That sounds like me.
  • It describes the following scenario for preparing dinner: "you remember there was a story you wanted to catch on the 6:00pm news, you promise yourself you'll only leave the kitchen for five minutes.  But, oh my god, the story is fascinating! While in the family room, you notice the pile of newspapers and toss them into the recycle bin in the garage.  While in the garage, you decide to take the garbage to the curb.  While outside, you notice some flowers wilting and decide to pick, oh, just a few dying petals off.  Twenty-five minutes later when you're back in the kitchen, the rice is scorched, ruining your pot and you dinner." I don't watch TV, and I don't leave things cooking to long, but this way of wandering from task to task describes me.
  • In the section on de-cluttering the kitchen, the book says go through the kitchen and put everything away.  If you find something that belongs in another room, don't leave the kitchen.  Have a box or bag for each room, and sort the things based on where they belong.  Then when you have finished in the kitchen, take each box or bag and put those things away. I have done something similar, putting things into piles depending on what is to be done with them but then when I finish sorting, I don't feel like putting the things away.  
  • It says "Brain scans show that when people with ADHD are forced to do boring tasks, the prefrontal cortex slows down, causing sluggishness.  In order to be productive, focused, and alert, the ADHD brain needs a higher level of stimulation than the non-ADHD brain."  
  • It suggests keeping a log of how you spend your time.  You may put off doing things because you feel it will take too  long.  When you realize it does not take as long as you thought, it may be easier to do it.  At the same time, you may end up being late for things because you don't allow enough time for getting ready.  I tend to have a departure time in my mind, and when that time arrives, I stop what I'm doing and depart.  Except that I still need to put on my shoes, brush my hair, and go to the bathroom, so I don't depart at the time I planned.  
  • The book says plan your day every day.  You can make the plan either in the morning, or the night before.  Make a to do list and prioritize the items on the to do list.  Then the book adds two important steps, the steps I always skip: 1) Reduce the number of items on the list to something that you can actually accomplish in the allotted time, and 2) Do the things on your list.
  • Set timers for start and stop times for activities.  Also, when you take breaks, set a time for when to end the break and get back to work.  Avoid doing "one last thing," like checking email.  
  • Give yourself mantras to help through difficult areas.  For example, when facing tasks you are avoiding, "Don't do it because you have to, do it because you can."
  • Make peace with routine.  Routine may seem unappealing to you, but it will give you peace of mind to have your chores done and to be on track.  
  • If there is something you are putting off doing, think about it.  What aspect of the task is putting you off? 
  • Sometimes people with ADHD have trouble listening on the telephone.  They need to be able to look at the person talking in order to pay attention.  I do have trouble paying attention to people talking, but I think the worst is in person in a group setting.
  • People with ADHD may have trouble with shopping, because there are so many sights and sounds.  I'm thinking about how it can be tiring for me to be out in the world, even just looking at scenery, and restful to be home in dark and quiet.  When I was on vacation, I couldn't sit by the ocean all day.  I needed to stay inside and do stuff on the computer, because staying in was more restful, even compared to just sitting by the ocean.
  • When others are talking, you wish they would hurry up and come to the point.  This is true for me.  People just keep going on and on blah blah blah in circles repeating themselves, and I interrupt them and get to the point.
  • We may argue because we crave the stimulation of arguments.   
  • When talking, it may seem that you jump from topic to topic, which may make it hard for your partner to follow your train of thought.  Make explicit the way your thoughts are connected.
  • Stay focused on what your partner is saying by repeating his words in your head, or paraphrasing out loud.
  • Looking at your partner and having physical contact with him may also help with staying focused on what he is saying.
  • When he is telling you something, it may feel like it is the same thing he has said a thousand times before, but remember, this is the most important person in your life.  Stop, drop, and listen.  
  • Your partner needs to offer support, not enabling.  Enabling is treating you like a helpless child.  Your partner needs to see you as a competent adult who has strengths and weaknesses.
  •  People with ADHD are sensitive to sensory stimulation.  They may find it hard to concentrate on something else when there are background noises.  They hear the hum of the fan, and of the refrigerator -- the sounds others don't even notice.  They jump when they hear a sudden noise.
  • Many are sensitive to touch.  They don't like sticky doorknobs, wrinkled sheets, or restrictive clothing.  But some feel the are calmed by being enclosed -- wearing close-fitting clothing, sleeping under heavy blankets.  
  • In addition to sensory sensitivity, women with ADHD may have emotional sensitivity.  They may be sensitive to criticism.
  • Women with ADHD may seem to have a strong sense of empathy, reacting strongly to the emotional states of others, or they may seem to lack empathy, because they have trouble focusing their attention on what is going on with others.  This is true for me.  I can get very sucked in to a story in a book or movie, but in real life, it may be difficult to wrap my mind around other people.
  • ADHD symptoms may be affected by puberty, PMS, and perimenopause.  During perimenopause it may be helpful to take a stimulant, an SSRI, and HRT.
  • "Many women with ADHD are underemployed and underpaid because they are afraid of taking the leap into a job they fear might be too difficult for them, resulting in many unhappy years stuck in dead-end, boring, or stressful jobs."
  • "Inattentive women still have hyperactive brains and need to be challenged and stimulated, so it's important that you don't fall into the sort of job in which you feel stagnant."
  • Schedule the things you hate doing in order to make sure they get done.  
  • Overcommitment is a common problem, agreeing to take on more than you can really handle. 
  • Sleep, nutrition, and exercise help a lot with ADHD.  Try to get out for midday walks.  Eat protein in the morning.  Eat complex carbohydrates rather than simple carbohyrdates.  Cut back on sugar and caffeine.
  • Hiring a personal organizer, buying prepared foods, hiring a tutor to help your kids with homework -- these are not luxuries.  They are accommodations for your disability.

Saturday, August 15, 2015

Spirituality Without Structure

Some notes from Spirituality Without Structure by Nimue Brown:
  • She says "I've even had Druid practitioners tell me that I must repeat meditations that don't work for me, and repeat them daily because they are necessary.  To question that, was, I was told, to disrespect both the teacher and the tradition."  When I think of it from the outside, when I think of a religious leader telling people what they must do  in order to show their respect to the leader, it seems like a situation which should inspire fleeing.  But when I'm in the moment, when I've chosen to embrace a tradition, a person, I try to comply with what that tradition or person tells me I should do.  I try to give them a chance.  And then I get mad at them.
  • She describes a spiritual experience as "an uplifting, inspiring, and positive occurrence"  which may inspire "love, hope, compassion, and the like."  That makes me think of a Pete Seeger concert.

Tuesday, August 11, 2015

Inner grove

Books that talk about meditation tell me that I should visualize my inner grove, that this will be a place I can return to time after time in meditations, a place for finding peace.  The books talk about starting by imagining approaching on a path, bridge, or stairs.  Then enter the place.  Then maybe you will be greeted by creatures who inhabit the place. Then you can explore the place.  Then you can leave using the same path, bridge, or stairs you used to enter. 

So, I have been creating my inner grove.  I'm terrible at drawing, but here's a general layout.   The entrance is on the bottom of this map.

Now, the more descriptive details:

You start by walking on a stone path that goes beside a creek.

You cross the creek on a bridge.

Then, before you is a field, with occasional trees, including maple.

In the field, you may find goats, sheep, llamas, rabbits, and chickens wandering about.

Off to the sides, there are shrubs -- lilac, hydrangea, and mountain laurel.

Ahead and to the left is the apple orchard.

Ahead and to the right is a hardwood forest, with trees including maple and oak.

Straight ahead is a forest of white pine trees, with a carpet of pine needles and boulders.

If you continue through the forest, you will come out to wild blueberries.

Beyond the blueberry hill is the granite ocean coast.

Hidden away in the forest is a cottage.  In summer, the thick stone walls keep it cool inside.  For winter, there's a sunroom in back, with a woodstove, so you can sit in a chaise chair reading, cozy and warm. 

Monday, August 10, 2015

The past, the future

Druidry and the Ancestors by Nimue Brown reminds of us our roots.  Wherever we live, this ground we walk upon has been walked on by humans and animals for centuries, for millenia.  We are just one link in the chain.  And we have a long chain of genetic ancestors -- 4 grandparents, 8 great grandparents, 16 great great grandparents, and so on back for millenia, except that not all are unique -- when distant cousins marry, they have some common ancestors. 

And my life is itself a chain in time.  From the present, my life stretches back to the past.  Living around here the past 20 years, discovering scenic areas around here, learning to rollerblade, being unemployed.  Before that, living in the suburb of a big city while going to grad school.  Walking a half hour to school.  Walking to grocery shopping, hauling groceries in a backpack, taking the train to my internships, living in a basement apartment, choosing the basement because I can dance around, stomping on the floor all I want, without disturbing anyone below.  Before that, living in the suburbs of a different big city, working a boring job in the big city, taking aerobics class, walking to visit my boyfriend, discovering the parks.  Before that, college, a community, a circle of friends, a place where I belonged.  Before that, growing up, my hometown, a misfit at school, some friends at school, vacations in more rural, rugged places, hippie parents who listened to Donovan, a rock band at my father's commune, playing on a homemade see-saw, getting a "swinging ladder" for the swing set, dressing up like a nurse.

And from the present, the future stretches wide before me.  An unwritten story.  An unforged trail.  It could lead anywhere.  We never know what's around the bend.  We don't know what we will find, but when we find it, we choose what course to take. 

Sunday, August 9, 2015

Book report: Taking Charge of Adult ADHD

Back in June, the doctor suggested maybe I have ADHD.  I'm not sure if I do or not, but I do have difficulty focusing sometimes.  I figured I'd read about ADHD, and even if I don't have it, I could get some ideas for strategies to help  me focus.  I read through the reviews on amazon, chose three books that I thought looked most promising, and ordered them on inter-library loan.

The first of the three is Taking Charge of Adult ADHD by Russell Barkley with Christine M. Benton.  Dr. Barkley has a thorough background on ADHD-related research, and shares the findings in a readable way.  He has found that people with ADHD need to be on medication.  The coping strategies he suggests are meant to be used after you get onto medication.  He offers 8 basic guidelines:
  1.  Stop the action: Before you blurt something out and do something impulsive, stop.  You have the urge to do something, so find a halting action you can do.  For example, inhale, exhale, and say, "Hmm, let me see now." 
  2. See the past and then the future: Imagine a TV screen, computer screen or whatever works for you.  Imagine that you are watching a video that shows you what happened in the past in a similar situation.  Also, for specific situations in which your mind's eye is blind, post images.  For example, a woman would impulsively buy designer shoes and then not be able to afford books her son needed for school.  She posted a shoe ad with a zero balance bank statement.  On the other side, she posted a photo of her son and an image of a diploma. 
  3. Say the past and then the future: Picture yourself holding a microphone and interviewing yourself on TV.  Be a journalist who asks tough questions.  Ask what's going on here, what did I do last time, how did that turn out, what are the options, what will happen if I do X.  Talk to yourself out loud as you try to choose your course of action.  Not necessarily in public, but at home, while driving, while walking in the woods at the beginning of the day planning the rest of the day. 
  4. Externalize key information: Post notes and images in key places.  Examples: a note with your wallet reminding you not to spend too much, a sign on the computer reminding you not to surf the internet.  Carry a journal at all times to write down the things you have to do, and check it hourly.  Use to do lists, and figure out how to make them realistic.  Identify how long each task will take, so that you can set realistic goals. 
  5. Feel the future: Think about the negative consequences of doing the wrong thing, but also the positive consequences of doing the right thing.  Think of how satisfied you will be when the task is finished. 
  6. Break it down and make it matter: Break tasks into chunks.  Steps that will take an hour or half an hour.  After completing a chunk, take a break for just a few minutes, and give yourself a small reward, such as looking at the view or playing a musical instrument.  Find someone you can be accountable to, and tell them when you've completed each step. 

    In a book on writing, Anne Lamott said that when her brother had to write a paper on birds and was having trouble getting started, their father advised to just write about one bird at a time -- take it bird by bird. 
  7. Make problems external, physical, and manual: Use tools so you don't have to hold it all in your head.  Like children using counting items like beads as the learn arithmetic.  Designers make models. 
  8. Have a sense of humor: Take ownership of your ADHD and laugh at yourself.  Say to people, "Well, there goes my ADHD again.  Sorry about that.  My mistake.  Now I have to try to do something about that next time."
 Then the book goes on to discuss strategies for certain arenas, such as education, work, health, driving, etc.  Of those, the only tips I found useful were in the education section.  Tips there included:
  • Find a coach or mentor, and meet with them twice a day for 5 minutes.  At the beginning of the day, tell them what you need to accomplish that day.  At the end of the day, tell them what you did accomplish.
  • Use a device that cues you to stay on track.  There is a device called MotivAider that vibrates.  You can set it to vibrate at certain intervals or randomly.  
  • Taking notes helps you pay attention to what is being said.
  • Use SQ4R method for reading: Scan the material to be read to get an idea of how long it is and how it is organized.  Write some Questions that the reading should answer.  Read one paragraph, the Recite out loud what it said, then wRite what it said, then Review what you wrote.  After you get practice, you can do this every two paragraphs instead of every paragraph.  
  • For tests, time off the clock seems to work more than extra time.  Take a break, walk around a few minutes.  The time of the break doesn't count toward the time doing the test.  The amount of time you spend actually doing the test is the same as for the other students, but you do take longer because of the breaks.  
  • Exercise helps with focus.  Do aerobic exercise before a test or before a boring class.  Develop a routine to do aerobic exercise at least 3 times a week.