Tag / Anxiety

by Therapy place uk

Can self-determination theory be the ADHDers’ defence against RSD?

 (This blog article was originally posted as Can autonomy, competence and relatedness be the ADHDers’ defence against RSD? on Attention Allies: Therapists for ADHD in Nov 2024.)

RSD (Rejection Sensitive Dysphoria) is an overwhelming challenge for many ADHDers. However, I suggest that by focusing on autonomy, competence and relatedness (the three basic psychological needs outlined in self-determination theory (SDT)) we can begin to build ADHDers resilience against the intense emotional pain of RSD.

If you live with ADHD, you may have experienced the intense, sometimes overwhelming, set of emotions known as RSD (Rejection Sensitive Dysphoria). Although RSD doesn’t yet constitute a formal diagnosis, it’s a term that resonates deeply within the ADHD community.

RSD is generally understood as an extremely intense emotional reaction to perceived or actual rejection, criticism or failure. The emotional pain can be overwhelming, leading people to avoid social situations, withdraw from relationships or, in some cases, express explosive anger. These reactions can deeply affect an individual’s psychological needs, leaving life feeling like a series of high-stakes emotional hurdles.

Sam’s rejections 

Sam, who was diagnosed with ADHD aged 38, describes her past experience with RSD as feeling like an “internal ticking bomb”. In her words:

I was hypersensitive to anything that might feel like rejection. When I was in that headspace, neutral or sometimes even supportive comments would feel like attacks. 

This hypersensitivity undermined her sense of competence and her belief in her own ability to handle life’s ups and downs effectively. During times of real and perceived rejection, Sam’s confidence would plummet – being replaced by self-doubt and a sense of deep failure.

Before Sam entered coaching and therapy (where she developed skills that helped her to “step back from herself”) she strongly believed the classical thinking about ADHD: that she lacked control because of impaired executive function. Coaching and therapy that used SDT principles began to support and develop her sense of autonomy (our ability to regulate our own responses and manage the emotional world), helping her to become engaged and invested in personal change that no longer felt out of reach:

I went from feeling like my reactions had a life of their own to having a stepped framework to understand I could be autonomous and competent. The intense RSD feelings – the after effects of which could last for a few days – became something I began to deal with as soon as I was aware I’d been triggered.

Therapy helped Sam to recognise specific triggers that tended to precede these emotional surges, gradually supporting and developing her sense of autonomy. By becoming more aware of these triggers, she could manage her emotions before they spiralled out of control.

Connection amid emotional pain

RSD often chips away at our sense of connection to others (relatedness). When minor misunderstandings or perceived slights can feel like intense rejection it’s easy to question whether we’re genuinely accepted or valued by others. For Sam, this played out in her relationships with friends, family and colleagues. A seemingly casual comment, for example, could be misinterpreted as criticism, threatening her sense of security and belonging.

Our need for relatedness runs deep, but when RSD undermines our connections it can lead to social withdrawal or frustrated outbursts. Sam found that coaching and therapy helped to strengthen her communication skills so she could be clearer about her needs, feelings and boundaries, in turn easing the impact of RSD in her relationships.

Feeling with meaning

Many ADHD researchers suggest that emotional regulation issues stem partly from impulsivity and challenges with executive functioning. Yet for those with ADHD, emotional control often aligns with how competent, related and autonomous they feel. For example, when a task feels meaningful and we feel capable, emotional regulation is easier. When an ADHDer feels disconnected or the task lacks value and interest, managing emotions becomes considerably harder.

Ali, another person with ADHD, describes how, “when I’m feeling overwhelmed, it doesn’t take much to set me off. A crowded store or a car cutting me up in a queue would feel very personal, like an attack.” Ali found that his RSD was often connected to previous experiences of times when he’d felt invisible or unimportant leading him to spiral into feelings of rejection – even when he logically knew that wasn’t the case. Through therapy, Ali worked on recognising his emotional triggers and particularly developing his sense of competence. He additionally developed greater autonomy in handling his emotions, further reducing the power of RSD episodes over his life.

Recognition

Being able to recognise situations and people who challenge our fundamental experience of autonomy, competence and relatedness can help us to begin to gain control over RSD. Recognising triggers can begin the process of developing our autonomy, empowering us to manage our emotional responses. Techniques learned through therapy or coaching can help us to release pent-up emotions, fostering a sense of competence and self-efficacy. By nurturing supportive relationships, we can reinforce our relatedness, creating a safety net for times when RSD feels especially intense.

Sam’s journey through therapy highlighted the importance of strengthening all three of these psychological needs. When she learned how to identify her triggers, she gained autonomy; when she practised emotional regulation techniques, she built her competence and when she improved her communication with friends and family, she was able to see and develop her relatedness. Each of these shifts contributed to her ability to better manage RSD, improving her emotional health and overall wellbeing.

Understanding how RSD impacts our core needs of autonomy, competence and relatedness can offer those with ADHD a new way to navigate life’s challenges, build stronger connections and feel more secure within themself.

You can read more about adult ADHD on Attention Allies blog site.

All character-based realisations contained in this post are either of a fictional nature or have been derived from heavily disguised, consensually given information. 

All rights reserved © Copyright Duncan E. Stafford 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.

by Therapy place uk

Am I normal?

(This post was originally posted on Attention Allies: Therapists for ADHD in August 2024)

Psychotherapist, counsellor and ADHD coach Duncan E. Stafford hopes you “don’t feel normal”. Why is this and how can it help ADHDers to create useful tools for self-development?

The subject of “normal” in connection with adult ADHD is one that comes up regularly in my consulting room. Any quick search online for information about adult ADHD will support the persistent nature of questions like this, returning results such as:

  • “Can someone with ADHD have a normal life?”
  • “Is ADHD considered normal?”, and
  • “Can you be normal and have ADHD?”*

This fascinates me because the concept of the “normal” human being is both subjective and perhaps, surprisingly, a relatively new concept.

The word “normal” – from the Latin root normalis, meaning something made according to a carpenter’s square – hadn’t been applied to human beings before the nineteenth century, when Adolphe Quetelet published “On Man and the Development of His Faculties, or Essay on Social Physics”.

In the years before 1835, “normal” was a term used only in mathematics and related disciplines, including astronomy. Quetelet took the astronomer’s error curve or, as it became known, the “normal distribution curve” and applied it to measuring humans. And the rest, as they say, is history.

A subjective term

“Normal” in relation to people is a subjective term. When used as a description, it implies a thing that should be aimed for or agreed upon. Being “normal” in human terms suggests the acceptable boundaries of what a person is or should aim to be. “Normal” is applied to the body through size, weight, shape, strength and so on; it’s applied to the mind in terms of aspects such as cognitive ability, sanity, reasoning and perceptual speed, among other measures. If we look at the term historically, it has often been used to reinforce white, Western and middle-class people’s definitions and standards of humanity. And so, you might see why I have a problem with ADHDers asking if they are “normal”. I might even suggest: “Who wants to be ‘normal’?”

Our development since childhood has been measured against created “normal goals”. In school, our abilities are tested to see if we reach at least the minimum, “normal” or “average” of others in a range of things thought to be the most useful.

Hyperkinetic to ADHD

When I was at the end of my school education, the term ADD (1980)** had hardly begun to be used, and ADHD (1987)*** hadn’t yet been created. In my own school era (and perhaps even today), students with ADHD were likely to be castigated for their internal motor-driven impulses and told to sit down, behave, stop being careless, stop making silly mistakes and stop being naughty, disruptive or “stupid” rather than receiving positive comments about themselves. Nothing on the preceding list was valued as good “normal” behaviours in classrooms. But the balancing behaviours often seen in the hyperkinetic child – as pre-1980s psychiatry, developmental psychology and education then termed ADHDers – weren’t valued in such children. It was, and perhaps still is, almost invisible to many the ultra-inquisitiveness, robust enthusiasm, unusual or eccentric creativity, sweeping spontaneity, fantastical imagination, and lively conversational skills and personality that the ADHDer brings.

When an ADHDer asks me “Am I/Is it normal?”, I tend to answer “I hope not!”. I suggest that we replace “normal” with “typical” in terms of feelings and behaviour. From there we can often see what someone’s real question and/or concern about themself is: “Are there other people like me?” If that inquisitiveness (typical of many ADHDers) can be engaged with, it may allow the inquisitor to feel calmer, less alone and, importantly, able to ask more questions of themself and what I call “the soup” we were brought up in and live in. In creating an interest not in normality, but in similarity, we potentially lead to the prerequisite for the creation of vital personal tools for self-development. As a therapist, I can help ADHDers engage and support self-actualisation and self-determination.

Back to the curve?

So, are you tempted to plot all of this on a standard deviation curve? I’m not. To do so is to limit our creative engagement with understanding ourselves in an attempt to reach mythical, societally created norms.

I like to know what others do and why they think they do things, but I like to help ADHD people understand that living your life by comparison to created norms tends, on the whole, to make an ADHDer feel claustrophobic, tense and constricted at minimum. ADHDers don’t need more restriction or created failures; they need freedom to be, and for that they need flexibility.

Footnotes

* Retrieved from Google search 10 August 2024.

** The American Psychiatric Association released a third edition of the Diagnostic and Statistical Manual (DSM-III) in 1980 in which it renamed Hyperkinetic Reaction of Childhood to Attention Deficit Disorder (ADD). Two categories were outlined: with – and without – hyperactivity.

*** The American Psychiatric Association released a revised third edition of the Diagnostic and Statistical Manual (DSM-III-R) in 1987, in which it renamed ADD as Attention Deficit and Hyperactivity Disorder (ADHD).

You can read more blog about ADHD on the  Attention Allies blog pages.

All rights reserved © Copyright Duncan E. Stafford 2024. Unauthorised use and/or duplication of this material without express and written permission from the author of this post is strictly prohibited. Author contact via website Contact page.

Website version and image © Copyright Attention Allies 2024.

by Therapy place uk

Helping men to help themselves 

Men2018

It’s been a little while since I blogged about men and therapy. So, at the start of the year, when many people decide to put things in order and turn to psychotherapy and counselling for some clarity about their lives, I thought I’d write something that might help men take a therapeutic step.

It’s a sad fact that, according to the latest 2016 release from the UK Office for National Statistics, men still make up around three-quarters of deaths by suicide and yet are only reported to make up just over one-third of referrals to NHS talking therapies. So, if that sobering statistic makes you think, read on …

Access to therapy isn’t about men vs. women. It’s much more about why, as men, we might find barriers to getting help.

The continued high suicide figures for men by comparison to women suggest there is definitely something going wrong for us men – but taking your life by your own hand is just the start of the male distress story. It’s also true that around three-quarters of adults who choose to ‘go missing’ from home are men, and close to 90 percent of rough sleepers are men. It’s men who are three times more likely to become dependent on alcohol and three times more likely to report frequent drug use. Men also make up two-thirds of drug deaths, 95 per cent of the prison population, and commit more than 85 per cent of violent crimes. Additionally, they are twice as likely as women to be victims of violent crime. Sadly, men have lower access than women to social support networks, and are 50 per cent more likely than women to be detained and compulsorily treated as psychiatric inpatients.

If we look at boys, then we see they perform less well than girls at all levels of education and that close to 80 per cent of children who are excluded permanently from schools are – you guessed it – boys.

While there might be a number of reasons that these gender differences exist, what’s really important to perceive is that, for a large number of men, life is difficult.

When it comes to depression we already know from practitioners’ reports and some academic research that the commonly recognised and described symptoms of depression – being tearful, withdrawn, lacking in motivation and energy – are a more typically female presentation of the issue. Men will actually often express symptoms in an externalized way that we call ‘acting out’. This might be through uncontrolled anger, addictive behaviours that are used as a cover up for the felt distress, or the use of physical aggression. And, of course, if you express your depression in these sorts of ways it tends to compound difficulties in the social world, and will often make family, friends and professional helpers less sympathetic in their response.

Data drawn from population level studies suggest that men who are in psychological distress are more likely than women to choose coping strategies that don’t help them adjust adequately or appropriately to the environment or situation. A popular strategy might be to self-medicate through alcohol, drugs, or porn and/or sexual addictions. Of course, generalised data about gender is just that: general! And so it doesn’t tell us about any one individual. But my experience since joining this profession at the beginning of the 21st century certainly adds up with the data.

This blog hasn’t sought to offer a quick fix or a set of tools to use. What it has done is outline to anyone who reads it that we might need to approach men and their problems in a different way. Men need a space that will reflect their male nature in a positive frame. Sometimes that means that a male therapist can be a good starting point – although it is suggested by some research that as long as the  space takes a ‘male positive’ stance men make better progress. For other men it might be the environment in which they access their therapy that helps them to make progress – for example, men can thrive during online sessions or walk-and-talk sessions where the therapist is alongside them rather than sitting face-to-face.

——–

In my own practice, I see more men than women (excluding couples work) and I offer face-to-face sessions as well as online video-based counselling, psychotherapy and coaching through FaceTime or What’sApp. I also provide single-session therapy and one-off walk-and-talk therapy sessions (on particular days throughout the year) in Cambridge, Bath and Bristol. And, of course, a one-off session can become a gateway to deeper ongoing work …

Statistics for this blog were drawn from sources reporting between 2014 and 2016, including those from the Office for National Statistics.

by Therapy place uk

There’s something about anxiety right now (2017)

stressBoth the West and the UK as a nation have had a difficult couple of years – from terror attacks in major European cities that many of us know well, to the Brexit vote and result, quickly followed by the political fall-out and Trump’s control of the USA. Just when we thought it couldn’t get worse, terror came back to the streets of the United Kingdom in the middle of yet more political uncertainty during the 2017 general election. Then, most recently, we witnessed the unprecedented loss of life in the Grenfell Tower horror.

For most of us, these events are stories we digest through the various forms of news and political and social media coverage – something happening in the outside world, well away from us. But these events have been quite triggering for people with worked-through and unworked-through trauma in their life stories.

At my own practice, contacts from people experiencing anxieties appear to have risen dramatically since the June 2016 Brexit vote; 2017’s events have done nothing to quell this near tide.*

Anxiety can be an extremely difficult and life-restricting thing to experience or have to live with. The professions of psychiatry, psychology and psychotherapy have created many working models of anxiety and many labels with which to subdivide or associate types of anxiety. Social Anxiety, Panic Disorders, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Acute Stress Disorder and Generalised Anxiety Disorder form the kaleidoscope of disorders humans feel when anxiety gets overplayed and out of hand. And yet, anxiety is a natural thing to experience. Indeed it is the body’s response to danger. You can think of it like a monitor or alarm that is set to be triggered if you are put in the position of feeling threatened, under pressure or when you are facing a stressful situation.

In small amounts, anxiety is often a very good thing and in some situations it can even be the thing that saves your life. However, get too much of it happening inside a human being for too long a duration, and it can cause problems with pretty much any area of your life. At that point, we start to think of it not as a friend that can help us to feel alert, motivated and push us into action, but as a disorder that can control and even ruin our life.

If you find that you have – in addition to the primary anxiety symptoms of irrational and excessive fear or worry – other common emotional symptoms such as feelings of dread or apprehension, vigilance for danger signs, expectation of the worst, difficulty with concentration, feeling irritable or tense and jumpy, or that you experience mind fade (where your thoughts just go blank), then it might be time to think about taking steps to talk through your anxiety issues with a professional or, at the least, take some positive actions which might include things like mindfulness practice or regular exercise. And, if you don’t feel like being confined to a room to work through your issues with a therapist, then you might want to consider taking your anxiety to an outside environment with some walk and talk therapy – such as the type I offer within my Cambridge or Bristol practice.**

* There has been a reported five-fold increase in traffic to the Mental Health Foundation’s online anxiety page since July last year (Therapy Today Magazine May 2017)

** Walk and talk therapy will be the subject of a future post on this blog site.