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Sunday, November 18, 2012

Mindfulness and ADHD

From CHADD - Children and Adults with Attention Deficit Hyperactivity Disorder

By Mark Katz, Ph.D.
November 16, 2012

Can simple mindfulness practices, when mastered, help adults with ADHD reach their goals, manage their emotions, and enjoy more productive lives?

Indeed they can, says Psychiatrist Lidia Zylowska, M.D., and she should know.

A California psychiatrist recognized nationally for her expertise in both adult ADHD treatment and mindfulness training, Zylowska helped create UCLA’s Mindful Awareness Program for ADHD (MAPS), an eight-session mindfulness-based treatment model for adolescents and adults with ADHD. She also led the first study of mindfulness training in ADHD.

Initial outcome results are promising. A majority of participants reported decreased ADHD symptoms, decreased anxiety, depression, and stress, and an improved ability to pay attention under distracting conditions.

Additional studies are planned with more stringent controls to corroborate these findings; for example, a replication study is currently being conducted at Duke University by John Mitchell, Ph.D. Zylowska’s MAPS model was also recently piloted with eight-to-twelve-year-old children with ADHD, with positive results.

Mindfulness and Attention

What does it mean to be mindful? "It’s about being less distracted and bringing our attention to aspects of the present moment," says Zylowska. "It is also about having an open, nonjudgmental attitude when mindfully observing what is."

It sounds simple, but it’s not. As with learning any number of new skills, mindfulness involves practice. But with practice comes mastery, and with mastery, a variety of benefits follow. Research shows that simple mindfulness practices not only reduce stress, anxiety, depression, and attentional difficulties, they can even help us regulate our emotions.

Through mindfulness people with ADHD develop "meta-awareness," the ability to not only be aware of their attention, but to monitor and remember where it goes. The ability to notice where our attention wanders actually increases our ability to redirect it to where we want it to be.

"Even when lost in the moment, with mindfulness you usually won’t stay lost too long," says Zylowska. "You’ve trained yourself to become more aware of your attention, and so you’ll be better able to recognize these moments so that you can shift your focus should you choose to do so."

Mindful Self-Coaching

While external strategies often play an important role in helping adults with ADHD successfully reach their goals, the practice of mindfulness focuses on strengthening internal resources, or our "mindful self-coaching voice." This voice is based in having a curious and nonjudgmental attitude, especially when observing one’s ADHD patterns.

Zylowska observes that people with ADHD often have little difficulty embracing a curious mindset. Many, however, have lived lives burdened by negative, self-critical thoughts about themselves and their capabilities. It’s not easy to immediately switch to a non-judgmental mindset, but people who have struggled their whole lives with ADHD can indeed make the switch. As with other mindfulness tools, says Zylowska, this kinder, gentler attitude with oneself (and in turn with others) takes practice.

By mastering the skills outlined in the eight-step MAPS model, adults with ADHD learn how to use their mindful self-coaching voice to successfully navigate through their day. "A mindful self-coaching voice is supportive, compassionate and encouraging, void of self-criticism and harsh personal judgments," says Zylowska. "At the heart of mindfulness training is acceptance."

"A mindful self-coaching voice is supportive, compassionate and encouraging, void of self-criticism and harsh personal judgments. At the heart of mindfulness training is acceptance."

For people with ADHD who have spent years trying to will away their troublesome ADHD characteristics, and who have spent just as much time beating themselves up when unable to do so, the notion of acceptance comes as a welcome relief.

Zylowska observes that through mindfulness training, people with ADHD can learn to accept themselves and to embrace their strengths and their challenges. The acceptance then forms a basis for increasing ability to make a positive change.

Zylowska finds that when adults with ADHD learn to become mindfully aware they are less driven by outside distractions or by inner reactions. They also learn to have better self-regulation skills. They become better able to notice an impulse arising without acting on it. They also gain skills in managing strong emotions. She says this can turn frustrating experiences into moments of empowerment.

Improving Self-Regulation Skills

During his keynote presentation at the 2010 CHADD conference in Atlanta, Russell Barkley, Ph.D. spoke of self-regulatory strength as a limited resource pool. The more we’re called upon to control and regulate ourselves, the more likely we are to deplete our self-regulatory fuel tank.

This may help explain why people who have to work much harder than others to manage their emotions and control their behavior can feel so depleted after a day at school or at work.

"The more we’re called upon to control and regulate ourselves, the more likely we are to deplete our self-regulatory fuel tank. This may explain why people who have to work much harder than others to manage their emotions and control their behavior feel so depleted after a day at school or at work."

Replenishing that self-regulatory tank is thus important for people with ADHD, says Barkley. But how do we do that? One way, says Zylowska, is through mindfulness training.

Even brief moments of pausing and taking a few deeper breaths can interrupt the stress response and help us to recharge. In addition, meta-awareness and mindful self-coaching can improve self-regulation skills, or shift the way we respond to stressful or taxing situations.

We can, for example, more readily notice emotions that can potentially overwhelm us and deal with them more compassionately and also proactively.

We can also become better at catching ourselves acting out of an impulse, such as interrupting someone who is speaking, so our communications become more effective. This can turn frustrating experiences into moments of empowerment.

Mindfulness is ADHD-Friendly

Zylowska is the first to acknowledge that helping people with ADHD spend more time in the present sounds counter-intuitive. After all, it’s time spent in the present that often prevents people with ADHD from attending to future goals.

In actuality, though, being more aware of the moment is very different than being stuck in the moment. It’s this increased awareness that actually makes it easier to choose where to focus our attention, says Zylowska.

Zylowska finds that people with ADHD can benefit from mindfulness practices simply by incorporating these practices into their day. For those wishing to do so, she wrote a guide describing eight easy-to-follow steps, each explained in detail in her recently published book, The Mindfulness Prescription for Adult ADHD: An 8-Step Program for Strengthening Attention, Managing Emotions, and Achieving Your Goals (Trumpeter Books, 2012).

Material is drawn directly from UCLA’s MAPS model.

Steps one through three provide tools for training attentional control skills and for focusing on the present moment. Steps four through eight provide tools for learning how to observe and manage thoughts, feelings, and actions. Steps are arranged in sequential fashion. Skills taught in step two, for example, build upon skills mastered in step one.

Zylowska recommends spending one to two weeks mastering the skills in one step before moving on to the next. One to two weeks is a recommendation, however; she encourages people to go at their own pace. The book also includes a free audio CD of guided meditation instructions that correspond to specific exercises.

Readers who wish to exchange ideas on mindfulness and ADHD may visit the book's Facebook page. Zylowska is scheduled to present an institute on mindfulness and ADHD with colleague Mark Bertin, M.D., at CHADD’s upcoming international conference in San Francisco.

The Eight-Step Program in Mindfulness for ADHD

Here is an overview of the mindfulness training program developed at UCLA by Lidia Zylowska, M.D.
  • Step 1 - Become More Present: Attention and the Five Senses
  • Step 2 - Focus and Wandering Mind: Mindful Breathing
  • Step 3 - Direct and Anchor Your Awareness: Mindfulness of Sound, Breath, and Body
  • Step 4 - Listen to Your Body: Mindfulness of Body Sensations and Movement
  • Step 5 - Observe Your Mind: Mindfulness of Thoughts
  • Step 6 - Manage Your Emotions: Mindfulness of Emotions
  • Step 7 - Communicate Skillfully: Mindful Listening and Speaking
  • Step 8 - Slow Down to Be More Effective: Mindful Decisions and Actions

About Dr. Mark Katz

A clinical and consulting psychologist, Mark Katz is the director of Learning Development Services, an educational, psychological and neuropsychological center located in San Diego. He is a contributing editor to Attention magazine and a member of its editorial advisory board, a former member of CHADD’s professional advisory board, and a recipient of the CHADD Hall of Fame Award.

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