ADHD Progressivity and Implementation Strategies, with Dr. Russell Ramsay

The final segment of our three-part series, we'll wrap up our discussion with Dr. Russell Ramsay, co-founder and co-director of the University of Pennsylvania's adult ADHD treatment and research program and associate professor of clinical psychology in the department of psychiatry at the Perelman School of Medicine.

We all know we should do things like eat better and get our money straight, but what kind of implementation strategies do we use to put those things in motion?

Focusing on the Positives

The average ADHD person has up to 20,000 more negative experiences or interactions as they grow up than those who don't have ADHD. The power of negative experiences can be a positive thing insofar as helping us to avoid danger, allowing for problem-solving and learning from setbacks.

It can take as many as four positive experiences to outweigh one negative, so it takes willpower and determination not to give up when things don't go as planned.

Component Features of CBT (Cognitive Behavioral Therapy)

The component features of CBT include behavioral interventions, engagement, and tasks. Tasks are broken down into a sequence of steps, like a menu, as minutely as needed for you to feel they are manageable to complete. Otherwise, you risk what is often known as progressivity, which is escaping a higher priority task. For folks with ADHD, you haven't broken it down small enough if you're not starting a particular task.

For example, you should be preparing for a meeting, but instead, you start doing something else you've been procrastinating. This type of positive procrastination allows you to feel the accomplishment of getting something done, just not what you set out to do initially.
The progressivity task tends to be more manual or hands-on, even among academic tasks like reading or writing.

Front End Perfectionism

Perfectionism is the number one thinking error endorsed by adults with ADHD and is an emotional regulation strategy. We often say, "If I can get this done the first time perfectly, I can be done with it." The reality of that scenario is that it rarely happens. 
Things have to be perfect as a precondition to getting started. You tell yourself you have to be in the right mood, or you're nervous about meeting a new client because what will they think about you? We run anticipatory simulations in our heads that may never happen, causing anxiety and self-doubt.

Instead, focus on what you can control, such as being professional, helpful and drawing on positive past experiences.  

Resources:
Part 1 of this interview series
Part 2 with Dr. Russell Ramsay
Dr. Ramsay's book: Rethinking Adult ADHD: Helping Clients Turn Intentions Into Actions

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