Understanding the ADHD and Anxiety Overlap with Dr. Mona Potter

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Welcome to Hacking Your ADHD. I'm your host, William Kerb, and I have ADHD. On this podcast, I dig into the tools, tactics, and best practices to help you work with your ADHD brain. When you're distinguishing between ADHD and anxiety, it can feel a bit like if you're trying to figure out if you're sneezing because of a cold. or because your neighbors are mowing their lawn and your allergies are just off the charts. Or maybe it's a bit of both. The symptoms can look the same.

But the solution is very different. This week I'm talking with Dr. Mona Potter, a Harvard-trained board-certified child and adolescent psychiatrist and the Chief Medical Officer and Co-Founder of InStride Health. Dr. Potter spent years in the Glean Hospital pioneering treatments for anxiety and OCD, and has a unique perspective on how we can manage the specific brand of exhaustion that comes with being neurodivergent in a world that never stops moving.

Today we're exploring the bio-psychosocial model, which is just a fancy way of saying we're looking at your sleep, your stress, and your chemistry all at once. We discuss the optimal zone of anxiety and how it can actually mask ADHD symptoms until you find a treatment that works the right way for you. We also look at the difference between a crutch and a tool, and why parents and other adults should stop trying to be the external executive function for everyone around them.

And then we take a deep dive into the specific mechanisms of OCD and why the structure that saves ADHDers might actually feed into an obsessive loop for someone else. If you'd like to follow along on the show notes page, you can find that at hackingyouradh.com slash two six nine. Alright, keep on listening to find out how to tell if the world is tapping you on your shoulder, or if your brain is just heckling you.

I am so glad to have you here. And with our free conversation, you know, I've found that we just have this like great jumping off point of going into this idea of What's this distinguishing like ADHD and anxiety? Because they can often look very similar if you're just looking at symptoms. Yeah, and I see this clinically all the time where somebody will come in with a diagnosis of ADHD and they've done all this ADHD treatment and they are so frustrated because

They're not getting better in that things continue to be hard. They're really struggling. They're exhausted because they're trying hard, but it's not working. What I really um I've learned clinically to say is. When you come in, when you're having a hard time focusing, and when you think about inattention, think about it like a fever. There can be a lot of different causes. There can be a bacterial infection, a viral infection, even hyperthermia.

And so instead of saying, let's immediately say inattention is ADHD, let's really be curious about what could be causing it. Inattention can be caused by ADHD, absolutely. but also by anxiety, by depression, by trauma, learning difficulties, even our basic biological needs like sleep and nutrition and movement and exercise and even chronic stress. And so I think that before we dive into diagnosis and treatment, we need to make sure that we truly understand.

all of the parts that might be leading to the symptoms that the person's coming in with. Oh yeah, absolutely. Cause even within ADHD, you go like there's there's inattention, but what is driving that inattention because Like I could be like, I'm not focused here because, you know, I can see, you know, stuff happen out my window or, you know, I'm really uncomfortable or all these other things. Yeah, figuring out like the root of what's causing that I feel is such an important piece of treatment.

Yeah. It's easy for us to sit here and kind of say, well, this and this and this. And you so any I wanna have a caveat that people do not read the TESM, which is our psychiatry like manual. And people come in with all of their complications. And that being said, I think as we're talking, it is nice to kind of try to have like put in some rules, put in some simplifications.

So when somebody comes in to me saying, gosh, I am having a really hard time focusing, I'm having a really hard time physically sitting still. I'm noticing my body is revved up. my mind is revved up and that can be ADHD, that can also be anxiety. And so a few things that I ask about to kind of help me make that differentiation is One kind of when when you're distracted, when you're noticing your thoughts are not where you need or want them to be.

what is causing that distraction. With ADHD, oftentimes it's external. It's kind of like the world is tapping you on the shoulders multiple times. Like there are all these things that are just interesting or just grabbing your attention and your tension goes.

Whereas with anxiety, oftentimes it's more of an internal distraction. N there's kind of the You're hearing what what's going on, but then there's this all the side commentary of what could go wrong, the uncertainty, all of the worst case scenarios, the ways in which you've messed up the judgments.

And those can get really distracting and make it hard to focus on what's in front of you. Yeah. And then I can also see that being like different from like the uh inattentive side of ADHD where it's inattention but Not because of, you know, it's just like, oh, I'm just somewhere else, kinda.

I mean, I think that oftentimes we think about ADHD as just like pure hard time having attention. It's more of an attention regulation. It can be due to different different distractions. It can also just be that the brain has just kind of like just kinda settled into itself and and you're just

focused elsewhere and not on not on the task at hand. The ADHD brain, it's just it has a higher threshold for for latching on. The anxious brain, on the other hand, almost has that hypervigilance. It latches on almost too tightly.

And so you can have almost similar kind of presentations, but very different underlying brain processes that lead to it. Yeah. And I feel like it's also important to add into this that you can definitely have both at the same time. Absolutely. And that can have different uh ways that that manifests and uh does some interesting things.

Completely. Well, I mean, and so this is I'm like, they're going kind of three buckets. There's the one bucket of misdiagnosis where I've seen ADHD misdiagnosed as anxiety, and vice versa, anxiety misdiagnosed as ADHD. And then there's the bucket of Somebody comes in. with ADHD. Their ADHD is not well managed, and so they are still asymptomatic. Life is hard. They're

They're feeling they're having kind of difficulty remembering things, difficulty keeping on top of things, meeting deadlines, like, and and then there's kind of this internalization of like, I'm not good enough, I'm a failure, I can't do these things. And then of course you're going to feel anxious. about responsibilities. Of course you're gonna feel anxious about all the things that on your on your plate that you need to get done.

And then there's kind of the third category of ADHD and anxiety both exist together. And I'd say that that all three of them have some overlapping interventions and then some very different ways that you would want to manage them. So I think it is important to be able to say which bucket is this person in so that I can make sure that the intervention I'm putting in place.

is actually matching the needs of this individual. A couple of years ago I had uh done a switch up in my medication and it helped with uh some of my anxiety, which I had then realized was

what had kept me from being late all the time? Like that was I was very good at being on time, but it was just like all anxiety driven. And so then the medication helped with that. And suddenly I was getting I was like late all the time again. And I was like, oh I actually have to use some of these strategies I like I knew all the strategies to do and I was like, I just actually have to do them now.

Yeah. It's like that zone of like optimal anxiety. I mean, I I talk about this all the time in in my in my clinic and actually remind myself of this even in my own personal life of like Anxiety is a really important emotion and there are times where it is actually very motivating and it helps us know what's important to us and it helps drive behaviors that matter.

And at the same time, anxiety can get to a point where it becomes overwhelming and it's no longer helpful. But I think when it's in its optimal zone, it can almost sometimes even mask some of the symptoms of ADHD because it kind of counters. Or or protects again some of some of that distractability and inattention of ADHD. So I think that's a really interesting point, an interesting experience you've had. Yeah.

Yeah, I also had this uh friend that they like I met through a coaching group that just he was like, Yeah, I don't have anxiety and we're like everyone's like, Oh, that sounds so great. He's like, No. I don't worry about anything. And he's like, It's a problem. I can't it makes it really hard to have any motivation. I'm laughing because I have this

picture that I show when I when I talk about anxiety and anxiety on a spectrum. And I have I don't know where I found this picture, but it's a picture of this woman sitting on a plank in the middle of the ocean reading a book with a bunch of sharks all around her. and she has no anxiety and it's like No, a little bit of anxiety in a moment like that would be great. It would motivate. It would help you know that something's important. And

and help you choose behaviors that you you need in the moment. And so it is kind of finding that optimal zone though, because again. when it kind of goes into the into the more what we call anxiety disorder zone or the more severe zone, it gets overwhelming, it gets exhausting, it starts distracting. Kind of that body fight fight freeze comes in.

where it can paralyze or cause you to just avoid things that really do matter. You can also have like some really negative like uh physiological symptoms too, from what I understand. Yeah. So anxiety is a very both physical and emotional and cognitive experience. And we talk about this all the time where like the interventions need to match kind of all of the different parts of it.

Oftentimes with the really younger kids, and actually even with adults, Sometimes the first thing that somebody notices is actually a physical symptom. whether it's their like stomach aches or headaches or chest pain or body tension. And that's very much part of anxiety and um and something that is a really important part to to make sure that you intervene on as well.

Really funny was that too with uh I've talked to people about like the different places they feel their their anxiety. Like'cause I know a lot of people feel their stomach. I feel like my shoulders and neck and Then you have the I've done a hard workout and my shoulders and neck are feeling tight. Am I anxious or am I just sore?

Yeah. Well, anxious or sore, anxious or excited, because a lot of the same hormones that get released when you're anxious also can can get released when you're excited or when you're when you're when when you're doing something that's really important to you. And so what we talk about is like short bursts of that stress hormone, of the kind of whatever comes along with anxiety.

is absolutely okay. Again, it prepares your body to do something, to be more attentive, to be more motivated, to be able to like really focus on that thing you need to get done. The problem is is that anxiety has now become this chronic. thing. You have an anxious moment, you get through that, but then the next moment causes anxiety or the next thought causes anxiety. And now you're just your body's just getting flooded nonstop.

And it's it's when it's that kind of chronic flood that causes and just wreaks havoc on the system. Yeah. My uh friend Brenda describes anxiety as being the only emotion that you can uh burn for energy that creates more anxiety. It's like it creates itself. Yeah. Oh. You like you're like, oh yeah, I'm gonna run on anxiety. And it's like, oh, that just makes more anxiety.

Yeah. It can be really helpful in the short run. It becomes problematic when it just becomes chronic, unrelenting. It just keeps beating down on you. You're running a marathon after a marathon after a marathon. And that is just way more to ask of your body and your mind than is reasonable. Yeah. And I feel like that's something that neurodivergent individuals really suffer from is they're like, oh, I found this.

key to getting stuff done and then not really thinking about the long-term negative effects of just being like like when I was like, oh yeah, I'm gonna keep myself on time all the time by just being anxious about being late. And then it's like, oh, that's also very distracting.

It is it and and eventually it gets exhausting, right? But I think that is where even with anxiety we talk about setting reasonable expectations, understanding when what is on your plate is just beyond what is reasonable given kind of all the different things going on, whether it's kind of your coping skills, kind of the the competing requirements and and needs.

And to really try to be able to kind of break these expectations down and to be able to to ensure that you're taking pauses, you're taking breaks, you're giving yourself a chance to refuel. We talk about just putting coins back in the piggy bank.

Although I guess we don't use piggy banks so much anymore. My kids have one, but I I always forget to give them their allowance because my parents' expectation was like, Oh, you come to us for allowance and I'm like Hmm. Yeah, that's not great with a ADHD kids. I mean it wasn't great for me. I basically always forgot. Uh

But I like that actually. It's like a it's it's a small way to kind of build a habit. It's like trying to teach a life skill and you're coupling it with something that can be important. So it's like it's not I like being able to teach. Skills with things that are not earth shattering if they don't happen. So I love that your parents were like, okay, the allowance is important to you. And so if you want your allowance.

then you need to find a way to remember to come to me to ask for it. Because what that's teaching you, it's helping your muscle, your brain build that muscle of there's something important to me. I tend to forget to do things. What do I need to do in order to remember? And you might try four or five different things until you find the thing that works.

And that thing that works might work for a little while and then it might stop working because we know that the ADHD brain likes novelty. And so it might just be like, okay, this wor this will I'll do this for a month and then maybe I'll try something new, but it's it's deliberately thinking about What is it that I need to do in order to ensure that this thing that matters to me happens?

Absolutely. Because there is so much, especially with like kids, I'm like, I don't want to become their external executive function for everything where they don't learn the skills behind doing that themselves. I think that's something that we've been seeing. So this is not super scientific, but this is kind of observational. Just I've been a child psychiatrist now for over twenty years.

And what I've seen is that as we've gotten better with our middle and high schools of really supporting kids and all of the ways in which they show up and need to learn. Again, I'm we're by far perfect at it, but But they're with more accomp with more accommodations, more support, what we're finding is that they'll go to college and then kind of there's a big step up in the demands of college.

Are more than they can manage. And so these are the kids I'm seeing in my clinic. And so it might be that I'm kind of over indexed on this. But when I think about my own kids, I feel this like absolute pressure to say, how am I teaching you the executive functioning skills? Because it is so much easier for me to just rescue you. It's so much easier for me to plan out your day, for me to do all of this.

Because while it's exhausting on my end to have to think about it, it's faster. And life is full of so many competing demands. that it at least gets the morning done, it gets the evening done. And so I'm having to catch myself constantly and finding that balance of how am I coaching you to learn to do this eventually on your own. Yeah, it's like making dinner not my favorite. And then if I'm adding in, oh yeah, I'm also having my kids help me make dinner, which is

Great for them to learn it, but it's make this makes it so much harder, but worth it in the long run probably. Well, I guess w one place we can go into the medication aspect of this because

one thing I try to always remind listeners to the show from I am not a doctor and so I try and not talk about medication too much'cause I'm like, I I don't know what I don't know and I don't want to give people bad advice there. So medication shortage has been something that has been an issue for a while, although they from what I understand that has been production has been okay to increase recently. Yeah, it seems like we are in way better shape. I actually just looked it up.

before it just in preparation. And and it looks like there are a handful of some generics, but o overall it seems like we're we're and I I personally in my clinic have have been okay now. But I think it was it was an interesting thing that happened. The shortage for of the stimulants was an interesting thing in that when in that kind of the pandemic era, there was a loosening of the regulatory laws where there was the ability to prescribe via telehealth, which increased access.

to prescribers and there was simultaneous kind of social media and just general education happening. And so there was also an decrease in stigma and a increase in awareness, especially of adult ADHD. And so what we've seen in the past several years is that there while the kind of pediatric ADHD diagnosis has stayed pretty s constant, the adult ADHD diagnosis has gone up.

And so what we've had is like a supply and demand issue, supply-demand issue where the demand for ADHD, for medications for ADHD, specifically the stimulants. Went up because of the increased awareness, the decreased stigma, the more access. But the supply did not meet did not meet that demand because they're controlled substances and regulated. So

the quota for how much can be produced w did not match. The production, there were some shortages in the material. And so it really was a supply-demand issue. But it for as a clinician, it was interesting to me. in that I'm just hearing more about adult ADHD. More people in my personal life are asking me about it as well. And so

it's been an interesting conversation to have. And then like you said, in my anxiety clinics, like we're constantly thinking about the overlap and is this really ADHD or Yes, this this part is ADHD, but if we don't also manage the anxiety, then life is still gonna be really hard. At the twenty twenty five ADHD conference, uh that was in Kansas City, they had uh Bill Dobson gave a great keynote talking about how often people were stay sticking with treatment options and it's like incredibly low.

Except for women because often they're seeking out the treatment on their own rather than being pushed into it. And so then when you have this increase of so many women getting diagnosed, it's like, well Now there's actually a real demand here because The initially you have people like, Oh, I'm gonna try this for a month and it didn't change anything, so I'm gonna drop

Yeah. Yeah. It's a really great point. So yeah, it's interesting with also with ADHD medication and especially with anxiety because um I do know some people do experience that, especially with stimulants. having that increased anxiety response.

Yeah, and I've seen the full gamut. And so I've seen where somebody comes in with ADHD and anxiety and So what I'll say is that whenever I'm prescribing a medication, I'm looking at we're talking about the risk and benefit of medication and the risk and benefit of not medication. of not medication. Right. And in and it's really important to have that kind of very thorough conversation because sometimes you might

choose to take on a couple of risks because the benefits are still bigger. And sometimes you might say, you know what, even if there is some benefit, the risk is bigger and it's or it's a risk that I don't want. So I'm done with I'm gonna do a different option. And with stimulants and anxiety in particular, what I I've seen is that for many, it's more that it causes a little bit of a physiological arousal. We talked about um both ADHD and anxiety already having kind of a physical aspect to them.

the stimulant might cause a little jitteriness, which could be mistaken for anxiety. I think that's unfortunate when it when it could actually be a helpful medication, you just need to get through that initial phase of it. Because I have seen situations where somebody has ADHD and anxiety, we use the stimulant and their anxiety actually gets a lot better.

And those were cases where the anxiety is really secondary to the ADHD, where just a little bit of improvement in executive functioning, ability to like attend and sit still and and kind of do the things that were really hard and start feeling like they could actually show up in a way that they want to actually help the anxiety get better. And um so I think in those s situations to me it's it's a shame to not use a stimulant.

And then even when I've had people come in with both ADHD and anxiety, I've still been able to use stimulants successfully. And sometimes I will also use a medication to target the anxiety along with it. But so I think I wanna what I wanna make sure people know is that every individual is different. And so I don't think it's fair to have a blanket statement of stimulants raise anxiety, therefore be um don't prescribe a stimulant if you have anxiety along with it.

I think more of its stimulants can cause some individuals to feel more physiological arousal or maybe even some more anxiety. And in that case, just work through it with the person who's prescribing for you. There are a couple of there are many different options that you can go through in those cases. I mean, I know my experience talking with my own doctor, I always feel

Subwhat apprehensive about like asking for medication changes and being things because I'm like, I don't want to seem like I'm med seeking or anything. Uh, because uh, you know, there is still the stigma that exists and I've, you know, worked through a lot of that and been like

Let my doctor, hey, I am worried about coming off this way. So I just want to let you know that. But I n so when people are approaching their doctor about getting stimulants or stuff, are there ways that they can help themselves uh Make sure that they're gonna be getting the right medication without like, you know, having their own anxiety here about the stigma aspect of it, medicate. Yeah.

It makes me sad to hear you say that. And and I I won't counter you because I I understand what you're saying and I and I've seen it. And so it it still makes me feel sad because as a doctor it's our responsibility to make sure that we are being very open minded and collaborative and um and that's only gonna happen if

when you come in for help, you feel comfortable and you feel like you can be upfront and honest. I like how you did it. I think it's even reasonable to say, hey, there's a lot of stigma around this. Like I feel nervous to talk about this because I don't want you to think that I'm I'm like seeking meds. Um I think the the most helpful thing to lead with is just is what you're experiencing. So as much as you can observe in your own life.

how your symptoms are showing up and how they're then impacting your life and across different s different settings. And um and to be as descriptive as you can about what you're experiencing. Um, my hope is that then the the doctor will be able to ask questions to follow up and together you'll ki you'll go down the path to really understand, um, is this really ADHD, in which case we really do want to talk about a stimulant, or

Could this is this m a little messy or could this be more anxiety related? And let's talk through other options. Um, I would say that also I rarely like to prescribe well, I really don't prescribe without also saying, hey. Medication does not build skills. It doesn't build the brain muscles.

And so being very open to saying, Hey, here are non medication things I'm trying or here when you're given advice to to try something, just being open to it and and actually demonstrating that openness. So I think it's

I think that can help make it more of a collaborative relationship. Yeah, I love the pills don't teach skills, but They really help develop them. So I I talk about the biopsychosocial model all the time, the biological, the psychological, and the social. So there is a biology here that is absolutely important to address. And the biology is both kind of like the our our natural core like needs that everyone has. Are we getting enough sleep? Are we how is our nutrition? Are we moving enough?

I think sensitive brains are more sensitive to not sleeping enough, not eating well, not moving. And so know your body and know what your threshold is for being more vulnerable when you're not getting those basic biological needs.

And then there's the like the biological need of like your system, just like with diabetes or asthma or cardia, there there is a systems issue it that needs to be addressed. And that's where I talk about the medications as an opportunity to turn down the intensity of the symptoms.

So if you're if you are so anxious that the moment you walk into a room, you are entirely flooded by fear and by thoughts of all the things that can go wrong, by physiological arousal where your stomach is is churning and your heart is racing. It is really hard to practice a skill, no matter how well you know the skill.

And that's where the medication can turn down the volume so then you can practice interacting with the world in a different way. You can make decisions based on what you know and need you know you need to do. But it is really hard to do that when the biological volume is just turned up. And that's and so that piece is really, really important.

Yeah, there's so much that goes into like getting the right medication too.'Cause I've known I think the thing that uh you mentioned earlier is, you know, like the effects of medication, but the effects of not taking medication is often overlooked because people are like, oh, there are gonna be side effects or there There could potentially be side effects, but they're not thinking about, well, what are the side effects of not Medicaid?

Generally speaking, stimulants and SSRIs, which are the category of medications we most commonly use for anxiety, are pretty well tolerated. And if you have a hard time with one, oftentimes switching to another can actually work pretty well. And so generally speaking, I will say that they're prescribed a lot. I talk through the side effects. I watch carefully for the side effects, but they're pretty well tolerated when used correctly.

And that being said, to your point, I think that there's a huge risk of not using all the tools on your tool belt to address ADHD or anxiety. 'Cause then you're living in the world and interacting with the world in a way that's not completely you almost have like goggles on. You're seeing the world in a different way. The world is seeing you a different way too. And that that starts becoming part of how you see yourself. It changes.

um your self concept, which that's where I get most worried, is where it's this is very treatable. And I know some of the interventions can feel uncomfortable. But when you're not being able to live the life that you want to live, that you are capable of living, I owe it to you to make sure that you're trying all of the tools that are available. And there's, you know, things like, oh yeah, you know, unmedicated ADHD has a higher risk of like just

Like running into traffic or something. And it's like, oh, that is a very serious side effect there of being unmetigated. Yeah. Some of my colleagues are actually pretty against doing stimulant holidays. for ADHD for that very reason. They're like, well, it's not just about am I am I producing at work or at school, there are also other really serious risks associated with ADHD that

um that you want to make sure somebody is protected on. And so again, it's a very individual conversation because we are all different and our circumstances are different. So we have all the research studies that look at the population and they're good guidance. But in the end, the decision has to be one where you're really thinking about

What is important to you? What are the ways in which the ADHD or the anxiety or or whatever it is are showing up? And what are all of the different options you have again in the biology, in the psychology, again, with with therapy, with kind of skills and then also in the social aspect of like What supports are you bringing in? How is your environment helping or interfering with your ability to get on top of things?

And it's funny with like the uh diagnostic criteria for ADHD requiring both it being at work, school or and home. Like you're not just it's not just one place and then being like, Well, we're only gonna worry about treating it at work and school. My hunch is that it's because we think about consequences. It's like in it saying, Well, when you go home

There are not as many external consequences as there are worry. You won't lose your job. There are a lot of consequences to having ADHD show up at home as well. Um, whether it's in your like your relationship with your partner or your kids or with friends or um just being able to just manage like your calendar and get out to social events. And so there are a lot of consequences again based on quality of life and just continued development of yourself.

in the world. And so I think it is really I don't wanna diminish how important other aspects of life are as well. Yeah. And I also don't wanna uh tell people that they shouldn't be that the only solution is medication either. Like I I know many people that manage very well without medication, but also I don't think it should be something people write off immediately either.

I really appreciate that you said that because I think because I'm a psychiatrist and because I talk so much meds, I think I sometimes run the risk of seeming that way. And in fact, I will think of non-medication interventions first. And I think what's happened for me, when I started prescribing or when I started to as a psychiatrist decades ago, I was super, super conservative.

And I was kind of like, all right, let's try all of the behavioral treatments, all of the therapy, let's make sure you have done it all before we go to meds.

Because I don't want to introduce your system and your developing brain or or your brain to something that it doesn't need. And I've really shifted over the course of of just seeing and living and breathing this and and seeing how There's also exhaustion in when you work so hard, it it's you can only do that for so long before again, it's human to just get too exhausted to keep going.

And so what I want to do is just reduce the shame or reduce that feeling of like, I'm using a crutch if I use medication. I hear that a lot. And I'm like, well, use glasses if your eyes are not sharp. And you when you break your leg, you use a crutch. Why is a crutch even bad? A crutch allows you to be able to do the things that are important to you. And so I think I want to shift the thinking around medication.

It is not the end all be all and it can really be useful as a tool in the toolkit. Yeah, absolutely. It's Not the only tool, but it is one of the first tools that we should look at if we have that available to us.

So I kinda wanna switch gears here and talk a little bit about one of your other specialties in O C D because that's something I know a lot of people Don't have a good understanding of what OCD is. Some of the first times I've had like real conversation. I'm like, oh. Yeah, that's some of my thoughts. Uh so obsessive-compulsive disorder. It's characterized by having obsessive thoughts.

that are intrusive or recurrent. And then in order to neutralize those thoughts or in order to calm those thoughts, you'll do a compulsion or a behavior in response to that thought. And um and that then creates a loop in that doing that behavior then calms the thought, but it only calms it temporarily. And so then you get caught in this loop. And it can show up in a lot of different ways.

I think the hard part about O C D is we kind of use it as a as like a day to day term. Like it'll be like, Oh, that's just my C D like like I I'm just kind of like when when we're kind of rigid or fixed on something or when we And I'll say that even I like I was thinking about O C D and I'm like, oh, like I have a I have a little kind of with my daughter, every day I wanna watch her walk to the bus.

And whatever reason it's like'cause I worry about my daughter. I worry about her health. I worry about her safety and she's going off into the world. And so there's something about that I have this thought of like this worry thought that my daughter can get hurt or can and or is gonna have a bad day. But if I s if I stand and watch her, there's something com very comforting to me and it calms my mind. And I was like, gosh, is that part of O C D?

So what separates kind of just having little rituals or having behaviors that that kind of help calm some kind of distressing thoughts is how important are they and how much time do they take up? And so

With my daughter, there was a day where I'm like, okay, I can't. I have to get back. I have to get in the shower, get ready for work. And so I couldn't. And now I was like, yeah, that's fine. I'm not going to. So it wasn't something that I had to do in order for that thought to go away or f in order for me to feel calmed. But in O C D that thought is so sticky.

And it is so strong that not being able to do whatever the O C D tells you to do in order to calm it down develops a life on its own. It gets very distressing. And so we'll have somebody, for example, with contamination who might have the thought that if I don't wash my hands thoroughly for five, ten minutes, then I will not have gotten all of the germs off. And if you interrupt that cycle, that is incredibly distressing for them. And they cannot do anything else.

Until they wash their hands. Mm-hmm. And one of the interesting things I've seen about the differences with ADHD and OCD, because you can have some of the like similar symptomology there, often very helpful to like Just kinda grease the groove. Make things easier for yourself to like

This is gonna like, oh, I'm gonna make this a seamless process. And from what I understand, that's kind of like the opposite of what you want to do for O C D. Yeah. No, I mean, so you're right, like adding rituals, adding structure, adding predictable pathways is incredibly helpful for O ADHD.

Feeding into rituals can actually feed the O C D and so what we're often talking about with O C D is we wanna break the accommodation. With ADHD, we're thinking about what accommodations in the environment are we gonna use in order to kind of help structure and break down the day to day. With OCD, we're breaking we're saying we are no longer going to accommodate.

We're going to ask for you to sit with distress, to sit with intolerance, to sit with um not actually being able to do the thing that that your OCD is telling you. And we're not going to give you reassurance because if we do that, we're just feeding the OCD. We're telling it that. what it's asking you to do is important, is the most important thing, and it has to win over everything else.

And so it is a really interesting difference. What we're trying to teach with OCD is flexibility of thought, flexibility in action, and that ability to then sit with the distress that comes with that flexibility. Yeah. And so then that uh the uh treatment you were described, that's the uh uh exposure and response prevention, right? The ERP. Exactly. And what you'll find is that ERP is kind of like the gold standard treatment.

for OCD and also for avoidance directed anxiety. So whenever OCD and anxiety are really like what fuels them is avoidance. You have a thought or feel a feeling, it's uncomfortable, you just don't want to feel it anymore. You avoid

And then you feel better. And so what the brain learns is, Oh, I have a thought, I have a feeling, I avoid, life is good again in this moment, and it creates that loop. And so exposure and response prevention is gradually teaching your brain that you can handle it, that approach rather than avoidance is what's gonna help you get back to living the life you want to live.

And it is way easier said than done because nobody likes to feel uncomfortable. And even therapists don't like making patients or making people coming to ask for help feel uncomfortable. And so what we even find is like we can even find ourselves getting distracted and just talking about the day or talking about what was hard rather than saying, all right.

You know what? We're gonna get very behavioral here. We're gonna get very active here. Let's talk about the ways in which your anxiety or the ways in which your OCD showed up. And let's let's talk about how you want to, what you want to do that your anxiety or OCD are not letting you do. Because it's easier to avoid than it is to do the things that will that are required to do what you want to do. And let's gradually work our way to being able to approach those things.

And I imagine for people that have the like a comorbid ADHD, that's like an even

harder proposition where they're just like, I really don't like seeing discomfort. Yeah. Yeah. Well what I find is that it's just it's cumulative. I mean, again, any one of these is exhausting because even if you're able to to to do it all, it takes work. It takes more work than somebody who is not contending with with some of these difficulties. And so they're just additive. And so what I say to people when they come in for treatment, I'm like,

This is not gonna be pleasant and I'm really sorry. I wish I wish that we could like if it were easy to deal with anxiety or ADHD or or OCD, you wouldn't need to come in for help. This is really, really hard exhausting work and it is even more exhausting when you have ADHD on top of the anxiety or along with the OCD. And so what we do is that's where pace matters and that's where

It's really important to get aligned. I think when treatment is least effective is when we as a clinician are say have one expectation and we're trying to move at a certain pace. And the person who's coming in and asking for help has the same desired goal. What we're asking is just overwhelming. And so it seems like they're like treatment resistant or not working hard enough when in fact it's just overload. And so it's really important that we

that we are making sure to say like what is our shared goal? What like what is a reasonable expectation for for what we want to accomplish? And how do we break it down into small steps? and and work on those small steps, we're creating new habits in the brain. It's really hard to create a new habit. And so the more we can simplify, the more we can set expectations that are reasonable so that you have little wins. 'Cause when you have little wins, then you're more likely to keep going.

Um, I really despise exercising. I just, it's not, I just for whatever reason, I just don't like to exercise. I mean, I think I'm probably not alone in that. And as I'm getting older and I'm feeling my hips and my left and all of this, I'm like, I need to exercise. I need to be more consistent.

And so one way I tried was like, okay, well I I do things very intensely when I do them. So I was like, okay, I set this huge regimen and huge plan, even had an accountability buddy, all of the above. It did not work. So instead I said, okay, I'm going to expect myself to exercise five minutes three times a week. That's all I'm expecting of myself.

And when I when I did that, I'm I set a goal. I mean, it's a smart goal, right? And it's really thinking about what can I do easily? What am I willing to do? What will I not be What will I not talk myself out of? And then once you develop that new habit, you can build more and more habits on top of that. There's definitely a lot to try and Get yourself to

The point where you you're you're happy where you're at and happy with your progress. Cause that's always my fear with ADHD is I'm I'm not going to be happy enough with this progress. So I need to do more. But then doing more is too much. So one of the things I was just thinking here too is when should someone actually think about coming in for help? Like what are some of the things that are clues to them that like, oh, I'm not doing well enough on my own?

I would do much better if I went in for help. What what are some of the clues people could look for there? And help is along a spectrum. So I would say that we're humans, we're not built to worry alone.

So if there's something that's on your mind, if you're worried about something, ask for help. You can start with just kind of your your social circle or start with your PCP or or your child's pediatrician if it's your child or And so there it's not kind of either you're going in for clinical help or you're you're kind of trying to do this all on your own, which I know is a statement of the obvious, but I still feel important to say because sometimes

we're reluctant to ask each other for help because we don't want to bother a friend or we we're worried that we're gonna be a burden or there's shame in what we're experiencing. And I think more often than not, when you talk about it, you'll realize there are lots of other people who are kind of going through very similar things. But I think when it reaches threshold for asking for help clinically is when you notice that it is really getting in the way of functioning.

when when your symptoms are driving your decisions rather than your decisions being driven by what matters to you, what you value, kind of what you wanna get done. Or you've tried some things at home, you've tried things that you've read online and you're not getting the results that you had hoped. I think all of those are reasons to go in for help. And I said this before, but because like what I've seen is that it might start off as some symptoms.

But over time it can start becoming part of how a personality or how to like self-concept. And I really want people to come see me before it gets to that. Or um right, because it's what the the more we practice. something, the more it becomes part of who we are. So if we're practicing

engaging in the world in a highly anxious way, it o it starts becoming more of the way we we, it just becomes our habit. And so asking for help to shift that and to try to get to that, it's easier to shift that earlier in the course. than when it's been going on for a long time.

I was wondering if there were any final thoughts that you wanted to leave the audience with. We're living in a world that is so beautiful and um and it can also be just incredibly exhausting and overwhelming and especially when Especially for those of us with sensitive brains.

That um it's really easy to lose ourselves in that overwhelm. And so I think my final parting words are, um, are to just really accept yourself for all of the wonderfulness, all of the messiness that makes you you and human. And Also keep challenging yourself to build on your strengths and manage those vulnerabilities.

so that you can build a life that is truly worth living, in which you're making decisions, you're choosing behaviors based on what matters to you rather than what your symptoms are kind of telling you to do in that moment. And if people wanted to find out uh more about you and what you do, where should they go? I'm chief medical officer and co-founder of Instride Health. So people can go to instride.health to learn more about the work that I'm doing clinically. Okay. Great.

Well thank you so much for coming on the show and there's in here this is fantastic thank you so much thank you so much for having me i really appreciate it Thanks again to doctor Potter for coming on the show and thank you for sticking with us all the way to the end. So let's do a quick rundown of today's top tips.

To tell ADHD and anxiety apart, look at what's pulling your focus. ADHD's distractions are often external, you know, the world tapping you on your shoulder, while anxiety distractions are typically internal, a side commentary of what could go wrong.

Remember that medication can turn down the biological volume of symptoms, but it doesn't build skills or brain muscles. You can use the quiet provided by the medication as a window to practice those executive function habits you need and build those skills and brain. While structure and rituals are helpful for ADHD, feed into OCD. If you have both, you must learn to sit with the distress of not performing. That's through exposure and response prevention therapy. than just making things seamless.

All right, that's it. Thanks for listening. I'd love to hear what you thought of this episode. Feel free to connect with me over at hackingyouradh.com/slash contact. If you'd like links or to read this episode's transcript, you can go to the show notes page at hackingyouradh.com slash two six nine. And if you'd like even more hacking your ADHD, be sure to sign up for my newsletter, Any and All Distractions, which comes out every other week. In it, I give it out my best distractions of the week.

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