“Skills not pills, but sometimes pills”

What Cognitive Behavioural Therapy can do to help with ADHD

When I was diagnosed with ADHD at the age of 24, it was a wake up call that completely changed my life view, in the same way a good movie plot twist will redefine everything you saw before it. It explained so much of my past behaviour. It laid a foundation to my journey out of my own self loathing. My diagnosis was the equivalent to telling a kid that reason they can’t follow anything in class is not because they are stupid, (although they could certainly be made to feel that way!), but in fact that they need glasses. Suddenly, the world makes sense. The doctor prescribes glasses, and they start improving in every aspect of their life. ADHD medication is the equivalent to getting new glasses. 

The medication, typically a stimulant, allows the part of your brain responsible to make executive functioning decisions, (i.e. not procrastinate!), to get that extra kick that allows you to make those decisions. A known self medicating substitute is caffeine, which has been used in the past to make hyper excitable children calm down. (I know! You’d think a child with ADHD paired with coffee would result in disaster, but it causes the opposite effect in just such children! We thankfully know much more nowadays and can prescribe medication instead of coffee.)

Unfortunately, medication can be expensive, and you might not get the right ones right away. There are several different classes of ADHD drugs with their own sublist of mediations. Picking out the right one could take you several tries. Sometimes, the medication just won’t cut it. It might make executive functioning easier, but without an actual roadmap on how to reorganize your life, you might still end up falling into old habits and tricks that you relied upon all your life. Just because you now are able to do things easier, doesn’t mean the “doing” comes easier. Let me explain; pills can make you more productive, but you still have the problem of figuring out what to do once that potential is unlocked. That’s where CBT (Cognitive Behavioural Therapy) comes in. It’s a program designed to give you scientifically proven skills to combat the adverse effects of ADHD, even if you don’t have medication. 

I took this life changing course. Here are a (few) ways that CBT has helped me. 

1. It changes the perception of blame

In the duration of my life before diagnosis, most people would say I was “mature for my age”, and that I was “really smart for a kid”. But in reality, I felt like I was a fraud. I couldn’t study like the other kids. In fact, I remember this being a problem throughout my whole life. Assignments were half-baked and tended to always be done last minute. I had a reputation among my peers to be lazy and unmotivated. Unless I was really, REALLY excited about a specific subject. Then I highjacked the entire group project and finished it before it was due. I felt unreliable, I felt like a burden, and I felt like I struggled just to keep the impression I was smart. But inside, I could only blame myself. 

Blaming oneself is a common trap among people with ADHD. Deep inside, I knew I should know better. In fact, I did know better. I had all the skills that neurotypical people (people who do not display neurologically typical patterns of thought or behaviour), but I would never use them. My mom and sister, who were both always hard workers, definitely thought I was a lazy spoiled brat. And who could blame them? I just could not get myself to do the difficult and boring things most people could do without too much of a push. This realization that I must be just “the worst person in the world” ate away at my self-confidence and self-esteem…

…until the diagnosis and the CBT. All of a sudden, the moment I could begin taking control of my executive functioning, was the moment I ceased to blame myself for my shortcomings. Realizing just how difficult life can be while unmedicated, gave me an appreciation of just how hard I actually worked all my life. I could also take control of my self-esteem and my self-worth shot up. I could now confidently say, without blaming myself for being lazy, that no, I do not like doing taxes, or laundry. I will gladly do all the dishes, (which is a meditative activity I love doing!) rather than subject myself to doing laundry. I just can’t do it, because I forget and it stays in the wash, moulding over the entire week and smelling bad. And knowing that, I have a loving understanding with my partner that I’ll always do the dishes, if the laundry gets taken care of. (Thankfully, my partner hates doing dishes and loves doing laundry, that neurotypical weirdo!)

I know it seems weird to bring up laundry and taxes in a section about blame, but you have to understand that these things would make me feel incompetent and lazy because I could never do them on my own. But I don’t have to feel that way. I can always ask someone to help with the promise of an exchange for something I can do. It does not make me lazy or stupid. It makes me human.

2. It changes your source of motivation

I procrastinated because the stress of the last minute deadline overrides my lack of motivation and pushed me to pull off the impossible. That’s why I did it. Nowadays, I prefer to dole out the task over a few days prior before any deadline. Which was impossible for me to do during my life before diagnosis. In these situations, my motivation was stress.

I also would fall into deep holes of discovery or creativity and would literally rather starve myself for the whole day than look away from whatever puzzle, piece of art or youtube deep dive I just so happened to be distracted by. In these situations, my motivation was obsession. 

Stress and obsession are emotions that can drive any human being under normal circumstances, but for neurotypical people, it’s just one of many motivations. For people like me, these two are the ONLY motivations. Or at least they were. And just thinking about how much of life’s work requires motivation outside of these forces, you can begin to imagine everyday scenarios where these emotions would never ever show up. 

CBT exposes this for me. It showed me how much of my life was dictated by the extreme emotions and why anything I would get into would have to have been triggered by some major life altering push. The amount of “rock bottoms” I felt I needed to hit in order to “finally realize I was being lazy” and “needed to make significant changes” were so plentiful, I’m astounded I’m still even alive. I needed my life to be destroyed constantly, so the stress could motivate me into becoming a better, more productive person. But soon enough, I would use that motivation to rebuild my life, and then all of a sudden, I’m fine again. But emotions are fickle. Just as you can’t stay happy forever, you can’t depend on stress that isn’t there anymore. And you become comfortable, and then lazy, and then poof! You need another life altering jolt in your life. It’s simply unsustainable. 

The cycle has to be broken, the motivation needs to come from somewhere stable. Enter CBT’s value-based motivations. The trick is to really focus on things that are important… which is something easier said than done. What does that even mean? You’ve probably heard this so many times you’re wondering why I even brought it up. But it’s true. A value you hold dear will have a stronger chance of staying long term than those ever changing emotions. Think of your family, your friends, your partner, your lifetime goals. There are a multitude of different values to pick from, but mine are these: I want to be known as caring, dependable and strong. I’ll be a lot more motivated to finish a project if I want to uphold myself as being a dependable member of a group. I’ll be a lot more motivated to start those dishes, (yes, I know I said I like doing dishes, but remember, emotions are fickle!), if I want to appear caring in my relationship and my environment. I’ll be a lot more motivated to keep to a workout, if I want to be known as someone who is strong of will, body and mind. That’s a shift in motivation. 

3. It gives you common sense (or for people with ADHD, not-so-common sense) strategies to help with everyday life.

I have a sense that I might have inherited parts of my ADHD from my father, who, while currently undiagnosed, has a lot of the behavioural traits I experienced all my life. He was unfortunately, notorious for forgetting birthdays. Growing up, this caused a lot of pain for my mom, my sister and occasionally myself. Surprisingly, now that we are all grown up and separated, my dad remembers our birthdays all the time. What gives? Well, one thing has changed all of our lives dramatically. Technology. 

I spoke to him about this one day and he admitted that, he never actively chose to forget our birthdays, as it was never something he did out of malice. It would dawn on him one day, and he would scramble to the get something for all of us. But we ungrateful lot, we’d see right away how last minute these gifts were and be disappointed. But why is he better now? It’s because his phone tells him a least a week in advance and he has more time to remember. How different my parent’s lives would have been had my dad been able to rely on technology to remember birthdays. Or basic tasks. Or really anything. 

See, a common critique of technology by neurotypical people is that it’s distracting, addictive and makes us dumber because we “forget more”, like phone numbers. But in reality, it’s a tool that can be configured properly to give a leg up to those like us who forget birthdays, and who forget to grab some milk on the way home. People did this long before technology, so why not use it to benefit us?

Google Keep is one of those apps that was vastly discussed in the group. That and sharing your calendar with your partner. If you live with someone who like organizing, why not share your calendar. That way, all you have to do is keep looking at notes and events and you’ll see exactly what you need to do. Obviously, you still want some agency in your life, and I’m not at all saying you should let your parter plan your life for you. That is unhealthy for both parties. But letting someone with organizational skills and better memory to work with your schedule and implement changes you both agree on will help you in the long run. 

Another common sense strategy often forgotten is the art of writing things down! The moment you are told you need to do something, write it down! Stop whoever is talking, tell them to give you one moment as you pull out your notes on your phone, and write the tasks down as soon as you hear them. Because I know for a fact I am lying to myself if I say, “It's okay, I’ll remember it.” LIES! So often I have been asked to go get something from the basement, only to instantly forget the moment I’m there, and get distracted for 20 minutes as I pick up a book or a trinket. Distraction is so easy, so make memory easier. It’s also proven you’ll remember things better if you write them down. Google Keep also has shared notes, so if you have a grocery list and your partner wants to add something to the list, they can write something on and it’ll sync up with your notes. 

4. It helps you break down tasks to its simplest forms. 

One of the many reasons I would struggle with projects is that I never seemed to really understand where and how to start. Often I would then wait as long as possible and then suddenly, I would kinda scramble and try to get 5 different things started all at once, until I eventually got into a groove. Unfortunately, this strategy wastes so much time! 

This trick reminds me of a study they conducted on game design students who were tasked at building a flash game. They were told the general concept and given a limited amount of time to complete the game. Most students would jump right into building the game, but had to spend lots of time rewriting the codes of the game over and over again until they got it right. Some students never finished before the deadline. The students that spent time, before even starting to make the game, asking as many questions as possible were the ones who sped through the whole process and succeeded in time. Deadlines be damned, these students would rather have all the answers ahead of time, than to start the gruelling task of trial and error. 

CBT taught me how to put that into real world practice. Taking a large and potentially daunting task, and reducing it to it’s bare bones, simple step-by-step process until it was so simple, anyone could do it. Literally putting into a list what the old proverb “a journey of a thousand miles begins with a single step” said. You have to reduce the task so simply, writing down “get up and walk” often can be the first statement. Once you can cross off step one, finding motivation to do step two will be just that much easier. In fact, if you really need to find that motivation, writing down “make list” as your step one, can accomplish just as much. 

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Hopefully with these examples from my life, you can see whether or not CBT can truly be of use to you. Programs like these are essential in giving confidence and self-esteem to people who have lived their lives struggling while undiagnosed. Now, to explain the maxim “Skills not pills, but sometimes pills” is really to just go back and expand on how important knowing your condition is. That being said, medication is meant to help, and in no way should it be discarded as an important mean of coping with ADHD. There are days where no matter what you do, you just can’t seem to move ahead with your day. But being informed will always lead to personal betterment. Because while taking off your glasses won’t make you see better, you’ll know not to blame yourself next time you can’t see. 

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