Breaking Down Tasks and Big Feelings with Vanessa Gorelkin

This week I’m talking with Vanessa Gorelkin, a seasoned occupational therapist and ADHD coach who’s been working in the field for nearly 30 years. She holds a Bachelor of Arts degree from Brandeis (Bran-Dice) University and a Master's degree in Occupational Therapy from New York University. She specializes in executive function strategies, emotional regulation, and anxiety management, and she brings a unique perspective to helping adults with ADHD navigate the day-to-day.

In this episode, we talk about why people with ADHD struggle with even the things they want to do, how anxiety and executive dysfunction team up to make life extra frustrating, and why strategies that work for a while inevitably stop working. We also dig into emotional regulation, how to break down tasks so they actually feel doable, and why giving yourself a crisis plan before you need it can make a huge difference.

William Curb: All right. Well, it's a pleasure to have you on the podcast. And I was kind of thinking one of the best places to start here would be kind of talking about what occupational therapy is, because a lot of people, I imagine, don't have a great idea of what occupational therapy is. They kind of hear that and they go, that's work therapy, and that's clearly not what it is.

Vanessa Gorelkin: So occupational therapy really has an unfortunate name, kind of like ADHD, which is poory named because ADHD oftentimes is an over-attention, not an under-attention, but occupational therapy, occupation refers to what you do in a day and in your life. So occupational therapy is about living your life to the fullest. So you will find occupational therapists working all the way from the neonatal intensive care unit to a nursing home with somebody in the later stages of life, even in hospice. And the running theme for occupational therapists is that we help people to adapt to their circumstances, whatever those may be. And it may be habilitation or rehabilitation.

William Curb: I've had my kids go through some occupational therapy for ADHD. Is that something that's more of a focus for kids or is it something that you see a lot more all ages coming in for?

Vanessa Gorelkin: Well, I specialize in working with adults with ADHD, anxiety, emotion regulation issues. But I would say from the feedback that I've gotten and the trainings where I have learned how to do what I am doing, that ADHD treatment for adults is a much more emerging area of practice for occupational therapists. I would love to say in any state or any country where people are listening, oh, you could just go to your local occupational therapist as an adult with ADHD and somebody will be able to help you. We're not there yet because I think occupational therapists as a profession have not necessarily realized that our expertise really matches the needs of adults with ADHD.

But as you said, I think people often are quite familiar with ADHD if they have children or nieces or nephews or grandchildren who have been through school-based occupational therapy that is very commonly seen for hand writing, for behavior issues, for fidgeting with all things that people tend to complain about children with ADHD and want to fix. And I find that both helpful but also unfortunate since people with ADHD are not broken. They just are different and need to be helped differently to succeed.

William Curb: Yeah, there's absolutely this idea that we see with people being like, okay, we're going to fix the ADHD. And I mean, I think that leads to a lot of masking and other negative consequences. But there are good aspects of being able to sit still and listen and learn some of the skills that you would learn through those kinds of things with how long you can keep your attention, how well you can frustration tolerance, that kind of stuff, which is very important. But yeah, it is also so focused on how you're affecting others rather than how you are affecting yourself.

Vanessa Gorelkin: Yeah, you know, I'm a listener of your podcast because I myself do not have ADHD. So oftentimes I will listen to ADHD podcasts so that I can hear from people who have ADHD, not only in my practice, but get like a wider view of what people say about their ADHD. I think that while we don't need to fix people with ADHD, I think teaching people with ADHD how to adapt to more neurotypical environments is extremely helpful. And of course, I think medication for ADHD, the research shows that it really is quite helpful for people to take medication for ADHD.

Though I often have people in my practice who prefer to not have medication. And these are choices that people are absolutely entitled to make when they're adults. But when they're children, they don't have those choices. And also I wanted to highlight the fact that I heard on your show and agree and I have said in my own career that children with ADHD suffer so much criticism in their childhood. They're called lazy. They're told, why don't you just do this? Why don't you just sit still? Why don't you just anything?

And those are the two four letter words in my practice that I really will kind of call out. You know, people can say anything they want when I'm working with them. But when someone calls themselves lazy, I will definitely have a nice little chat with them about how I think that that is something that we really don't want to be saying about ourselves at all. It's not helpful in any way. And it probably comes deeply from a childhood of being called lazy. And why don't you just? J-U-S-T is one of the worst things you could say to anyone who's having any problem. But for somebody with ADHD, they can't just that's why they're not doing it. And that's what's hard.

And that's where somebody with occupational therapy experience can help break tasks into smaller pieces, can understand the background, bio-psychosocial issues that go into why a person has trouble waking up in the morning, why a person has trouble getting out of bed. What's wrong that is interfering with brushing your teeth? Or why do you have trouble not having outbursts, so to speak, in classes? And how do you handle those things?

William Curb: I think those are two great words to really slow down and examine. Like whenever I have that in my own personal language, I'm just like, OK, but if you're saying that, go beyond that. What is OK, why can't I just do this? Oh, actually go from non-judgment to why can't I do that? What is keeping me from doing that? And then it's like, oh, that opens up a world of possibilities of things I can do.

Vanessa Gorelkin: Absolutely. And I really like that idea because when you are saying or someone else is saying to you, why don't you just? Let's talk about getting out of bed. There are many steps to getting out of bed that may become very difficult for somebody who has trouble getting out of bed in the morning, not to mention the emotional load of whatever is going to be happening during the day.

But an occupational therapist could literally help somebody break those steps into very small parts. I had somebody in my practice quite some time ago who part of their morning routine was get out of bed and take medication, have breakfast. And we worked on sequencing what to do when, how to arrange it for success every day. And we wound up with a solution that looked something like we put their favorite crackers by their bedside and water and their medication where they could see them very clearly.

We had them wake up and immediately start with eating. I know crackers in bed usually don't go together, but this was like, we've got to find what's going to go in your mouth because this person's appetite was really affected, by their ADHD. So we wanted to get something nutritional into them so they wouldn't be nauseous with their ADHD medication. And then they would go through the steps that we planned out so they could get sitting up, taking their medication, eating a little something and get their day started effectively so they wouldn't miss their college classes. I see a lot of college students and university students.

William Curb: Yeah, I can also feel that there's probably a lot of having to deal with people talking about what they should be able to, like when they're like, oh, I 'should' just be able to get out of bed. And then that level of judgment that you have on yourself, like I should be able to do this, but also like having to step back. OK, if I can't, what can I do?

Vanessa Gorelkin: Yeah, well, should is probably like the six letter word that I ought to say. Let's, let's stop and examine that. As you said, I really like that language of let's examine how we're thinking about ourselves and talking about ourselves. Originally, the idea of like, 'shoulding' yourself to death comes from cognitive behavioral therapy, which I've studied, but it's actually not my favorite technique alone. Thought errors are great to examine things like all or nothing, thinking, blaming, guilting, generalization, personalization. So when you're blaming and guilting yourself and saying, I should do this and I should do that, it's very good to hear yourself. And that's usually where I start with my clients in my practice.

I'll say, do you hear the words you're saying about yourself? I should have done this. I didn't do that. You know, I'm a failure. All of those things and assumptions and black aand white thinking if you get one thing wrong, you're always wrong. If you get late one time, you're always late always is a big one to. And so, yeah, I think that looking at the way that you talk about yourself from the perspective of cognitive behavioral therapy and trying to change thought distortions is a really good idea.

But my beef with cognitive behavioral therapy, which is that the notion is that thoughts come before feelings in cognitive behavioral therapy. So you think something like I was late. So and I should have gotten out of bed on time. And now I failed that test because I didn't get to school and I should have known better kind of thing.

And so those are the thoughts that lead you to feel depression and anxiety, right? But oftentimes, and especially in people with ADHD as I've found and people with generalized anxiety, OCD, things like that, the feeling comes before a thought even happens. And oftentimes we attach a thought to a feeling. So heart starts pounding, stomach is aching or you're sweating. And then your mind is like, oh, I must be upset about something. And then could even sort of attach a feeling or memory or even like a past trauma to whatever is going on inside of your body.

And that isn't covered by the notion of CBT. But there are other techniques like DBT, which I also work through that's dialectical behavioral therapy. And there are a lot of T's here, acceptance and commitment based therapy, which really, really help with kind of thinking about things and actionable steps to help oneself when you're getting into those whirlwinds of feelings and thoughts and and getting almost paralyzed by those things.

William Curb: Yeah. When I'm dealing with those like downward spirals, too, I often feel like I don't want myself to feel better a lot of the time when I'm in that emotion. And so it is hard to think my way out of it.

Vanessa Gorelkin: Say more about that. I'm very curious about what you're saying.

William Curb: So like something happened where I was very upset. I want to feel justified in that feeling of being upset. And so my mind will come to justifications for why I should be upset and why I shouldn't try and make myself not upset. Like why shouldn't try and see the other person's point of view? Why I shouldn't do things that I cognitively know would make the situation better. Like if my kids did something that, you know, was like made me mad, I want to be mad then. And it's like I want to be justified in being mad.

I don't want to think my way through of like, oh, well, they're kids and they weren't doing that on purpose. And, you know, they weren't trying to make me mad. And, you know, because it'll be like, yeah, it's OK for me to be mad. And it's just also sometimes I'm like, OK, I need to slow down and like calm myself more from the feeling of being mad than trying to think my way out of it.

Vanessa Gorelkin: Well, that was so interesting. And it really I want to bring up another therapeutic method that I've been trained in that I think is terrific to sort of address what you're saying. And that's internal family systems. I just heard you and a bunch of different parts of you have a conversation. And I wonder if the listeners heard it as well. It was sort of like a manager part of you and yourself having a conversation. So a manager part saying, hey, you know, you really need to get going about this. You can't like stay too focused on the feeling and what have you. And then the self in you is sort of having some really rational, wise thoughts.

And then there's also probably an exiled piece. I know I'm kind of talking a little bit of IFS jargon. We can we can talk a little bit about it. Like the part of you that it's actually really holding the feeling of whatever it is that upset you in the first place. And it's trying to fight to get up there. And it's saying, hey, respect me. I want to be heard. You know, I'm just pissed off at my kid right now. And this reminds me of something from my childhood or something that happened a year ago. And I want to have a feeling.

And so all of those parts are valid. And it's one of the things that I do in my practice is help people identify the parts of their personality, which are very normal and how they may be having conversations and making it OK to have that conversation internally and hear that and honor all the different parts of you as they're all trying to help yourself, like have a good life.

William Curb: Yeah. And sometimes if I'm going through like some sort of depressive episode, which is in retrospect, incredibly frustrating that I'm like, not only did I know that I was in a bad place, I knew the things that could get me out and I chose not to do them on purpose, knowing that I would stay there because my brain at the time was like, this is where you deserve to be. This is where you want to be.

And being like, OK, yeah, that's something I'm still working on. Because it's like, yeah, that's not not always the best place to be at, especially the state of the world right now. Like I'm sure I'm going to hit those points again at some point. And so it's being like, oh, yeah, I need to preemptively figure out methods to do that. Because when I'm in the state is when I don't want to seek help. And when I'm not in the state, it doesn't feel like I need help. And so I'm like, OK, I need to preemptively do stuff because that's not best pattern to be in.

Vanessa Gorelkin: Your listeners can't see my facial expressions, but you did. As you were talking about your depression and I don't know how you interpreted them. But what they meant were, you know, I was just really feeling with you that sadness and heaviness of depression because depression is an illness in and of itself. So major depression disorder is like diabetes. If you don't get medication, you're going to be suffering until you get medication.

Fortunately, with depression, it does go away eventually, but oftentimes people fall into another episode very quickly. But that blaming yourself, guilt, helplessness, hopelessness can make it really hard to get anything accomplished. And so when you are a person who lives with depression, learning the workarounds for when you are really in one of those kind of depressive states, it's really helpful. Another thing I want to say is sometimes people with depression just really need to stay in bed that day.

And that is also when I was, you know, early in my career, I don't think the words mental health day existed, but I think that they're really valid things. And I recall it in my career, like staying home because I just felt like I couldn't cope or deal with something or other. And I didn't know how to call it, but I know that I did it because intuitively I was like, I can't handle this or that. That's coming from a place of privilege. Sometimes people don't have a choice but to go and do even when they're in pain. But depression is actually pain.

And so I was having a response to you describing that because I think you describe the pain and suffering of feeling depressed and having difficulties. That's not ADHD, but it's certainly comorbidity. We're going to find a lot with ADHD. You can also have a reactive depression to failures that come up from ADHD. But sometimes people just have major depressive disorder, which is far more biologic in nature and is like a truck ran you over oftentimes. So like you were OK a few days ago and now you're unable to do much of anything to take care of yourself.

William Curb: Yeah, the comorbidities with ADHD are such a strong thing that it's like, I'm sure you have to are constantly like finding like, OK, we're dealing with this one thing, but we can't hit this issue unless we're also hitting this other issue that is also in existence here.

Vanessa Gorelkin: Yeah, I mean, I think that while I am not an ADHD researcher myself, my observations in my practice are that if you think about ADHD being part of a Venn diagram in circles around ADHD, you're going to have obsessive compulsive disorder. You're going to have generalized anxiety disorder and you're definitely going to have depressive disorders, disorders of mood.

And I kind of think of it as when I meet with people at first and I'm getting to know them, I am looking for those signs of undiagnosed anxiety and OCD because OCD is, I believe, well under-diagnosed. Oftentimes, I find people who have quite a lot of something I would call that's what's called in the field moral scrupulosity OCD, where they feel terribly guilty about things that they didn't even do or they're worried and they think that they did something and they're not sure if they did it or they caused it.

And this really causes a lot of distracting thoughts. It's not with everybody. But yeah, I think as an occupational therapist with training in both mental health and physical health, these are things that an occupational therapist can find and say, hey, let's talk to somebody in psychiatry to see if we can get a proper diagnosis that includes perhaps other things that might have been missed here.

William Curb: And just with thinking about OCD and anxiety, like is it just kind of an offshoot of anxiety?

Vanessa Gorelkin: No, it's kind of different. It is related. It's a tough question. And while I'm not an expert in the latest DSM, OCD has come in and out of the diagnostic and statistical manual. It's closer to anxiety and then placed further away and specialized. So I don't want to confuse your audience. OCD definitely is related to anxiety, no matter where we put it in a recipe book of psychiatric disorders. And I think they are the experience of OCD is about anxiety. And I absolutely agree with you. So if you're washing your hands, flipping a light switch, or going around and around in circles in your head about how you didn't do this thing and why didn't you do this thing? Those things can be clinically significant enough to be OCD.

But in and of themselves, if you check your oven once or twice, leaving the house because you're not sure as a person with ADHD, if you turned off the oven, that's not OCD. But if you can't leave your house because you have a ritual that is so long to ensure you turned off the oven, that is diagnostically a problem that is likely to be OCD. And by the way, I don't want to be diagnosing anybody, but obsessive checking or fixing or even obsessively thinking something repeatedly to keep yourself safe. Those things are worth an evaluation.

William Curb: Definitely worth thinking about because of the importance of actually identifying OCD and how it is so differently treated than ADHD at a friend that was dealing with this and was like, yeah, with ADHD, you often are just greasing the groove, going along, making this your process easier. And with OCD, if you make the process easier, you are entrenching those behaviors.

Vanessa Gorelkin: Yeah. I think what you are saying might be well exemplified by leaving the house, like what we're talking about. A person with ADHD may need a ritual of things, so to speak, to leave the house. But if that ritual isn't totally done exactly the same way each time, a person with ADHD may be a little thrown off, but they're not going to spend the rest of the day outside of their house thinking maybe their mother is going to die because they didn't flip the light switch eight times or they didn't wipe their shoes in a certain way. So those two things can be separate.

They can look very similar, but it sometimes depends on the motivation for the ritual, if you will. I think we're talking about rituals and compulsions. That's probably the wording we should use. So people with ADHD do well having routines and rituals for certain things, but when the ritual becomes the primary reason you're doing something and not to get to something else, we're having a problem and we need to think about that because there's nothing wrong with a routine and a schedule and a plan. I mean, if I said that that was bad as an ADHD therapist, like I need to quit my job.

William Curb: Yeah, it's like, oh yeah, these rituals and routines absolutely make my life so much easier when I'm like, okay, I'm just following this, but then the ability to be, to modify and be okay when things are not going as planned is what really changes things.

Vanessa Gorelkin: Yeah, and it's not necessarily OCD either if things don't go as planned for somebody with ADHD. I know we're getting into complex matters here and oftentimes these things meld together in one big octopus of problems. One of the diagnostic principles where you can separate out ADHD and anxiety from themselves is you have somebody with ADHD who becomes incredibly anxious around getting to an appointment on time or leaving the house or getting up or turning off the oven. Right?

But once they're out of the house and they're doing their thing, they're in school, whatever, they feel great, they're not anxious, they're fine, they're having fun with their friends. That's not anxiety. That's ADHD based fear of really not having a good performance. It feels like anxiety, but it's not like an anxiety disorder because an anxiety disorder is like all that stuff that I just said and then you go to school and you're anxious because the teacher looked at you funny and the kids may not like you.

That's RSD that I'm talking about or that you think that there's going to be a bomb going off, which again, now we have different problems that are in the world. When we think about diagnosing, we want to consider all of these different issues. Oftentimes, I'm really upset by the list of diagnoses people come to my office with because I'm just like, really? Doctor, could you kind of, it's up to them, but they come in and they sort of look like a bunch of diagnoses and people will even rattle them off. I have ADHD, I have bipolar too, I have generalized anxiety disorder, OCD.

I'm like, okay, what can we help you simplify that what's really difficult here for you is selective attention in your life and that you are anxious about things that cause you to ritualize things in a way that doesn't function for you or what have you. Not to doubt the diagnosis, but just to say a list of 25,000 diagnoses starts being kind of redundant and difficult for anybody and it makes the person into a professional patient, which we definitely don't want them to feel like.

William Curb: Yeah, and there's so much overlap between all these things, especially with things like executive function, which is so nebulous that it can be hard.

Vanessa Gorelkin: Yeah, and executive function is a huge issue with all people with ADHD, but in my practice in particular for adulting, if you will. with ADHD feel like I don't know how to adult right. It's usually they're saying I don't know how to get my executive functional skills together in a way that are going to work and I feel really challenged about putting things together in a multi-step way and I don't know how to respond to the environment effectively when it's going wrong. I'm thinking of a funny thing that my son always does to me.

My son has ADHD and he permits me to say that because he's 20. One thing that he has learned to say is no multi-step instructions or requests. Like I'll say I need you to do your laundry, clean your room, have you brushed your teeth and he's like, ah, stop. That is absolutely too much mom. What is it that you're trying to get me to do? And so he has a way of managing his environment. Lucky him he has an ADHD therapist for a mom and so we've sort of gone back and forth but I am not immune to doing it wrong even when I know very well that that's not going to work.

William Curb: Oh yeah, I'll be trying to get my kids out the door in the morning and be like, okay, you need to get your shoes on, you need to get your backpack, you need to get your coat, you need to and then like they're like, ah, and I'm like, that's fair. That's that's with a lot of things in a row that I'm like, but also we have like five minutes so you really need to.

Vanessa Gorelkin: And so oftentimes executive function it is really affected by that working memory issue. So you have like this mental blackboard. So somebody says, I need you to wash the floor, clean your room, get your laundry out of the dryer and then don't forget to brush your teeth which is like a number of things I might say and his blackboard he doesn't have any chalk like he can't write on it.

So it all just has gone out the window for him is his that working memory issue is really a big issue oftentimes with executive function because you got to have that blackboard in order to be able to be functioning like in space so to speak not like in outer space but in space and so that's often times why it can be helpful to write things down or it can be helpful to make a voice note of things because then you can listen again or see it again or what have you and that's like one area of executive function that can be managed in that way, for some people. Can I also say at this moment, no solution works for every person with ADHD and oftentimes solutions that work for people with ADHD start out by working and then don't work and this flips people out particularly with a new diagnosis.

They're like, I was doing fine with using that alarm and blah blah blah something that I do and now it doesn't work. What's wrong with me? Nothing's wrong with you except for you know ADHD is happening here and so we need the novelty, we need the newness, we need the challenge of something different. We need to stimulate your brain to be able to do this thing in a different way and there's really nothing wrong other than ADHD and I'm not trying to say it's wrong but I think you follow what I'm saying.

William Curb: Yeah well there's it's not wrong but it is there are challenges that come along with ADHD that you need to fix.

Vanessa Gorelkin: 100% so I don't love to sort of feature the notion of you're wrong, you're wrong, you're wrong because I feel like it's a recapitulation of all of that criticism so I love challenge is a much nicer way of putting it so ADHD challenges will really result in someone being able to use one solution for a while and then get really bored of it and it's to the path that's too well worn for it to work in the same way and that's a really common problem that I run into with people.

William Curb: Yeah and it's very frustrating because you're like you get back I was doing this why can't I just do it again?

Vanessa Gorelkin: Yeah the why can't I just, there's that just, yeah there's four letter words right so you know you certainly could say it I mean I think expressing feelings is important and having feelings is important and as a lot of the times people with ADHD are not permitted to have their feelings because they're told they're wrong to feel bad about something in the first place so it becomes a whole mess but I think it's okay to feel the disappointment but not be stopped by it we have to then say all right what's the solution.

Like the work that I do is is very solutions based but also feelings based enough to honor that we have that internal family system. We have the part of us that's still the little kid most likely who's like I don't want to do anything I want to stay in bed and I hate everybody and everyone's mean and then we have the kind of meanest parent ever or person who's like the firefighter who comes and says get out of bed or I'm not going to let you watch TV for you know a week and all that other stuff that's sort of in us from our childhood if we can sort of welcome that it makes it easier to cope with.

William Curb: So we've been talking a lot about feelings here and another area we wanted to kind of get into also was the emotional regulation side of things which is you have these big feelings and they can be very hard to deal with.

Vanessa Gorelkin: So I think one thing that really helps people with emotional disregulation is to get a plan together ahead of time for when things become overwhelming. Certain little tricks can really help people in moments of great distress so for example one that people sometimes hate at first but it does work is to focus on breathing but that I'm I'm not a fan of take a deep breath like everyone says that right and it's just like oh shut up like it just immediately people want to say be quiet I know I'm supposed to breathe right but what I will do is I'll teach people box breathing which really focuses on the exhale and lengthening the exhale.

So trying to get the vagus nerve teaching people little vagus nerve tricks because the vagus nerve goes all the way from the top of our head into our gut and so if we can figure out ways to tell ourselves that things are safe when they become unsafe because that's where that disregulation comes from tell our body that we're safe then our mind can kick in and be like okay I can be safe here.

So the deep breathing no but the long exhale the box breathing box breathing being breathing in for let's say it's usually breathing in for four holding for seven and then exhaling for eight counts and doing that at least four or five times that will lower your heart rate whether or not you want it to that's like a parasympathetic rest and digest response. So that's one another one is using the diving response you can get an ice pack if you you know if you're a person who's at school or work and you can't just go and wash your face with cold water or stick your face in a bowl of ice cubes and cold water which is very effective or jump in an extremely cold shower or take a cold plunge don't people love that I wonder if those people who love that the most are people who have emotion regulation issues.

William Curb: I did do a polar plunge this year.

Vanessa Gorelkin: You did and how did you like it?

William Curb: Well I've done it for like a decade now and I my children are like what are you doing this is why would you do this but my wife and I are like this is so much fun it's like rejuvenating and awful at first and then not.

Vanessa Gorelkin: Right. So what does it feel like if you can return to it like what does it feel like when you get out of that cold if you can sort of get to that moment right out of the cold can you think of

William Curb: It feels like refreshing in that like my brain is clear for now, which I think is like also like your body's going I am being attacked I am a very bad situation I need to think now I can't be thinking about future I can't be thinking about past I need to be thinking now.

Vanessa Gorelkin: Now in this yeah this is it all I am.

William Curb: So yeah it kind of gives like you know instant mindfulness and then when I get out I have like lingering effects of that where I'm like oh yeah I'm feeling now more than I usually do.

Vanessa Gorelkin: And what kind of feelings is the feelings of calm and relaxation or can it be also sort of big feelings emotional feelings?

William Curb: Sometimes it could be big feelings sometimes but most of it is like kind of like yeah I'm here now and I feel good about what's going on especially like warming up like this feels nice and I'm like future problems seem very approachable I'm like I can think through what I need to do and I'm not worried about what's going on a lot of the anxiety and worry that I would have is just not as present.

Vanessa Gorelkin: It's intensely grounding is what you're saying like in other words at least the way I'm hearing you because grounding is extremely helpful when you're feeling a sense of tremendous alarm and lack of safety. Grounding is as simple as bottom line grounding is getting on the ground like if you are so upset and again we have to choose our place if you're in the middle of a grocery store and you're really upset you can't do this but if you're at your house get down on the ground and lay down on the ground like just lay out that can help you or if you're in a place where you can't get away and you're literally trapped and there's nothing you can do and you don't want to feel like you're going to flip your lid, you could try like doing the five fingers thing I don't know if anyone's ever told you that on your podcast like five things you can hear four things you can smell three things you could taste two things that like are a texture that's on your body and then take one deep breath and people find that immensely helpful.

Just because it instead of your brain being all over the place it for that few moments you're focused in on that grounding exercise and so that's a little hack if you all I'm not my favorite hack but grounding exercises is another hack so ice polar plunge kind of stuff that you can either do in your home or you can actually go do polar plunge. Boxed breathing and grounding activities are quite helpful and then my last one that I want to tell you is for people who get very big emotions and feel really intense and can do things to harm themselves or do harmful things like drugs they shouldn't do or or binge eating or things like that. A good thing to do is to develop ahead of time a crisis plan maybe somebody to call a favorite show a weighted blanket things to kind of soothe you in the moment because sometimes you can't slow down even enough when you're so upset so having a crisis plan I ask people to put them in their phone or in their wallet if they carry one and then they can sort of turn to that if they need to if they're feeling a lot of distress.

William Curb: Yeah like yeah because like as I was saying earlier too yet when you're in that emotion it can be hard to get yourself to do the things that you want to do and it's even harder to think through the process of what you need to do.

Vanessa Gorelkin: Yes and the last time you want to be developing a crisis plan is during your crisis like so if you know you're a person who tends to get highly emotional, practicing these things that we're talking about right now ahead is really good because then you know what the feeling is and maybe you'll do one of them because that paralysis is part of a trauma response even if you aren't technically a victim of trauma trauma response includes fight flight freeze or fun and that's a freeze when you can't as an ADHD person do anything. Again I'll bring up my son I was talking to him this morning and I said you know like what's it like for you when you're having difficulty doing something or something like that.

I don't know because I said I'm going to be on this podcast today and I'm interested in sort of hearing your perspective again because it's always helpful for me and he said you know mom I um sometimes I can't even do things I really really want to do like I'm stuck on my bed and I want to play Minecraft and I can't get myself to do it or I can't remember that I wanted to do it and I'm just kind of like stuck there in this ADHD haze and sometimes it's like you're waiting it out or you do something that'll help you snap out of it so having a kind of a plan for that can really be helpful.

William Curb: Yeah absolutely yeah I think that's one of the like defining characteristics I think of ADHD it's like yeah you have trouble doing things you don't want to do but you also have trouble doing things you want to do and that's really what kind of like when we have that like talk about laziness is like yeah not being able to do things you want to do is not laziness like that is so far from laziness.

Vanessa Gorelkin: 100% and it's also there's two things I would say one is it can be overwhelm like because that there's so many steps in the process that you can't like you know it's like if you have to get out the door in a certain amount of time and like you have gotten up late sometimes the overwhelm of having to do that and get yourself to do it by yourself can be so overwhelming you're just like I'm just gonna pull the covers over my head and forget it because I just I am in this moment right now as a person with ADHD and this is where I am I am not thinking ahead I am thinking I am uncomfortable right now and I'm trying to get through it.

But the other thing that we haven't talked about is something that I think is badly named pervasive demand autonomy. So it's something with people with neurodivergence pervasive demand autonomy or persistent demand autonomy is like where somebody asks you to do something and you immediately say no like it doesn't matter what it is doesn't matter if you want to do it if and it also could be you asking yourself to do it you're like no I'm not doing that. And it is common in people who have a lot of anxiety it's common in people with neurodivergence because just the person talking to you and asking you to do something can begin the overwhelm and it's an anxiety response and so the answer is no and things like eating changing clothes showering like the basics of your activities of daily living can become very difficult.

This is why it's difficult when raising children who have ADHD because they often have a touch of this pervasive demand autonomy I feel like it's a very insulting way to put it but let's call it like anxious avoidance of activity I prefer to put it like that so it's like there's too many steps there's too many things to do or I'm going to be uncomfortable doing it and so I would rather just immediately say no and then it turns into when it's pathological it turns into a thing where the parent or a spouse comes and says like do you want to do it no like do you want to go no and then that's that's it and it's and that can cause a lot of arguing and difficulty but when you can tease it out and you can sort of figure out what's happening you can get around it.

William Curb: Yeah this sounds so much like why my wife and daughter have a lot of their fights is my daughter being getting home from school my wife being like hey do you want to go do this thing that I think you would be fun and my daughter being like no I don't want to do that I just want to do nothing.

Vanessa Gorelkin: Yeah so what helps with that sort of thing we'll call it anxious avoidance because again as I know I'm repeating myself but I hate the name of that but as a therapist I think it's just very kind of like judgmental about the person who's having the issue rather than helpful. So if your daughter is having this sort of anxious avoidance response trying declarative language rather than interrogatory language there's a lot of big words so like I think we should go to the store rather than would you like to go to the store would you like to eat ice cream would you like to do this or that it's saying it in a declarative way like we're going to the store when you're doing it's a parent but my story will fit here and that is to say.

Like when my husband and I first were married and I didn't know he had any of this going on but I know he's anxiously avoidant at this point again I have his permission to talk about him as well number one giving somebody like that more time or a warning for the transition is super helpful right. So I'll say hey do you want to walk the dog and my husband will be like I can't do it right now that always happens and I'm like I know how long do you need until we can walk the dog and then he'll give me I can do it in 20 minutes okay great and then we're good. But the story I'm thinking of in particular is wanting to go visit my parents. My husband and I had many an argument about me wanting to go visit my parents like I we lived in New York and I wanted to go to New Jersey to visit my parents and you can imagine first of all it's his in-laws who you don't know he doesn't know very well and it's also a trip we had to do a bunch of things.

And so I would be like at first I would say do you want to go visit my parents no like I would just get the no and it began to frustrate me but somehow in my brain I realized if I say it differently and make it about me then and a declarative thing then he because he loves me and cares about me is probably gonna be able to do it and sure enough that's what happened so I would I learned to say hey I'd really like to go see my parents this weekend without a question and then let them sink in into his auditory system and then like let him without anything else not asking anything I'm just saying I'd like to go see my parents and then he would he would come back to me and say you know I think it's okay we could probably go to your parents let's make a plan and then we would go and we weren't arguing but it started from us having a bunch of arguments and him saying no like immediately before I even got the words out of my mouth.

William Curb: Yeah I can also think of like I'm thinking internally of how this sometimes someone like will ask me about doing something and I'll be like no and then like 10 minutes later I'm like no actually I do want to do that why did I say no.

Vanessa Gorelkin: Yeah and then how do you handle that?

William Curb: I usually go you know what I was wrong let's do that I'm being gone letting people know when I'm wrong this is my mistake let's do this thing hopefully we can still do it that might try to not be like super aggressive when I tell people no on things like oh no not right now or.

Vanessa Gorelkin: Yeah that's very evolved of you I think then when you're talking about it seems to me your daughter is young like a younger person. So when you're talking to a younger person it's hard for them to pull that mature response together and oftentimes when I'm not saying you've done this but like oftentimes children with ADHD hear a lot of no don't do that stop that stop doing that stop doing that's a big one stop that stop fidgeting stop playing with your hair picking your skin stop stop stop stop so they are very much invested in having autonomy and it makes them anxious when when being asked to do even the most minor things because it's like what contract am I signing right now. Am I gonna have to sit still am I gonna have to do something uncomfortable and I don't see people I don't want to see so there's that as well in terms of children.

William Curb: My initial ADHD assessment they were asking like oh do you think you think like other people and like I assumed I did but apparently not.

Vanessa Gorelkin: Yeah. I think that is really common I work oftentimes with a neuropsychologist in my state who sends me people that she has evaluated and I read her diagnoses and the information she gathers is amazing I've often sent patients to her and so I'll like I am one of the people she's asking what are they like what are the issues so she gathers a lot of information and it is incredible the way that people don't know that they have neurodivergence issues and so the diagnosis in and of itself is such a validation. And also knowing that society can be really unfriendly when people are neurodivergent and just being able to close that gap.

William Curb: Yeah and having the proper labels rather than the colloquial labels that are not nearly as kind.

Vanessa Gorelkin: Yeah. For sure and having a reason like I will fully admit this before I understood what was going on my son used to he has like kind of longer hair also haircuts forget it did not like that he would be like twirling his hair around with his fingers and I would be like stop twirling your hair tapping your foot that's another one and you know in retrospect and I have apologized to him I'm like that's just the way he is like that's like me saying stop having blue eyes it's not fair and reasonable that's a way.

That he expels some of that tension or like sort of hyperactivity like agitation even though he's not was never a disruptive kid he had those little kind of agitated things that he would do that I think the neuropsychologist who diagnosed him understood as ADHD. Aside from school OT and PT which he had I didn't have somebody I will say like me because oftentimes I'll work with parents of kids with ADHD will sometimes come to me for some support I didn't have anybody telling me oh that's a symptom of the ADHD that's like the internal hyperactivity that's going on that you're seeing the fidgeting and the hair twirling and the 'whatevering' that's going.

William Curb: On I mean even knowing about ADHD it's still hard sometimes for like you gotta stay at the table when we're eating dinner like I know you want to get up and go and do something over there but we need to finish dinner and this is a skill you need to learn.

Vanessa Gorelkin: So that balance also is really important to think about like. Sometimes it's better to really emphasize the skill because it's gonna be something that's needed over and over again and sometimes it's okay to just let it go you know if it's not that important. But being able to sit long enough to get through an activity when it's important or it's like a family related activity I think is really a good thing for somebody with ADHD because whether or not a person knows that they have ADHD and is dealing with their ADHD the world is not built that way and so there are sometimes where we really can't be accommodated though we would like to be and so that in the end adds up to having to make some concessions or more concessions because there's a lot of concessions people with ADHD just generally have to make but sitting still at a table for a meal is one of those where it may just be like I'm gonna have to do it and be a little uncomfortable and like deal with my discomfort.

William Curb: Are there any thoughts that you want to leave the audience with?

Vanessa Gorelkin: I'd like to tell your audience that I think that you're okay. I think you're actually really great and fun and interesting as a person with ADHD and while there are challenges living with ADHD, looking at yourself as a broken person is the last thing I as an ADHD therapist and specialist, I would never want to see anyone think of themselves as broken I think you can think of yourself as a work in progress if you've been having difficulties but know that there are lots of people out there who understand you and can appreciate you and the people who don't are probably just not your people. So hang in there.

William Curb: Thank you.

Vanessa Gorelkin: Thanks for having me.

This Episode's Top Tips

1. If something feels overwhelming, try breaking it down into micro-steps. Even something like getting out of bed can be broken into “sit up,” “put feet on the floor,” and “stand up.” In more practical ways, we could think of this as starting out as just opening the document you need to work on, adding the formatting, and starting your first sentence. The idea is you want to build momentum and go with the flow.

2. Be mindful of language; words like "just" and "should" can be damaging. Instead of “I should just wash the dishes,” you can reframe it as “I could wash the dishes,” and then also if you need a little bit more asking yourself, “What’s making this difficult, and how can I work with it?”

3. It’s important to have a crisis plan ready before you need it. When emotional overwhelm hits, it’s hard to think through what you need. You can pre-plan strategies like a weighted blanket, a favorite show, or calling a friend so you don’t have to figure it out at the moment.