ADHD and: The anxiety spiral

It’s a common challenge for many women with ADHD. Where a single moment of forgetting about a task, or feeling stressed about making a mistake, leads to a full-blown anxiety spiral. 

In this episode, host Dr. Monica Johnson dives into the connection between ADHD and anxiety. Listen as she explains common ways anxiety can show up in women. And shares helpful ways to manage anxiety. 

We love to hear from our listeners. Email us at podcast@understood.org.

Related resources

• ADHD and anxiety 

• The difference between typical anxiety and an anxiety problem

Timestamps

(00:48) Is it common for women with ADHD to have anxiety?

(01:59) Common ways anxiety can show up 

(02:24) How to manage anxiety

(03:11) What is TIPP?

(07:10) Can mindfulness help with anxiety?

Episode transcript

Dr. J: Imagine this. You've been working hard all day, and you're weary. You start thinking about a conflict you've been dealing with and suddenly you're two hours deep into what is often called an anxiety spiral. How did this occur? What happened and how did your ADHD contribute to this event?

This is "ADHD and" I'm your host with the most Dr. J. I'm a licensed psychologist who works with those with ADHD and co-existing disorders. Today we're talking about ADHD and anxiety spirals.

(00:48) Is it common for women with ADHD to have anxiety?

It's common for people with ADHD to have anxiety. In fact, they're more likely to struggle with anxiety than other people. That's partly because of the challenges that come with ADHD. It can create frequent problems in school, at work, and at home.

People with ADHD have trouble with executive functions, a group of skills that we rely on to get tasks done. These skills help us to get organized, plan, manage time, and follow daily routines. They also help us to regulate our emotions. Trouble with these skills can create stress and anxiety. 

If we're not getting the outcomes that we want in ourselves and our environments, anxiety is a pretty normal reaction to that. Typically, anxiety isn't constant. It comes and goes and it might be limited to specific situations. But when these feelings of anxiety are more frequent or they start to take over, people may be diagnosed with an anxiety disorder.  Whether it's short-term or long-term, anxiety can show up in different ways and look different in all kinds of people.

(01:59) Common ways anxiety can show up 

Some of the common ways that anxiety shows up is in anger outbursts, not being able to handle criticism, avoiding social situations, and rumination or constant worry. Identifying the signs and then taking action is an important step in managing your ADHD in your life. 

(02:24) How to manage anxiety

I'm going to review a few ways to help you with your anxiety. Some of these ways will be what I call preventative, meaning that if you implement them in your life, you will reduce your overall level of anxiety. And I'm going to walk you through a scale that you can use in an actual anxiety spiral. That skill is TIPP. 

One of the things to know about me is that I am a Dialectical Behavior Therapy or DBT therapist. And TIPP is in a set of crisis survival skills that I routinely teach to my patients. Crisis survival strategies are used when we are in intense emotional situations or feeling overwhelmed, and they also help us to reduce impulsive behavior. 

(03:11) What is TIPP?

TIPP stands for Temperature, Intense exercise, Pace breathing, and Progressive muscle relaxation. In all honesty, I love this skill and my patients overwhelmingly report that it works. TIPP skills are great for reducing the physical symptoms of anxiety. It won't get rid of the reasons for the anxiety spiral — for instance, if you had a fight with your best friend, that might be problem-solving for later on — but what it will do is reduce your physical overwhelm and get your body back to a nice equilibrium, or at least closer to it. 

If you have any heart conditions or medical conditions that would give you pause, speak to your medical provider before using the skill because like I said, it works. The T in TIPP is for Temperature. This skill involves utilizing temperature in order to induce a sense of calm. One thing to know about yourself is that you are a mammal and mammals have a diving response. 

As I've already noted, when we're in an anxiety spiral, there are a lot of physical symptoms. A lot of times things have been sped up or they increase in some way, like our heart rate and our respiration. By utilizing our diving response, it triggers a slowing down reaction in our system, which actively combats the anxiety spiral. But don't worry, you don't have to sit at the bottom of a pool or anything in order to elicit this response. 

The two most common ways that people use this skill for temperature is by immersing their face in a bowl of water or using your sink for that. The second way is by using a cold pack on your face. It's really important when you do this skill to lean forward or to bend over because that will strengthen that response.

An anxiety spiral typically speeds everything up, and by triggering our cold water dive response, it helps to slow everything down. Just to get a little bit more technical for a moment, when you're in an anxiety spiral, oftentimes some of what is happening is your heart rate is increasing, and your respiration or the rate at which you're breathing is also increasing. 

What's really cool about us as mammals is that when we dive deeply into cold water, it triggers this response in us, where our heart rate naturally slows as well as our respiration so that we can conserve energy and stay under the water for longer. And we can utilize this natural ability to help us during an anxiety spiral. 

The I is for Intense exercise, so engaging in short bursts of intense physical activity can reduce emotional energy and overall arousal. Activities like climbing stairs, sprinting, and jumping jacks, even for just a few minutes, can work to alleviate the stress. 

The first P and TIPP is for paced breathing. This involves slowing down your breathing to promote relaxation. A very common way to do this is to inhale through your nose for four seconds, hold your breath, and then exhale out of your mouth for 7 to 8 seconds. Utilizing your breath is a great way to increase your sense of calm. 

The second P in TIPP stands for Progressive muscle relaxation. This technique involves systematically tensing and releasing different muscle groups. Most of the time, people start from their feet and work their way up, or vice versa. This helps to reduce physical tension and promote overall relaxation. For more detailed information about progressive muscle relaxation, go listen to my episode on ADHD and anger. 

(07:13) Can mindfulness help with anxiety?

The next skill I'm going to talk about is our friend mindfulness. Practicing mindfulness and focusing on more positive thoughts when you're in an anxiety spiral is a great way to cope in the moment, and it can also train our executive functioning in the long term. Whenever you see the anxiety train coming through, you can opt out of boarding it by focusing on neutral or more positive thoughts. 

The next thing that I'm going to talk about is something that I reinforce with my patients all the time, and that's creating a daily routine. Listen, predictability reduces stress. Stress is a part of the anxiety response. So, the more predictability you have in general, the less stress and anxiety you're going to have. So, I'm just going to repeat this one more time. The better you are at routines, the less likely you're going to be to get overwhelmed. So, please try to implement this as a skill. 

The next thing I'm going to mention is something I've probably said to you before. Get comfortable with making mistakes. Mistakes are just lessons. So, don't let the possibilities of making mistakes in the future consume your thoughts today. 

The last thing I'll mention is breaking tasks down into smaller chunks. If a task is feeling overwhelming or inducing a lot of anxiety, really breaking it down into tiny steps can help. And then you can work yourself through each tiny step. 

A lot of the time when we're spiraling out of control, it's because we're focused on a step that's too distant from where we are in the present moment and it can make things feel impossible. By breaking things down and focusing only on the step that's right in front of you, you can systematically chop away at any problem. 

That's all for today. Thank you for joining me on this episode of "ADHD and..." I would love it if you subscribe to our YouTube channel for more.

This show is brought to you by Understood.org, a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. Learn more at Understood.org. 

"ADHD and..." is produced by Tara Drinks and edited by Alyssa Shea. Our video producer is Calvin Knie. Ilana Millner is our supervising producer. Briana Berry is our production director. Neil Drumming is our editorial director. Our audio engineer and music composer is Justin D. Wright. Our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. And I'm your host, Dr. J.