March Mindfulness is Mashable’s series that examines the intersection of meditation practice and technology. Because even in the time of coronavirus, March doesn’t have to be madness.
I used to say I was allergic to meditation. Actually, the mere suggestion felt offensive, a passive-aggressive euphemism for telling me to just calm down and relax via some New Age-y bullshit that seemed diametrically opposed to how my ADHD brain worked.
In some ways, I was right. In most ways, I was wrong.
“It didn’t always seem like a good match,” said Dr. Lidia Zylowska, a psychiatrist and researcher at the University of Minnesota Medical School who authored Mindfulness Prescription for Adult ADHD (2012) and Mindfulness for Adult ADHD: A Clinician’s Guide (2020). People assume practicing mindfulness meditation requires one to sit still, empty the mind, and pay attention for prolonged periods of time — all things folks with attention deficit hyperactive disorder struggle with. “It seemed like it might be a setup for failure. But when you think about what we do when you break a leg, it’s strengthening exercises. So from the rehabilitation perspective, of strengthening wherever there’s a weakness or difficulty, mindfulness makes a lot of sense.”
In actuality, the tenets of mindfulness meditation sounds on paper tailor-made for managing ADHD symptoms. Mindfulness helps you monitor and refocus your attention away from distractions through non-judgmental acceptance of your moment-to-moment experience. Zylowska and other researchers proposed applying it as a treatment precisely because study after study found evidence of mindfulness improving nearly every facet of the core deficits associated with ADHD. Aside from strengthening the parts of the brain responsible for attentional functioning, organization, impulse control, and emotional regulation, meditation can also raise dopamine levels (which ADHD brains lack) as well as help with anxiety and depression (two common additional conditions for people with ADHD).
A 2008 UCLA study led by Zylowska revealed just how much of a perfect pair these strange bedfellows could be, although its sample size was small. Eight out of ten participants reported a reduction in ADHD symptoms after just an eight-week training course, with a three-month follow up showing sustained effectiveness. Since then, various other studies have continued to bolster the argument for mindfulness meditation as an effective management strategy for ADHD in all age groups, especially when combined with stimulant medication and behavioral therapy. While more extensive research (like bigger, more diverse sample sizes) are needed before it can become a widespread, mainstream form of treatment, a 2017 survey from ADDitude magazine found that 35 percent of adult participants were already using meditation for their ADHD.
Terry Matlen, a top mental health professional in the field who both lives with and treats patients with ADHD, has been practicing transcendental meditation (another approach to meditation) on-and-off for 40 years. Yet, her clients often avoid it, rejecting the idea before they try meditation.
“Just right off the bat, it’s, ‘I can’t do that.’ They’ve already decided even though they have no clue what meditation actually is. Because they’re too hyperactive or too unfocused, can’t imagine slowing their brains down enough,” she said, repeating my own rationale nearly word for word. “It sounds boring, too — and boredom is not a friend of ADHD. But once you get into it, in my experience of people I know with ADHD who meditate, it’s just the opposite.”
Yet undoubtedly, practicing something that targets many of your greatest difficulties is not without its challenges.
John Mitchell, an assistant psychiatry professor at Duke University’s ADHD Program who co-authored research alongside Zylowska, added that, “We hear people say they’re doing it wrong all the time. And that’s one of the misconceptions.” Far from “wrong,” getting distracted or frustrated during meditation is, “an opportunity to come back to whatever your focus was on before. That’s attention regulation.” But, “it takes time and patience. And that’s easier said than done.”
Practicing mindfulness with ADHD is often a confrontation of the proverbial baggage that tends to come with the neurological condition. So much so that, once, a patient of Mitchell’s actually started crying after their first meditation session from the sheer discomfort of it, making them shame spiral for struggling to do such a seemingly simple task. During a silent group session, one participant got so frustrated they let out an F-bomb, disrupting everyone. Rather than chastising either reaction, it was handled as a learning experience for everyone. The patients could dig into exactly why it was difficult with Mitchell guiding their revelations, while he himself learned lessons as a clinician.
There’s just no wrong way to do it, and a world of possibilities to discover exactly what suits you.
It was essential, researchers found, to tailor these mindfulness training programs for ADHD specifically. For example, people with ADHD commonly struggle with establishing new habits and persisting with these behavioral techniques. So instead of insisting on prolonged formal meditation, they found more success with informal, five-minute or even one-minute daily meditations. The point is to try whatever you can make work, then gradually build up the skill from there.
There’s an infinite number of types of meditations, modifications, and workarounds for people with ADHD. ADHD brains crave stimulation, novelty, and excitement. So meditation doesn’t have to feel like boring torture, even when it’s challenging.
If paying attention in the moment isn’t for you, maybe the promise of achieving an altered state of consciousness sounds enticing, so the transcendental meditation Matlen practices is your bag. Or perhaps your ADHD comes with oppositional defiant disorder (difficulty with authority figures) meaning teachers and guided meditation harshes your vibe. On the other hand, rejection sensitivity dysphoria could make external positive feedback necessary, through a guide or game-ified high-tech biofeedback meditation headbands. Possibly, like me, your ADHD manifests through hypersexuality, so anchoring your mindful practice in exploring different pleasure sensations works best.
There’s a world of possibilities to discover exactly what suits you when it comes to meditation.
“A lot of people with ADHD have curious minds. They want to know about things. They want to learn, explore, look for ways to make their lives better,” said Matlen. That openness is an ideal trait for mindfulness. But it just takes some trial-and-error to learn how to hone your curiosity. “Not everybody is at that level of being able to experiment because they’re so overwhelmed by daily life that they’re just hanging on to the boat. But those who are able often want to try anything to help answer the question of, ‘What do I do? How do I get better?'”
Your ADHD brain on mindfulness
Importantly, researchers aren’t suggesting mindfulness-based treatment as a substitute for stimulant medications or other lifestyle interventions. There’s no one-size-fits-all cure for managing ADHD, ever. As Mitchell said, “it’s just another tool in the toolbox.”
ADHD exists on a spectrum, so some individuals may find mindfulness more beneficial than others. No studies have looked into its impact across different subtypes of ADHD, though there’s indication that the mindfulness program Zylowska and Mitchell studied is more effective for inattention over hyperactivity symptoms.
Zylowska also emphasized that she doesn’t want their research “to contribute to the confusion that somehow you can will yourself out of ADHD. That if you just try harder, you wouldn’t have this developmental disorder with a high genetic predisposition.”
But what does make mindfulness an exciting new potential for ADHD treatment is that — unlike current standards exclusively recommending medication — it addresses helping patients cope with their inner worlds.
Despite a growing understanding of all the misconceptions around ADHD, common emotional impairments and more internalized symptoms — which are more prevalent in girls and women — are still not part of the official assessment for diagnosing it. Treatments tend to focus on executive dysfunction related to inattention, distractibility, disorganization, and lack of productivity, even though that’s only half the story of what people (especially adults) with ADHD struggle with most.
“ADHD is a bit of a misnomer with its emphasis on attention deficit,” said Zylowska. Far from a deficit, folks with ADHD can also wrestle with hyperfixation, or too much focus on one thing. Hyperactivity and impulsivity can be turned inward, also, manifesting in emotional overreactions and angry outbursts from rejection sensitivity dysphoria. “ADHD is better conceptualized as a self-regulation difficulty.”
Women and girls are severely under-diagnosed with ADHD.
Image: vicky leta / MASHABLE
Early stages of mindfulness meditation training do emphasize noticing when your mind wanders and re-focusing it to stay present in your body instead, without getting down on yourself for getting distracted — a great exercise for folks who struggle with regulating what they pay attention to and when. The more you cultivate a non-judgmental attitude toward your own experience, the more you can acknowledge emotional reactions and accept them with neutrality rather than negativity. For people who often develop low self-esteem after a lifetime internalizing the shame and stigmas of ADHD, with loud inner critics reinforcing the negative feedback from authority figures who’ve blamed them for their symptoms, these lessons in self-compassion can be radical. Hopefully, after developing the non-reactive self-awareness skill, people with ADHD can then feel more able to control whether they act on their impulsive emotional responses or not.
“I’ve come to more acceptance, of walking into my ADHD tendencies instead of pushing them away,” Matlen said.
She described it as the power of yielding, a Buddhist term. Often exemplified through the metaphor of two people pushing against opposite sides of the same door, it’s the person who yields and walks away that sends the other one pushing as hard as they can flying.
“I do that in my life. Instead of fighting all my tendencies, my negative self-talk, I go with it. I say, ‘Yeah, that’s how my brain is wired. And that’s OK.'” She remembers a moment when this perspective shift jumped from meditation and into daily life. On a road trip with a friend, they passed a dead dog on the highway. Normally, it’d be an overwhelming, debilitatingly devastating site for Matlen. But instead, “I just smiled and said, ‘OK, that’s the way it’s supposed to be. That’s perfection. That’s how it is.'”
What happened in this moment is key to what makes mindfulness training effective.
“We want to bring a mindfulness mindset to ADHD moments, and ADHD moments happen throughout the day. That’s why informal practice is so valuable,” said Zylowska.
Whether you’re struggling to pay attention to a task at hand, annoyed by how long it takes to brush your teeth, or spacing out while having a conversation, this is where the practice of returning your attention without judgment applies to real life. Teaching how mindfulness and meditation can happen anywhere also combats a tendency for people with ADHD to get stuck in all-or-nothing thinking.
“They’ll say they just couldn’t keep up with the daily practice of meditating, so it must not be for them. That’s not really true. Mindfulness can still be a good tool for you, you might just have to approach it a little differently. Find your way to learn it,” said Zylowska.
In fact, Matlen has gone through years of life — especially after becoming a mother — where the onslaught of daily responsibilities overtook her capacity to meditate. Even still, she said the accumulative knowledge from previous years of transcendental meditation stayed with her.
“Knowing people with ADHD, myself included, putting too much pressure on yourself every day is not a good idea. It doesn’t become a positive experience,” she said.
How to meditate with ADHD
The field of mindfulness-based ADHD treatment is still developing, with a lot of important questions left open.
Studies related to ADHD and meditation almost exclusively examine a specific approach to mindfulness meditation that researchers found successful in treatment for other conditions. So it’s entirely possible that other strategies could be better for your ADHD, especially since many mindfulness practices put a high premium on the “use it or lose it” daily exercise mentality.
However, balancing structure and flexibility does seem key for people with ADHD. The structure of the program Zylowska and Mitchell researched, where participants train weekly as a group and are held somewhat accountable for “homework” by therapists or even just their commitment to fellow participants helps many overcome those initial habit-forming challenges.
That’s why Zylowska and Mitchell champion having a mindfulness buddy or starting in a group class setting. Like a gym buddy, the social element not only holds you accountable but also gives you a support system to share knowledge, experiences, and struggles so you learn from each other.
Matlen sets very intrusive reminders to meditate on her computer because, otherwise, she’ll forget. Since people with ADHD also struggle with task-switching, though, reminders don’t necessarily make it easier to end a cool conversation or put down a fun video game to go meditate.
“It’s not always easy to stay on schedule with meditating, to transition from one activity to another,” she said.
Zylowska agreed with the need to avoid “setting rigid rules for how you are ‘supposed’ to meditate, that if you can’t do it a certain way, you’ve failed.” Instead, “focus on following your own curiosity about your meditation experiences. So if you’re sitting in practice and your mind is busy, learn from it, ask why, explore the reason, play around with something different.”
“Think of ways to anchor your attention in more active ways.”
A vital takeaway from the research is to “think of ways to anchor your attention in more active ways. For example, if you’re doing a breathing exercise, maybe put your hand on your belly, so there’s another sensation — your hand rising and falling — to focus on. Visualizing can be great too, so imagining a wave hitting the shore as you breathe out, then receding as you breath in.”
Or, when that inner self-critic is acting up, offer yourself some kindness through a gesture like placing your hand over your heart. If the hyperactivity feels unmanageable, forget sitting and meditate during physical activity. Even if it’s hard or not relaxing, there’s no such thing as a bad meditation, just like the pain in your muscles during a workout means it’s working.
Being observant of the different ways meditation feels in your body helps people with ADHD develop the self-awareness that’s essential for regulation. It’s also affirming informal education in understanding more about the unique characteristics of your ADHD brain.
Both Zylowska and Mitchell have found that it can take people with ADHD some time before the self-compassion part of mindfulness resonates. So, instead, they ask patients to try to describe the challenges they’re experiencing in more neutral terms.
“Going from ‘I can’t stay focused, it’s impossible for me,” to ‘Well, I just tried this. And here’s why I had difficulty,’ makes a big difference,” said Mitchell.
Another strategy that’s worked is asking someone with ADHD to describe their struggle with mindfulness as if it happened to a friend instead of themselves. For one, this helps patients realize how hypercritical their inner voices are. But also, it de-personalizes their suffering into something more universal rather than alienating.
“You develop a different inner voice that’s not just more kind, but more ADHD informed. Like ‘I understand now that this is part of ADHD. It’s not me that’s wrong. This is part of of a condition, this neurobiological challenge,'” said Zylowska.
So, the next time something feels so frustratingly hard you want to yell a cuss word, or you’re so overwhelmingly ashamed for making a mistake you want to cry, you instead give yourself a break. The mindfulness mindset from your training can remind you that it’s all part of having ADHD, and having ADHD doesn’t make you broken, bad, or wrong.
It means you experience life differently, and that’s OK or maybe even the way it’s supposed to be.