ADHD Comorbidities: The Depression/Anxiety Cocktail with Dr. Michael Felt
This week on the show, we explore the topic of comorbidity with ADHD & Executive Functioning specialist, Dr. Michael Felt. As a lecturer at Yale University School of Medicine and a professor at Columbia University, Dr. Felt brings his knowledge to the discussion, focusing on the relationship between ADHD and comorbid conditions such as depression and anxiety. Dr. Felt's approach, known as Experiential Rehabilitation, has helped many individuals and organizations enhance their executive functioning, and now, listeners of The ADHD Podcast get a taste of the same.
The conversation delves into the prevalence of comorbid diagnoses among individuals with ADHD. They discuss which condition is typically diagnosed first and whether the symptoms of depression and anxiety could be a result of untreated ADHD. The discussion also touches on the potential for misdiagnosis and the importance of healthcare providers considering comorbid conditions when assessing patients with ADHD.
The episode also examines the impact of comorbid diagnoses on treatment protocols. They question whether the recommended treatments for depression and anxiety change when ADHD is also present and if these conditions are best treated by the same medical professional.
Dr. Felt introduces listeners to his technique, Experiential Rehabilitation, and the "Cycle of Ambiguity” (ambiguity - anxiety - avoidance) and “Cycle of Clarity” (acceptance - acuity - agency - action). This science-based approach has helped numerous coaches, therapists, and individuals to reclaim control over their lives, offering hope for those struggling with ADHD and comorbid conditions.
Links & Notes
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Pete Wright:
Hello everybody and welcome to Taking Control the ADHD podcast on True Story FM. I'm Pete Wright and I'm here with Nikki Kinzer.
Nikki Kinzer:
Hello everyone. Hello, Pete Wright.
Pete Wright:
Nikki. Hello, hello. A fine, how do you do? Today we're talking about our favorite subject, ADHD and co-morbid conditions like depression and anxiety. Cue the firework.
Nikki Kinzer:
Oh, yay.
Pete Wright:
So excited. I'm very excited about our guest because our guest comes to us as a referral guest from another of our favorite guests, so we get to talk behind our other guests back about them. So this is going to be really, really great.
Nikki Kinzer:
Right.
Pete Wright:
Before we dig in, however you know the drill you got to head over to takecontrolADHD.com. You got to get to know the show a little bit better. You can listen to the show right there on the website or subscribe to the mailing list on the homepage, and you get an email with the latest episode each week, and we have the new tool is up, the AI tool. If you want to ask questions, if you want to interview past episodes of this show, you can go onto the website takecontroladhd.com/podcast, and there's a little box that says Ask Nikki and Pete, and you can just say, Hey, have you ever talked about this? And it'll tell you. It'll find the past episodes. It'll tell you. It is an extraordinary feat of AI wizardry, trained on our past shows, and you should give it a shot and see how it works.
But I mean, don't try to make it hallucinate. I'm sure somebody will find a way to break it, but don't because it's just a good, it's a thing of goodwill. Don't be that guy, but definitely try it out. Ask some questions, see how the AI works, and we will hopefully get some great questions that way. So you also can find us on Facebook or Instagram or Pinterest at Take Control ADHD. You can jump into the Discord community, takecontroladhd.com/discord. You'll be whisked over to the general invitation. We want you to head over there, come into the community. It's really, really great. This is the thing, I think Discord is the primary planet around everything else that revolves around it because what is this podcast? It's just a perk for the Discord members. That's really all it is anymore. It's just a perk for the community. They're all perks around Discord.
So come into Discord, and if you really, really like Discord, you should head over to patreon.com/theadhdpodcast to support us for a few bucks a month, and you'll get access to all the secret community stuff at Discord. You can get access to all great channels. You can watch the show live, you can ask questions. It's really, really great. And so we'd love you to be there, patreon.com/theadhdpodcast to learn more.
Disclaimer, today's discussion about ADHD and depression and anxiety will express the opinions of our guest, Dr. Michael Felt, and should not be taken as medical advice. The conversation is being provided for informational purposes only. Everyone's situation is different, so please consult your healthcare professional for any and all matters regarding these topics.
Dr. Michael Felt is an ADHD and executive functioning specialist who has lectured at Yale University School of Medicine and is a professor at Columbia University where he teaches psychopathology. In his work, he helps organizations and individuals enhance their executive functioning with his unique, powerful, tried and true approach, known as experiential rehabilitation. Michael, welcome to the ADHD podcast.
Michael Felt:
Really great to be here. Always love being around fellow ADHDers and talking about ADHD.
Pete Wright:
You come as a referral. You are a referral. We don't get a lot of referral guests to the podcast, but you come as a referral from our good friend Hall of Famer, Dr. Ari Tuckman, and it is great to have a community. Any friend of Ari's really is a friend of ours.
Michael Felt:
He's a really great guy, and he's done so much for the ADHD community. It's really amazing how one man could be so powerful and also in his ever-humble way, which is-
Pete Wright:
For sure.
Michael Felt:
... something really inspiring.
Pete Wright:
And his humble way of introducing you, we told him we were talking about these subjects and he said, "There's nobody better. You've got to get Michael on the show," and you were able to turn it right around and just be here. Today we're talking about comorbidities.
Nikki Kinzer:
It's a hard one.
Pete Wright:
This is going to be a show; comorbidities. It's really going to be fun. We're talking about comorbidities in ADHD, particularly depression and anxiety. So get us started. Professor, where do you want to start with a conversation on these topics?
Michael Felt:
All right, folks. So the syllabus for today's session is really going to focus on the fact that really most of the DSM disorders are clusters of executive functioning deficits, and we just kind of conveniently bunch them together and give them a name. So, hey, if you really struggle with self-restraint or inhibition and can't handle emotional regulation so well, so we'll just call that OCD because you can't control your thoughts and behavior. But now if that comes out in ways that you also are super impulsive with low working memory, then we're going to now start saying, "Oh, well, your attention issues make that, that we're going to call that one a ADHD." If you struggle with attention and controlling your anxious thoughts inside your head and other kinds of stuff, then we'll just call that regular anxiety. Oh wait, if it's around people, we'll call that social anxiety. So it's really just different ways for us to categorize those different clusters of executive functioning deficits. And I think that's a great background to start off with is just to recognize that the foundation of all of this are executive function.
Pete Wright:
That's a great way to give us that foundation that actually, that's a way I've never heard to look at these things. I don't think anybody has ever said that it's always been executive functioning part and partial to the diagnosis, and we're just flipping it on its head.
Michael Felt:
In a way. Yeah, I feel like that it gives it a little bit more of a calmer perspective. What I try to teach is I'm teaching students how to discern between the symptoms to read what's going on underneath to figure out, okay, so what is this person really presenting with? A lot of times folks will come in and be like, "Yeah, so I have so much anxiety." And then so before we let them diagnose themselves from TikTok, I think it's important that the professional be able to tease out what's really going on. And so what I try to teach my students to do is to look for the underlying executive functioning deficit. So you would ask questions, "So tell me about that. What does this anxiety look like for you?" And then you could hear either it'll come out as like, "Yeah, I can never fall asleep at night. My thoughts are always racing through my head, and I'm always worried before that I'm going to lose something or that I'm going to be late for something."
Then you can start asking, "So how often are you late to things? How often do you lose things?" When you hear, "Always, I'm always losing my stuff." You can be like, "Oh, okay, we have a different name for that. We call that one ADHD."
But the point is it really depends on the person's own subjective lived experience of whatever it is that they're describing, and it's so important to beneath the surface of a person's description, to get the actual nuts and bolts of what their life is being like. What does that look like for you? I often will use this magic question, which is, "So walk me through your day."
It's such a helpful thing because then you see if their morning routine is totally shot the heck, and it's like every day they're coming, running out with only one foot in their pants and forgetting to brush their teeth. Okay, this is giving me some real clinical data, if you're hearing that, "No, no, no. I always leave my toothbrush right there at a 90 degree angle by the sink, and that I make sure that I give myself at least 30 minutes to make sure that go to the bathroom and everything's good," that's very different than the guy who takes six minutes, barely in and out of that bathroom. He's done everything all at the same time, shaving in the car, very different. It's a very different presentation.
So it's really, I think, dependent on the ability of the clinician to kind of tease out what's really happening. And I think that even when we self-diagnose, looking at our own life and being like, "Hey, do I have ADHD? Do I have anxiety," to ask ourselves? Well, what is it like for me? What's the experience of living like this? And then it'll give us symptoms. It'll give us things that then we could neatly categorize for ourselves.
Pete Wright:
It's a funny way to experience that because I am one of those people that had to be told I had ADHD. I had no idea, ADHD and anxiety. It was exactly what you just described. It was like, "tell me about your day. Now, let me talk to you about your ADHD," kind of an experience.
So if we're here talking about comorbidities now we're talking about things that present together. Can you walk us through the basics of this?
Michael Felt:
Sure. So first, let's talk about what a comorbidity is. So there are two things that we need to know. We need to know that there's something called the primary presenting problem and then a secondary issue that would kind of come along with that primary thing. And then there's something else called a comorbidity, which is when you have two things happening at the same time that are both presenting issues. Now obviously once you look at the comorbidity, you then want to ask, "Okay, which one's primary, which one's secondary?"
But comorbidity really just means that you're kind of struggling with both at the same time. Now, the really tricky part about comorbidities is what causes what. So for instance, and this could probably be very relatable to a lot of people listening, especially to myself, is that we could have anxiety that we use to kind of cope with our ADHD.
For instance, I always get super nervous before even this podcast, so I have a million little notes and stuff of like, "Okay, what are the things I'm covering?" I have my bullet points, and I've saved things on my desktops for easy reference. Or if you're going to ask me on a certain question, I could be like, "Bam," like this. So I didn't eat yet. I have all my food next to me that I was supposed to eat during the break before this, but I'm just too nervous. I have no appetite, and I'm on Concerta, so appetite suppressing to begin with.
Pete Wright:
Sure.
Michael Felt:
But this is my coping mechanism is that before I get on, before I present, before I go to class, before I teach, before I do anything, I kind of walk through all of the things as much as I can. And in a way, it's almost like it's artificially generated anxiety. You know what? It really helps me get stuff done. And that's what I find in a lot of folks who will have, let's say anxiety and ADHD, is that we're kind of using that anxiety to help with the ADHD.
And the flip side of this, and I'm not saying that this has to be true, but sometimes you'll have a comorbidity where it wasn't necessarily developed on our own where we did that for ourselves, but rather it kind of comes naturally and organically as a response to it, which was what I would call ADHD-induced anxiety or ADHD-induced depression. For instance, if I'm never able to get stuff done, I'm always late to class and I never fill out the form that I need to do before I get onto something that I need to do. Or if my reports are always late, then I could start feeling like, "Hey, maybe I should just give up. What am I doing here? I'm a useless broken... I'm broken. I'm just broken."
And that feeling of, I always say dumb stuff with friends, and I'm always alienating people, and I get into weird political fights with people who you shouldn't be talking politics about. Then it could lead to me slowly removing myself from those social scenarios and becoming more of a recluse and stopping to do a lot of the things I like, which we would all diagnose with depression, where a person's just feeling like there's no point in me getting up. Why am I even... That hopelessness that comes from a life of a lived experience of failure? I'm getting emotional only because I've been there. I've felt that as a kid, when I had my ADHD and I could never do anything right. I was expelled from three schools, I felt like a loser. I felt like I was broken. And I think it's important for us to recognize that with certain comorbidities, it could be ADHD induced. Because I didn't have the ability to be on top of what I needed to do, it led to this breakdown in my daily function that I wasn't able to perform, and then it led to a natural depression. It actually made sense that I would be depressed.
Pete Wright:
I guess the question then with this comorbidity is it treated as if it is a primary diagnosis? At what point does the depression become the maladaptive presentation versus clinicians who recognize that it is, it stems from ADHD, and that if we work on some ADHD stuff, we might actually help with the depression?
Michael Felt:
That's a really tough question, actually. So I'm just going to rephrase the question in a way that makes it easier for me to understand it, which is, so how do we treat it? Meaning, what do we do now? What do we do now?
Pete Wright:
That's a much better way to ask the question.
Michael Felt:
I think the answer really comes down to the primary presenting problem, what's getting in your way? And I think that that takes a discerning clinician to be able to weave through it and see it looks like the real issue here is his ADHD. He's he has a extremely low sense of self-efficacy, feels like he can't do anything. So let me build that up first. It could be that a clinician may have to say, "Listen..." For instance, when I'm feeding a lot of, let's say OCD, I know that's not the topic, but a lot of times OCD and ADHD, that comorbidity becomes very complicated because a stimulant medication, which would help us with our ADHD, right, will oftentimes will increase anxious thoughts and then obsessive thoughts and the compulsions. And it could be very debilitating for someone. So it could be very hard to figure out where do you start, but the guiding light should always be, well, what's robbing this person of their ability to function, their daily function just to get through the day?
And it goes back to that question of, "So, walk me through your day." Meaning, if their day is dysfunctional, we want to figure out why. What's getting in the way of this person's function? How do we put the fun back into functional? That's really what we need to be able to do, is to be able to help people figure out how to live with a certain amount of life.
Nikki Kinzer:
So you're looking more at the symptom or what's going on, more so than the label of whether it's ADHD, depression or anxiety.
Michael Felt:
Right.
Pete Wright:
Because again, it's all executive function.
Nikki Kinzer:
Right, right.
Pete Wright:
Yeah.
Nikki Kinzer:
Yeah. So I know in my own personal experience, and I've shared this on the show before, my daughter was misdiagnosed with, well, she has depression and anxiety too, but they missed the ADHD, and I had to be kind of a more louder advocate for her. So I'm curious about how does that happen? Because it's so masked so well?
Michael Felt:
Yeah, it's very masked really well. I think that anxiety, depression, ADHD is really a complicated trifecta, especially because so many of the symptoms are basically overlapping. They're really the same stuff. Here, watch. Ready? If I told you that, "Oh, this person's having a hard time concentrating, feeling calm, they're always restless, they're really struggling to feel good about themselves, and they have a very hard time with emotional regulation." That could be any of those three.
Nikki Kinzer:
That could be any of them.
Pete Wright:
Yeah, right.
Nikki Kinzer:
Yeah. Right.
Michael Felt:
So it is very complicated. And again, this is why I think it's helpful, and I'm happy, Pete, you had this, to have a discerning clinician who's able to see the person behind the pathology, listen to the story behind the symptoms, you really need to dig a little bit to kind of see what's going wrong. And I'll do this even on a simple thing. Let's say, here. This is just a drop of a flex. I really love the way I give my midterm and final exam, so I'm going to show off a drop. So the way that I give my midterm and final is that I put out these vignettes and we have these vignettes, and the students have to diagnose the vignette, and I tell them straight up, "I'm going to put in red herrings. I'm going to put in weird stuff, substance use and all other things, and I'm going to try to throw you off so that you could dig through. I want you to develop that critical thinking skill to be able to look through it and see what's really causing the problem."
And that's really the key here, is being able to kind of dig deep. And so one of the questions, let's say we'll have is you'll have, let's say Jessica really struggles to get to school on time. She's always late. And when you ask her, she says, oh, because she really hates going on the train. And so that's why she ends up, it's just takes her a while until she gets it and she takes buses and this kind of stuff. So in that setting, I could hear someone saying like, oh, scared to train. Oh, is that a phobia? All right, phobia, right? But if you were superficial like that, you totally missed it, that if you kept asking here, you'd say, "Hey, what about trains is scary for you?
"Oh, I hate that. I'm so close to so many people and it's just so crowded." Oh, someone might say, that's agoraphobia. "Wait, so why is that uncomfortable for you to be near people?"
"Because I just feel like everyone's looking at my outfit and judging me." Oh, now that is a social anxiety, that fear of judgment of other people is a social. So you see how there are so many layers here, and unless you dig through it's very hard to see what's actually going on. So I feel like with your daughter, it's hard because a clinician could feel like, "Hey, I asked a whole bunch of questions. I did a lot of the digging, and I keep seeing anxiety and depression," but it takes a lot of digging to really get there.
Nikki Kinzer:
But see, that's the problem. I mean, you hit the nail on the head. They didn't do the digging. All they did is they just looked at the assessments from her teachers and then looked at my assessment and my husband's assessment and her assessment, and they were so different, but they took more clout on the teacher's assessment and they didn't do the digging. They didn't. So I think that's key is finding somebody that's willing to really ask those questions to figure out what's going on. They would've seen it. They would've seen what I had seen if they just asked, and were more open to just not looking at what the teachers were saying.
Michael Felt:
Yeah, Ari has a great line. Ari Tuckman says ADHD is the worst kept secret. It's there. It's there. No matter how much you want to hide it or think that no one sees it. It's there.
Nikki Kinzer:
You'll see it. Yeah.
Michael Felt:
You just need to look for it and you'll see it.
Nikki Kinzer:
For sure. That's so interesting.
Pete Wright:
I want to back up just a second because I think this is part and partial to the same conversation, which is when you have these, let's say we're dealing with ADHD and comorbid with anxiety and depression, is it possible to address depression fully without addressing the ADHD at some level?
Michael Felt:
The tough questions. So you're basically asking how could you ever deal with the ADHD without dealing with the depression?
Pete Wright:
And conversely, how could you ever truly deal with the depression if you aren't aware of the fact that these underlying conditions might be stimulated by ADHD maladaptation?
Michael Felt:
That's a really tough question. I think the answer is unfortunately that sometimes medication, and thank God we have really good medication out there, but sometimes because of its efficacy, because we have such great meds, it could obfuscate what's going on. And so let's say you'll get some really great stimulants. And so now the person's feeling like, oh yeah, they're stoked, and now they're ready to kind of really take things on. But that may not really solve the problem because what you're really dealing with is this hopelessness of the underlying depression. So he's probably very capable of getting stuff done when he starts something, but because of the depression, there's just apathetic lack of interest. Yeah, you're right. That would be really hard. Or even the other side is let's say I'm trying to treat the depression and give this guy some prescriptions for pro-social engagement, getting out and walking with folk and doing that kind of stuff. But his ADHD means that he is always getting distracted watching Netflix till 3:00, 4:00 in the morning. That's early night actually, for those of us ADHD, right?
Pete Wright:
Yeah, right. Right.
Michael Felt:
If you have to finish that season, you're going all the way until daybreak and then sleeping in until 1:00, 2:00. Where are you getting that pro-social activity when you're, you're just in a different world than everyone else around you. Everyone else is living daylight hours and you're basically living at night. It could be really difficult. Yeah, I think that's really, really tough.
Pete Wright:
Well, and I think that's the same token with anxiety, right? That's my bouquet is ADHD anxiety, and I-
Michael Felt:
Looks great on you, Pete. [inaudible 00:21:36].
Pete Wright:
Thank you. One of the things that I find so interesting about it is that am able, when I am properly dosed and medicated for the anxiety, I'm able to more effectively address the executive functioning issues that I deal with with my ADHD. It's like I can shut the window a little bit and on the noise, the anxiety, the noise of anxiety and the recursive thoughts and the, I can sleep better and all of that, but I worry just a little bit that I'm not actually making any long-term change. Is it possible to that, that I'm just effectively in a mode of stasis, or is that just my anxiety talking? Do you know what I mean? I wonder how-
Michael Felt:
Could be both but it's still a good question. I think it's still a great question. You're right. How do we change ourselves or here's a great question I get from a lot of patients is, "Hey Doc, could you rewire my brain?"
First of all, I wish I could, but we technically could recondition your brain, meaning it's always going to be wired a little bit funky because that's just us being neurodiverse. We're just kind of awesome like that. But what we could do is recondition our brain, and if I could, I'd love to share a success story of this patient who has OCD, bipolar disorders. It's BPD, autism so it's ASD and obviously ADHD. So I joked when I met him, I was like, "Wow, you have more letters after your name than I do." And he's great. So what we've been doing is this. We've been going through this thing I call the cycle of ambiguity and the cycle of agency.
So these are my cycles of clarity that was referenced in that intro about the experiential rehabilitation. So what we're doing is we're trying to help recondition his brain that when he gets anxiety, that becomes the trigger for him to recognize that. So now I'm feeling anxious there's something going on, and this is a cycle of ambiguity. Ready, folks? So it starts off with ambiguity. That is the being of our existence when you're just, "How do I do this? When do I do it? Okay, I know what to do, but I don't know when. I know when, but I'm not sure where it goes, what button? "
And just, all right, next. So that ambiguity is really our Achilles heel and at least anxiety. Now we're kind of uncomfortable and it could either be conscious or unconscious. It happens almost instantly this internal anxiety, either about the actual issue or about the ramifications of this issue of the thing that we're ambiguous about. So it goes ambiguity, anxiety, and then the sister of anxiety is avoidance, right? We're always checking our phones, right? Bam, right? No one likes being in that anxious state and we all hate that. So we go straight off to, all right, next. All right, let me see what else I could get on. J Crew.
"Let me check out that influencer's thing. Or let's just do Reels again," and then we end up just reeling our way out of that and that anxious avoidance. But unfortunately, we never really dealt with that issue. The example I always gave was about my taxes. So I'll get this thing an email from my accountant with 12 things that he needs from me. 1099, I know that. 1040, I think I know that also. Okay, W2. All right, I'm good. K-12, what the? What the... I went through K to 12. What is? I don't even know, right? Then prof, PnL. Oh, I know it stands for profit and loss. Look at me, finance bro. Right? But I'm going to have to make that. What am I going to make that? All right, that's the ambiguity, right? The anxiety of like, "I don't want to screw this up. I don't want to get audited." And then bam avoidance, mark unread.
Nikki Kinzer:
And then it sits there.
Michael Felt:
[inaudible 00:25:24] are stuck in that cycle. We just get caught there.
Nikki Kinzer:
And then you feel bad about that. And I feel bad that I just spent an hour watching Reels about cats and dogs and everything else, yeah. Yeah.
Pete Wright:
But that's the secret sauce, right? The act of marking it unread. This is it. The act of awareness is easily confused in my head for being done, right? I know that those things exist. So I guess I can move on to some other thing that I don't know because I'm checking off the ambiguity, right?
Michael Felt:
Yeah. Technically it is done in my head. I signed off.
Pete Wright:
Yeah. Yeah, I signed off. Oh, my.
Michael Felt:
So that's where it gets really tricky, and I find that a lot of people really enjoy the cycle of ambiguity because it just makes it so clear. It's just like, oh yeah, it's exactly what's going on.
Pete Wright:
That's exactly [inaudible 00:26:11].
Michael Felt:
I get caught in the cycle of ambiguity all the time, folks. This is what happened with not filling out the form for this podcast. It's the cycle of ambiguity. I was caught. I didn't know how to write what I wanted to say in the right way. And so I was just anxious that I don't want to mess this up. I want to look cool and I want everyone to think I'm cool. And then avoidance. I was like, "Yeah, all right, I'll do it later." And then whatever. It just never happened. And then page got refreshed And that was it. It was gone. But in my head, Pete, I was like, yeah. "Oh, I did try. I filled out 90% of it." How many of us get there, right? Where it's like the end of the form and it's one last thing and it's just like, "I'll go get lunch."
Pete Wright:
Yep, yep. Oh my God, I eat lunch seven times a day. I work out of my house. I mean, come on. There's always that project. God. Well, I don't love this bit of awareness. Okay, so let's talk about moving forward, right?
Michael Felt:
So how do you recondition the brain. So, good. good. I'm very happy you refocused that. So that brings us to the cycle of agency. So the cycle of agency, again, everything has to have A's because I'm cute like that, right? So it's going to be, it's acceptance acuity, which is just a fancy word for clarity that obviously needed an A. So thank God I found that word in the thesaurus. And then there's agency and action. So let me walk you through it. So acceptance is that first just, "Okay. All right, Pete. This is just my anxiety. I know this. All right. All right, I'm good, I'm good. This is just me being anxious. This happens to me all the time." If you want, I won't use you as an example. I'll do me. So, all right, Mike-
Pete Wright:
I'm a willing [inaudible 00:27:50] example by the way. So go ahead.
Michael Felt:
Perfect. Right, so that's the first step is the acceptance of our own anxiety or our own ambiguity and just to breathe it out, all that mindfulness and all that stuff. It's great stuff because what it does is it's reducing the neurophysiological arousal. A lot of times we get in that fight or flight and then that energy, we take that energy to go, all right, maybe I'm going to check if there's anything new in the fridge. Come on, there's nothing new in the fridge. It's the same thing. It was seven minutes ago when you checked before, and it's that first acceptance of just recognizing that I'm feeling a little bit overwhelmed. Yeah, yeah. That is what's going on right now. I'm breathing that out. I often just say, do the 3, 6, 3 seconds in through your nose, six seconds out through your mouth and that's it. No fancy box breathing, whatever. If you want to do box breathing, go for it. I'm just saying, it doesn't have to be fancy. I like to keep things simple, otherwise I just forget them. So it's just that deep breath. It's so cute because part of my parenting coaching is that we have to model for our kids. And I've seen my 2-year-old and he broke his collarbone. My wife say, "Are you okay? What's going on? Do you need any?" And he woo-sighed like a boss.
I was so proud of him. "Good for you."
Nikki Kinzer:
Yeah, are you kidding? That is great.
Michael Felt:
Two years old.
Nikki Kinzer:
Wow.
Pete Wright:
Two years old?
Michael Felt:
That means that dad clearly is losing his stuff at home way too often and has to sit there woo-sighing also. Okay, let's not think about that. But-
Nikki Kinzer:
That is fantastic.
Michael Felt:
Great modeling. Great modeling. And so that's the first step is this acceptance. I trying to reduce that neurophysiological arousal, letting that tension out us. Otherwise, it's going to push us to go check something, do something. We're going to go straight into that anxious avoidance. That energy is going to push us somewhere. So that's the first step is reduce it. Let it out in a more adaptive, healthy way. Let's just breathe it out. Let's breathe it out. This also is really helpful for the shame that comes with all this ambiguity and not really dealing with our stuff is let it out. This is us, this is our life. What do you want? This is the way our brain was made. What are you going to do, return it to the manufacturer? I heard the warranty is not that great. Like, really.
So that's step one and I think it's the most powerful step, but the next one is acuity. Acuity is creating clarity for yourself. Okay, so what's my issue here? So it's really just the K-12 or whatever that form was, right? That's really my issue. I'm good with the 1099, I'm good with the 1040, I'm good with the W2s. it's just, I don't know this and the PnL. All right, so let's go slow. I could do the first four, I think. I know it's all saved and I think all of my companies send me those things. All right, so let me send those, right? So let me just jot this down. I'll make a list of the things I do know. Let me do the things I know and then I could work on the things. I don't know. So even that, just getting clarity in what is the ambiguity, what's my problem?
And that clarity itself is very focusing because now we have a target, target acquired. And utilizing curiosity, which is a massively powerful asset, an amazing cognitive function. Is this okay? How could I figure that out? That's kind of cool, but now I know and I'm able to reduce the overwhelm. I pushed away the... I got rid of the things that I do know. So those are easy. Okay, let move that out of the way. And I've identified and hyper-focused in on the ambiguity. I call this one fighting forward because you really have to fight towards that ambiguity to lean in as opposed to our natural instinct is to lean away and to just go into some social media deliciousness, deceptive goodness of just like, ah, life is good. Let me look at other people's patients. So then the idea of fighting forward to create that clarity for ourselves, that acuity is a huge step.
That's really where we start winning the battle because when we break it down, that gives you that agency because then you're like, all right, hey, the first three, I got these, right? I know these things. So now all I have to do is this K-12 thing, or I don't know what that is. And a PNL. All right, PNL is not so nuts. I think I've done math before in school at some point. I could do this. All right, so let me figure out a time to do that. But the point is that once I've broken it down, because I've created that clarity for myself, I now have agency. And that's the thing that's oftentimes most missing from us is that we just feel like, the British, my father's from London and they have this great line called "Can't be bothered." It's so perfect for this. You're just like, "Can't be bothered." Really. It's you know what you're supposed to do. But I think the American phrase is, "Meh."
Nikki Kinzer:
Yeah.
Pete Wright:
Yeah.
Nikki Kinzer:
Right?
Pete Wright:
British do it better.
Michael Felt:
We don't like saying all those words.
Pete Wright:
So classy.
Michael Felt:
Yeah, right?
Pete Wright:
Their avoidance is really classy.
Michael Felt:
Excellent.
Nikki Kinzer:
It really is.
Michael Felt:
I've even taught my kids that when they burp, they should do pardon me.
Nikki Kinzer:
Right.
Pete Wright:
Of course.
Michael Felt:
It makes it a thousand times more classy.
Pete Wright:
Absolutely.
Michael Felt:
And so that agency is really empowering because now we feel like, all right, hey, I could do this. And then the key is to then take an action to channel that into action. Otherwise it just becomes another thing that we just marked unread and just stays as another index card or to-do list somewhere. But to start on, okay, what's the next physical action I need to do to get this moving? But the point is that then the reason why I call this a circle is because then that reinforces the acceptance. So much easier for us to accept ourselves when we actually get stuff done, when we actually feel, hey, you know what? I'm not entirely incapable. "Hey, I could do some stuff. Look, I got the first three, I got the first three things done, so hey, that's not so crazy."
And I really like the cycles of clarity I think are very helpful in terms of both just conceptualizing what's going on for us in the moment. Using that cycle of ambiguity to be like, "Oh, right, I'm caught. Oh, in that part. Right now I'm in the avoidance part. Or right now I'm in the anxiety part of that cycle." And then at whatever point we want, we could always initiate that cycle of agency by breathing it out. "Okay. Okay, here I go again."
Nikki Kinzer:
Right.
Michael Felt:
"All right. All right."
Pete Wright:
Give me the five again, just in order.
Michael Felt:
Oh, which one do you want? The cycle of ambiguity? That's just three.
Pete Wright:
Oh, that's just three?
Michael Felt:
Cycle of agency is four.
Pete Wright:
Cycle of agency. Okay. So I had, there's acceptance.
Michael Felt:
Yeah, very good.
Pete Wright:
Ambiguity.
Michael Felt:
No, no, no. That's the cycle of ambiguity.
Pete Wright:
That's a cycle of ambiguity? Yeah.
Michael Felt:
So the cycle of ambiguity is just three things. It's the problem cycle. That's where we catch ourselves. So that's ambiguity, which is where it always starts because it's some executive functioning, something problem that we're not able to fully figure out. So we have this ambiguity that leads to anxiety, both either conscious or unconscious. Either you're aware of that anxiety or it just happens and just kind of pushes you into avoidance, which is Reels, TikTok, the fridge again for the fourth time. And that's that cycle of ambiguity. And again, very powerful. Even if you never got to the cycle of-
Pete Wright:
It's reinforcing itself too, right
Michael Felt:
Yeah because now you're even further from the taxes.
Pete Wright:
Yeah, exactly. Exactly. Okay, I want to get back. There were so many A's, you have to forgive me.
Michael Felt:
I know, right? [inaudible 00:34:58] AAA. Remember those guys?
Pete Wright:
What was the other one that included Acuity? That's the one that I really liked.
Michael Felt:
That one's the cycle of agency. So the cycle of agency is how do we get ourselves to feel good that I could do this? How do I deal with this? How do I fight forward? So that-
Pete Wright:
[inaudible 00:35:11].
Michael Felt:
... starts with acceptance.
Pete Wright:
Okay.
Michael Felt:
That's acceptance. And that could include, and if a person's able to, they should include a deep breath there. Just again, the goal of the acceptance is not like, "Oh wow, you're so amazing. I'm not into these affirmations thing." I think it's just more BS that we feed ourselves and we could do without more deception. Really honestly, our lives are so much better when the light of truth shines the way for us. So the first thing is acceptance and authentic acceptance means accepting the good, the bad, the ugly. All of us, we are pretty capable. Look, we're still alive. We haven't overdosed yet. We're still here. I'd look both ways before I cross the street. Thank God, not hit by a truck yet. So there's parts of me that are good and there are parts of me that aren't so great. And right now this is probably one of them.
Pete Wright:
Yeah, okay.
Michael Felt:
And that's all right. And I think that's a huge step. And again, this is why I focus on it a lot because acceptance is a huge, huge, huge step. It's so calming and it allows really to rebuild our self-efficacy. It allows us to rebuild that sense of goodness that we are capable person, so that after that deep breath goes acuity, because now that we're a little bit more calm and we're a little bit back to ourselves, we're back online. We're not in that, "Ah," that frazzled and short-circuited. Now that we're back online, we can now be, all right, so what do I need? What's my problem here? The clarity, the acuity of, okay, so what's the issue? What's in my way? What's going on? What is the ambiguity? What about this do I know and what don't I know?
Pete Wright:
Right. So once I have that clarity, I'm able to move to-
Michael Felt:
You then feel agency. Now you're like, "Oh, okay. That was pretty... it's only this issue. It's not all of taxes." Come on. The word taxes that makes my heart rate go faster.
Pete Wright:
Totally. Totally. Blood pressure the worse.
Michael Felt:
Right? And that's just like, "Oh god damn." The point is that when you're able to kind of say, "No, but it's just the K-23," or whatever that is, then it's a little bit easier. Now it's like, "Okay, okay, this is not so horrible. It's not taxes, it's just a K-12 and a PnL. Okay, okay, okay."
Pete Wright:
Okay. But once I feel agency, I'm allowed to open the door to action.
Michael Felt:
Yeah. Because otherwise we're just going to go straight to avoid it. Boom, boom, boom. So it's got to have that action, the action's, what reinforces the acceptance of the goodness in us and that we are capable, and this is something I could do. And even if it's just 20 seconds, or even if it's just writing down, what do I want to do? Or where am I going to start? Or who should I call? Or even sending an email back to your account and saying, all right, I have these first three. How do you want me to make a P&L? Or do you have a template? So all I really did was stall, but what I did do is I started the process and now he's going to send an email back to me and that could remind me, and hopefully I'll be in a little bit of a better mood or a little bit more clear when that next email comes. But I've put the ball in his court and I've started the process. It's not him still waiting on me and me feeling that pressure. And this is another one. No A's, it's called PIP, right? I say that we have a lot of times we just PIP all over the place, which is pressure induced procrastination, which is... Thanks for laughing.
Nikki Kinzer:
We PIP, we PIP everywhere.
Michael Felt:
I made it a verb. Yeah, it's a verb. "Sorry. Yeah, I was just PIPing. Yeah, what do you need?"
Nikki Kinzer:
That's awesome.
Pete Wright:
It's funny to hear that because I feel like we need an acronym for the other way, which is pressure induced action. When you can't do anything until the dopamine-
Nikki Kinzer:
Until the pressure starts.
Pete Wright:
... or the urgency of dopamine hits, right?
Nikki Kinzer:
Yeah.
Pete Wright:
I have procrastinated so long now that I can't do anything else. I'm incapable of success until I wait until the last moment.
Michael Felt:
Yeah. Well, those are the CNUs that got us kind of moving. Yeah.
Pete Wright:
Yeah, yeah. That's really, that's great. Yeah, Nikki. Go ahead.
Nikki Kinzer:
I was just going to say-
Pete Wright:
My mind is blown. I had all the A words down. I just want you to know, professor, I did have the A.
Michael Felt:
You get an A.
Nikki Kinzer:
Yes.
Pete Wright:
I just didn't have them in the right order.
Nikki Kinzer:
In the right order. Right. No, it's so interesting to me because a lot of what you're saying, especially with the cycle of agency, reminds me so much of coaching because it really is talking about figuring out from the client what is it that they really want? What is it that they really need? And so often they don't know. And so it kind of goes back to you digging for that diagnosis, really asking more questions and more questions so they can get more clear about what it is. And it's a huge breakthrough at that point because Pete and I were talking about this a while back when I was, and I always get this metaphor wrong about ADHDers often look at the forest, but they can't necessarily always see the trees or the details of the trees.
Michael Felt:
The metaphor is exactly right.
Nikki Kinzer:
Is it right? Okay. And then sometimes-
Michael Felt:
Well, you can't see the forest for the trees, right?
Nikki Kinzer:
And then sometimes you see only the little trees and you don't see the forest. And so it's very confusing.
Michael Felt:
You don't even know you're in a forest. Right, right.
Nikki Kinzer:
Right? Yeah. So it's that getting that clarity is so important. I wrote notes. So, I-
Michael Felt:
Yay. You're a great student. I'll give you an A in my class.
Nikki Kinzer:
That's right. I have notes. This is great. I love it. Thank you for sharing.
Pete Wright:
It's really good. I'm imagining somebody listening to this and saying, "Look, this is great. I know when I go to my GP and I tell them I have anxiety, they pull out their prescription pad or sit down at the computer and say, 'You want to try some Zoloft or something?'" There's no conversation in it. And so I'm looking for some guidance for folks who are looking for help in finding the right team. When you're looking at comorbid conditions like this, how do you build the right setup of professional support?
Michael Felt:
That's a good question. Meaning you're basically asking, how do I get the help I need?
Pete Wright:
Yeah. And is everybody equally qualified to handle all of these things? Is there one person I should go to or?
Michael Felt:
I don't know. I don't know. I do think in general, going to folks who are ADHD trained or specialized or a ADHD sensitive is a good phrase. But again, the reason why I teach psychopathology is so that I don't think that every nail is ADHD. I don't want to be that. When you're a hammer, you think everything's a nail. So I don't want to be that guy who thinks that everyone's got ADHD. This is why I teach it so that I could be able to see when it's not ADHD. So keep in mind, you want someone who's ADHD sensitive, but not ADHD specific, meaning you don't want them to be like super, "Oh yeah, everyone's got ADHD. Here, Ritalin."
But I think that also it could be helpful that, and this is a little bit of a big ask or our generation, but to kind of shy away from using all the professional jargon, it's not helpful. It's not.
When you come in telling us that you have anxiety or that you're depressed, it's not fair because now you've created a baseline, right? And I'm going to be comparing you to this clinical definition, and you may not mean that. You're just using some, I don't know, TikTok thing that you self-diagnose yourself with or whatever. And maybe you're just feeling low affect or maybe you're just feeling very overwhelmed and down and out. So that isn't necessarily depression.
So I think step one, and if we're doing this as a what not to do and what to do. So what not to do is don't come in with professional phrases because it's only confusing. I know that it is easier and convenient because it feels like it captures a lot, but unfortunately it does capture a lot and it keeps it captured, and that's a problem.
Pete Wright:
Wow.
Nikki Kinzer:
That's so interesting.
Michael Felt:
You want to share that and let the clinician figure it out on his own. And so therefore, what to do would be to tell him what you feel, tell him what's going on. Say, "This is what I'm feeling overwhelmed. I'm feeling like I just can't do anything. I'm feeling like I just have no reason to get out of bed because it's just going to suck anyways. I'm feeling like I'm useless and there's nothing good in life."
Pete Wright:
I love the way you say that, and I think you actually gave me a question that unlocked a lot of that conversation earlier in our conversation today, which was, if I'm not asked this question, I should say, "Let me walk you through my day. Let me tell you how I live my life." I think that is a really great framing mechanism for any conversation about emotional behavioral experience.
Michael Felt:
Yeah, I think so too. I think it's also with between spouses. Don't tell them like, "Wow, you're a horrible jerk. You never listen." It's, "I don't feel like I'm being heard." This is the basics of couples counseling. I'm sure you've had even better presenters talk about this, but it's the same idea is creating clarity, clarity, clarity, clarity, clarity, clarity. And that's the key to, I think, everything in life, but especially ADHD because our executive function is not on par sometimes with everyone else. And so it's harder for us to create that clarity that everyone else just gets so seamlessly that we kind of have to do it on our own. Again, we could wait for the things that we're really interested in or the things that are due in six minutes from now. We could wait for that until it kind of, but it's a very passive life and it's very crisis to crisis kind of life, and no one wants to live like that.
It's very stressful and tense. But if we could create our own clarity, then we could generate that motivation. We could generate the interest, we could generate the agency and autonomy to be able to do what we need to do when we could do that, and I think it's the same thing when you're looking to tease apart these comorbidities, is to create clarity for yourself. What's getting in my way? What are the feelings getting in my way? Not the diagnosis. When you finish grad school, then you could give yourself diagnoses, but what are you feeling? Because we're all human and we all know our feelings. I am what I am. Right? Sorry, that's a Popeye reference.
Pete Wright:
That's good Popeye reference though. That's good.
Michael Felt:
Old farts among us.
Pete Wright:
I'm with you.
Michael Felt:
But we know I feel what I feel. We know what we feel and just say what you want to say. Let the words come out and honestly just be brave.
Nikki Kinzer:
Yeah. Oh, I love this. Thank you so much. This is great.
Pete Wright:
Good mic drop, Michael. Good mic drop.
Michael Felt:
Yeah, thanks. I was [inaudible 00:45:31] but I think it's really, yeah, just share what you're feeling and let the clinician figure it out.
Pete Wright:
Yeah, really illuminating. I'm so glad Ari hooked us up. This is a good meet cute. What we had just here, podcast meet cute. Where do you want to send people to learn more about your work?
Michael Felt:
Oh, they could always just head over to my website. We're starting groups soon, so we're going to be doing this kind of psycho-ed where we walk people through the cycles of clarity and how to identify and recognize when they're in a cycle of ambiguity, how to recognize when or where they could start or initiate that cycle of agency, and it's going to be kind of cool. It'll be fun. It'll be tiered by levels of experience, like folks who've been in therapy, folks who've done coaching. I'm a big fan in general of people kind of leaning on each other. We have so much to grow from each other, and to me, I view groups as a better alternative to individual. First of all, it's cheaper usually, but more importantly, there's so much to gain.
Nikki Kinzer:
So much, yeah.
Michael Felt:
Two heads are better than one, and it's just we could learn so much from everyone else's lived experience. We could hear the way they describe it. Even here, us talking together, we all gained from the fact that we met up. If it was just each one of us just twiddling our thumbs, nothing would. I mean, maybe something would've happened, but it wouldn't have been as much fun or creative or-
Nikki Kinzer:
It's a different conversation for sure.
Pete Wright:
Right.
Nikki Kinzer:
Yeah. Yeah. That's great.
Pete Wright:
It would've taken a lot longer. It was great. Everybody, please go check out the website, links in the show notes. And I'm going to put A words in the notes too, just because I know people were in the chat room trying to remember A words as we were saying them.
Michael Felt:
Sure, yeah.
Pete Wright:
That is an incredibly useful cycle, so we'll point all of those facts-
Michael Felt:
I'll try to put that actually that. I have a worksheet for it. I'll try to put that on the website, adhddoctor.org. Here, let me put it up.
Nikki Kinzer:
That'd be great.
Michael Felt:
Let me just give myself a note.
Pete Wright:
Outstanding.
Michael Felt:
Upload the Cycles of Clarity worksheet. And it's like, again, you could copy it, print it. Honestly, my one request to folk is if you make it better, let me know. I've seen people take it and apply it to kids. They make it with media and pictures. It's more colorful. Please, please, please. I want to see how you made it better. That's so cool. You could just take what I'm doing and make it even cooler and the same symbiotic productivity that we can get from other people. That synergy, I'd be so excited to see. It also makes me proud, so that'd be really great.
Pete Wright:
Outstanding. We'll absolutely do that. Thank you so much Dr. Michael Felt for being here, for being a part of this conversation, and to you, our dear listeners, thank you so much for hanging out and downloading listening to this show. Thank you for your time and your attention. Don't forget if you have something to contribute to the conversation, we're heading over to the show Talk channel and our Discord server. You can join us right there by becoming a supporting member at the deluxe level or better. On behalf of Nikki Kinzer, Dr. Michael Felt, I'm Pete Wright. We'll see you right back here next week on Taking Control, The ADHD Podcast.
