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Monday 12 July 2021

How do you treat ADHD impulsivity?

 If you have difficulty paying attention, often feel restless, and give in to urges easily, you may be living with the hyperactive-impulsive presentation of ADHD.

Managing impulsivity is possible, even if it might feel really challenging at times.

The first step is to seek the support of a mental health professional who can help you create and maintain a treatment plan for adult attention deficit hyperactivity disorder (ADHD).

But there’s a lot you can also do on your own to manage and improve impulse control. By being an active player in your treatment, you can further improve your quality of life.

What does impulsive behavior look like in ADHD?

Every adult is unique, so it depends on your personality and circumstances.

In general, impulsive behavior often looks like an improvised or unpredicted course of action that’s not based on logic. It’s your emotions driving your behavior.

These actions may sometimes go against your own plans and habits, and on some occasions, they might become harmful to you or others.

Examples of impulsive behavior include:

  • Constantly interrupting conversations or say things you later regret.
  • Hopping from one activity to the next one or try to handle three simultaneously.
  • Go shopping for one item and return home with endless bags.
  • While driving, you get impatient and begin cutting in front of everyone.
  • Go out to have one drink and end up coming home with someone you don’t know.

Most people act impulsively from time to time. The difference is that ADHD — particularly the hyperactive-impulsive subtype — affects impulse control to the point that these behaviors become persistent over time and across situations.

The following impulse control techniques may help.

How does your impulsivity manifest? What are the common negative consequences? When and where are you the most impulsive?

“No two ADHD adults look the same,” says Terry Matlen, ACSW, a psychotherapist and author of “Survival Tips for Women with AD/HD.” “That’s why it’s vital to understand how your particular ‘flavor’ of ADHD affects your life.”

To become aware and identify the particulars of impulse control challenges, you can begin by taking notes and keeping an inventory.

Eventually, you’ll find a system that works best for you. To start, you could:

  • list recent behaviors that you consider impulsive
  • list recent behaviors that other people consider impulsive in you
  • identify negative consequences of recent impulsive behaviors
  • identify positive consequences of recent impulsive behaviors
  • pinpoint the places where you most often become impulsive
  • select some impulsive behaviors that might be the most harmful to you or others

Matlen also suggests reading about ADHD in adults and attending support groups and conferences that can provide further resources.

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You also can sharpen your self-awareness by practicing mindfulness.

“[B]ring attention to the present moment and observe what is happening without judging it,” says Lidia Zylowska, MD, a board-certified psychiatrist who specializes in adult ADHD and penned the book “The Mindfulness Prescription for Adult ADHD.”

For instance, focus on your thoughts, emotions, and urges along with how your body feels when you’re about to be impulsive, says Zylowska.

This may not be easy at first. You might pick up on your impulsivity only after being impulsive. But with practice, you can start identifying what precipitates your impulsive behavior.

Mindfulness may also help you gain some distance from your urges. This way, you aren’t driven by your impulses but simply observing them. Then, you can decide on your actions, adds Zylowska.

Here’s how it could work:

  1. Practice how to recognize an urge before you act impulsively.
  2. Put a name on that urge. For example, “This is anger I feel.”
  3. Identify the action that emotion is leading you to. For example, “I want to criticize my spouse (because I’m angry).”
  4. Identify what you need to do to stop the impulsive behavior. For example, “I need to express my frustration without making it personal.” Or, “I need to step away, take a moment, and come back later.”
  5. Approach the situation once your urge has decreased.
  6. Document your emotion, what you felt like doing, and what you ended up doing.

Use a supportive, compassionate, and encouraging voice, says Zylowska. For instance, if you want to manage your impatience, you might say: “Waiting is hard for you, but see if you can be a bit more patient right now.”

Checking in refers to taking inventory of how you feel and what your predominant thoughts are right before acting impulsively.

The goal is to pinpoint the inner dialogue underlying your impulsive behaviors. Once you do, you can challenge them.

For instance, let’s say you had to complete a job task but ended up browsing Facebook for an hour.

Carol Perlman, PhD, a psychologist who developed a cognitive behavioral therapy for adult ADHD, suggests asking yourself a series of questions.

For example:

  • What was going on when you started the task?
  • Did it feel doable?
  • Was it interesting?
  • Was any resistance in you regarding the task itself?

Maybe you started looking at Facebook because the thought of sitting at your desk for two hours straight seemed utterly unbearable, she says.

Once you’ve identified the challenges or emotions underlying your impulses, you can implement correctives.

There are many ways you can go about this. Here are some examples Perlman, also co-author of the therapist guide and workbook “Mastering Your Adult ADHD,” suggests:

  • Break out your tasks into bite-sized steps. For example, work on your task for 30 minutes and then take a five-minute break in a different environment.
  • When taking a break, plan for short and relaxing activities. Also, set up an alarm. If you stay on break too long, you may get distracted and move to other tasks.
  • Keep asking questions about the task you’re having difficulty completing. For example, “How bad can this really be?” or “Can I coach myself through the less enjoyable parts?” or “How good will it feel once I finish?”

Once you improve your self-awareness and mindfulness, you’ll be able to know where and when you typically act impulsively. The following step is to sabotage those instances, says Matlen.

For example, if you usually overspend when you go out shopping, leave your credit card and checkbook at home. Take cash instead, and take only what you need to purchase what you’ll be shopping for.

If you need to curb impulsive speech, Perlman suggests taking a notepad with you to important meetings. Instead of blurting out your comments, jot them down as soon as they come to you. Read them later and mention them at the appropriate time.

To plan for this, go back to your initial list. Next to the impulsive behaviors you have identified, write the possible impulse control solutions.

Sometimes ADHD impulsivity might be the result of being stressed or on edge, says Perlman.

Relaxing can increase your impulse control.

Perlman suggests the following:

Managing ADHD impulsivity might be challenging at times, but it’s possible.

Self-awareness is the first step, besides seeking the guidance of a mental health professional.

You can begin taming your impulsive behaviors by checking in with yourself, making it more difficult to act on impulse, and improving your mental and physical relaxation.

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