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Mindfulness and ADHD: An Interview With Lidia Zylowska, M.D.

Typically, when we first practice mindfulness, we find how really busy our mind is (and even more so for someone with ADHD). Successful practice is becoming fully aware of what is, and then using that awareness to choose where you place the most attention.
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Lidia Zylowska, M.D. is the author of The Mindfulness Prescription for Adult ADHD. She is a UCSC-affiliated psychiatrist who specializes in mindfulness-based approaches to mental health and adult ADHD. She practices in northern California. Dr. Zylowska is a cofounder of UCLA's Mindful Awareness Research Center, where she conducted the first study of mindfulness-training for adults and teens with ADHD. She frequently speaks about mindfulness as a way to promote psychological wellbeing, and she focuses on making the mindfulness practice accessible to diverse groups of patients and clinicians. Dr. Zylowska's website is here.

What are the main tenets of mindfulness training, and how can it help people with ADHD?

The main tenets of mindfulness training are: becoming more self-aware, less driven by unhelpful and automatic reactions, and being more compassionate.

Mindfulness training can help with:

  • Developing better awareness of attention and learning to be less distracted.

  • Learning to step back and observe one's thoughts and feeling so they don't overly drive our sense of self or understanding of our life. This is very helpful in learning to have more flexible mind and controlling impulsive reactions.
  • Managing stress better by having new perspective and less emotional reactivity, but also by replenishing the "self-regulation" tank.
  • Knowing when to be compassionate and accepting of ADHD symptoms, and knowing when to encourage changing an unhelpful pattern in thinking, feeling or actions.
  • Could you explain the difference between meditation and mindfulness?

    Mindfulness is a state of mind that can be strengthen by specific meditation practice; however, not all meditation training is mindfulness. The meditation training used to develop mindfulness skills is often called "open awareness meditation" or, in the Buddhist context, Vipassana meditation. In addition, the word "mindfulness" can refer to a psychotherapy approach or a quality of a person, so it is important to know how one is using the term.

    In "Step 3 Direct and Anchor Your Awareness: Mindfulness of Sound, Breath, and Body", you use the acronym "STOP" to help people practice mindfulness in daily life. Could you explain what each of the letters in "STOP" stand for?

    In the acronym S.T.O.P. each letter is a reminder to take a brief step:

    S=Stop (or pause) for a moment

    T= Take a deep breath

    O =Observe mindfully in the moment (for example, you can notice more consciously your body sensations or what you are doing)

    P=Proceed with relaxation and awareness

    The last step, "proceed," is also an invitation to use choice in your actions (for example, if you noticed you were distracted or avoiding something, you could resolve to change that). Of course, the change part is not always easy and often requires effort. But with practice (and sometimes together with medications or other ADHD tools), that choice can become easier.

    What recommendations would you give to an adult with ADHD who has tried mindfulness training, and feels like he can never empty his mind of thoughts?

    I would say "You don't have to empty your mind to practice mindfulness." Mindfulness practice is about observing your mind in that moment. Typically, when we first practice mindfulness, we find how really busy our mind is (and even more so for someone with ADHD). With more practice, or with more intense relaxation, we may experience some quieting of the mind -- but quieting the mind or "emptying" your mind is not necessary to have a successful mindfulness experience. Successful practice is becoming fully aware of what is and then using that awareness to choose where you place the most attention.

    In terms of practice tips, for some people with ADHD I recommend having "foreground" and "background" awareness. For example, keeping most attention on the breath, and allowing the busy thinking to fall more into the background. For others, the process is more about catching themselves being distracted and then returning to focus on breath. In the latter situation, it is important to note that the moment of catching yourself distracted is a moment of mindful awareness.

    What are three things an adult with ADHD can do today to start practicing mindfulness training?

    • Become more curious of where your attention goes (i.e. pay attention to attention). Whenever you catch yourself distracted, gently bring attention back to what you intended on doing.

  • Periodically ask yourself, "How am I right now?" and practice mini "check-ins" with your breath (or your body) throughout the day. That can make you feel more present in your life.
  • Practice patience and compassion toward yourself when struggling with ADHD. This forms a basis for growth, change, and thriving with ADHD.
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