Larry Maucieri Ph.D., ABPP-CN

The Distracted Couple

Anxiety with Adult ADHD: What to Do

Why is Anxiety Common with Adult ADHD and What Can You Do About It?

Posted Jun 14, 2015

Adult ADHD doesn’t usually travel alone. Among its more common companions are depression, alcohol and drug abuse, obsessive-compulsive disorder (OCD), Tourette’s syndrome, and of course, anxiety. Having ADHD and another condition can make treatment trickier, but it’s crucial to address everything that’s going on if you’re going to get the most out of your treatment.   

Anxiety comes in a lot of different forms, like phobias or panic attacks. The kind of anxiety that crops up with ADHD is usually stress-related. That means a “grinding, I can’t take it much longer” stress. It’s the type of anxiety that keeps you awake at night, wondering how you’re going to pull off that massive presentation next week? Or how you’re going to learn a semester of stats by Monday? Or how you’re going to pay your bills this time? In jargon-speak it’s sometimes called Generalized Anxiety Disorder (GAD).

The generalized part of GAD means that it cuts across situations and environments. It’s free-floating and pervasive. That’s different than a phobia for instance, where you might panic only when you’re visited by a spider, or feel terror in a crowded elevator that stalls. The anxiety in GAD is a more chronic, persistent, and gnawing stress. It’s never being caught up at work. Feeling unproductive and unable to get ahead at home. Worrying constantly about money issues. Feeling stressed out about your kids.

And it’s long-lasting. By definition GAD must last at least 6 months. That duration distinguishes it from passing stressors that come and go. It’s not short-lived or temporary, but more like an unwanted new normal.

Given the way adult ADHD disrupts lives, it’s not surprising that chronic worry and stress often overlap with it. ADHD erodes self-confidence. New plans and projects feel ominous. Past struggles and mistakes are replayed over and over again, usually in an unrealistically negative or amplified way. Wins and successes are minimized. This is a breeding ground for performance-related anxiety of course, but it also leads to a sense of chaos and incompetence. When we don’t feel able to manage our lives and struggle to find personal successes due to our ADHD, we are going to feel chronically stressed and doubtful of our own abilities.

What to do

While both ADHD and anxiety batter self-esteem and confidence, the good news is that they are both very treatable. We’ve looked before at treatment options for ADHD. Anxiety is responsive to treatment too, and often in a pretty short period of time. The most common treatments for anxiety involve medication and skill-based therapy.

Anxiety medications usually come in two classes: (1). Selective serotonin reuptake inhibitors (SSRI’s), like Paxil, Zoloft, Lexapro, or Prozac; and (2). Benzodiazepines, such as Xanax, Valium, Ativan, and Klonopin. You probably know of SSRI’s already. They’re used extensively to treat depression. Benzodiazepines are highly effective and fast-acting drugs to reduce anxiety, but they have a potential for abuse because they’re short-acting and people develop tolerance to them easily. Still, benzodiazepines are used quite often in the treatment of anxiety. A qualified psychiatrist is the best individual to talk with about medication for anxiety, and about whether stimulants for ADHD might be inadvertently increasing anxiety symptoms.

The other major treatment approach for anxiety is therapy, and specifically cognitive behavioral therapy (CBT). Other therapy and counseling treatments are of course available for anxiety, dating all the way back to Freud’s case of Little Hans, but the current gold standard treatment for anxiety is CBT. The American Psychological Association (APA) Society of Clinical Psychology web site lists only CBT as having “strong research support” for GAD. If you’re interested, see the details at their web site at: http://www.div12.org/psychological-treatments/disorders/generalized-anxi....  CBT is often fairly effective after only 10-20 sessions.

The appeal of CBT is that it helps you develop new skills and habits that you can then use in your own daily life! That can feel empowering rather than just relying on a pill to do all the work. And CBT has no side effects. The techniques and tools used in CBT depend on the specific problems involved, but they might involve learning relaxation methods, recognizing and challenging false negative beliefs that sabotage your life, unlearning stress and anxiety reactions when faced with a challenging situation (e.g., speaking in public), or noticing and challenging more pervasive errors in thinking. The most difficult part of CBT is consistently using and practicing these skills to the degree that they actually become new habits in your life.  

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