412 How ADHD Steals Your Self-Trust and How to Get It Back with Dr. Russell Ramsay

Summary

Podcast Summary: I Have ADHD Podcast – Episode 412

"How ADHD Steals Your Self-Trust and How to Get It Back"

Host: Kristen Carder
Guest: Dr. Russell Ramsay
Air Date: June 16, 2026

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Episode Overview

This episode features a conversation between host Kristen Carder and returning guest Dr. Russ Ramsay, a renowned psychologist specializing in adult ADHD and author of “Once I Get Started.” The central theme is self-trust in adults with ADHD: why it erodes, how it manifests, and practical strategies for rebuilding it. The discussion touches on ADHD’s pervasiveness in adult mental health, misconceptions about CBT for ADHD, the complicated relationship with self-trust, and actionable advice for fostering behavioral change and self-compassion.

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Key Discussion Points & Insights

1. Why Write “Once I Get Started”? (03:44–06:32)

• Dr. Ramsay explains the title: Procrastination and avoidance are core ADHD struggles. “Once I get started…” is a phrase he’s heard from clients for years. Tackling engagement is often the main hurdle.
  • Quote [05:17]: “I had the title before I had the book.” — Dr. Ramsay

2. The Evolution and Role of CBT for ADHD (08:40–14:35)

• Misconceptions in ADHD Circles: CBT has garnered criticism, e.g., for supposedly “masking” ADHD or failing to address core executive function struggles.
• Key Point: Traditional CBT must be modified for ADHD—executive functioning has to be explicitly addressed, not just mood or cognition.
  • Quote [10:08]: “…the power of the emotional, the power of the therapeutic alliance... the close proximity of emotions, feelings, and cognitions.” — Dr. Ramsay
• Needs of ADHDers: Unlike depression/anxiety, ADHDers often forget to implement strategies or don’t feel capable, even if they know what to do.
• Growing Recognition: ADHD is the second most common adult psychiatric diagnosis in the US ([13:12]), yet most clinicians lack proper training.

3. The ADHD Training Gap in Healthcare (14:35–20:20)

• Rage & Frustration: Kristen expresses anger at clinicians’ lack of ADHD training, which Dr. Ramsay attributes to a cycle: trainers weren’t trained either, and most programs never covered it.
  • Quote [14:35]: “Why don’t clinicians have copious amounts of training on adult ADHD? …It enrages me.” — Kristen Carder
• Hopeful Developments: Grassroots efforts and pending US guidelines may soon create more standardized training for clinicians.

4. Modifying CBT for ADHD (20:24–23:51)

• Approach: “Grandmother rules” (have a plan, schedule, start early) matter, but coaching clients on how to personalize and perform these strategies is crucial.
• Therapeutic alliance and normalization are integral: relapse (“failure” to stick with routines) is expected and should be destigmatized.
  • Quote [23:59]: “ADHD has a 100% relapse rate.” — Dr. Ramsay

5. Understanding & Rebuilding Self-Trust (28:31–39:44)

What is Self-Trust? (29:05)

• Definition: Self-trust is the belief in one’s own capacity to follow through—a mix of self-efficacy and “self-regulatory efficacy” (the willingness to persist through the tedious/hard parts).
  • Quote [29:05]: “…ADHD is like a relationship with yourself—the things you set out to do… it's that mistrust but turned inward.” — Dr. Ramsay

Why Do ADHDers Lose Self-Trust? (33:22)

• Self-mistrust grows from repeated failed attempts, procrastination, goal-setting without follow-through, and negative internal (and external) messaging.
• Persistent evidence bank of “failures”: ADHDers drag around a “ball and chain” of things they didn’t do, overshadowing successes.
  • Quote [33:22]: “…evidence of the times that we said we would do it, but we didn't do it…” — Kristen Carder

The Cost-Benefit Analysis Trap (37:15)

• ADHDers often “accurately negatively gauge” tasks, seeing the costs as predictable and benefits as uncertain—encouraging avoidance.
  • Quote [37:58]: “What’s the risk of doing it? But what's the risk of not doing it?” — Dr. Ramsay

How to Cultivate Self-Trust (39:44–45:59)

• You “do” your way into trust, not just “think” your way in:
  • Break large tasks into smaller steps.
  • Build evidence for things you do right—however small—even if it feels hard to acknowledge.
  • Accept that “relapse” (falling off routine) is not a personal failure: it’s normal for everyone.
  • Start with any self-acknowledgement, however basic; use motivational interviewing to meet yourself where you are.
  • Quote [40:35]: “You can't think yourself out of something you behaved yourself into.” — Dr. Ramsay quoting Stephen Covey

6. Personalizing Progress and Reframing Success (50:02–56:35)

• ADHDers personalize inconsistencies, making missed attempts mean “I can’t do it”; NT (neurotypical) folks see them as normal hiccups.

• Behavioral wins: Even modest improvements (from 20% to 60% follow-through) are immense but often dismissed as “still failing.”

• “Defectionism”: Failing to value one’s work/efforts, even when others see it as highly successful.

    [51:39] Dr. Ramsay: “That's part of the emotional regulation piece... With ADHD, it comes on quicker, it doesn't have the same rumble strips.”
    [54:07] Dr. Ramsay: “If we invented a medication that [increased success from 1/5 to 3/5], we're billionaires. But because it's behavioral, I’m still failing 40% of the time.”
  

7. The Influence of Childhood and Systems on Self-Trust (57:13–66:24)

• Family origin, school, and societal expectations shape foundational self-trust: ADHD often runs in families, influences parenting skill/practices, and is reinforced by academic grading and peer comparison.
• Repetitive criticism and unmet expectations feed the narrative of being “too much and not enough.”
  • Quote [62:48]: “How can we be too much and not enough at the same time?” — Kristen Carder

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Timestamps for Key Segments

| Segment | Timestamp (MM:SS) | |--------------------------------------------------------------------------------------|--------------------| | Intro & Purpose of Book / Naming “Once I Get Started” | 03:44–05:34 | | Why Now for ADHD Literature & the CBT Approach | 06:32–09:54 | | Challenges with CBT and Executive Functions | 09:54–13:12 | | ADHD as the #2 Adult Psychiatric Diagnosis; Lack of Training | 13:12–16:47 | | Modifying CBT for ADHD: “Grandmother rules,” relapse is normal | 20:24–23:59 | | What is Self-Trust? Defining the concept in ADHD | 29:05–33:22 | | Gathering “failure evidence”—the burden of self-mistrust | 33:22–35:48 | | Cost-benefit analysis and avoidance cycles | 37:15–39:34 | | Rebuilding self-trust: behavioral steps, reframing relapse, motivational interviewing| 39:44–45:59 | | Reframing missed attempts & celebrating improvement | 50:02–54:07 | | Childhood/family impact on self-trust | 57:13–66:24 | | Hope for the future; Closing thoughts | 66:29–70:35 |

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Notable Quotes & Memorable Moments

• On the Relapse Rate:
  “With ADHD, the relapse rate is 100%. I procrastinated three times this morning already.”
  — Dr. Ramsay [23:59]

• On Personalizing Setbacks:
  “We really personalize those inconsistencies and really make them mean: I didn't do it, I can't do it, I'm never going to do it.”
  — Kristen Carder [50:02]

• On Hope & Efficacy:
  “ADHD is one of the more serious diagnoses... but [treatments] are among the most effective we have. Once you understand it... it’s transformative.”
  — Dr. Ramsay [66:44]

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Advice & Strategies from Dr. Ramsay

• Reframe “failure” as normal and expected; don't let it define you.
• Break large goals into tiny actionable steps.
• Customize plans: What works for one person won't always work for another; leverage creativity.
• Acknowledge when you do follow through—track and revisit successes, however small.
• Use behavioral change (“do”), not just intellectualizing (“think”), to build self-trust.
• Employ motivational interviewing: Start where you are willing.
• Normalize inconsistency and strive for persistence, not perfection.
• Seek communities or professionals that understand ADHD's reality for support and guidance.

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Glimmers of Hope

• ADHD training for clinicians is (slowly) improving.
• Systematic guidelines are coming, enabling better identification and support.
• Societal understanding and self-advocacy within the ADHD community are rising.
• Individual transformation happens: “Once you understand it… it’s transformative” ([66:44]).

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Further Resources

• Dr. Ramsay’s book: Once I Get Started (Penguin Random House, Avery imprint)
  • Features: Letter to loved ones, portable coping glossary
• Kristen Carder’s coaching program: FOCUSED (ihaveadhd.com/focused)

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This episode provides actionable insight, validation, and hope for adults with ADHD struggling with self-trust. Dr. Ramsay’s blend of research, clinical experience, and humanity make it a valuable resource for anyone on the ADHD journey.

Transcript

[Podcast Host Kristen Carter]

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[Sponsor Voice]

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[Podcast Host Kristen Carter]

Welcome to the I have ADHD Podcast where it's all about education, encouragement and coaching for adults with adhd. I'm your host Kristen Carter and I have adhd.

Adhd.

Let's chat about the frustrations, humor and challenges of adulting relationships, working and achieving with this neurodevelopmental disorder. I'll help you understand your unique brain, unlock your potential and move from point A to point B.

Hey, what's up? This is Kristen Carter and you've tuned in to the I have ADHD podcast. I am medicated, caffeinated, regulated and ready to roll. I am so looking forward to today's episode. Get in here, get in here. Grab a snack. Grab Your water, do your multitasking, whatever it is that you do while you listen to podcasts. I love to multitask. I will never fold laundry without a podcast in my ear. And if you are the same, then you are in the right place. I'm so glad that you press play on this pod today. Today we have on the show three time guest. I'm so excited. Dr. Russ Ramsey, he is back to talk about his new book. And let me tell you, this is going to be. I say this a lot, but I truly do mean it. This is going to be an impactful conversation. You are going to absolutely love it. We are going to talk about his new book, but specifically we're going to be talking about self trust. Self trust through the lens of adhd. What does it look like? How do we develop it? Why don't we have it in the first place? And so that's where we're going today. Let me tell you a little bit about our guest. Dr. Ramsey is a psychologist specializing in the assessment and psychological treatment of adult adhd. He has lectured internationally and is widely, and I do mean widely published. He's written six books on adult adhd, including his most recent, Once I get started, that name, let me tell you,

[Sponsor Voice]

I just wrote a book and naming

[Podcast Host Kristen Carter]

a book is harder than naming a child. Do you agree?

[Dr. Russ Ramsey]

This one was easy. I can tell you why now if you want, or we can save it for later.

[Podcast Host Kristen Carter]

Save it. But like, it's the best name. It's such a good name that like captures me immediately once I get started. Okay. Dr. Ramsey is a Chad hall of Fame inductee and he is with us today. Russ, thanks for being here.

[Dr. Russ Ramsey]

Kristen, it's a pleasure and it's nice to do this face to face for once. Even voices on a podcast or things

[Podcast Host Kristen Carter]

like that, it's so different when it's over Zoom, you can connect, but it does feel more impersonal. And so I'm glad that you're here with me. We just chatted about the Phillies, the Eagles, the Flyers, the Philadelphia Union. You're a Philly born and bred.

[Dr. Russ Ramsey]

I live nearby here.

[Podcast Host Kristen Carter]

Yes. It's good for a couple years. So good. But do tell me, why was it easy to name the book once I

[Dr. Russ Ramsey]

get started in one of the things I see as one of the most common problems with adhd and no surprise, procrastination as well as escape avoidance, they're subtly different but it's sort of orbiting around tasks, getting ready to get ready, things like that. So very often it's Getting engaged. How do I face the thing I know I have to do? And for years I'd be telling clients, if I ever write a proper self help book, it's going to be entitled once I get Started. Now the dot dot dot didn't happen. But the publisher asked for a list of potential titles. I'm asking my wife, I'm asking my daughters, you know, just trying to think of things. And as an afterthought, I put that in there, saying I'm duty bound to add this because I've been telling my clients over the years, blah, blah, blah. And when the editor got back and they said that was far and away the most popular one. Looking at the editorial team. So I had the title before I had the book.

[Podcast Host Kristen Carter]

I love it and I'm jealous because it took me forever to name my book. But that's not, it's not about me. It's not about me. You've spent decades helping people with adhd. You've worked at Penn. You did work at Penn for years in the Adult ADHD center there, or you co founded it.

Yes.

Incredible.

[Dr. Russ Ramsey]

Tony Rothstein was the Zuckerberg on the team. But I stumbled in and I just said, yeah, sure. And here I am.

[Podcast Host Kristen Carter]

That's amazing.

[Dr. Russ Ramsey]

Many, many years later.

[Podcast Host Kristen Carter]

That's amazing. Why write this book now? Because you've written books, like different types of books. We were just talking about rethinking adhd, which or rethinking adult adhd, which I was saying to you, and I will say on air is one of the most impactful books for me with my work, with my clients, in my work, with my clients. It's just amazing. Manual for helping people with adhd. But why write this book now?

[Dr. Russ Ramsey]

You know what? Much like the ADHD program, like the line I use, I had as much business starting an ADHD program as I did joining the Blue Man Group. And you know what? Actually I use that line a lot. And I look back and said, we actually saw them one time when we were visiting. I have a selfie taken with each of the characters. So one of these days is going to be on a slide. But the previous book, the Adult ADHD and Anxiety Workbook, you know, somebody at har, I guess you start writing things and then people have ideas and they reach out. So there was an acquisitions editor there who said, hey, what do you think about something about ADHD and anxiety? And I wasn't thinking. It's certainly a common problem, the most common. But I hadn't thought about doing it, but it was an opportunity to do a workbook, a proper workbook. So I said, okay, let's do that. And even before that one came out again, I stumbled into things. I got contacted by agents and only later I'm hearing, everybody I know has an agent. I never did. So I was like, what am I doing wrong? And at first I went, yeah, right. Where do I enter my credit card number? Right, yeah. And yeah, the scam. But I looked into it, somebody I knew, and I'll give her a shout out. Amishi Ja. She was a Jha, a colleague at Penn. Hermind Peak Mind.

[Podcast Host Kristen Carter]

Yes.

That book is great.

[Dr. Russ Ramsey]

She's at the University of Miami now. See, I'm really good at promoting. So I figured, okay, these guys and they, they had worked on the publishing side, now they were on the agent side. And they said, adult ADHD seems like a hot topic. We had a conversation on Zoom, and I don't know if they got a word in edgewise, but they said, okay, let's find something. And how it shifted. And writing a book, the first draft or two, I was sort of demoralized because I had something in my mind. It was going to be this manifesto, but then it got guided more into a term I learned, prescriptive nonfiction. So a self help book, but it's really an overview apart from the introduction to what is adhd? What goes into a competent evaluation. But then it's into the CBT approach really. But CBT for adult ADHD for the masses, yes.

[Podcast Host Kristen Carter]

Okay.

[Dr. Russ Ramsey]

Call out to Depeche Mode Music for the masses if you need to cite your sources.

[Podcast Host Kristen Carter]

I wanted to ask you about CBT because, um, in ADHD circles, like in, in, in ADHD circles, sometimes CBT gets a bad rap.

Thank you.

Yes, and let's chat about that because I liked how in your book you said that it needs to be modified for, specifically for adhd. So can we talk about that a little bit? Because, you know, there, there have been things that have come out that's like, well, maybe CBT is not the best approach for people with adhd.

[Dr. Russ Ramsey]

Or maybe CBT is promoting. Masking is another claim that I've heard. So this is actually timely because I'm doing my 2026 slides coming up for talks and I have a slide specifically on this stuff. What are some of the ongoing misunderstandings? And I like the idea of radical ownership. Okay. I didn't do a good job. Enough job explaining it. Yeah, we have word counts and page counts with books, so you don't get to everything all the time. But that's like one thing I'm looking at correcting.

[Podcast Host Kristen Carter]

Okay, so talk about maybe where you. Not you, but like the collective. You like experts. Yeah. Maybe didn't get it quite right and where the shift needs to be.

[Dr. Russ Ramsey]

And even within cbt, there are some approaches I have for ADHD that sometimes get pushed back against the classic model. Now I think some of the leaders like Judy Beck and others. And Judy was nice enough to do an endorsement of the last couple books.

[Podcast Host Kristen Carter]

Nice.

[Dr. Russ Ramsey]

But the close proximity of emotions and feelings and sometimes. I'm sorry, emotions, feelings and cognitions. And that sometimes. And this is backed up by some neuroscience, like what are our cognitions? We're putting words on our emotions now. They're different, but they're very related. But all this going back to what I don't think got well explained early on. Mary Cilanto did a nice job because her cognitive behavioral therapy book explicitly talks about a focus on executive functions. But. And Steve Safran's does to a bit. But it didn't. It's not on the marquee. And so it's in there. But people, there's this thought that, oh, cbt, where do we go for executive functioning, coping? And I think that's been. I say this respectfully. I think that's where coaches have jumped in and it's been more associated with, with that. And just like there's not enough. Well, this is a larger thing. There's a lot of excellent CBT therapists, but. And there are very good manuals. But if you haven't had the felt experience, the clinical experience of sitting with somebody with adhd, now, I'm not going to. What I'm about to say is not easy, but it's a closer trip around the block. If you work with depression, then get trained in anxiety, you have psychotherapy or CBT for anxiety. There's a lot of overlap there. But the executive functions with ADHD and how the nature of the diagnosis gets in the way of the actual interventions. Yes, because somebody who's depressed can do an activity chart and maybe have a plan. Okay, I'm going to plan to do this, but maybe they don't do it because they're depressed. But the adult with ADHD wants to make the plan but forgets the plan or doesn't get around to making the plan. There's some other things that back in the day would have been interpreted as resistance or non compliance. Like probably the first psychosocial study on ADHD was 1992 and John Ratey was one of Them, but it was more like a case series. And they just said these were people not identified with adhd. So we did medications and some sort of coping support and they got better, whereas before it was, these are resistance, there's unconscious aggression and things like that. So. So that's one of the things. I don't think it was emphasized well enough, how the executive functions are part of the CBT approach. I think in the second edition of my CBT manual and the toolkit, which was its companion, it was more explicit there, but I think that's been a failing. And what I just said about there are very good manuals, but it's not like a recipe book where, okay, I can't cook, but I can add these ingredients. But you know, the following, the analogy, you gotta have some clinical experience, which that was another thing I've written more and more about how you know what, at least on data I can find, and this is persistent over time. Adult ADHD is the number two psychiatric diagnoses for adults in the U.S. i

[Podcast Host Kristen Carter]

have that on my list to talk about. So let's talk about it now. That is, I didn't know. Is that new information?

[Dr. Russ Ramsey]

Actually, you know what? I'll give him David Goodman in a presentation. He went Back to the 2004, 2005 National Comorbidity Study headed up by Ronald Kessor. That was the study where the 4.4% adult ADHD in the US came from. And at that time, depression was number one and anxiety number three. And David put that on a slide saying, this is number two. And it's like, it was like a dope slap. It's like, I know this data, but I never like sequence them in that way or look through everything. So with the most recent CDC study saying it was 6.0% in the past year within the US for adults, and that's the one where 50% were diagnosed in adulthood 18 or later for the first time. And 61% of those late identified were females. So I went back to other CDC data for the past year, and again, this time anxiety was like 12.5. Depression was 5 or 6, but again, ADHD was 6.0, I think. Yeah, depression was like 5.8 or so number two. But I didn't get trained in it in my graduate program medical school. Still, it's not a core feature.

[Podcast Host Kristen Carter]

Why, I'm sorry, as someone with ADHD who supports people all over the world with adhd, who talks to people face to face on the podcast, but also just like over zoom in real Life. It enrages me. It enrages me. Why don't clinicians have copious amounts of training on adult adhd? What's the answer?

[Dr. Russ Ramsey]

Well, that I don't know, but it might be the trainers weren't trained in it. And another thing, and this also gets back to somebody with ADHD and why they might procrastinate on something we don't like feeling dumb.

[Sponsor Voice]

Yeah.

[Dr. Russ Ramsey]

So sometimes it's a knowledge or a skill base that's getting in the way of getting started. Okay, I know they said use an Excel sheet and I did, but I'm not. I don't feel comfortable with Excel. So I'll get around to checking it out or whatever, getting better at it or sometimes with certain things of technology. I know I should upgrade my phone, but the last time I did that, I lost this. And just these things get in the way, but also at the higher order. Now I think some of that is starting to change. And I think with the forthcoming U.S. guidelines, and I don't think she'd mind this because I think it's going live. I did a blog on this, this very topic. And Kate Nadeau, Kathleen Nadeau, a leader, and she's every one of her books is something along the life cycle. So from Cradle to Grave, Kate Nadeau has had an excellent book on it. And it's a little humble bragging, but she responded saying, hey, I read this blog and now I'm going to start a nonprofit for the actual training. And I think she's just announcing a conference, sort of like a kickoff conference for training clinicians. Well, it's for training clinicians. Now, I haven't looked that closely at it, but it is, I think it will be. So the wheels are turning. Hopefully the wheels are turning. And with the guidelines, hopefully that will spur one. Well, I'm also part of a group that will probably collaborate in some ways. It's juggling a couple different organizations working with the same ends, but not just having the guidelines out there, but how do we disseminate them and have training in these factors. So I think 2026, 2027 might be the years of ADHD. Finally, adult ADHD.

[Podcast Host Kristen Carter]

Fantastic. That's so good to hear.

[Dr. Russ Ramsey]

Well, I likened it to imagine going to your family doctor and not only do they say, I don't specialize in a number two diagnosis and diabetes, it may not be it, but it's close. But we didn't cover that in med school, so I can't even tell you if you have it or not.

[Podcast Host Kristen Carter]

Again, full of rage. I'm so angry, it's enraging. And when I talked to Ari, the esteemed Ari Tuckman, friend of the pod, agreed. His number one thing is most clinicians aren't even looking for it, like, because they just don't understand it. They don't know it. Like, he, When I, When I, you know, kind of prompt him with questions like, what. What can we say to clinicians? He's like, just look for it. Like, you need to be looking for ADHD.

[Sponsor Voice]

And like, as a child of the

[Podcast Host Kristen Carter]

90s, no duh, right? Like, no freaking duh. Like, why aren't we looking for it? It's just, again, in my position as someone who has struggled with adhd and I do feel like I'm. No, I don't feel like I am thriving now, but that took decades. And when I was diagnosed, it was just like, yep, you struggle with focus and attention. Here's some pills. And the pills helped, so I'm grateful for that, but I didn't learn anything about it. And so just the lack of education around it from the top down is just like, I am so looking forward to that changing. So looking forward.

[Dr. Russ Ramsey]

You know what the. You know, it's an overly glib line, but it says something like, in the field of behavioral health, psychological treatment, depression and anxiety are considered the common cold. Even if you're not going to specialize it or even treat it in your training, you're going to get like, how do we screen it? What are the scales we use? What does it look like? Who do you refer to? If. If you're living, if you're working in a rural area and you're the only psychologist there, you could probably do a well enough job in it. So you're going to get exposed to it. Just like the family doctor who doesn't go into obstetrics, they can deliver the baby in a cab or something like that if need be. So I think it's getting it in there. The. And again, I didn't get any. So it is having it be a module. It doesn't have to be the only one. But, you know, you go to your family doctor, you're. You're going to get a depression screen. It's going to be the World Health Organization phq9. You'll get a couple questions about depression and if you answer no to them, they'll move on. There's a screening. You'll probably be asked, do you feel safe in your household?

[Podcast Host Kristen Carter]

Yes, I was asked that a couple months ago when I went for My,

[Dr. Russ Ramsey]

we have a World Health Organization adult symptom rating, Adult ADHD symptom rating scale. Six items are as reliable a screen as the, the full 18 items. Now it is a screener. So it casts a wide net to catch all the people and who should then be evaluated. Who should then be evaluated. Somebody comes in, they go, well, no, you have a couple of these symptoms but you don't have adhd. So we're willing to. And usually those people won't. They'll say, ah, this, it's not that bad. I don't go in. There was another study within the past couple years, 50% of adults in ADHD, at least that sample thought they might have ADHD. Now with all of it out there, I'm sure there are people going, I wonder if that's me. And I hear that all the time. I think I might have this or I should get evaluated. But probably after they get through a time or they see overall it's like, no, I'm generally on top of things. That was a bad stretch.

[Podcast Host Kristen Carter]

Right, Right. So, okay, let's circle back because that's

[Dr. Russ Ramsey]

all the time we have for today.

[Podcast Host Kristen Carter]

And let's close in prayer. Let's circle back to how is CBT specifically modified for adhd?

[Dr. Russ Ramsey]

It's, it's the inclusion of the executive functions. There's no trade secrets about what works. So it is the.

[Podcast Host Kristen Carter]

So I just.

[Dr. Russ Ramsey]

Ari quotes me on this. He calls, I talk about the grandmother rules. It's the things our grandmothers would tell us. Have a plan, keep a schedule, get started early. They weren't wrong. Right. But it's just reminding somebody to do that. It's not going to be enough. It's going to be that performative. How are you going to do it? What works for you? For some people it might be a planner that's personalized, but other people, and this is where the creativity of clients comes out. It's like they'll come up with something and it's like, that's brilliant.

[Sponsor Voice]

Yeah.

[Dr. Russ Ramsey]

And I will take that and use it as my own in my next book. And like kidding aside, it is that. And it's also the patience and understanding. And I think this is why. And this gets short shrift in CBT in general, but the power of the emotional, the power of the therapeutic alliance, sitting across from somebody who gets it, who understands it, makes sense why this is hard. It'll take it. And slip ups are par for the course. The relapse rate is 100%. I'll say. I procrastinated three times this morning already. It will happen. So it's not whether it happens, it's how do you bounce back or salvage a day or get back to it a day later. There's a lot of different ways to do things well, but even going back to the training, there was a study out of the uk where the National Health Service cognitive behavioral therapy is the recommended psychological treatment of choice. And so there was a sample of 40 some adults who went through a manualized course. I'm assuming I'd have to look back again. Steve Safrans and the Harvard groups, Mastering your adult adhd, which is excellent, great randomized control design, everything. One of the foundations for it being an evidence supported treatment. And they did questionnaires and interviews with a handful of people and the results were awful. People saying it went too fast. It didn't seem like the therapist knew about ADHD or cared. Things like that. If this is the best treatment for adhd, what now? For me, the hopelessness. Now, there was one person who was interviewed who said, my therapist understood ADHD and described the effects as transformative. I was able to recognize how my brain works rather than trying to fit it into the world. So I think, and I raised my hand to say I could have easily been one of the therapists who followed the manual, follow the cookbook, but it's almost like there's a dietary sensitivity with adhd. If I want to extend the analogy where you can't just use these ingredients, might have to modify it or whatnot, or check for sensitivities. But I would have been that, because I wouldn't. I did a postdoctoral fellowship at the center for Cognitive Therapy that, you know, Dr. Beck started and Judy was there, and they started their Beck Institute before ADHD was even on my radar screen. So.

[Podcast Host Kristen Carter]

So what you're saying can easily be

[Dr. Russ Ramsey]

done, but so it goes back to the training, having the clinical experience, the clinician.

[Podcast Host Kristen Carter]

It goes back to the clinician truly understanding adhd, maybe even to the extent that they can. The felt experience of ADHD, what it feels like for someone to have ADHD.

[Dr. Russ Ramsey]

Dr. Beck in general called it the accurate empathy. Yeah, let's get it. Try to see the world through the client's eyes. That's good. Yeah.

[Podcast Host Kristen Carter]

You've said this on the podcast before and you just said it now, so I want to zoom in on it. ADHD has a 100% relapse rate.

[Dr. Russ Ramsey]

Right. I thought you said, Russ, you're running out of material. Well, what it means to be highlighted, that could be said of Anything like feeling sad, feeling anxious, even if it's not an anxiety disorder in a way, if we think about it, including the sometimes called negative, I like to call them the unpleasant emotions or like being able to feel pain. That is adaptive because pain signals allow us to take care of ourself and ease up anxiety. There's a dose of that. That is motivation. I want to be ready for the exam, so I better study a little bit and that'll make me less anxious. But we will slip up. We'll wait for the last minute. But with ADHD and the executive functions especially. So I think because they are. We talk about ADHD as a performance problem, not a knowledge problem, and how it can get in the way of. Not that we're defined by our gpa, our degree, our occupation, any of those things, but the endeavors that we choose for ourself are not nothing. We want to give an honest try. Including that means, okay, I tried out for the football team, didn't make it. I guess it wasn't meant to be, or I never got the lead in the play or whatever, or I want

[Podcast Host Kristen Carter]

to work harder, then I want to, like, I need to train harder and I want to, like, go for it.

[Dr. Russ Ramsey]

And there can be a reasonable, you know, part of that, okay, I'll get a coach. I'll take acting classes. But sometimes we run through stuff and say, okay, this is as far as I got, and at least I was able to see it through and find out. But the line I use a lot, ADHD punctuates so many things like, okay, I was doing well through midterms, but then I skipped some classes. I had a couple zeros, then I had to drop the class, and now I have to take the whole class over again. And that's how it can start interrupting or in some cases, ending any sort of structured education. So that's where being mindful, normalizing. And I think I did this. I emphasize this even more in the more recent book, Normalization is a Good Reframe, that even though ADHD is a little different, there's divergence, but nobody's going to feel like doing homework. Nobody feels like doing taxes. Yeah, it's not like, oh, I'm going to practice taxes in September just to be ready for spring, like spring training for baseball players or something like that. So it's a degree. It may be more difficult for somebody with adhd, but it's not unheard of. And even that sort of perspective, it can help a little bit, but sometimes a little bit's all we need to get engaged. Because once I get started, it's not as bad as I thought it would be, or I'm actually doing a little better than I thought I would.

[Podcast Host Kristen Carter]

This wasn't. I do feel that with myself, with my clients is like, the getting started is the hardest part. And once the train has left the station, it's like, okay, like, I can keep this going for. Maybe not forever, but for a little while. It's just getting the train to, like, engage and leave the station that's like.

[Dr. Russ Ramsey]

And this is part of the working memory issue, being able to imagine ourselves a little bit in the future doing it, because we can imagine 83 different awful scenarios. I'm going to be just staring at the page. I'm going to be stuck. I'm going to have writer's block. All these things which are statistically possible. I always tell clients. But if we're able to get into it, like, okay, let me reread the paragraph I wrote last time. Let me at least write a hundred words or ten words. Let me open up the document. Let me open up the page, the book, to the chapter I'm supposed to read. Let me go to my work or study station, the thing I share with a lot of clients. If I can get to the coffee shop on Saturday morning and get my coffee. That routine is behavioral priming. Because location and movement and things like that and the externalization of information and motivation, reminding ourself. Okay, why am I doing this? The valuation of a task. I call it just like I said, it's like swing votes in Congress, 51, 49. I'm not all in, but I'm willing to give it a try. And then we get to. And then face that one reality. And usually it's better than we anticipate it will be. Not always, but then that becomes the next task. Okay, I need help with this. Who can I go to for help?

[Podcast Host Kristen Carter]

Okay, let's shift a little bit into self trust. So I loved your chapter on self trust. I know that Rethinking Adult ADHD also talked about self trust. I see in my clients this as one of the primary barriers to taking action, moving forward. Having healthy relationships, all of the things, is just a immense lack of self trust. I'm curious if you could define it for us and, like, why don't we have it right?

[Dr. Russ Ramsey]

Self trust, it draws on. And this is where I go into a deep dive in the rethinking book. Albert Bandura's notion of self efficacy, the belief in our ability to do things and that's sort of like at like a Google Satellite level. Okay, I can do class, I can go to the gym, I could walk, I could. The things that we do. But in reading some of his work. And I started the book not really knowing what the I was thinking about what's the core theme of adhd. So nothing like the pressure of writing a book to figure it out. But I had some sense and efficacy was on the roadmap. But it seems so general because somebody who's depressed goes, I don't think I can do this. Now I know I have done it, but I don't think I will do it. But it's more with the mood. But I ran across what's called self regulatory efficacy. And since then I've actually ran across a couple of studies from the last couple of years. Not specific to adhd, but. But looking at students and procrastination where that is the key factor, that is the protective factor from procrastination. So it's not an ADHD sample, but at least that verifies the idea to a bit, maybe more non ADHD self mistrust. So the self regulatory efficacy is are you willing to put through the tedious, just the work, the yucky parts, lack of a better phrase. And they may not be huge, but sometimes it's enough like writing or other things that we know we can do, but they're difficult. And so that crystallized for me something I talked about in the first book when I was looking at the self. I'm sorry, the mistrust schema in cognitive therapy. So there's the automatic thoughts. What thought went through your mind when Kristen invited you to do this? Or when they said camera go. It's like, oh my gosh, do I have anything to say? But that might come from a deeper like themes along that line that could be isolated, but it might come from themes like emotional deprivation. Didn't get a lot of affection, so you might like glom onto it when it's there or not expect it, or maybe doubt people if they express that they like you and that they're friends. But mistrust was basically you've been harmed by others and so it interferes moving forward. It might have been an abusive relationship, it might have been abandonment, whatever, but you don't trust others. I was thinking like ADHD is like a relationship with yourself, the things that you set out to do. And that's where I coined like the self mistrust. It's like, it's that mistrust but turned Inward, Yes. And then the self regulatory efficacy added to it. So it is this. You know what, it gets back to the ADHD definition, I think first put forth by Russ Barkley. You know what to do, but you have a hard time doing it. Now that's from the executive functioning standpoint. But that can easily morph into this ongoing mindset, which why do we have these things just like we have with the emotions trying to predict what's going to work, what's dangerous, where do I want to go, what do I want to stay away from? And we have some core four ones that we're born with. But we also learn a whole lot in our life experiences and these can be great experiences. If you work hard, you get ahead and you can at least pass. But there can also be messages or lessons and actual messaging we hear that can lead to maybe I can't. And all of a sudden the swing vote is, all right, now it's 51, 49, I'll do it later or not now or one of these days or I'll get back to it. Which can morph into, like you said, it could be school tasks, it could be relationships, it couldn't, you know, another, you know, thing I've, I'm glad I pointed out more and added to the model is the social interpersonal side, like advocating for yourself. So it's, you know, it can get in the way of saying the things you want to say to your partner. You don't say it, but then there's distance and drift and all those. Now relationships can go sideways a lot of ways, but in terms of adhd, the mistrust is knowing you can do it but not believing you can in the moment or some. There's some difficult steps in the moment that you don't want to risk the pain that can come from them.

[Podcast Host Kristen Carter]

And we drag around this ball and chain of all of the evidence of the times that we said we would do it, but we didn't do it. Yeah, the times that we set a goal but we didn't reach it. The times that we, you know, had the opportunity but procrastinated our way out of utilizing the opportunity.

[Dr. Russ Ramsey]

So I did it, but I almost didn't. Yes, I talk about the client who she was working on being on time and she got up there on time. It was a work issue, a performance improvement plan. And she was there a couple minutes early. And I said, hey, you know what? I just want to point out you're on time, but I was almost late. Don't hold me to it, don't expect this tomorrow. Which is again, it could be something like, I got lucky, I hit all green lights, there's no school buses, whatever. Okay, but you're still on time. Now, those other factors are important, but this goes back to what you're saying. One of the questions if you're evaluating thoughts in cognitive therapy is what is the evidence for that thought? The student who never got a grade below an A but got a C and is worried about like college, their first college class, oh, I don't belong in college. What evidence do you have? I got a C. Have you ever gotten a C before? Have you ever failed or whatever. So those are data, but what are we going to do about it? But the student with adhd, I'm going to fail this course. What evidence do you have? This is the second exam I failed and there's only three exams. It's possible and I have failed before. But this also gets back to getting adequate support and treatment for adhd because a lot of times people are going back and I'm just going to study harder the way I was studying or not study or whatever it was. And there's not the modification to make it more ADHD aligned. And there's only so many ways you can study, but at least doing something different that somebody believes or trusts more or, and sometimes it is more time, it can be harder. But most people, people sometimes the claim about anybody with adhd, oh, they're looking for an easy way out. But these are the people staying late at the office, working on weekends, sacrificing personal time, which can be the impairment. I'm doing okay at work, but at the cost of my family or my kids or whatever the case may be. So even somebody who's putting it together and that could be sort of the masking that people talk about. But usually people are saying, I just want to know if I have to put double time into this, that it will pass, that it will be sufficient.

[Podcast Host Kristen Carter]

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[Podcast Host Kristen Carter]

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[Dr. Russ Ramsey]

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[Podcast Host Kristen Carter]

It's that cost benefit analysis that we're constantly running in our brain, whether we realize it or not. And so often we can't accurately gauge or we are actually accurately negatively gauging the cost benefit analysis because it's like, I know what it's going to cost me and I can't even guarantee a positive result. So is it even worth it? And that's like, maybe I'll just avoid it. Maybe I'll procrastinate, maybe I'll wait till the weather's perfect. Or like the everything is perfect so I can just do it then, which that obviously never happens. But that cost benefit analysis plus the ball and chain that we're dragging around is like, it is just debilitating.

[Dr. Russ Ramsey]

I've heard a nice little twist on the the risk reward or the cost benefit or it's the risk risk. What's the risk of doing it? But what's the risk of not doing it? What could you lose out of that? Now it's just a reframe and it's not magic, but it's sort of like, well, why do I want to do this? Which is. That's a valuation question. That's a values question. Like, and it's important what's in it for me to do this or my relationship or anything else? And it's like, what do I want to achieve? Because that's so easily wiped away by not doing it. And that's the part of okay, and I use the word decidedly, are you willing to invest some of this comfort? It's an investment just like putting into a retirement fund. I'd rather have those hundred dollars but if I can get more later from it. And once it's gone, meaning once it's invested, it's taken out of the paycheck or something like that, okay, now I can adapt to not having it. And so it's, you know, it's that finding out, okay, maybe I can do more than I thought I could. Or. And sometimes it's okay, school was really hard. And adult life is harder in some ways. Not, not any competition, but there's no end of the school year in adulthood or parenthood or things like that. But it can be. It's like, oh, this is a little different. Or like even a work place, you know, work in large measures, pass, fail, you know, do you get it done well enough on time? And that's. That's all it's called for. But there can be. Yeah, but what if. Yes, but, you know, thoughts inside.

[Podcast Host Kristen Carter]

So how does someone with ADHD who has a significant lack of self trust, or as you call it, like the presence of self mistrust.

[Dr. Russ Ramsey]

Right.

[Podcast Host Kristen Carter]

How do they begin to develop this, like, what. Lay out for us kind of the steps of developing self trust.

[Dr. Russ Ramsey]

This is one of these things where. What's the line Stephen Covey used? You can't think yourself out of something you behaved yourself into. Now, that's a little all or nothing, but it's like one of these. It works like 85%.

[Podcast Host Kristen Carter]

Can we just pause and say, I'm so jealous of the way that your brain retains statistics, research, authors, quotes.

[Dr. Russ Ramsey]

If I could just like 8090s music.

[Podcast Host Kristen Carter]

I want to grab it out of there and like, have it in here.

[Dr. Russ Ramsey]

I tell people my main career should have been a game show host. Game show contestant. Like what? Remote control on the old mtv? Yeah.

[Podcast Host Kristen Carter]

So anyway, okay, take. Walk me through that Stephen Covey quote because I want you to repeat it for me.

[Dr. Russ Ramsey]

Think yourself out of something you behaved yourself into as that idea of, well, and it's a little all or nothing, but what it means is, yes, we want to reframe ADHD and understand and see it through that lens. And another, I think pretty much every book I've written, I cite this one because the quote captures the mindset. You mean I'm not stupid, lazy, or crazy? That is why that book still resonates. A great book too, but that was like, I think around the same time as Driven to Distraction. They put adult ADHD back on the map. But Adult ADHD on the Map. And it's a great title because that just, you know what people say? They probably say to you sometimes. Are you in my head right now? Because that's exactly what I'm thinking. But this gets back to, we build confidence, we build trust by the doing and finding ways that work for us to do it. And like many things, ADHD with, we all have executive functions, ADHD or not, it's part of our human factory settings. It's just that ADHD is clumsy wording, but let's just say at the diagnosed end of the tail where it's the consistent inconsistency, whatever we want to call it, it's not all or nothing, but it's that maddening variability. I know I can do it, but I can't trust I will do it. So it comes to the relationship with yourself. And that's also a line used with self compassion. Yes, that's what self compassion is. It isn't a get out of jail free card. It's just like, you know what, you were closer. You were on time today by two minutes. Yes. But now let's maybe take a road that doesn't have traffic lights. So you don't have to worry about that next time. Like that one client and it's really working with somebody about, what do you want to do? Why is this important to you? What's your buy in? And I know sometimes it's just I just want to pass the class, which is sufficient. But then it is, which is what intact working memory does. The fancy phrase is event segmentation and sequencing, which is what our grandmother would say, break a large task down into small steps. What is it you want to do? What are the first couple steps that can get you engaged? And we don't want to come up with a whole list. You know, I remember back in the day it was the APA monitor, it was the magazine of the American Psychological association. And there was an advertisement for some executive functions test. And it had like the 58 steps of making a peanut butter and jelly sandwich, which we would be starving if we go, oh, I have to do all those. But if we start with a sequence and there's some logical thing, which is also how we as a species learn things being taught. Or by first this, then that, and we then can chunk them together better. Or have reminders like packing lists for trips for people who say, I hate packing. Okay, here are the items. Check, check, check, check, check. Right.

[Podcast Host Kristen Carter]

Make the list once.

[Sponsor Voice]

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[Podcast Host Kristen Carter]

And then use it every time you travel.

[Dr. Russ Ramsey]

So going back to like, what is it you're not doing or what? Yeah, they're procrastinating on and let's figure out why. But how can we repurpose this, refashion this to make it more workable for you and also just any or things you want to try for the first time or you say, I never finished that class, I wonder if I can go back and get my degree. Or things that you say, I always wanted to try this but I didn't think I could. So there's a lot of. But it is the. There's nothing like the personal felt experience of getting it where somebody goes, I was able to get started and I wrote 100 words. I didn't think I was going to, but I was like, okay, I stuck with it and I actually got going. Getting through to that other side, I

[Podcast Host Kristen Carter]

think to add to that. And I'm curious what you think about this. What I notice with my clients is that they have this idea of I can't trust myself. I'm not going to trust myself until I prove to myself. Right. Like, I'll trust myself when I X, Y, Z. Right. And so we're sitting. It's kind of like perfectionism, kind of

[Dr. Russ Ramsey]

I'm going to go to the gym after I get in shape, after I lose weight, right?

[Podcast Host Kristen Carter]

Exactly. That's exactly it. And I keep trying to say like, sure, it's going to be a lot easier to trust yourself when you are able to persistently do things. I don't use the word consistent or I really try not to when you're persistently doing things, sure, that's going to. That self trust will be available to you then. But how can we start now and, and, and begin the pro. Because like, how are you going to get it done if you don't trust yourself at all? So what I try to do, and I'm curious what you think is say you got yourself this far, like, what have you done Right, let's build the evidence bank because we've got a shit ton of evidence for all of the things we've done wrong. What is the evidence for like what you've done right? Like, what are the things? How have you taken care of yourself up to this point? And let me tell you, people are like, nothing. I haven't done anything. I'm like, okay, well you're existing as a human in the world. Like you're alive. You've kept. It's so interesting how resistant people are to naming the things that they've actually done well up to this point. And I'm wondering like what your thoughts are about that.

[Dr. Russ Ramsey]

I'm just riffing on this One, but I mean, that's part of what, you know, self monitoring is what executive functions allow us to do too. Now that can be tracking over time. How am I doing? Is this far enough? Should I stop here? Should I keep going, you know, things down to have I drank any water today? Or, you know, oh, fill up the car with gas, those sorts of. It's also, you know, environmental monitoring. But you know what, but that's, that, that is the power of avoidance. Well, because I've said it's the most addictive drug known to man, with all apologies to the, you know, all the crises out there with, you know, different medications, but because it works immediately.

[Podcast Host Kristen Carter]

Avoidance, avoidance.

[Dr. Russ Ramsey]

I know I should do this. I'll do it later. I'll let my future self worry about that relief. Yeah, but I don't have to do it now. But it's, it's underestimating and like you said with perfectionism, I'll do it later when I'm invariably more in the mood, more ready, whatever, to do it. And if we do, that's fine. And some people do it that way. But a lot of times it's like, well, no, some of this is so deep seated or just so repetitive that it's the same task. And it's like we haven't built up any more trust magically or even given ourselves credit for things we have done already. So it really is, you know, part of this one is finding what somebody's willing to do. And it does draw on. And Margaret Sibley, one of my favorite people in the ADHD universe, is trained in this, an expert in this, and talks about it in addition to her 834 other talents and research studies and things like that. But motivational interviewing, and part of that, the idea behind it is starting where the person is, okay, I'm not motivated to stop smoking. Okay. But you know, could it be important for another reason? Like what would be in it? In what ways would your life be better? And what, you know, how do you understand, you know, you understand the risks, but are there some things like even getting up a flight of stairs? So it's really being able to engage with and not having skin in the game? Not like, no, by the end of this hour, you must commit to stopping smoking. It's allowing somebody, even if they decide after that discussion to go, I'm still not ready to do it. Okay, we can keep talking about it if you like, or we're here when you're ready. But generally it's, you know, I'll run through there's pre contemplation. That is, somebody's maybe considering change or it's been suggested by somebody else. Then there's contemplation. Maybe you go, all right, maybe I could, you know, make some sort of change and try to do it. But maybe, like, so it doesn't hurt. Yeah, I won't start smoking till an hour later or something. Like, I don't know, I'm a lifetime non smoker, so I don't know. Well, but it is actually where motivational interviewing got its foundation. It was changing addictive behaviors, including smoking nicotine, as well as following healthcare recommendations, doing all the PT exercises that we know will help. So there's pre contemplation, then there's contemplation, then there's preparation. You're actually trying to start making some changes, but, okay, I'll only smoke on weekends or something like that. And then there's action. Okay, buying in. I'm going to do the patch. I'm going to do the. Again, lifetime smoker. I don't even know what they might say that's like bloodletting these days. But anyway, it's making a good faith effort to actually modify what you're doing. But. And then, Then action. Then it's maintenance or. But people will. We will all cycle through these changes. It could be like exercising or whatever. We might go back to. Oh, yeah, the gym was closed for a week because they were redoing it and I haven't gotten back for six months. Right. So we might have to start over again sometimes or go back a step or two.

[Podcast Host Kristen Carter]

And I think what people with ADHD do is say, I knew I. I knew I'd fail. I knew I wouldn't do. I knew I wouldn't be consistent. Instead of like, oh, yeah, this is just a normal process that we all go through. And it's actually not that big of a deal. Like, we really personalize those inconsistencies and really make them mean. Like, I didn't do it, I can't do it. I'm never going to do it.

[Dr. Russ Ramsey]

Right.

[Podcast Host Kristen Carter]

Instead of just like, no, this is just.

[Sponsor Voice]

Every human does this.

[Podcast Host Kristen Carter]

Every human has to deal with this. Every human has to. My husband is so neurotypical. You all know that we're on episode 400 and something. You all know how neurotypical my husband is. And even he is like, I'm off the wagon at the gym and I have to get back on. But he doesn't make it a personal failure. There's not all this drama about I wasn't consistent, and now I'm just never gonna be able to do it. I just knew I wouldn't do it. I don't know why I bothered. Try. Like, that's what we do with 83

[Dr. Russ Ramsey]

days in a row at the gym. This is the one that defines, right?

[Podcast Host Kristen Carter]

Exactly. He does not. He's just like, ugh, I haven't gone in two weeks. I need to get back on. He's so good and I love him so much.

[Dr. Russ Ramsey]

But you know what I'm saying?

[Podcast Host Kristen Carter]

Like, I'm just saying, as someone who's neurodivergent, I would never do what an app tells me to do. But he's just like, oh, here's the next. And I'm just gonna do it. Okay. Anyway, he follows his app, he does what it says, and he's like, that was hard. I'm glad I did it. And then he goes. The next day, it's just like. And he's constantly falling off the wagon, but never making it mean something bad about himself. And that's what I'm jealous of.

[Dr. Russ Ramsey]

Right. I think that's part of the emotional regulation piece. Because, you know, when we talk about emotional regulation with adhd, it's not the mood or anxiety disorders. Like, the mood states, the more persistent. Now they can be there and often are, but it's the same emotional hiccups during the day or frustrations that anybody has. Yeah, but it's, you know, you know, Barclay talked about the deficient emotional self regulation. It comes on quicker. It doesn't have the same, like, what do they call it on the highway? Rumble strips, where it gives you. There's not those same rumble strips, like, okay, don't overreact. And then there's also, you know, no stoplight or anything, or brakes where it just has the roll to a stop way too long, as opposed to, okay, this is one day, the gym's closed. I can't redo today, I'll go tomorrow. And these sorts of things. One, that it may be taken more personally as a failure and also sort of like what you're saying before, it makes it harder to get back to it because of that really hurt before. And it's easier not to do it and not fail than to, you know. And again, it puts it in the fail category. So it is insidious. But that's the nature. That's that experience of adhd, those failure experiences, and then building up the mistrust. No, it's insidious. And because it gets in the way of things, we want to do. The analogy I use with that is normalizing, that we all slip up, you know, where all our executive functions are imperfect, even the person at the other end of the curve who's annoyingly organized and on time and all those things. But I say, let's just say you're. You do what you want for one out of five times, you only follow through 20%. And we get that up to three out of five times. 60%. Yeah. 200% increase. If we invented a medication that did that, we're billionaires. But because it's behavioral, I'm still failing 40% of the time. That's unacceptable. And even I'm sure we can come up with a better reframe and maybe that could be a title for. A title for none of the other books. Something the opposite of. I think there's a lot of things like failing forward or things like that. I think they said in Silicon Valley, there's the failure narratives. Oh, yeah, I started this company, blah, blah, blah, and whatever happened and lost all this money, and now I'm worth $800 billion.

[Podcast Host Kristen Carter]

Darn.

[Sponsor Voice]

Yeah.

[Dr. Russ Ramsey]

What hardship. But, but, but, but. Kidding aside. But sometimes people coming through the other side or, you know, clients with ADHD that. I've seen it where, you know, some small things, some self advocacy, that trust of being able to say, well, I can at least say this. I can't control how it goes over. But usually people say I felt better having said it, or at least I gave it a try. And then a good number of times it's like, okay, let's build on that. And then it turns into, oh, not only am I not getting fired, people are coming to me asking how I do one of the terms. I just came up with it with the writing of the once I get started book defectionism. It was like the same week, and there are these two clients I was working with, and each of them had some sort of professional work assignment. A writing. And another was a presentation. And they were both sure it was awful. They were just doing it. I just got to submit this chapter, or I just got to have enough slides that I can get through this and not show up. And then they came back and the one person said, not only did they accept the chapter, it is the keystone of the presentation, the work. And the other person came up and said, you know what? It went really well. And people came up to me, I want to work with you. How do you do what you did? Now these are people who say, this is not worthy, almost not Doing it. So it's that other side, how virulent that failure and the mistrust belief can be. It's like, there's no way. And it wasn't like, it's okay, yeah, it belongs and I'll get through it. Oh, it went better than I thought. It was like, no, I feel embarrassed showing this, but I have to because I can't not submit something.

[Podcast Host Kristen Carter]

And how often do we not even submit it?

[Dr. Russ Ramsey]

Well, yeah, people who are not working

[Podcast Host Kristen Carter]

with you, who don't have that support, then say, no, you're submitting it.

[Dr. Russ Ramsey]

Oh, it was no good.

[Podcast Host Kristen Carter]

Right?

[Dr. Russ Ramsey]

Nobody wouldn't have done anything.

[Podcast Host Kristen Carter]

I hear that all the time. And I, I try to really get that across to my people. Is like your, you know, C quote, unquote, C level work is like, you're not accurately assessing this work. Like to you it's like, oh, this is like C minus work. But to others, like, this is not. That is not what it is. We don't accurately assess the work that we do so often or we don't

[Dr. Russ Ramsey]

look at the context or like a kid in Ivy League school or let's just say an Ivy League professor to go, oh, this was an average paper, but it's sort of like, you know, if it was a sports hall of fame. Oh yeah, you're an average hall of famer, right? You're not Babe Ruth or something like that. But yeah, you're still hall of fame. It's like, yeah, I have a final

[Podcast Host Kristen Carter]

question for you and it is based on relationships because that is really what I am like so interested in. And what I've been studying is that in families and like early relationships are where the self is built. That's where like the self is created.

[Sponsor Voice]

And I wonder what you think how

[Podcast Host Kristen Carter]

much of our self mistrust is from growing up in families that were either dysfunctional, emotionally immature, lots of mental health issues, ADHD and. Or just really like not understanding the kid that they had. Because so few of us, so few people with ADHD are diagnosed as kids.

[Dr. Russ Ramsey]

Right.

[Podcast Host Kristen Carter]

How much of our self mistrust is not from our own failures necessarily? Although that certainly compounded it. But like, is that something that's built in childhood? Because like, I will like, parenthetical statement here. I feel like it is, I feel like so much of our lack of self trust is from growing up in these types of families. But I'd like to hear your expert opinion on that.

[Dr. Russ Ramsey]

It's an interesting question. I mean, there are children diagnosed with ADHD who then it persists into adulthood. It's a reciprocal feedback loop because ADHD can make good parenting skills difficult and not work and can lead to more discord between the parents. And if we think about the heritability rates, probably at least one of the parents has at least features of adhd. So there's a lot going on. So certainly. And you know what, there's actually at least one qualitative study looking at kids of parents with ADHD and their memories like once they're adults about being left at the store or something like that. And just the. Or what it was like around the house. Well, I couldn't bring friends over because this, that and the other thing. So it is a two way direction. So you know, it's not me sidestepping it. So I think that is part of it. That is our first laboratory for how the world works. The rules for life. And again, there can be positives even mixed in with the difficulties. So that is a big area, I think. But. And there are rules there and you know, getting ready, are you ready for dinner? All these things. But really academics are really the first time we really have a tracking and a literal grading system and behavior system and somebody outside the house looking at it. So one, it's within the family of origin household and there can be adoptions and more complex family systems. That's an area of it. But usually we might have multiple generations with some features of adhd. So it's like this ADHD ping pong match and talk about siblings of somebody non ADHD siblings of siblings with adhd. So there's, there's a lot of stress in those households. But then when we carry it forward so that can lay some groundwork. But then if we move towards performing in school, in the classroom or on the playground, athletics or other interests and socially with starting with those outside the family relationships which are most of what we'll have later in life. Life.

[Podcast Host Kristen Carter]

Yeah.

[Dr. Russ Ramsey]

There's a lot of laboratories where even, you know, even if the messaging at home. And I've heard this parents just always said try your best, whatever. But brother Eagle Scout sister undeniable. The comparison Sister student government and you know, student UN ambassador and me had to retake third grade.

[Sponsor Voice]

Yeah.

[Dr. Russ Ramsey]

Type of thing. It's in the water because you know, it is part of our factory settings. These, the comparisons with others. The sociometer it's called where we just as humans. You mean just humans. Yeah. Where we. Yeah. And part of this can be, oh, my friend's really good at math, I'm really good at history. He's good at that sport, she's good at this sport. And we find our way what our skill set is and it could be one among many. But you know, and there's that statement that by age, whatever, kids with ADHD have had what, 20,000 more criticisms or corrections. Now this actually wasn't based on a study. I've been looking for it for years because it's been out there. What it was, at least what I found was, and this is cited by Dr. Dodson, there was an essay by somebody who specialized in ADHD and made the estimation. Okay, if we say a student with ADHD gets, I might have the numbers wrong, but six corrections in the day, if we move that out over the whole school year, this many more days and this much at home, it would add up to this. So it was a, it was a well meaning conjecture. And so I do think it captures something. But it wasn't like a randomized or a controlled study. At least I haven't been able to find one. But that was the one core source I saw. But it is getting back to the messaging that after a while we hear, you know, from teachers, if only you tried harder, what did one's person as an adult, they heard a colleague say, you know, look at all those millionaires. The only thing difference between you and them is your effort. If you could sustain your effort. And it was a, it was a, it probably tried to be a motivational, hey, that's all you need to do. But it was like, okay, you're depressed. If you were as happy as these other people.

[Podcast Host Kristen Carter]

I want to take a nap now. That was horrible.

[Dr. Russ Ramsey]

You're welcome.

[Podcast Host Kristen Carter]

Oh, it's just, it's so interesting how much the family system, the school system, even like religious organizations, like what, what is expected in society and how we don't really fit into that then sends this constant message of like, you're doing it wrong, you're too much, you're not. Like, how can we be too much and not enough at the same time? Like that's the, this like overarching theme of what I hear. Like I'm too much and I'm also not enough. And I don't even know, like down is up and up is down. And I'm very confused. And so it's so hard from that foundation to then build the self trust skills.

[Dr. Russ Ramsey]

Right? Right. Now that being said, there can be things that people find like a, like this came up with a recent client, they were talking about their history of school, but then like they got the middle School or maybe it was high school and there was actually a student, I'm sorry, a teacher who was interested in students with learning differences. And there's actually like a qualitative study I saw where, I think it was in the UK where students with ADHD they, they went on to graduate school and education so they could go back to their schools where they were taught and then you know, sort of change. So I think that, you know, getting back to the training, even though some of the teachers still may not have maybe a lot of background in adhd, it's probably getting better. But there's a lot of like, I see a lot more when I'm doing a literature search, a lot more graduate psychology majors with their dissertations on things related to adhd. So I think there's some generations coming up in addition to whatever else we can do. But there can be, you know, it is looking for, you know, where people can shine, you know, athletics creative and those areas where they can get the positive feedback. And you know what, sometimes what happens is the parents see that and then it's like, oh, our kid has something going for them. Well, because it's like one of those, you'll hear parents talk about, you can't wear that to school. What will people think of us? You're representing the family here. So I think there's a little bit of that internalization which makes, it makes sense. You're also, you internalize. I have to keep you safe, I have to feed you, I have to protect you. There's a lot of positives and protect the family. And protect the family. But then there's also that like oh, we have to come in and here's our weekly meeting with the teacher or whatever it is to talk about. But there are a lot of programs about interfacing with the school like daily behavioral report cards and check ins and you know, double checking the book bag to make sure you have everything you need where it takes care of some of these administrative things that you know, can cause a lot of stress. Oh, you didn't bring your book home or you forgot your password for the website or something like that to do your old school Gen X or your book. What, what is this book you speak of? No, but there's a lot of ways to take care of these, these oversights that are still important but not have them be defining features. But we're not there yet, but I think it's been better. But there's still a lot of, you know what, there's just sort of ways you Know also things we all get used to. You know, just what did I was reading essay one time, they said if you look around you and look how much of the world isn't the same as it was 100 years ago. But what about a classroom now? There might be, you know, teachers standing in front. There might be more technology now, but there's also a lot of things that haven't changed with it.

[Podcast Host Kristen Carter]

Yeah, okay, I lied. I do have one more question which

[Sponsor Voice]

is can you offer some hope?

[Podcast Host Kristen Carter]

What do you see in the ADHD world? You're so deeply embedded in it. You've alluded to some things which I hope you'll talk about here. But what hope do you see on the ADHD horizon?

[Dr. Russ Ramsey]

You know what briefly, when I'm asked to sum it up with one message, even though I'll elaborate on it, it's sort of like, you know what? ADHD is one of the more serious diagnoses we have in clinical psychology and psychiatry. Wait, the good stuff is coming. But it's also, there are reliable diagnostic protocols for making an accurate diagnosis, getting people treatment and other supports or just even self awareness and the medical and non medical treatments we have that are evidence based and some on their way maybe like coaching and some other things and we need more like relationship family treatments. But they're among the most effective we have because it is like one of those, once you understand it, we have the integration of the executive functioning piece, people who understand ADHD and can have a good treatment alliance. Then like that one client said in the UK study, it's transformative. It's like I'm not a different person but I'm doing what I set out to do and that's part of who we are. That's part of we are what we repeatedly do.

[Podcast Host Kristen Carter]

And new diagnostic criteria are coming for

[Dr. Russ Ramsey]

adults that I'm not. I hadn't heard of. Oh man, it's still the dsm. Yeah, I haven't heard. I'm trying to rack my brain now to see if I saw anything on that. But they may be looking to update the dsm. So I'm not sure what that might mean for the neurodevelopmental disorders. One interesting factoid about that, the neurodevelopmental disorders. That again. Greg Mattingly, a colleague psychiatrist, a leader at absard had identified. He said, you know what for depression, anxiety, some of those more traditional ones, emotional distress about symptoms is a viable impairment which is a requirement for a diagnosis. That is not the case for neurodevelopmental disorders. Like autistic spectrum or adhd. So you could be really upset from your adhd, but. Yeah, but we have to see some impairment. Not just that you're wearing yourself down or feeling like a failure and not doing stuff. You know, it's. Now I'm painting a picture here. It's a little all or nothing, but still, it's. It's notable that it's notable that difference.

[Podcast Host Kristen Carter]

Russ, thanks so much. This has been fun. I. We were saying we could talk about this all day, every day, and, like, it is just such a passion. Really want to thank you for the work that you've done, the books that you've written. It has made its mark and really impacted the ADHD community. The ripple effect of your work just continues to impact. So I appreciate you.

I really do.

Everybody go buy Russ's book, which is called Once I Get Started. Where can they find the book and get more of you?

[Dr. Russ Ramsey]

It's available online now, so it's published by Penguin Random House, the Avery imprint, but anywhere books are sold, amazing you can get it. But I'm pretty happy with it because I had. It was a quick turnaround. It was in a year, which I usually take longer, but I was able to get a lot done and had some help and really think I was able to fit a lot in. And one of the things I'm proud of, there's a letter to loved ones of ADHD in there. That was one of those. I got to trust this. Okay, let's just do it. And the other thing I. There's a coping glossary in the back that if you need a quick reference. And one of my clients, I sent her an early copy because, you know, just a preprint of it, and she took it, cut them all out, laminated all of them, and has them on a ring, and she carries them around with. That way I can use them. So it is meant. It is making. It is making the skills portable, literally.

[Podcast Host Kristen Carter]

So that's cool. Everybody go buy it. Yep. It's been great to have you. I appreciate you.

[Dr. Russ Ramsey]

Thank you. I appreciate you, too. Looking forward to time number four. Yes. Let's do it.

[Podcast Host Kristen Carter]

A few years ago, I went looking for help. I wanted to find someone to teach

[Dr. Russ Ramsey]

me how to feel better about myself

[Podcast Host Kristen Carter]

and to help me improve my organization, productivity, time management, emotional regulation, you know, all the things that we adults with ADHD struggle with. I couldn't find anything, so I researched and I studied and I hired coaches, and I figured it out. Then I created Focused for you. Focused is my monthly Coaching Membership where I teach educated professional adults how to accept their ADHD brain and hijack their ability to get stuff done. Hundreds of people from all over the world are already benefiting from this program and I'm confident that you will too. Go to ihaveadhd.com focused for all the details.

[Sponsor Voice]

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