Dr Aja you so much for having me. You. I'm very excited to be here. I am very excited to have you here, and I can hear you loud and clear. You heard in the intro, obviously, I care enormously about this area. It is extraordinarily important and impactful and not talked hard enough. So I now need to hand over to you. How do you want to take it? I think you may have some slides for us. I do. Yeah. I'll bring on screen now. Uh-huh. And I'll say, Aja?

Great. Okay. Thank you so much for that introduction. So, yeah, as Henry says, I'm gonna be talking about something which I think is quite important to a lot of people with ADHD, the emotion dysregulation aspects of ADHD. So what I'll do is I'll cover a bit of the background science of emotion dysregulation in ADHD, and then I'll move into talking about some practical tips based on the research evidence for how we can try to better regulate our emotions and kind of take the edge off of some of that emotion dysregulation. So I'll first just, oh, my slides aren't moving on. Let me see. There we go. I'll first just super briefly introduce myself and our team. So I'm a professor in the developmental psychology.

Of mental health, which means that I'm interested in what influences our mental health across the entire lifespan. But I'm particularly interested in mental health in relation to ADHD. So our group is really interested in understanding how we can better support mental health in ADHD, and that goes from sort of basic discovery science all the way through to developing interventions that can be used by people with ADHD to support their mental health. But what I'm gonna be focusing on today is emotion dysregulation, something that is very important for mental health in ADHD.

So what I'll do is I'll cover some of the kind of background about what emotion dysregulation is and what emotion regulation is. I'll talk about how that's relevant for ADHD, and then I'll move in to talk about some more practical stretch strategies that we can use for regulating our emotions more effectively. So a good place to start would be what is the definition of emotion regulation. Essentially, emotion regulation is the set of processes that we use to keep tabs on and modify our emotions as needed. There might be various different reasons why we want to modify our emotions. It might be that we have some particular goal that we need to achieve. Sometimes it's about displaying.

A certain behavior in a certain context, or sometimes it's just about feeling better. So there's loads of different reasons why we might want to modify emotions in a particular situation. To be clear, what emotion regulation isn't or what effects of emotion regulation isn't, It's not tightly controlling our emotions. It's not about eliminating our emotions. It's not about trying to be a robot without any feelings. It's not that at all. It's much more about taking the feelings that come up and what we do with them, kind of doing something that's adaptive with them.

Emotion regulation is a really complicated multistage process, which means that there's lots of different places where it can potentially go wrong, and different people might experience emotion dysregulation in, different ways, or people might experience lots of different aspects of emotion dysregulation. It might be having difficulty with identifying or labeling feelings, so being able to realize that you feel sad and being able to call it sadness. Sometimes there might be a misidentification of feelings. We might think, I'm feeling really angry right now, but maybe the root is actually more something like anxiety. It might look like really strong reactions to situations or stressors, like feeling really angry.

Or actually it might be positive emotional reactions that are quite, pronounced, like feeling super, super excited. And there is some evidence that even these more positive emotional reactions can sometimes cause trouble for us as well. It might look like taking a long time to come down after an emotional reaction to a situation. So something triggers us. We feel angry or sad, and we just really continue to feel that way for a long time, and it takes a long, long time for us to get back to our normal kind of baseline state. It might look like really rapid marked changes in emotion, which is sometimes called lability, or it might be more related to emotionally driven behaviors. For example, doing things like lashing out, self medicating.

It might be emotional eating. Behaviors that are quite impulsive and emotionally driven that might, the very short time, make us feel a bit better, but in the long term are definitely not gonna make us feel better. On the other hand, many people report that being emotionally dysregulated is much more about being paralyzed by emotions. So just feeling unable to function, unable to get work done, unable to think properly, unable to get stuff done because of that feeling of being overwhelmed and paralyzed by emotions. Another element of emotion regulation is to do with interpersonal emotion regulation, which is the way that we might use other people to regulate our emotions. Again, that can have various different aspects.

It might be that we don't have the confidence or don't think there's any point in looking to others for emotional support, so we don't do it in the first place. It might be about seeking support from the right people. There's definitely differences in terms of how, good people are at making us feel better or worse and whether they make us feel better in the short term by just agreeing with us or make us feel better in the longer term by helping us solve the problem. So sometimes it's about who we seek support from, and then, sometimes it's also about how we actually reach out to people. So doing that in an effective way, something that looks much more like reaching out for support rather than, for example, lashing out.

Another important aspect of emotion regulation is emotion regulation strategy use, and I'll talk about this a lot more in detail in, in a few slides. But, essentially, that's about whether we choose to, once an emotion arises, what we choose to do with it. If we, for example, try to suppress that feeling versus express it, if we judge ourselves for feeling a certain emotion rather than kind of accepting that feeling, or whether we kind of ruminate about something or solve problems, etcetera. So focus on solving the problem. So there's a variety of different emotion regulation strategies that people might use that play into emotion dysregulation as well. So I've got here some examples of what people have said, people with ADHD.

As regards what emotion dysregulation feels like for them. So this person says, I'm very emotionally volatile. Something will happen, and it'll be like this is literally the best day ever, or something else will happen, and I'll just be so sad that I cannot stop crying for five hours. And it's very little things that set me off. So this person is showing its degree of emotional ability. They're talking about being quite volatile emotionally. They're showing some example of inertia. So they're saying that they can't stop crying for five hours, so it's taking them quite a long time to get back to baseline after they've been upset by something.

And they're also showing a degree of emotional reactivity because they're talking about how it's quite little things that might set them off in the first place. In this example, the person says, normally, my brain can't comprehend emotions when they come up. This time I'm crying, and I couldn't tell you why. My brain just doesn't cry when it's supposed to. It gets so scattered that I appear calm.

So what this person seems to be showing is some difficulty with understanding emotions. They're saying that their brain can't comprehend emotions when they come up, but they're also showing some difficulties with expressing those emotions as well. So, essentially, they're saying that on the surface, they appear to be quite calm, but beneath the surface is a bit of an emotional storm. So, they're showing this combination of having difficulty with understanding their own emotions and then subsequently showing those emotions.

And then this person says, I can't really verbalize what it is that I'm feeling, which frustrates me even more because I can't put the words to what I'm feeling. If I don't know what's wrong with me, then why in the world am I upset? So this person is showing some difficulties with label labelizing labeling their emotions, saying that they can't really verbalize what it is that they're feeling, and what they're also saying is that that is really frustrating for them. It is really frustrating when we can't express ourselves, and that's creating this additional meta layer of angst and being unable to properly label and verbalize their feelings. So if you relate to any of those examples, that's not, unusual.

It's I thought that about seventy percent of people with ADHD have difficulties with emotion regulation, both children and adults. Is not a core part of diagnostic criteria for ADHD, but it is recognized as an associated feature. And it's probably the only reason it isn't a core diagnostic criterion is that although it affects so many people with ADHD, it isn't unique to ADHD. So you do see it in, for example, depression and anxiety, and other psychiatric conditions. So it's not uniquely diagnostic of ADHD. It has quite a wide range of impacts. Henry mentioned some of them already. So it can cause difficulties in relationships and friendships.

It can cause difficulties in functioning at school and at work. So for example, college students who've got difficulties with emotion regulation have much more difficulty with their academic work. It increases the risk of mental health issues like anxiety and depression, and it's also been associated with suicidality, with disordered eating, and with, risky behavior. Now these are just some of the impacts that have been quite well researched. It's probably just a subset of the wider range of impacts that emotion dysregulation associated with ADHD has, which raises the question, I think, of why do we see more emotion dysregulation in ADHD?

There's a few different reasons. So one of the reasons is the evidence suggests that actually ADHD brains just tend to generate stronger emotions, so there's just a greater emotional intensity experienced by people with ADHD. And, of course, at some point, that's just gonna overwhelm any capacity to regulate those emotions, having to deal with that constant onslaught of intense emotions. That is compounded by executive function difficulties, which might make it more difficult to regulate emotions. And then, another element of it is that ADHD brains can kind of process time a bit differently.

And be more focused on the immediacy and the short term rather than the kind of longer term. And what that might do is lead to the favoring of emotion regulation strategies that are a bit more short term in nature, but might not be the most helpful ones in the long term. For example, if there is an emotionally evocative situation, there might be a preference to avoid that situation rather than to to engage in problem solving in relation to that situation. So it's another aspect. Something else which isn't, I would say, as well researched, but I think also is probably quite important is that.

I imagine the ADHDers also tend to learn over time maladaptive emotion regulation strategies because the people around them might be sending them implicit or explicit messages that, they should be suppressing their emotions, that maybe their emotion is too much or whatever. And so they're kind of being taught that they need to suppress their emotions, but aren't being taught more adaptive strategies for dealing with emotions. And so that becomes internalized and becomes more of a habit over time. And then there's the element of, there's just probably more triggers as well in the environment for emotions. So there is the whole thing about obviously.

Having an ADHD brain in a society which is much more kind of neurotypical in its setup and the difficulties associated with that. And then there's things like sensory sensitivities, cognitive overload, just a bunch of stuff that means there's just more environmental triggers for emotions as well. So all of these factors probably come together to make it much more difficult to regulate emotions in ADHD. On the other hand, there are definitely strengths associated with ADHD that are a positive for emotion regulation. For example, we know that people with ADHD are good at having an optimistic outlook as well as thinking creatively and thinking outside the box, and that can be really good for serving emotion regulation strategies.

Like reappraisal, which I'll talk about in more detail in a little bit. Also, know that ADHD brains are good at absorption and distraction, and distraction can be a really good, way to, or can be a really good part of adaptive emotion regulation as well. I mentioned that ADHD brains tend to generate stronger emotions, and that's true for negative emotions, but it's also true for positive emotions as well. So there is a positive side of, like, having the tendency to feel positive feelings more intensely as well as negative feelings. So when it comes to treatment and emotion dysregulation, emotion dysregulation difficulties associated with ADHD are not, I will say, very well addressed by current treatments.

ADHD medications can help. They do reduce emotion dysregulation, but they don't seem to completely resolve emotion dysregulation. And then, of course, there are many people with ADHD who don't take medications, so that isn't much help to them. Then if you look at non pharmacological interventions like therapies, there are some therapies that do have somewhat of a focus on emotion dysregulation, but they're not adapted for ADHD. And ADHD therapies tend to not focus on emotion dysregulation. So there's basically a big gap in terms of treatments for emotion dysregulation. There are, however, some possible self help things that people can do. So the good news part of this is that emotion regulation.

Is like any other set of skills, something that can be learned, something that with practice and regular use can be mastered and can become a habit. So that's what I want to kind of move on to next is to talk about some of these emotion regulation skills that can be learned. I'm gonna divide up into what I call thinking skills, which are cognitive emotion regulation techniques, the things that we would do inside our head, and relaxation techniques, which are much more about dealing with physiological arousal. There's lots of lifestyle factors that can help or hinder emotion regulation, but I'm gonna focus on sleep because that's a particularly important factor and something that a lot of people with ADHD struggle with. Some general advice.

Which applies pretty much across all of the things that I'll say next, is that, when learning new techniques, including motion regulation techniques, it's most sustainable to add those techniques to your repertoire gradually. So, for example, just trying one new technique each day or each week rather than trying to change everything at once.

I think we know that if we try to change too much at once, it's not gonna be sustained in the long term. I think we've all heard, someone say, oh, I'm gonna start going to the gym tomorrow. I'm gonna start eating well. I'm gonna start sleeping well. And you kinda think that that's probably not gonna last because it's much more sustainable if we master one thing at a time and build up those changes gradually. The other thing about emotion regulation techniques is that you really want them to become a habit. So you really want to be practicing them regularly, and that also helps with mastery as well. So I would recommend doing something like setting reminders on your phone.

That prompts you to practice them over the course of the day, or maybe it's like putting a Post it note on your desk if you work at a desk or something like that. Just some things to remind you to keep practicing them. Okay. So I'm gonna start with some, thinking techniques or cognitive emotion regulation strategies. I'm gonna start by saying that traditionally researchers have divided these strategies into so called adaptive strategies, maladaptive strategies. And I'm just gonna say straight off the bat that that is an overly simplistic dichotomy. It isn't really the case that there are certain strategies that are always adaptive for everyone and vice versa for maladaptive strategies. Instead, it's much more about.

Being aware of the range of different emotion regulation strategies that you may be using, that may be possible to use, about selecting the ones that are appropriate for a particular situation and that work for you, and, you know, just being able to use emotion regulation strategies flexibly. The reason that they are classified traditionally as maladaptive and adaptive, though, is that on average, there are certain strategies when you use them a lot that's associated with better mental health, and certain other strategies are associated with worse mental health when you use them a lot.

So, it's a fair goal to try to be using more adaptive strategies and fewer maladaptive strategies, but just with the caveat that it's not quite as simple as having this straightforward adaptive versus maladaptive dichotomy. So here's some examples of some different strategies that researchers have identified that people tend to use. Turns out we're very creative at coming up with different strategies to deal with our emotions. And this is actually just a selection of different strategies as well. There's many other ones that have been identified as well that I haven't put on this slide. It's just to give you a bit of a flavor for the diversity of strategies that we use. So on the side that would be traditionally thought of as adaptive.

We have strategies like cognitive reappraisal, which is where we think about a situation differently in order to feel better about that situation or perhaps even just to shift yourself into a position where we're better able to tackle a problem. There's savoring, which is when we experience a positive emotion. And what we do is we really focus on feeling that emotion, prolonging the emotion, potentially, magnifying the emotion. We have distraction, which I spoke about briefly before, which is where we, take our mind off something that's emotionally evocative in the short term. That might be helpful if we need a little bit of a break. We're not quite ready to tackle something and just thinking about something isn't helping.

So we can give ourselves a little bit of a break from that through distraction until we're in a better place to, engage with something. Distance sorry. Distancing, easy for me to say, is, when we cognitively distance ourselves from something. So we take maybe a more detached intellectualized view of something. Maybe we distance ourselves by imagining what an objective observer who isn't us would make of a situation. Maybe we imagine ourselves in five years' time looking back and thinking about a situation, and that can help give us a bit more perspective on that and take the emotional edge off of it. And then we have acceptance.

Acceptance is basically where we allow ourselves to feel a feeling without judging ourselves for feeling that feeling. Sometimes we can really exacerbate a negative feeling because not only do we feel a negative feeling, we're also beating ourselves up for feeling that negative feeling. So not only are we feeling sad, we're also feeling annoyed with ourselves for feeling sad. Acceptance tries to take away that layer of met angst and just says, yes. I'm feeling sad right now. I'm just gonna sit with that. I know it will pass. I know it's normal to feel sad, and we don't judge ourself or beat ourself up for feeling a negative emotion. And then we have social sharing, which is a form of interpersonal emotion regulation.

And, essentially, that's like getting something off our chest. It's going to someone else and sharing a problem with someone else in order to help ourself to feel better about that. Humor is probably fairly self explanatory. That's about looking for the kind of funny side of something, which can help neutralize emotions around something a little bit and maybe put us in a better position to solve a problem. And then finally, we have problem solving, which is, again, as the name suggests, it's about really engaging with the problem rather than just worrying about it. We really take action towards, solving whatever it is that's bothering us. So that's the more adaptive.

Side of things. On the maladaptive side, we have strategies like rumination, which is like the king of maladaptive strategies. Rumination is where we just turn something over and over in our mind, but we don't get anywhere with it. We just make ourselves feel worse. We just focus on how we feel about something. We don't take any action. So we're really in a kind of negative cycle of thinking with rumination. Another one that's thought of as maladaptive is, expressive suppression, so not expressing our emotions, which is just where we try to hide our feelings, not show them. We have avoidance of feelings or experiential avoidance, which is where we actually try to avoid feeling the feelings in the first place.

And then similarly, we have avoiding situations, which is where we stay away from situations that we know we're gonna find emotional. You can kind of imagine how that would quickly become a problem if, for example, there's something that we really need to deal with. Like, we've got bills piling up or something. It's making us feel anxious. We're avoiding it. It's not gonna get any better. It's only gonna make the situation worse and make our anxiety about it worse. And then there's giving up, which I think is a little bit similar. It's about kind of just disengaging and just not bothering to to try and kind of solve the problem anymore. Another one, is self or other blaming, which is where we're very much focused on.

Blaming ourself or blaming others for something. So we're just, this is all my fault, or this is all such and such's fault, which doesn't help us to solve the problem. It just makes us feel bad. And then the last one is, emotionally driven behaviors, which I mentioned briefly before, which is doing things like lashing out, self medicating, emotional eating, the kind of behaviors that give you short term relief, but long term probably make you feel worse. So that's quite a list, and as I say, there's even more that I didn't list, beyond the ones, on the slide there. But just to kind of reiterate, the key thing is about being able to be flexible about what strategies are used according to the situation. And we need to be aware that.

There is some nuance to it. So for example, some strategies that we think of as adaptive might be maladaptive in some situations. We might use humor adaptively most of the time, but sometimes we might use humor in a way that we minimize or solve sorry, avoid a problem that actually we really need to engage with and solve. On the other hand, I mentioned that suppressive expression is a maladaptive strategy, but, actually, there are some situations where it's definitely adaptive to not express our feelings. So for example, if we were in a really solemn event and we thought of something funny and we really wanted to laugh, it's probably better that we hold on to that for that moment and maybe we can laugh about it later in retrospect.

Rather than laughing at the time and potentially causing offense. And then there are sometimes, like, it might be easy to blur the lines between different strategies. So we might start off solving a problem, but then we might actually find that we're not getting anywhere with it and we're actually morphing into rumination. Or sometimes we might be ruminating but kind of kidding ourselves that we're problem solving, but we're really just turning something over and over in our mind and not actually getting anywhere with it. So it is it's important to be attuned to the subtle differences between some of these strategies and be aware when we might actually have, slipped into using a more maladaptive strategy.

So next, I wanna focus in a bit more detail on a couple of key strategies starting with rumination. As I said, you're ruminating probably if what you find yourself doing is turning a problem or an emotional reaction to a problem just over and over in your mind, but you're not getting anywhere with it. Critically, that thinking is not leading to any action. It's not leading to any problem solving. You might find that you are struggling to think about anything else, and you'll probably find that rather than feeling better, you're actually feeling worse the more you turn the thing over and over in your mind. So rumination is really relevant for ADHD, actually, because what researchers have found is that people with ADHD or ADHD symptoms.

Tend to ruminate more. More than that, they also have found that it has a more negative impact on people with higher ADHD symptoms. So we did a study, for example, where over the course of the day, we asked people to tell us what emotion regulation strategies they were using and what they were feeling. We did this basically just by pinging them on their smartphones, and then each time they were pinged, which happened randomly across the day, they would tell us their feelings and their emotion regulation strategies. What we find was that people who were higher in ADHD symptoms were more likely at any given moment to tell us that they were ruminating.

And then they showed a greater increase in negative emotions after ruminating. So it seems if you take that together, that rumination might be a particularly toxic strategy for, ADHD brains, which leads us to the question of how can we stop ruminating. So I think half the battle is actually identifying when you're ruminating because I think a lot of the time rumination can happen in quite an unconscious way, especially if it's a habit that's built up over many, many years. We might not be aware that we're actually ruminating. As I said before, we might be thinking that we're problem solving or preparing for something, but actually what we're doing is we're just thinking in negative circles.

So the very first thing to do is to learn the warning signs of rumination. So looking at these characteristics and asking yourself, is this what I'm doing right now? Once you've become more attuned to the signs of rumination, the useful thing to do is to try and identify if there are particular times when you're more at risk of ruminating. So are there particular triggers? Are there particular times during the day, for example, when you're feeling tired, when you're feeling bored? For many people, it's when they're lying awake at night. That's a real risk period for them. And then what you can do is you can start to make if then plans for what you'll do when you start to ruminate. So what you do is you identify that you're ruminating.

And then you do x. So your if then plan might look something like, if I start to ruminate, I will write down the problem and then put that away somewhere. I will refocus my attention on an absorbing activity. I will talk to a friend. So for example, if you're someone who tends to ruminate while lying awake at night, but you listen to an audiobook, your if then plan might be something like, when I start to ruminate, I'm gonna really try to refocus my attention on the content of the audiobook. I'm gonna really listen. I'm gonna really engage with the story or whatever it is that you're listening to.

Another thing that can be really helpful to help tackle rumination is to do a bit of an audit of yourself and figure out what kind of activities do you do that give you a sense of flow or a sense of absorption where you're just, like, really in the moment. It's a bit variable for different people, but the kind of things that might give people that feeling of flow could include creative activities, so things like writing or drawing. For me, it's probably writing, maybe coding. It might be playing games. It might be reading about a topic of interest. And what you wanna do is then try and build those flow activities into your routine more.

The more time you spend in a state of flow doing absorbing activities, the less room there is for rumination because it's quite difficult for a state of absorption to coexist with rumination. It's also just generally good for your mental health to be engaging in activities that give you that sense of flow and satisfaction and enjoyment. And then the other thing that you can do is you can try to replace rumination with more adaptive strategies. So once you identify that you're ruminating, you then try to redirect yourself to using a more adaptive emotion regulation strategy, like some of the ones that were on the adaptive strategies list before, things like reappraisal, acceptance, or problem solving. The last one is.

Particularly important, I would say, because sometimes what sustains rumination is because we have a problem, but it's not formulated in a way that really makes it tractable. So maybe it's a bit too abstract, a bit too vague. So if we can learn problem solving skills, we can get better at translating that vague sense that something isn't right or that problem that we just keep turning over in our mind into something that we can actually take action towards solving. So one example is we can draw on the SMART framework, which is about goal setting, but also applies to kind of the goal of solving a problem, where essentially it encourages you to think about the goal in terms of something that's specific, something that's measurable.

Something that's achievable, something that's realistic, and something that's time limit sorry, time limited. So you've got a clear time frame for when you're going to do something, when it's gonna be done. And that just encourages you to take a problem and break it down into something that is much more concrete that you can solve. So I mentioned cognitive reappraisal as one of the emotion regulation strategies that you can pivot to if you catch yourself ruminating, but it's also just a really valuable strategy to practice anyway. Essentially, cognitive reappraisal is about thinking differently about a situation to feel better about it. For example, maybe we experience some setback as happens all the time, and we think to ourselves.

I'm such a failure, and that's obviously associated with negative feelings. But we could also think about that a bit differently. So we could think about that more in terms of what can I learn from this setback, or we could take a broader view and think, yes? I've experienced this setback, but, you know, I've had lots of successes as well. So this one setback doesn't define me. It doesn't make me a failure. It's just one setback. Or we could think to ourselves, yes. It's a setback, but I've overcome setbacks before, so I've overcome this setback. So it's just about more adaptive ways of thinking about a situation that don't just focus on an initial, maybe overly narrow, overly pessimistic, interpretation of that situation.

Another context in which we might use cognitive reappraisal is more interpersonal context. So we might have a weird interaction with someone and come away from it thinking, oh, that person really hates me or maybe I really offended that person. But we could also think about alternative interpretations for that situation. So we could maybe show a bit of curiosity and think, oh, I wonder if that person actually has something going on for them right now. I I hope they're okay. Maybe it's not really about me. Maybe they have, you know, like, a bad day today or something like that. So just take that broader perspective and think about different interpretations for that situation.

So just to be clear, concept reappraisal isn't about trying to delude yourself that everything's brilliant. It's definitely not that. It's about critically evaluating the automatic negative interpretations that we might have of situations. So, again, reappraisal is really relevant for ADHD. We know that people with ADHD are just as good at using reappraisal as people without ADHD, so it's not a competency issue, but it doesn't seem to be a natural tendency. So people with ADHD is not a habit to use reappraisal. It's not their their go to emotion regulation strategy.

So we know that people with ADHD tend to use cognitive reappraisal less overall and have more of a preference for suppressing emotions, which, again, might come back to, like, learning over time and what kind of messages have been received from people around them about, needing to suppress emotions. So it seems like people with ADHD are perfectly capable of using reappraisal but might need a bit of reminding, a bit, more practice to make it a habit. In terms of how to concretely do concise reappraisal, like with rumination, half the battle is just noticing the situations in which it's helpful to recruit cognitive reappraisal. So noticing, like, an automatic negative thought or interpretation and associated negative emotion.

And then using that as a trigger to think about alternative interpretations of the situation. And then in generating those alternative interpretations using things like compassion towards yourself and towards other people, for example, if somebody does something that's quite annoying, you could think to yourself, did they do that to deliberately annoy me, or maybe actually they misunderstood something about the situation, or maybe they don't have the whole picture or or whatever. So kind of giving people and yourself the benefit of the doubt. We want to avoid overgeneralizing interpretations. So, for example, with the idea that you might experience a setback, not allowing that to lead to thoughts of I'm a complete failure.

Thinking about all of the evidence, thinking about the times when you have succeeded, thinking about the times when you have overcome setbacks, not just focusing on the evidence that supports that initial negative, more kind of catastrophic interpretation. Okay. So I'm now gonna spend a little bit of time talking about relaxation techniques, which can be used as a complement to the cognitive emotion regulation techniques that I just spoke about. I'm gonna cover three different techniques, but actually there's a whole world of different relaxation techniques out there that you could explore and find out what works for you. There's a lot of individual variation in terms of what people prefer.

I'm gonna cover three techniques just now, so grounding, breathing exercises, and progressed muscle relaxation. And with all three, my suggestion would be to practice them at first when calm because it's easier to master something when you're calm first rather than trying to use something for the first time when you're already feeling in a state of emotional arousal. So we'll start with grinding, and a little clip, hopefully, that will play. Basically, grinding is something that helps you return to the present moment when your emotions are running high. So you start by looking around you and naming five things that you can see. Like, I would say, oh, I can see a pair of sunglasses. I can see my phone.

And then you focus on four things that you could that that you can feel. So you might say that you can feel the cough of your sleeve and then three things that you can hear. So I can hear some building works. I can hear the buzz of my computer. I can hear some birds outside. Two things that you can smell right now. So maybe you could say, I I can smell some coffee or whatever. And then the last thing is to focus on one thing that you can taste. So as the name suggests, the idea is it helps get you grounded. It helps take you out of your head and back into the present moment. Okay. So next one is breathing exercises, which taps into your physiology to help reduce physiological arousal.

There's lots of different variants of breathing exercises out there. This one involves breathing in for four, holding it for four, breathing out for six, holding it for two, and then starting the cycle again. And you can just do it for several cycles, and then at the end of that process, you should feel more relaxed. It can take a little bit of time to master it, so it does take a bit of practice. We'll just go through one round here just now just to demonstrate. So we start with breathing in for four seconds, holding it for four seconds, breathing out for six seconds, Holding for two. And then we start the cycle again. So I think you get the idea, but typically, you would go through that a few times.

And then hopefully feel more relaxed at the end of it. Okay. And then the last one I want to just make you aware of is progressive muscle relaxation. So what that involves is going through the different muscles in your body, tensing them, and then relaxing them. And, what I've got here, I won't play it, but we've got a video here that basically talks you through that process, going through each of the different muscles in the body. Okay. So the next set of practical tips I want to cover are related to sleep. So sleep difficulties are really common in association with ADHD. And, on top of that, ADHDers tend to be night owls. So there's kind of baseline sleep difficulties, but then there's also this mismatch between.

When ADHD bodies want to go to sleep and when society wants us to go to sleep and wake up and stuff. So that can compound the difficulties. Unfortunately, sleep difficulties can also exacerbate emotion regulation difficulties. On the other hand, the positive side of it is that maybe if we can work on our sleep, that can also improve emotion regulation. So what I'm gonna do is I'm just gonna go through some quick tips related to sleeping better. I'm gonna start with some don'ts, and then I'll move on to some dos. So good sleep doesn't start when we go to bed. It actually starts much earlier in the day. And during the day, we want to be avoiding doing things like taking naps.

Even though it might be quite tempting to take a nap to catch up on sleep, that can have a knock on effect on the next night's sleep, so it's better to avoid taking long naps during the day. Similarly, we want to avoid spending time in bed when we're not intending to sleep. The reason is that when we spend time in bed, but we're not trying to sleep, so if we're, like, you know, on our phone or watching TV or something in bed, what happens is our body learns an association between being in bed and not sleeping. But what we want the association to be is between being in bed and sleeping. So the more we can avoid being in bed when we're not trying to sleep, the better.

When it comes to around sleep time, we want to be avoiding things that are gonna be quite arising, like, caffeine, as we might find in energy drinks and coffee and stuff like that, emotionally arising activities, like emotionally charged conversations, or maybe even, like, you know, particularly exciting video games or films or something like that. It's a good practice to avoid screen use too close to bed because that can also interfere with the process of becoming sleepy. We wanna avoid things like big meals close to beds or drinking lots of water or whatever before bed because that can, delay our sleep or wake us up. And then another one that I think a lot of people don't do because it's quite counterintuitive is that if we go to bed.

Or we can't get to sleep, or if we wake up in the night and can't get back to sleep, it's better to actually get up, do something relaxing for a while, do a bit of a reset, then go back to bed rather than just lying there awake. It's a similar logic to why you want to be avoiding spending time in bed during the day when you're not intending to sleep because the more time you spend in bed not sleeping, the more your body learns in the cessation between being in bed and not sleeping. So it's better just to set yourself a cut off and say that if you're not asleep within, like, thirty minutes, get up, reset, do something relaxing, and then try again. And then there's the dos. So, again, this starts earlier.

In the day. Getting enough daylight during the day can be really helpful for sleep and for kind of regulating those circadian rhythms. Obviously, that can be difficult if you get shift work or something like that, but to the extent that you can, getting enough daylight, getting enough physical activity during the day as well can really set you up for a better night's sleep. And then when it comes to around bedtime, it's good to do some relaxation before bed. Maybe some of the relaxation techniques that we just talked about before, or there might be another relaxing activity that works for you. It's good to have a consistent time of going to bed and waking up as well and similarly having a bedtime routine.

And, again, that just helps train the body so that it has an association between doing certain activities and going to bed so it knows that it's time to wind down. And then in bed, paying attention to the sleep environment as well, so making sure that it's not too light, that the noise is the right amount of noise. I'm not saying no noise because, actually, for some people, a bit of noise is better than no noise, but making sure it's not too noisy, and making sure that the temperature is right as well. Actually, temperature is something that a lot of people get wrong because.

Many people think that the room should be quite warm. We should be quite warm when we're sleeping. But, actually, typically, the room needs to be much cooler than we expect it to be. So have a think about that as well and check if the temperature of the room is, cool enough. But as a general principle, I think a really helpful way to think about sleep is not that it's like flicking a switch where you can go from awake mode to sleep mode as soon as it's time to go to bed, but think of it more as like landing a plane. You need to have a gradual winding down in the hours towards bed. It's not something that we should expect to happen suddenly. We need to plan a little bit ahead for it and do relaxing.

Winding down activities in the lead up to bed. So I've now reached the summary part. So what I've talked about today is that emotion regulation difficulties are common in ADHD, that they can cause a range of different issues. But the good news is that emotion regulation techniques are things that can be learned with practice. They can be mastered. They can become a habit, and, that can really help with emotion dysregulation. For more immediate issues with feeling physically overaroused, relaxation techniques can be used. And then also sleep is a big factor in emotion dysregulation, so paying a bit of attention to sleep and behaviors around sleep that can help to sleep better can also help have a positive impact on emotion dysregulation.

So I've talked quite briefly about quite a few different areas. If you'd like to learn more, I've got a few suggestions for additional resources and some keywords that you can look up for further research. So I talked about some emotion regulation strategies. There's also clinical therapeutic approaches that cover emotion regulation skills. Dialectical behavioral therapy, for example, has a strong focus on emotion dysregulation. If that's a really kind of big impairing issue, DBT skills can be worthwhile learning about. I can try to get these links into maybe the video description once it's up on YouTube, but, basically, there's some good self help resources out there.

I talked a lot about rumination as a maladaptive emotion regulation strategy, and there's a whole therapeutic approach called rumination focused VBT, which can be helpful if that is a particular issue that you struggle with. There are some sleep tips that can be found on the NHS website, which are quite good. And there's a few other approaches to explore, like the unified protocol of CBT, emotion focused CBT, and mindfulness based cognitive therapy. What I will say, though, is that although there are resources out there to deal with emotion dysregulation, there's actually very little that's adapted for ADHD, and I think it's really important that these are adapted for ADHD. So if I had a call to action, it would be that.

If you have ADHD or know someone with ADHD, it would be great to get involved in shaping resources for people with ADHD that are specifically tailored for people with ADHD, whether that's kind of co designing interventions or whether that's taking part in research to better understand emotion dysregulation in ADHD. We and other researchers would very much welcome your involvement. So I've put my email address, nurse study email address there before if you want to reach out about that or anything that I talked about today, which I think now just leaves me to say thank you very much Oh, for your attention. It's been a pleasure to be with I I thought that was brilliant.

Really, really brilliant. Thank you. I learned a lot. I always find it I don't know, I find it hurts a bit when we talk about how hard it is and as someone late diagnosed, you do slightly look back on where you're being so tripped up. And that piece around maladaptive strategies that as a late diagnosed person, you you try and work out ways to cope and deal with things and that they're just, they don't have all the facts and they're not fit for purpose and actually do wrong. And I did not introduce you properly, I need to, because you talked about your research. So Doctor Aja Murray Professor, Aja Murray is a Professor of Developmental Psychology and Mental Health at the University of Edinburgh.

Which is one of the preeminent researchers at one of the preeminent universities. Research focuses, looks at mental health across the lifespan ADHD and emotional dysregulation. It's honestly, in my view, no one better on this. Yeah, you. We've had some questions and then we'll have to skip on for time. The very first conference we did, I thought it was kind of funny and like a bit funny for the ADHD Conference to run a bit late, because it's like except then we suddenly started hitting like where we'd met people with their own hard deadlines, and like, okay, that's not funny at all. In fact, I've caused a crisis. I had a really good question, and this is on the globaladhd.com.

Site. We've had questions on social as well. One of the questions is, is it possible to get your slides? And with your permission, can we put the slides up Global on ADHD site? She's great and I knew that, so we may have already done that. It's very good that she said yes, because we did it about five minutes ago. So if you want to go and download those, because there's obviously clearly very, very useful things to go back on, Just go to globaladhd.com, the conference site. Sharon uploaded a question there. Hi. I would love your thoughts on achieving co regulation in families with multiple instances of ADHD and ASD. We're a family of five boys, 11, 13, 18, and all of us are neurodivergent.

We are awash with teen and perimenopausal hormones. We struggle to detect and to respect each other's levels of volatility. It feels impossible to avoid triggering each other into a domino style dysregulation. Any advice? Welcome.

This is a really good question. I could do a whole presentation on that as well. Oh, there's always next year. Actually, we yeah. Come back into next year. Yeah. I think that's especially challenging. So, yeah, there's the element of kind of if you're a parent dealing with a child who is dysregulated and what's the effective way to do that whilst also dealing with your own dysregulation. I think many of the techniques that I talked about today do generalize, and I think that one big gap is that there's a lack of kind of family system focused.

Intervention approaches. So a lot of the intervention approaches that exist in relation to emotion dysregulation kind of, like, treat a person in isolation rather than kind of thinking about a whole family system and how that might interact when you've got multiple people who are struggling with dysregulation. And it's an area that's a bit under researched as well, I will say. But I think as a starting point, I think a lot of the things that I talked about today, if if they can be used individually, that's a really good starting point because it is interactive if one person starts to get more of a handle on their dysregulation that has a positive in the same way as you can have, like, a perpetuating.

Negative cycle, you can also have a perpetuating positive cycle as well. And in families, for example, people kind of learn through observational learning what others are doing. So if somebody starts to shift to more adaptive emotion regulation styles, that can have a positive impact on other family members who are seeing that and they're seeing the positive effect of it and start to kind of internalize that themselves as well. So I think I would say it's it's quite overwhelming. It's quite a lot to deal with, but I would maybe just start focusing on the kind of individual things that each individual family member can do with regulating their own emotions and that should propagate through the family system. Wonderful advice. You can see.

Professor Murray, she's an expert in her field talking about, right, we need more research here and wanting very clearly to and it's the thing that we need, right, which is to get do research to get us to the core understanding, to know what actually makes a difference. So beyond hyperbole and individual stories, which, whilst useful, we want cold, hard facts. And it's how change really systemically happens. I'd certainly, thinking about that answer and someone with a young family, I think one of the things parents can do exactly as Aja said is learn themselves because you hand that down to your kids. So if you can work on yourself, your kids learn from you, and that changes things. And actually, if you do this learning together, you can.

Help teach each other, you can say, you can have this shared understanding of what to do and use that to go, okay, this is happening. Let's do the grounding, which I thought was actually wonderful. I thought it was really I I've often struggled with my brain running away and being very hard to hold on to things and part of that is memory issues and I found it really simple and one I could I could remember. I'm And I could I could see that myself using it in my.

Anywhere, that way. You can do it out and about. It doesn't it almost doesn't matter what situation you're in. It's quick. It's simple. The other ones, you know, you need to maybe have a little bit space, but that one, you can just do on the go whenever you need to. So it's a really it's a really good one to start with. Thank you. Look. Thank you for thank you for kicking off our conference. It's such an important area. Thank you for doing this.

It was truly wonderful and and inspiring, interesting and improving of life. So thank you. Thank you for the research you're doing, and a sort of forward thank you, because I mentioned at the very start that we're doing work in prisons, and Professor Murray has very kindly offered to help Emotional dysregulation impacting people and being in the prison population is, I think, something that we really see extraordinarily funny that. So thank you. Thank you very much. Goodbye.