Why Knowing Isn't Doing: Adult ADHD Through a CBT Lens | Dr. Russell Ramsay

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Welcome to Refined Leadership ADHD Lens with Cathy Rashidian.

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Discover how to refine your leadership through the lens of ADHD.

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Whether you're advancing toward a promotion or redefining your professional approach, you're in the right place.

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Join our community for tailored insights that elevate your leadership.

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Let's dive in.

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All right, folks.

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It's been a while.

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I am back with another episode, and this one I am bringing a guest with me, and we're gonna talk about his latest book.

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Today I'm joined with Dr.

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Russ Ramsey, a leading expert in adult ADHD and CBT.

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And I've wanted to cover this CBT piece for so long, and I get to do it with the expert.

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He is the author of the new book that's coming out, Once I Get Started.

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Which looks at the biggest struggles for adults with ADHD, how hard it can be to turn good intentions into action.

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How many of us relate to that? Dr.

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Ramsey, welcome.

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I'm so glad that we finally get a chance to meet and to talk about your book, the amazing gem that it is.

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Cathy, it's a pleasure to be here.

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Like you were talking about before, we've been in each other's orbit, so it's nice to finally collide.

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Yes.

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Absolutely.

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Absolutely.

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Before we get started, I wanna read a couple of quotes because just to ground us into what we're about to get into, people, I wanna read from page 56 of your book.

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All right, here's one: As soon as somebody expects something from me, I start to doubt that I'll do it, even if it's something I know I can do."

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How many of us relate to that? Here's another one: "When I start doing something, I start overthinking whether the results will be good enough, what others might think, and how such things are easier for everyone else."

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And last one: "I know what to do, but I just can't do it.

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It takes a deadline pressure or some other extreme stress to get me into focus."

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Holy moly, get out of my head, doc.

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Get out of my head.

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I'll tell you what, I'll jump into that last one- because, and I've written on this, which I'm sure the publisher's gonna be thrilled that I say it this way.

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I wrote on...

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wrote this in a previous book.

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But, "I know what I need to do, but I just don't do it."

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I've done it before, I know I can do it, but I c- and this gets to the self-mistrust, I can't trust myself that I will do it when I need to do it.

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Tuesday at 3:00, I know I can, but will I be in the mood or, do I have the deadline or fill in the blank for that's where it gets really individualized.

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But that I did a whole previous book.

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Again, my current publisher will be thrilled with our promoting two different books now.

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But how I- I've made the a hypothesis is probably the best way to put it, that self-mistrust may be a central cognitive theme in the thoughts of adults with ADHD, and exactly that.

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And usually people saying it, I know exactly what I need to do, but I don't trust that I'll do it.

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So what good is talking with you g- about that gonna do me?" Yeah.

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You say with the therapist.

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And my answer for that is, "You know what? I think I, and others who do this are pretty good at helping people understand how they don't do things."

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Not, "Oh, you procrastinated.

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Try harder next time not to procrastinate."

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But the different elements of it, 'cause it makes it a fairer fight.

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If it's changing these smaller behaviors, "Oh, I didn't have a plan, so I never got around to doing it," or, "I had a plan, but it was unrealistic.

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I'm gonna write this paper in two hours."

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Even though I've had many clients reassure me, "Oh, I've done that before."

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Or whatever it is, there's some element, and be it the mindset, be it emotions, be it a behavioral avoidance some piece of information, "Oh, I have to do an Excel spreadsheet.

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I've never done that before."

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And so that lack of knowledge, which would get in the way of me doing it, but sometimes the task becomes, "Oh, how do I learn about Excel enough?" I get no money from Microsoft by saying this.

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That I can do it well enough, and that's the stuck point.

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And it seems obvious, but in the middle of everything else, these are the things that can kn- either knock people off track or keep them, stuck in that paralysis of the moment.

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Yeah.

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Ugh, so true on so many levels.

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All right.

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Great.

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Let's go down a journey together on this book, 'cause I, as you saw, I have read it, folks, page to page.

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And the amount of resources and research that's gone into this, tremendous.

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You left no stone unturned I think in this one, which is exciting.

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'Cause sometimes I read some of these ADHD books that are coming out.

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I'm like, "Yeah, okay, we know," and I just move on.

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This one I couldn't move on truly because it really validates the internal stuff a lot more, right? C- as coaches, clients come to us, "Give me a planner.

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Give me a time management skill."

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Dude, it's much deeper than that.

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And I like how you go much deeper than that.

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But before y- we, we talk about that, you've written six books.

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What makes this one a little bit different? And even the title, Once I Get Started, because that had me like, "Okay, and tell me more."

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I always When it came time for the title, I'm asking my wife, I'm asking my daughters, I'm racking my brain.

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But over the years, I had told my clients as we're talking about things, usually procrastination or something like that, and I said, "If I ever write a proper self-help book, it'll probably be entitled Once I Get Started...

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'cause a lot of people say, "Once I'm engaged," And I've used that line that like when I have a slide like, oh, here are all the areas of difficulty, but a meeting point seems to be disengagement, and I always have to rely on a double negative.

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It's not caring, but it's getting the overwhelm, the working memory of not, the breaking it down into small enough steps, which we all know.

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I've always referred that.

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That's what our grandmothers would tell us to do- and they're not wrong.

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But how do you do it? And I think that's where CBT and coaching or whatever, sitting with somebody and I usually hope my books feel at least somewhat like somebody sitting with them- Yes and talking to them and things like that, where it's the doing.

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ADHD is the performance problem.

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So that's, the once I get started, how it came from that, but it is about that engagement, the actual doing, touching the task.

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And rather than it being conceptual in graduate school, we know there's a dissertation coming, but it's conceptual until we get into it and say, "Okay, this is writing this chapter or doing this experiment or writing this paragraph or this sentence," whatever it is, whatever gets us in, whatever does the trick.

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So I think a lot of that is around, the implementation focus.

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I've described our, and I still use the we, like with Penn, even though I'm not at Penn anymore, but it's that yeah, how do I get engaged in it? How do I get started? And the implementation focus of the CBT, which I think is an element that isn't the same sort of requisite.

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It's not invalid, but it's not the same requisite for adult ADHD as it might be for depression or anxiety.

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No disrespect there.

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It's not like trying to play one- can I tell me more? You know what? I One of the things I like about CBT, at least the training I had, because I was trained in anxiety and depression and other things before A- ADHD was never on my radar screen until later.

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But a lot of behavioral is behavioral activation or with anxiety, it's exposure to something that you're afraid of- incrementally, baby steps, if you will.

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But usually- Like somebody doing some sort of activity scheduling.

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"Hey, how about going to the movie with your friends?" Yes, your depression's telling you, "Oh, it's not worth it."

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Are you willing to give it a try, then come back and rate your prediction before you go with how it was after? And it may not be, "Oh, 100%, that was great," but it might be, "Okay, I thought it was gonna be 30, but it was 60."

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"So I'm glad I went."

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Whereas with ADHD, it might be, "Oh, I've got to remember when does the movie start?" Oh, God, yes.

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"And when do I got...

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When do I have to be in the shower so I can get there on time? What movie theater was it again? What show are we going to? What movie are we going to?" We were talking about a bunch...

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All those different elements, not making light of it, but the different ways, the self-regulation, the executive function, the working memory, whatever all the nested skills that go into a seemingly simple task.

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But simple doesn't always mean easy, 'cause there's a lot of steps in what we do and a lot of a lot of aspects of adult life.

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Oh, my goodness.

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I appreciate that so much.

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Because actually in...

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towards the end of your book, let's jump there for a second, this is very relevant.

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There's this thing about CBT equals positive thinking.

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Oh positive thinking, right? Yes.

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And you mentioned that it's not.

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And what you just described i- is that, is it's...

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there is more to it when it's ADHD and CBT.

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It's, "Tomorrow I have a meeting that I'm planning.

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Oh, my God, I gotta go here, I gotta go there, I gotta travel."

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Yeah.

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All of it.

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And also to show up and be present for the meeting that I'm in.

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I'm already exhausted even thinking about it.

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Yeah.

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I wanna cancel.

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Yeah.

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And so for someone in dep- i- with depression or anxiety, I guess what I'm hearing is you're just addressing that particular part of it versus...

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s- so what's the difference? There's some aspects I would say.

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Now, somebody without ADHD- in the midst of a depressive episode or in the midst of facing anxiety, their executive functioning, their self-regulatory skills will decrease a bit.

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Yeah.

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But there, there might be some things you can take for granted that, the person with...

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A- and saying this respectfully, this is not, but, if they decide, yes, I'll do the experiment, I'll go to the m- the movie with the friends, there are some things like, okay, I know where we're meeting, I know what time.

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I'll get there on time with the i'll even see the pre- Those are good to go.

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Okay I'll see the previews.

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They're baked in.

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And if not- it can be, oh, I overslept, I didn't get out of bed in time.

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There can be things there.

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I don't wanna be too glib about it.

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But those things that you can't really take for granted with ADHD.

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And even, like you said, about the meetings and I have to go somewhere, oh, yeah, I have to pack first.

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And where, at least in the US, there's a certain driver's license we have to have that we can use for domestic flights, but if we don't have it, you have to use your passport.

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And it's oh, I have my driver's license, I have my ID, but it's not the real ID that we're required to use now.

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Oh, I can't board the flight.

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Oh, gosh.

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Yeah, stuff like that.

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The little details that are well advertised, warning this has been coming for five years, and we know it.

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But then when it comes oh, that's right.

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Now, anybody can do that, and using the example of a flight, that's why at the end of the flight they will say, "Be sure to check your seat backs in front of you and other places for things you might have put there."

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Oh, I never put my phone in that back thing.

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Oh, yeah, I did- when they brought the meal around.

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And it's I better check just in case, because it's an unusual place where we don't have the common associations, like our landing spot or launchpad, whatever we call it.

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Yeah.

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So there going back to going back to the question there, there are some things that are the more detail-oriented things that have to factor into CBT for adult ADHD that are just part of dealing with the nature of ADHD and executive functioning, including And it's what I like about CBT if people are trained in other things.

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There, there's not too much of a stretch if somebody also has some depressive or anxious features.

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It's not like you have to go, "Oh, today we're talking about your anxiety.

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Tomorrow we'll get back to ADHD."

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No they're ov- the things that you're doing to cope with ADHD will also help with the depressive symptoms and the anxiety symptoms.

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And jumping to a total different Not a totally different, but this is why sometimes people start medications, including stimulants- Yeah approved for ADHD, and it improves their mood, improves their anxiety.

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Yeah, 100%.

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When I was at my- Because people are more confident.

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Yeah yeah, that, that was my thing.

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Actually, speaking of executive functioning, let let's jump back to the beginning of your book.

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You talk about ADHD is not just those And my listeners probably are well-researched by now on ADHD.

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The typical I- it's not just the typical inattention, hyperactive, combined.

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You go into a little bit more there's different things that ADHD looks like.

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Like repeatedly apologizing and scrambling to make amends.

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Out of blue panic moments due to forgetfulness.

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Like- and then you go into executive functioning.

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Can you- Yeah talk about that that initial diagnosis and what's inside that? Yeah, like I say the formal list of 18 symptoms divided between, it's inattention, impulsivity, hyperactivity.

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They're not wrong, they're not bad.

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And some of this is standing on the shoulders of Russ Barkley the sadly late Tom Brown- Yes Martha Denckla, other people.

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But just reiterating and having this forum in a, probably a book that'll hopefully reach a wider audience at least that's what the publishers are gonna do.

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And what I wanted to do too.

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But just going into there's this piece of the executive functions where, the DSM symptoms are descriptors of things that are there.

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But really, at least my experience is people are coming in, they're using the language of executive functions.

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I always run late.

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I'm, I miss deadlines.

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I don't get started on time.

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I overreact.

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I under-react.

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One client we had that came to us with PEN, I was asking, "Are you overwhelmed?" He said, "No, I'm underwhelmed.

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My problem is I'm not worried enough."

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Yes.

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"I should be more, I should be more concerned about some of this stuff."

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And he, then he famously said, "I just wanna be whelmed."

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But it's like, it's the gamut.

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It's like too much, too little.

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It's like Goldilocks, too hot, too cold.

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Yeah.

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'Cause it can be on the extremes.

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So just reiterating and maybe getting out there for people who haven't heard yet.

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Like you said, you probably have a, an up-to-date audience.

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And also the list of 18 symptoms, the DSM, the International Classification of Disorders, the ICD they are ea- easy punching bags for skeptics to say you just described every child and adult on earth."

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Yes.

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"How can you say this is different?" But the executive functions where, you know, the the time management, the working memory, the emo- and a couple things, the emotional dysregulation and motivation.

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Those are both emotions.

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Motivation is emotion.

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And again I'm gonna be a ventriloquist for or I'm his ven- ventriloquist dummy, Russell Barkley.

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Emotion, motivation in executive functioning terms is the ability to generate an emotion about a task in the absence of an immediate consequence.

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To feel enough like studying for the midterm that's three or four days away, get started on it even though you won't feel like doing it or whatever, it'll be better off.

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Being able to generate that feeling enough- Rather than the night before where there's motivation, it's panic and, stress, and it's like a natural stimulant.

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Yeah.

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And people can pull it off, but it comes at a cost, and increasingly these unsustainable things through adulthood.

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So all this going back to ADHD as its...

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at its core as an executive functioning self-regulation issue, how efficiently do I do what I set out to do? Not in any sort of, oh, you have to be in graduate school, you have to have a six-digit salary.

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Th- these m- No, it's whatever we choose to do.

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It could be an art project, could be a letter to the editor.

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It could be a class.

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It could be exerci- it- whatever it is that you choose to do, that it also gets at our sense of self.

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That's the other insidious thing about ADHD.

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Even if it is a class or homework, we might have selected this for a reason.

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I wanna do this so I can pass the class, get the credit so I can get the degree.

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But that's also the other thing.

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As a defining feature of the executive functions is they're there to help navigate the environment and some flexibility, but also largely towards, or at least how we humans have been able to make use of them, towards these larger, later payoffs.

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The things that won't pay off now, it could be a retirement fund, it could be health and wellbeing, relationships, raising children, but also, other things, building roads, agriculture, o- other, whole wide array of these good human things.

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But shedding light on...

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And hopefully if some skeptics are reading it or they're saying, "Oh, okay, I gotta understand my kid or my partner," it's oh, hopefully this makes a little more sense.

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And it also...

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it helps, as a, somebody who also does diagnostic assessments, this is how you see ADHD.

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It's hard to see inattention.

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It's hard to see, you know- Yeah, and actually I- that silly restlessness.

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Yeah I appreciate that because when back in my late 30s or m- maybe mid-30s I was at a doctor's appointment.

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I was like, "I can't figure myself out.

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I'm...

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I feel anxious.

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I'm depressed," like all of the above.

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Two doctors are sitting in front of me asking a bunch of questions.

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Everything they asked ended up, "No I complete tasks.

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I'm a go-getter.

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I get things done on time.

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Are you kidding me? I follow through."

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But what they didn't know is I was at the right place at the right job.

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It was good for me.

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I was in tech- and tech was good for my brain.

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But it was these nuances I, I look at the ASRS questionnaire.

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I like that one.

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And it goes a little bit d- deeper.

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Yeah.

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And had they asked some of those ASRS questions, which, folks, if you're listening I'll put a link to the general PDF on there.

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Those things about interrupting About initiating a task.

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I have a hard time initiating because I need it to be the perfect first step.

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Yeah.

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I never thought myself as a perfectionist till I learned that my, my perfectionism- comes with my first perfect step.

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Front-end perfectionism- Yes we call it.

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So the diagnosis process I think for me was missed, so they said I have mild depression.

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It wasn't I...

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till I hit rock bottom with having a baby at 40 that- my doctor was like, "This is ADHD through and through," which was- Yeah I was skeptic.

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I wanna come back to this section on self-mistrust.

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There's a sentence in there.

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ADHD-generated self-mistrust beliefs color the lens through which you see your self-worth and place in the world."

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You know what? It came from the Rethinking Adult ADHD book, which I set out saying, "Okay, I wanna..."

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All the research we did, Laura Naugle, other colleagues had done on the cognitions, not that you think yourself into ADHD, but once you have it and you've lived with it, that, that built-up mindset- that, yeah the lenses through which you see the world.

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And it actually eventually came from reading some work by Albert Bandura- also since passed away, but he was an expert in self-efficacy, your belief in your ability to do things.

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And there was a lesser-known, I'd never heard about it, called self-regulatory efficacy.

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So I'm reading his book, and I still remember the I don't remember the date, but I remember I was on the train going to work, and we were pulling into Temple University Station as I hit upon it, and I'm, like, madly circling it and, putting Post-It notes on it.

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But it was...

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He talked about self-regulatory efficacy.

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Now, agency is the belief in our ability to make changes that improve our life.

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Self-efficacy might be, okay, so we believe that I can learn something if I need it.

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Self-efficacy might be, oh, there's a class in something I want to learn.

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So that's self- self-efficacy.

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I can take this action to learn this thing.

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Self-regulatory efficacy is embedded in there.

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It is the belief that I will show up every day at class, I will keep up with all the assignments and hand them in on time, be prepared for the test, and be able to complete the class.

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All the things that go in the building blocks of self-efficacy, and I hadn't seen anything about that.

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Later on, looking, I saw things around e- like exercise.

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Are you willing to put up with the soreness to lift the weights or whatever? And in reading it he was talking about, people with low self-regulatory efficacy if they don't trust that they can handle all the stress, boredom, all the little tedious things that go into the class, all the things nobody in their right mind is ever in the mood to do but we know we have to- and it is part of something that we want.

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We have skin in the game.

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But he, I think he even said, Those who distrust their ability to do it will say why engage in the first place?' And they'll be more likely to make a premature exit."

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And I just said, "That is pretty much a description of the executive function," so I said...

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And citing him throughout, but, this is ADHD, self-mistrust.

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You know what? And since then, I forget if it made the book I might have found out about it after the copy edits were submitted.

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Now it wasn't specific to ADHD, but there's a researcher who had done research on self-regulatory efficacy and procrastination and found that self-regulatory efficacy is a protective factor.

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If you have high self-efficacy- you would be more likely to procrastinate than if you have high self-regulatory efficacy.

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So that is something where I would hypothesize, and it still needs to be tested, even though that would be somewhat confirmation at least in that direction, that, ADHD, at least as a core element, there is that mistrust tied in with the executive dysfunction.

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Yeah.

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And that would be a connection.

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Yeah.

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And with any hypothesis, it could be wrong.

264
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It should be tested.

265
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No it's very real.

266
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But I'm- It's very real.

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Okay.

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I'm dealing with one right now because th- there's this side of me as we're growing our coaching firm- We've brought on amazing coaches to support our clientele.

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There's some...

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I'm backing away from some, focusing more on operations.

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And I'm also hiring people to do some of this marketing operations.

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And then there's a part of me that goes if I delegate this out, what am I gonna do with my free time? And am I gonna fill my free time with the strategic things?" So there's this mistrust that I'm having with myself these days around how will I navigate this new space- that's really new for me.

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So what you're saying totally resonates.

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Yeah.

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And then, there's always the question, all right, what do I do about it? But I think that's where...

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You know what I use many times the phrase that our thoughts, feelings, and behaviors are like a braided cord.

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Yes.

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So I might ask about thoughts, but sometimes thoughts are putting words on feelings, and thoughts can change feelings, but feelings, "Oh, I feel better now," and then that can change our thought, "I guess it wasn't that bad."

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And behaviors and all, every one influences the other.

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But at the end of the day, it's behavior change, using the coping skills, facing things, making informed decisions to say, "This isn't working out.

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I gave an honest try all the way through, so now I can disengage and re-engage elsewhere," which is- That's it important coping.

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00:22:38,2.9423783 --> 00:22:53,862.9429887
But even going back to, answering the rhetorical question, what am I gonna do with my down time? And then it might be, all right, how do I define in specific actionable terms what it means to, handle, and I forget the phrase you used, but your management time.

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And it's because that's one of those organize the house, get in shape use my management time.

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Broad, vague, and nonspecific, and that uncertainty or lack of clarity is gonna say, "Okay, let me check my email.

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That I can do."

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That.

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Yes.

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"I'm confident."

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Yeah, that sort- Yes that sort of thing.

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Yeah.

291
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And it's not wrong, and it's not illegal, immoral, unethical, but it's just that it's not getting, not getting back to the priority the thing that would be- Yeah, and it happens- important or rewarding in such automatic way.

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You talk about negative thinking.

293
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Or no, automatic thoughts.

294
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Automatic negative thoughts.

295
00:23:28,562.9353593 --> 00:23:32,832.9396317
Oh, the, Are we talking about the, There's also the the automatic avoidant thoughts.

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That's it.

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That's the one.

298
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Th- these are the distorted positive thoughts because, even cognitive therapy for depression, yes- generally more, if there's more pessimism, there might be room for at least a little more optimism.

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But, the line I think I use it a lot, gamblers are very positive thinkers.

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But it may not be adaptive.

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And so this is the work of Laura now.

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She's cited in the notes 'cause- that's just the way this book is cited.

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And she's done work specifically on ADHD, and- The avoidant automatic thoughts are positive thoughts, but also they can be known within, like cognitive behavioral therapy for addiction, as permission-giving beliefs.

304
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Oh- I've gone a week without smoking a cigarette, I'm gonna celebrate with a cigarette.

305
00:24:13,762.9443238 --> 00:24:14,432.9444001
Yes.

306
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Or, however many days sober, not to make light of it, but it can also be I know this usually sucks me in, but I'll just do it for a few minutes, and then I'll get back.

307
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And if we do, fine, but we're most likely...

308
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or waiting till the last minute is a big part of who I am.

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And it's just all these things that we know or at the...

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We know how the movie ends, but at the outset it's no.

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It's what is a rationalization? It's usion- using logic or rational thinking to convince ourselves to do something that's actually going against what we want to do.

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You know what? I...

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These cookies, you have cookies around the house, it's a temptation.

314
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I should just eat them all just to reduce the temptation.

315
00:24:49,782.9419206 --> 00:24:50,112.9437516
Yeah.

316
00:24:50,242.9440568 --> 00:24:53,42.9432939
That way I won't eat any, I won't eat any tomorrow or the day after.

317
00:24:53,162.9422257 --> 00:24:54,552.9416154
So n- Problem solved.

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I know.

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Not to go into the depth of it, but what's one way to address that? It, one, it's the recognition of where we're at.

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It's an on- You know what? And in a way it's not wrong what I say.

321
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It's recognizing this tendency that we can all have.

322
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Yes.

323
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Nanny, yeah, for sure.

324
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And making it...

325
00:25:14,572.9439042 --> 00:25:18,452.9411576
And this is also with planning and anticipation.

326
00:25:18,762.9387162 --> 00:25:23,722.9378007
Now, this could be planning work that we're doing on our own, like you said, your management or your- vision work.

327
00:25:24,132.9368852 --> 00:25:29,542.9283402
This could be, getting together with friends where you go, "Here's what I don't want to do.

328
00:25:29,542.9283402 --> 00:25:32,802.9304765
I don't want to smoke, I don't want to drink, I don't want to have too many sweets," or whatever.

329
00:25:33,72.9347489 --> 00:25:37,102.9335282
But also getting ready for what you may encounter that could trigger one's not bad."

330
00:25:37,862.9280351 --> 00:25:43,882.9323075
And in the grand scheme of things, maybe not, but maybe it's, it is too much, or it leads to too much.

331
00:25:44,312.9326127 --> 00:25:47,392.9344438
And having responses at the ready.

332
00:25:47,392.9344438 --> 00:25:54,172.9286454
So that pre-planning, especially with social situations and it's a little bit of cognitive rehearsal.

333
00:25:54,202.9274247 --> 00:25:59,342.931392
Okay, if they offer me something I don't want to do or even something that could be good, like a...

334
00:25:59,392.9344438 --> 00:26:03,122.9301713
And I get at this talking about the social interpersonal element of ADHD.

335
00:26:03,412.9387162 --> 00:26:11,812.9326127
A friend invites me to a lovely three or four course dinner, but somebody goes, "Yeah, I'm gonna fill up on bread, then I'm gonna be sitting there and just-" Yeah.

336
00:26:11,812.9326127 --> 00:26:13,42.9283402
It's just too long to sit there.

337
00:26:13,292.9283402 --> 00:26:14,932.9277299
It's maybe making a counterproposal.

338
00:26:14,932.9277299 --> 00:26:18,592.931392
Tell you what, how about we get together for coffee and dessert?" Or something like that.

339
00:26:18,912.9234574 --> 00:26:21,982.9307816
Or a business lunch that'll be like half an hour, 45 minutes.

340
00:26:22,382.9246781 --> 00:26:33,822.9302476
And it's playing to your strength, and still- playing a role in the relationship and playing fair, but also going, "You know what? This might work better for me 'cause that, I'll be distracted, I'll be looking around.

341
00:26:33,822.9302476 --> 00:26:37,582.9304765
I'll, I won't be able to be the best me in that situation."

342
00:26:38,22.9300569 --> 00:26:40,812.9300187
And just to see what happens, and see whether the friend goes- I love that "Oh, yes.

343
00:26:40,812.9300187 --> 00:26:41,632.9297135
Good idea, too."

344
00:26:41,722.9298661 --> 00:26:41,952.9294084
Yeah.

345
00:26:42,122.9294847 --> 00:26:47,482.930095
Cause what I'm hearing in the absence of it, then you automatically will do these things 'cause your brain is used to it.

346
00:26:47,482.930095 --> 00:26:50,202.9294084
Predictor machine, let me do the same thing as I've always done.

347
00:26:50,302.9297898 --> 00:26:56,302.9297898
The cognitive rehearsal kind of becomes your pause button as- Yeah as we talk about often, is take a pause.

348
00:26:56,332.9285691 --> 00:26:56,592.9307054
Oh, yeah.

349
00:26:56,632.9278062 --> 00:26:57,262.9288743
Take a minute.

350
00:26:57,822.9302476 --> 00:27:02,702.927501
And set yourself up for this is what I'm about to anticipate, and here's- this new roadmap.

351
00:27:02,992.9246018 --> 00:27:06,252.9267381
I always talk about having r- our brain likes a nice roadmap.

352
00:27:06,802.9259751 --> 00:27:07,2.9267381
Yes.

353
00:27:07,2.9267381 --> 00:27:09,272.9233811
To just rehearse all of this is what we've been doing.

354
00:27:09,352.9221604 --> 00:27:10,422.9218553
So love that.

355
00:27:10,422.9218553 --> 00:27:11,242.9215501
Love that idea.

356
00:27:11,272.9203294 --> 00:27:18,662.919719
And to get out of this loop of automatic way of just being versus- you know what? Also, you alluded to it in there.

357
00:27:18,662.919719 --> 00:27:23,232.9201768
There is a tendency I think in an early book called it automatic compliance.

358
00:27:23,282.9224656 --> 00:27:24,562.9250596
Automatically saying yes.

359
00:27:24,762.9220078 --> 00:27:25,32.9262803
Yes.

360
00:27:25,32.9262803 --> 00:27:26,302.9305528
How about this dinner?" "Yes.

361
00:27:26,462.9265855 --> 00:27:27,342.9314683
I want to hang out with you."

362
00:27:27,342.9314683 --> 00:27:37,452.9320786
And it's all good stuff, but then later on going, "Oh, what did I get myself into?" Or later on, have you ever been annoyed that you agreed to something, it's "Oh, why did I say yes? There goes my weekend," or, "I'm already over."

363
00:27:37,812.932689 --> 00:27:42,662.9311631
And just that, and you're right, that baked into a lot of interventions, I think, is a pause.

364
00:27:43,192.9299424 --> 00:27:43,882.9323838
Let me stop.

365
00:27:44,252.9351304 --> 00:27:49,952.9290269
And which is after a sense of self and self-awareness, that's the first executive function development developmentally.

366
00:27:50,522.9287217 --> 00:27:55,172.9226182
But working that in, and even something like, "Let me think about it and get back to you," or, "Let me check and get back to you."

367
00:27:55,592.9284165 --> 00:27:59,902.9259751
And that way you can, have a counterproposal or decide, "You know what? That really doesn't work for me.

368
00:27:59,902.9259751 --> 00:28:00,852.9229234
I'm gonna say no."

369
00:28:00,852.9229234 --> 00:28:02,732.9201768
And there's a whole thing around that.

370
00:28:03,212.9235337 --> 00:28:06,112.9250596
And it's also baked into I talk about assertiveness and self-advocacy.

371
00:28:06,112.9250596 --> 00:28:07,532.9232285
And which can be done nicely.

372
00:28:07,762.9220078 --> 00:28:08,852.9259751
But that would be an example.

373
00:28:08,852.9259751 --> 00:28:15,32.9186509
"I'm sorry I'm not be- gonna be able to make that," or making the counterproposal, or a host of other ways to...

374
00:28:16,382.9201768 --> 00:28:17,482.9262803
it's a both/and.

375
00:28:17,562.920482 --> 00:28:20,942.9253648
You'll put yourself in a better situation, and hopefully that'll be good for the relationship.

376
00:28:20,942.9253648 --> 00:28:23,372.9180406
And I'm all for returning favors and things like that.

377
00:28:23,422.9210923 --> 00:28:24,432.9308579
"Oh, you helped me move.

378
00:28:24,432.9308579 --> 00:28:26,82.9247544
I'll help you move," even though it's inconvenient.

379
00:28:26,82.9247544 --> 00:28:26,282.9217027
Totally.

380
00:28:26,622.9180406 --> 00:28:30,742.9284165
But a lot of times it's "Oh, I said yes, but I didn't think it through fully."

381
00:28:30,742.9284165 --> 00:28:30,922.9363511
Yeah.

382
00:28:30,922.9363511 --> 00:28:32,682.943065
"And now I'm at a deficit for something."

383
00:28:32,682.943065 --> 00:28:37,752.9442857
And you talk about this in, This is why I say, people, he's left no- stone unturned.

384
00:28:37,752.9442857 --> 00:28:42,362.9296372
Because the what you just went to is in the chapter around tending to s- your social life.

385
00:28:42,662.932689 --> 00:28:43,32.943065
Yes.

386
00:28:43,62.9418443 --> 00:28:45,22.9332993
And you talk about boundaries.

387
00:28:45,22.9332993 --> 00:28:46,792.9375718
And actually, there's a phrase you use.

388
00:28:46,792.9375718 --> 00:28:49,42.9345201
I don't know if this one is Wait, I'm getting ahead of myself.

389
00:28:49,892.9406236 --> 00:29:02,487.932174
There's one thing I want to come back to, but on the boundary side the resetting, I want to address the constant elephant in my room of conversations with my clients- I'm a people pleaser, Cathy.

390
00:29:02,767.9320977 --> 00:29:03,297.9320691
I'm a people...

391
00:29:03,347.9320214 --> 00:29:06,77.9318021
as if they- they've got it tattooed, they're proud of it.

392
00:29:06,377.9319928 --> 00:29:10,177.9311917
What is up with people pleasing and ADHD, doc? Please.

393
00:29:10,177.9311917 --> 00:29:10,457.9309247
Yeah.

394
00:29:11,317.931535 --> 00:29:15,757.9309247
What's up, doc? You know what? I think it is intertwined with the self-mistrust.

395
00:29:15,797.9318402 --> 00:29:19,997.9318402
And this is something I weave into the social life.

396
00:29:20,747.9318402 --> 00:29:24,607.9305432
It's the less than stance.

397
00:29:24,647.9314588 --> 00:29:26,47.9291699
The assumption that...

398
00:29:26,787.9308484 --> 00:29:30,907.9305432
What I've heard from clients "Oh, I'm always late," or they're "I forget things."

399
00:29:30,907.9305432 --> 00:29:37,627.9317639
And these may be accurate, and this is where I use the idea of social capital, like relationships are like a shared account.

400
00:29:37,677.9317639 --> 00:29:41,337.9316113
And it doesn't mean- Love that everything has to be even all the time.

401
00:29:41,337.9316113 --> 00:29:42,987.9331372
There, there can be, "Hey, you're a friend.

402
00:29:42,987.9331372 --> 00:29:43,957.9305432
He's going through a tough time.

403
00:29:43,957.9305432 --> 00:29:44,767.9319165
You lend them money."

404
00:29:44,767.9319165 --> 00:29:50,677.9317639
There's that they're building up a debt, but it's debt forgiveness or things like that, or you know them, or a sibling or whatever.

405
00:29:51,77.9332898 --> 00:29:52,317.9311536
But there can be other time...

406
00:29:52,347.9299329 --> 00:29:58,607.9320691
And I, I think adults with ADHD might overestimate their withdrawals on relationships.

407
00:29:58,607.9320691 --> 00:30:03,577.9302381
"Oh, they must be so angry at me," and- Yes they say it doesn't bother them, but they're just being nice.

408
00:30:04,267.9250501 --> 00:30:13,157.9244397
They're not gonna tell me what they really think, or all these things that can lead to trying to make deposits, and that could be, "I'm gonna say yes.

409
00:30:13,637.9277966 --> 00:30:17,237.9262708
I'll have the house cleaned up by the time you get home," even though it's unrealistic.

410
00:30:17,747.9238294 --> 00:30:24,27.9226087
And so it, it's almost like then you've built up more debt as opposed to under-promising and maybe over-delivering.

411
00:30:24,27.9226087 --> 00:30:25,147.9177258
"I'll see how far I can get."

412
00:30:25,147.9177258 --> 00:30:26,757.9183362
It's like, "Oh, I got this wall done."

413
00:30:27,27.9226087 --> 00:30:27,467.9174207
Great.

414
00:30:27,797.9192517 --> 00:30:28,497.9238294
That looks good.

415
00:30:28,497.9238294 --> 00:30:28,707.9229138
Yeah.

416
00:30:28,737.9216931 --> 00:30:30,927.9241345
Oh, more to do, but hey, that was pretty productive.

417
00:30:31,377.9241345 --> 00:30:35,517.9311536
So all these things, and getting back to the people pleaser, I think it's trying to pay down debts.

418
00:30:35,807.9244397 --> 00:30:45,867.9296277
Now, it can also be sometimes impulsively nice, even if they go, "Oh, you know what? No, I don't feel less than, but it's just I like being helpful," which is fine.

419
00:30:46,257.9290173 --> 00:30:53,277.9256604
But it can be, if it's coming at a detriment to them, or maybe in a workplace, members of a team.

420
00:30:53,737.9277966 --> 00:30:55,867.9326795
"Oh, you said our team can also do that.

421
00:30:55,867.9326795 --> 00:31:03,967.9265759
Did you consult with us yet?" Or everything- No, my hyperactivity got the best of me and the dopamine, and I call it- Yeah, exactly capacity blindness.

422
00:31:04,97.9314588 --> 00:31:04,737.9308484
Like There you go.

423
00:31:04,767.9296277 --> 00:31:05,227.9363416
Yes.

424
00:31:05,227.9363416 --> 00:31:05,777.9241345
Yes.

425
00:31:06,287.9339002 --> 00:31:19,107.9259656
No, but that's why, "Let me think about it and get back to you," 'cause then we can go, "You know what? I'm gonna be busy all weekend or for the next several weeks, and as great as it may be, I'm gonna say no this time," which can be hel- painful.

426
00:31:19,567.9326795 --> 00:31:24,727.9363416
But a lot of these things I'll liken it to, it's gonna be the investment of 20 seconds of discomfort.

427
00:31:25,107.9290173 --> 00:31:25,487.9339002
No.

428
00:31:25,487.9339002 --> 00:31:26,287.9369519
My no is final.

429
00:31:26,287.9369519 --> 00:31:26,787.9369519
Thank you.

430
00:31:26,817.9357312 --> 00:31:27,737.9339002
Oh, that would've been fun."

431
00:31:27,737.9339002 --> 00:31:32,277.9393933
But then it's "I just saved myself a you know what load of time- Yes and energy and yeah.

432
00:31:32,307.9381726 --> 00:31:36,297.9467175
And this one kind of ties into emotional impulsivity.

433
00:31:36,867.938783 --> 00:31:37,227.9393933
Yes.

434
00:31:37,977.9430721 --> 00:31:41,217.9429625
And you talk about how it's underappreciated part of ADHD.

435
00:31:41,367.9430578 --> 00:31:49,167.9432486
Does it tie to that one? I feel like it does, right? You know what? I think it, the emotions tie to a lot of things 'cause they're central to making decisions.

436
00:31:49,197.9429815 --> 00:31:56,127.942333
And But all that being said, they can sometimes be based on miscalculations or overestimations.

437
00:31:56,157.9430197 --> 00:32:02,977.9427145
"Oh, I'm sure they're furious with me," even though they go, "Yeah I would have liked to have had it yesterday, but I'm glad you got it to me today.

438
00:32:03,7.9434011 --> 00:32:03,407.9430197
Thanks."

439
00:32:03,407.9430197 --> 00:32:07,197.9420279
And, "Oh, they must be upset," or, that simmering inside.

440
00:32:07,667.9424856 --> 00:32:13,497.9435537
It can also be, it can also be over-enthusiasm, saying yes because it's really exciting.

441
00:32:13,987.9414175 --> 00:32:20,577.9453848
I remember when I was a post-doc at Penn, Friday afternoons, "Oh, I'm gonna take these book- books home and have a chance this weekend to catch up on everything."

442
00:32:20,807.944927 --> 00:32:24,857.9441641
I'd be carrying those books back on Monday maybe having opened one for a little bit.

443
00:32:24,857.9441641 --> 00:32:25,7.94569
Yep.

444
00:32:25,37.9444693 --> 00:32:27,427.9484365
And it's like that overestimation.

445
00:32:27,917.9455374 --> 00:32:28,687.9459951
Things like that.

446
00:32:28,687.9459951 --> 00:32:35,687.9493521
But often what causes the problems can be the more negative emotions, the things that require self-soothing.

447
00:32:35,737.9493521 --> 00:32:43,467.9450796
Now, what I described as motivation before, that can be upregulating emotions, like trying to gear up for doing something that maybe you don't feel like.

448
00:32:43,467.9450796 --> 00:32:43,527.9502676
Yeah.

449
00:32:43,557.9490469 --> 00:32:53,637.9478262
But a lot of times it's the unpleasant emotions, not necessarily negative, but unpleasant, because it's good to have some of the negative emotions because they give information, too.

450
00:32:53,637.9478262 --> 00:32:59,357.9566763
But often it's the self-soothing and not overreacting or getting overly frustrated, with things.

451
00:32:59,357.9566763 --> 00:33:00,907.9520987
But, I think the emotions tie in.

452
00:33:00,907.9520987 --> 00:33:07,37.9493521
And with the people-pleasing, it's that, maybe that nervous desire to, "Oh, here's here's my chance to make up things."

453
00:33:07,37.9493521 --> 00:33:07,337.9524038
That's it.

454
00:33:07,337.9524038 --> 00:33:16,642.9555152
To make, to, to be seen please the other person so they see me- there seem to be some better eyes for whatever And it, it's almost like seeking external validation.

455
00:33:17,82.9555724 --> 00:33:19,142.9555152
Yeah, if you wanna say it succinctly, that's a nice way to put it.

456
00:33:19,222.9556296 --> 00:33:30,662.9531119
You know what? And some of the research, I think it got mentioned in there, it was pretty fresh when I put it in we're proposing, and it hasn't been published yet but we're gonna be presenting a paper at the upcoming World Congress of Cognitive Behavioral Therapy.

457
00:33:31,182.9535697 --> 00:33:36,622.9541038
But that sort of external self-worth- externalization of worth and also comparative thinking.

458
00:33:36,782.9539512 --> 00:33:39,272.9537223
How do I size up with other people? That's...

459
00:33:39,302.9563163 --> 00:33:42,202.9578422
there's the cognitive triad of depression I mentioned before.

460
00:33:42,202.9578422 --> 00:33:44,492.9587577
Negative thoughts about the self, the world, and the future.

461
00:33:45,172.9590629 --> 00:33:53,342.9572318
We're proposing, this is early days, but we have a couple studies, perfectionism, this externalization of self-worth, and emotional reasoning.

462
00:33:53,672.9590629 --> 00:33:53,852.959368
Oh, boy.

463
00:33:53,852.959368 --> 00:33:55,242.9587577
If it feels good, it must be good.

464
00:33:55,242.9587577 --> 00:33:56,742.9587577
If it feels bad, it must be bad.

465
00:33:56,802.9563163 --> 00:33:57,62.9584525
Yes.

466
00:33:57,62.9584525 --> 00:33:59,112.9576896
But ho- homework's always gonna feel bad.

467
00:33:59,112.9576896 --> 00:34:02,842.9572318
Housework, yard work's always gonna- Taxes it's not gonna feel great.

468
00:34:02,842.9572318 --> 00:34:04,952.9578422
Taxes? Yeah, absolutely.

469
00:34:04,952.9578422 --> 00:34:12,802.9479239
There, in all the studies around the world over the past few decades on emotional reactions to taxes there's still no way you're gonna feel like doing it.

470
00:34:13,122.9476188 --> 00:34:14,282.9512809
It's confirmation, yeah.

471
00:34:14,282.9512809 --> 00:34:16,222.9537223
It's like you're not gonna go, "Oh, thank goodness.

472
00:34:16,222.9537223 --> 00:34:16,992.9503653
This is back.

473
00:34:17,32.9512809 --> 00:34:17,572.9521964
I missed it."

474
00:34:17,572.9521964 --> 00:34:19,302.9479239
Or I wanna practice in between."

475
00:34:19,982.9482291 --> 00:34:22,542.9457877
No, you're never gonna feel more like doing it the next day.

476
00:34:22,742.9503653 --> 00:34:34,482.9482291
So what's the gist of that paper that, that you're working on? Oh it's just, what it was, we had two s- two separate studies by trainees- Okay With us who are graduate students who did dissertation on our data.

477
00:34:34,922.9430411 --> 00:34:41,562.9500602
One was published in 2016, and it was a study where perfectionism emerges far and away the number one distortion.

478
00:34:41,562.9500602 --> 00:34:46,882.9451774
It's not a classic distortion- but the number one thinking pattern endorsed by adults with ADHD.

479
00:34:47,642.9396842 --> 00:34:51,442.942736
And then when I was looking at it, I think for the book or maybe it was for something else, I was noticing...

480
00:34:51,862.9409049 --> 00:34:54,712.9363273
'Cause I would've bet comparative thinking, but that was, it was there.

481
00:34:54,712.9363273 --> 00:34:56,522.9338859
It was at the top, and emotional reasoning was there.

482
00:34:56,882.9344962 --> 00:35:00,332.9314444
And then we had another person, and we'll probably try to get it published then.

483
00:35:00,722.9338859 --> 00:35:07,772.9369376
She w- but she used the same scale and just got a count, and I was looking at it, it's like, it's a different order, but all the same top four were there.

484
00:35:07,772.9369376 --> 00:35:18,482.9253409
So I started putting together, and there's a little bit of combining, but still overlapping, and it was just okay, there are these three things that sort of fit executive functions and the difficulties- with ADHD.

485
00:35:18,482.9253409 --> 00:35:28,862.9442618
And the perfectionism, there's a right way to do things, and if I can't do it the right way, yo- if I'm not in the mood to do it at the front end, I'm justified in waiting till I will be in the mood, assuming that we will.

486
00:35:28,912.9442618 --> 00:35:29,732.9363273
But that's hope.

487
00:35:29,852.9467032 --> 00:35:30,792.9338859
Hope springs eternal.

488
00:35:31,352.9467032 --> 00:35:33,512.9351066
Emotional reasoning, if it feels good, it must be good.

489
00:35:33,512.9351066 --> 00:35:34,832.9424308
If it feels bad, it must be bad.

490
00:35:35,222.9418204 --> 00:35:39,362.9412101
Oh, if this feels good, this will be fun, then it'll put me in the mood to do this other thing.

491
00:35:39,552.9436515 --> 00:35:41,162.9442618
And if it does, great, but it probably won't.

492
00:35:41,962.9503653 --> 00:35:44,872.9540275
And then like I said, the externalization of self-worth, the...

493
00:35:44,872.9540275 --> 00:35:48,182.9515861
I think that's what we're calling it, but it buil- it, it builds in.

494
00:35:48,182.9515861 --> 00:35:54,872.9569171
Is there some standard, like grades? Or is there something else "Oh, I'm not as good as everybody else in this," that these...

495
00:35:55,602.9569362 --> 00:35:57,782.9567645
And there's a certain degree of that we all do.

496
00:35:57,952.9568408 --> 00:35:59,652.9566501
"Oh, my friend's really good at math.

497
00:35:59,652.9566501 --> 00:36:01,22.9565356
I'm really good at English.

498
00:36:01,22.9565356 --> 00:36:03,172.9561542
They're good at this sport, I'm good at this sport."

499
00:36:03,392.9564212 --> 00:36:08,332.9569552
That's not my thing within reason, but with ADHD it just seems like there's a lot more.

500
00:36:08,362.9557345 --> 00:36:15,232.9565738
And this is how ADHD can get in the way of things that people want to do, maybe even skills and talents they have.

501
00:36:15,602.9555057 --> 00:36:37,992.9585574
But I've heard things even like from athletes who feel good, but like the the football player who forgets to play when they lose when they leave the huddle, or the swimmer who loses concentration, or the tennis player who loses concentration- Wow on a long rally, and it, just these subtle little things in that setting that are enough to go, "Oh, I was winning, but then I totally fanned on that shot," or whatever it was.

502
00:36:38,702.9576419 --> 00:36:40,332.95871
Oh, fascinating.

503
00:36:40,662.9567264 --> 00:36:40,832.95871
Yeah.

504
00:36:40,832.95871 --> 00:36:41,792.9577945
Fascinating.

505
00:36:41,902.9584048 --> 00:36:42,412.9567264
God.

506
00:36:42,852.9584048 --> 00:36:43,482.9594729
Good stuff.

507
00:36:43,532.9608462 --> 00:36:47,302.9651187
Back into our book, you spent a good amount of time on procrastination.

508
00:36:47,892.9652713 --> 00:36:48,402.9674075
Oh, yeah.

509
00:36:48,982.9616092 --> 00:36:53,362.9677127
And how it's with those of us with ADHD, this is our best friend.

510
00:36:53,672.9652713 --> 00:36:56,472.968323
Along with people-pleasing, procrastination, as you said.

511
00:36:56,892.966492 --> 00:37:04,522.9637454
How does CBT, without spoiling the book address the core or the surface of...

512
00:37:04,672.9652713 --> 00:37:08,412.9707644
Let's say the surface, 'cause there's quite a bit of content on procrastination in the book.

513
00:37:08,852.9686282 --> 00:37:14,82.9719851
It, in when, in some ways you, you don't, you can't do the surface without the underlying.

514
00:37:14,162.9707644 --> 00:37:23,852.9619143
What I found useful- and it was repeated in the book, and it's, anybody who's seen me I alwa- anymore I just always add it in 'cause it's the best thing I can think of, but I'm not biased at all.

515
00:37:24,932.9637454 --> 00:37:33,962.9594729
But the idea of procrastivity or- Yes productive procrastination, so that would be, "Okay, I'm gonna work on taxes, but let m- let me mow the lawn first, then I'll be in the mood to do it."

516
00:37:34,62.9579471 --> 00:37:34,462.9594729
Amen.

517
00:37:34,462.9594729 --> 00:37:35,632.9576419
Or let me do something.

518
00:37:35,632.9576419 --> 00:37:41,432.9606936
And we all do this, and on the continuum of procrastination, it is known as productive procrastination.

519
00:37:41,712.9594729 --> 00:37:46,292.9536746
"All right, it's not happening today, so if I'm not doing that, I might as well catch up on all these other things."

520
00:37:46,572.9677127 --> 00:37:47,882.9652713
You salvage a day.

521
00:37:48,242.9658816 --> 00:37:58,752.9634402
But it got me thinking what is it about those other tasks, like the student, the college student with six weeks of laundry who all of a sudden facing an essay says, "I gotta catch up on laundry first."

522
00:37:58,872.9616092 --> 00:38:00,122.9616092
Or mowing the lawn.

523
00:38:00,372.9616092 --> 00:38:07,312.9640506
The best example, and it's real, from my clinical practice, I told the person and she's fine with me sh- I'm not sharing anything confidential.

524
00:38:07,892.9536746 --> 00:38:11,932.9469607
But she had to do a journal presentation, journal club the next day in her lab.

525
00:38:11,982.9500125 --> 00:38:13,202.9512332
She was a graduate student.

526
00:38:13,732.9500125 --> 00:38:16,872.9494021
And we met, I think, earlier in the day or the day before, had a plan.

527
00:38:16,872.9494021 --> 00:38:18,512.9487918
She had a long day in lab or whatever.

528
00:38:18,512.9487918 --> 00:38:19,782.9378055
She's gonna come home.

529
00:38:19,882.9396365 --> 00:38:26,152.9286502
I think she had selected the article, and we were just talking about, "You know what? This only has to be like three or four slides just to get the discussion going.

530
00:38:26,152.9286502 --> 00:38:28,92.9310916
Read the abstract, read a couple things."

531
00:38:28,472.9207156 --> 00:38:31,927.9243443
She came home and said, "You know what?" I'm gonna bake a cake.

532
00:38:32,257.9243873 --> 00:38:34,577.9243205
And she baked the cake and all this and didn't get around.

533
00:38:34,577.9243205 --> 00:38:35,767.9243777
She got somebody to switch with her.

534
00:38:36,477.9244159 --> 00:38:40,577.9247973
And later on, she'd been watching baking shows, and it was just like, "Oh, I've wanted to do it.

535
00:38:40,757.9241488 --> 00:38:46,427.9244159
Why not now?" Yep and when she came back and talked about, "Yeah, I never got around to it.

536
00:38:46,427.9244159 --> 00:38:47,37.9250262
It got late.

537
00:38:47,37.9250262 --> 00:38:47,917.924187
I got tired.

538
00:38:47,917.924187 --> 00:38:50,107.924721
I found somebody to switch with me," whatever.

539
00:38:51,57.9235766 --> 00:38:52,97.9244922
But she goes, "You know what, Dr.

540
00:38:52,97.9244922 --> 00:38:54,67.9238055
Ramsey? I'm diabetic.

541
00:38:54,217.9253314 --> 00:38:55,297.9252551
I couldn't eat the cake.

542
00:38:55,327.9240344 --> 00:38:57,677.9244159
And it's not like it was for a neighbor or something like that.

543
00:38:57,707.9251025 --> 00:38:59,467.9253314
I just did it to do it that way."

544
00:38:59,467.9253314 --> 00:39:00,937.9227374
And people have asked she's diabetic."

545
00:39:00,937.9227374 --> 00:39:02,967.923424
She wanted to make the cake and figured she could give it away.

546
00:39:03,67.9235766 --> 00:39:11,697.921593
But what is it about those things? One, there's usually we usually have experience where there's clear s- steps for getting started that we're confident we can do.

547
00:39:12,27.923424 --> 00:39:14,127.9218982
In the cake, there's an explicit recipe.

548
00:39:14,157.9206775 --> 00:39:15,237.9225085
Here's what you need to do.

549
00:39:15,607.9214404 --> 00:39:21,257.9199145
Journal article, she's read a lot of them, but the presentation, where do I start, what's important, things like that discomfort.

550
00:39:21,677.9180835 --> 00:39:26,117.9205249
There's a probably clear sense of making progress and sustaining progress.

551
00:39:26,407.9168628 --> 00:39:38,37.9141162
Usually a clear endpoint, whereas taxes or the essay or maybe to a degree a presentation, you might, "Oh, I got more I have to do," or, "I have to look up something else," or, "I have to work on this tomorrow."

552
00:39:38,737.9186938 --> 00:39:43,547.9162524
And even within homework or things like that, there's probably like a rock, paper, scissors algorithm.

553
00:39:43,767.9098437 --> 00:39:45,497.9132007
Okay, writing's harder than reading.

554
00:39:45,497.9132007 --> 00:39:47,247.9132007
Reading's harder than a problem set.

555
00:39:47,727.9165576 --> 00:39:51,727.9165576
And you know what? And to wrap it up, I might be missing some steps, but I think you get the gist.

556
00:39:51,797.9162524 --> 00:39:51,947.9177783
Yeah.

557
00:39:51,997.9132007 --> 00:39:59,217.9174731
But people will spend more time on the mowing the lawn, laundry the cake than the actual task.

558
00:39:59,217.9174731 --> 00:40:02,207.9153369
I was gonna do 30 minutes of taxes, but I spent 90 minutes with yard work.

559
00:40:02,207.9153369 --> 00:40:02,967.9174731
That's right, yeah.

560
00:40:03,17.9205249 --> 00:40:04,567.9159472
Because they're more confident.

561
00:40:04,697.9208301 --> 00:40:14,577.9180835
It's more in line, more in harmony with their sense of I know I can, I trust I can do this, where this other thing, the uncertainty, it could be okay, but maybe not.

562
00:40:14,827.9180835 --> 00:40:15,757.9183886
And the self-mistrust.

563
00:40:15,757.9183886 --> 00:40:26,187.9064868
And that- There it is, yeah and that self-mistrust and also the uncertainty is also a core feature in the anxiety literature, the intolerance of uncertainty.

564
00:40:26,187.9064868 --> 00:40:35,547.9040454
And there's some preliminary data to say it is particularly relevant in the anxiety with adults with ADHD- because the case I make is ADHD itself is an uncertainty generator.

565
00:40:35,637.9003833 --> 00:40:37,817.9083178
I know I can do it, but will I do it? Oof.

566
00:40:37,817.9083178 --> 00:40:38,137.9003833
Oof, yeah.

567
00:40:38,137.9003833 --> 00:40:44,857.901604
Or even if I get engaged, will everything go? Will I have the ideas? Will I stay? Will I last long enough? Whatever the case may be.

568
00:40:45,587.9125903 --> 00:40:46,677.9089282
Oh, man.

569
00:40:47,137.9003833 --> 00:40:48,297.9040454
God, we could be talking forever.

570
00:40:48,727.8997729 --> 00:40:49,227.8997729
So the...

571
00:40:49,227.8997729 --> 00:40:55,207.8955005
what I'm pulling out of that one, sometimes procrastivity does offer benefits.

572
00:40:55,377.8967212 --> 00:40:58,507.901604
For me, I intentionally- from time to time...

573
00:40:58,777.9058764 --> 00:41:06,757.9199145
Actually, every time I want to read a few chapters of your book, I did something else first- to just get myself, because I knew I was about to read the book.

574
00:41:06,757.9199145 --> 00:41:08,7.9199145
I was about to read the chapter.

575
00:41:08,317.9138122 --> 00:41:16,377.9132865
But washing the dishes or- just doing a mundane task, that got me into this is my launchpad into the book.

576
00:41:16,407.9139731 --> 00:41:18,347.9135535
Because reading- is really hard for me.

577
00:41:18,397.914202 --> 00:41:20,177.913935
It takes a lot of energy out of me.

578
00:41:20,797.9138205 --> 00:41:23,517.9131339
And so I use it as a launchpad for my procrastinating.

579
00:41:23,567.9142783 --> 00:41:26,127.9156516
Now, and that's an adaptive use, and this is why know thyself.

580
00:41:26,127.9156516 --> 00:41:26,317.9142783
That's it.

581
00:41:26,317.9142783 --> 00:41:27,367.9154227
'Cause some people can do that.

582
00:41:27,367.9154227 --> 00:41:27,457.9155753
Yeah.

583
00:41:27,787.915499 --> 00:41:34,187.9139731
What did, what client describe it to me, he said, "It's almost like I'm riding a horse, and once I get it going, I can jump on the horse I really wanna ride."

584
00:41:34,217.9146598 --> 00:41:34,317.9150413
Yes.

585
00:41:34,317.9150413 --> 00:41:34,457.9163382
Yes.

586
00:41:34,457.9163382 --> 00:41:35,37.916262
That type of thing.

587
00:41:35,37.916262 --> 00:41:35,267.9158042
Yeah.

588
00:41:35,297.9164908 --> 00:41:35,607.9159568
Yeah.

589
00:41:35,607.9159568 --> 00:41:36,257.9155753
So good.

590
00:41:36,597.9157279 --> 00:41:40,252.8508411
There's one, one thing you talk about, taskidermy.

591
00:41:40,387.915499 --> 00:41:42,897.9138205
There, there were- Oh quite a few phrases that you used.

592
00:41:42,897.9138205 --> 00:41:44,157.9159568
Yeah, some of them- That was a new one.

593
00:41:44,157.9159568 --> 00:41:44,567.9158042
Yeah.

594
00:41:44,687.9139731 --> 00:41:57,977.9148887
taskidermy is on a- taskidermy, yes yeah, it's on a to-do list, and it's if you notice the same task s- hanging on the to-do list for four or five days- Yes that's almost it's almost like- So true that animal, that stuffed animal, and it's okay, it's not going anywhere.

595
00:41:57,977.9148887 --> 00:42:00,767.9158042
It's not gonna run away, but it's also not moving where it needs to go.

596
00:42:01,97.9138205 --> 00:42:05,817.9119895
It's just a cute little way to identify it and go, "Okay, is this something I'm...

597
00:42:05,877.9171775 --> 00:42:07,547.9153464
This is my pocket veto.

598
00:42:07,547.9153464 --> 00:42:09,37.9132102
I'm deciding not to do it."

599
00:42:09,497.9153464 --> 00:42:12,827.9171775
It could be something to be delegated, maybe in a situation like you're in.

600
00:42:13,197.9153464 --> 00:42:16,967.9119895
Or it could be something like, no, I've, I'm procrastinating on this.

601
00:42:16,967.9119895 --> 00:42:17,827.9125998
I'm avoiding it.

602
00:42:18,217.9119895 --> 00:42:25,287.9116843
I have to, use some of the skills to say, I've got to set aside, make an appointment with myself to do this that's realistic.

603
00:42:25,827.9080222 --> 00:42:30,787.9071067
Def- you know, defining it in what are the three steps I have to do, how long do I want to spend on it.

604
00:42:30,787.9071067 --> 00:42:32,387.9055808
That, your- Ways to be more manage- your SAP.

605
00:42:32,587.9101584 --> 00:42:33,7.9083274
Can you tell...

606
00:42:33,7.9083274 --> 00:42:33,877.9034446
Sorry I'm interrupting you.

607
00:42:33,877.9034446 --> 00:42:33,957.9052756
Yeah.

608
00:42:33,957.9052756 --> 00:42:34,137.8979514
No, please.

609
00:42:34,137.8979514 --> 00:42:35,347.9046653
Because that got me excited.

610
00:42:35,727.9019187 --> 00:42:35,887.8979514
Yeah.

611
00:42:35,887.8979514 --> 00:42:37,897.9000876
That SAP method that you talk about.

612
00:42:37,997.9031394 --> 00:42:47,877.9003928
What was it again? Specific- It is define terms in specific ways, actionable ways, things that you can do, and then the P is for I like the phrase pivot points.

613
00:42:47,907.8991721 --> 00:42:48,597.9016135
I like that too.

614
00:42:48,647.9016135 --> 00:42:48,877.9049704
Yeah.

615
00:42:48,907.9037497 --> 00:42:59,27.9019187
And it, so it could be PP, it could've been sappy I guess, but it's when in the flow of your day or some other day are you going to do it? And this could be a clock time.

616
00:42:59,167.9013083 --> 00:43:00,187.9055808
Okay, at 3:00.

617
00:43:00,277.9019187 --> 00:43:04,77.9049704
You might do something, okay, at the end of this Ramsey podcast, then I will do this.

618
00:43:04,487.9040549 --> 00:43:05,267.9028342
And this could be...

619
00:43:05,267.9028342 --> 00:43:07,907.9022239
And this is also the use of the planner, having placeholders.

620
00:43:08,177.9064963 --> 00:43:09,397.907717
I don't wanna deal with this today.

621
00:43:09,397.907717 --> 00:43:10,977.9095481
I have some time Friday morning.

622
00:43:11,197.9107688 --> 00:43:17,747.8863547
And that way we can strategically forget about it rather than having it staring back at us and, making the good faith effort to get to it.

623
00:43:17,797.8863547 --> 00:43:24,157.8869651
And also maybe dealing with, all right, what is it about this thing? Is there some piece of information I don't have that I need? That's it.

624
00:43:24,217.8845237 --> 00:43:28,567.8936789
A knowledge base or I haven't gotten my W-2s yet or- what- whatever.

625
00:43:28,567.8936789 --> 00:43:30,597.8771995
Or, what- and that becomes its own task.

626
00:43:30,627.8912375 --> 00:43:30,697.883303
Yes.

627
00:43:31,57.8839133 --> 00:43:39,507.8843902
Let me ask for- Is there somebody else? Can I do this with my spouse? They seem pretty good at this, but I don't wanna dump it on them or maybe we do wanna dump it on them for all I know.

628
00:43:39,507.8843902 --> 00:43:40,737.8841231
But it's just...

629
00:43:40,977.8838942 --> 00:43:49,427.8827498
And there's a lot of elements in there, but it just gives options rather than- Yeah this all or nothing, am I doing it or not? And I have to try harder not to procrastinate anymore.

630
00:43:49,427.8827498 --> 00:43:59,727.8819869
And to dread the daunting to-do list that it's like- yeah you even talk about the approach of a to-do list, which we won't get into, but I want- people to go into the book and to find it.

631
00:43:59,727.8819869 --> 00:44:08,427.8854201
But so what I'm hearing in this is on the taskidermy stuff- because that's very common- yeah As these, they keep coming every wa- every week.

632
00:44:08,737.8822158 --> 00:44:17,517.8848098
What I love is that, yes, specific, yes, actionable, but then that pivot that you talk about to- what I'm gonna do it when X, Y, and Z.

633
00:44:17,517.8848098 --> 00:44:21,247.884352
That part I think was like, yes, eureka moment for me.

634
00:44:21,297.8835891 --> 00:44:21,357.8849624
Yeah.

635
00:44:21,597.8828261 --> 00:44:25,577.8823684
'Cause I naturally do it, but to even call it out, I'm like, "Oh, yeah- this is why."

636
00:44:25,857.8849624 --> 00:44:30,557.8849624
So I, some people will call it s- task stacking, you're stacking it onto- yeah something else.

637
00:44:30,667.8855727 --> 00:44:31,7.8857253
Yeah.

638
00:44:31,97.8858779 --> 00:44:37,337.8913711
But I like that, that you're giving it a nice flow, which again, goes back to give me a roadmap and I'll follow along.

639
00:44:37,387.8913711 --> 00:44:37,447.8889296
Yeah.

640
00:44:37,447.8889296 --> 00:44:42,817.8840468
If I don't know, I'll go into uncertainty and freak out, and will just- sit in a dysregulation.

641
00:44:42,817.8840468 --> 00:44:43,587.8806899
I love it.

642
00:44:43,587.8806899 --> 00:44:44,97.8828261
So good.

643
00:44:44,127.8816054 --> 00:44:47,927.8770278
Eh, CBT, through it all.

644
00:44:48,327.8785537 --> 00:44:56,287.8864882
There is there, there were some pieces that I saw somewhere, some expert going, "Oh, I don't know, talk therapy for those with ADHD may be harmful.

645
00:44:56,687.8880141 --> 00:44:58,67.8852675
Even CBT may be..."

646
00:44:59,37.8864882 --> 00:45:03,287.8864882
You acknowledge, but then you have your own reason as to why it does work.

647
00:45:04,27.8874038 --> 00:45:09,207.8953383
You know what? I, there, there are claims about, oh it's teaching masking.

648
00:45:10,97.894728 --> 00:45:10,217.8974746
Yeah.

649
00:45:10,247.8962539 --> 00:45:11,27.8950332
Or it's...

650
00:45:11,237.8941176 --> 00:45:15,967.8974746
And I don't think I address it in the book 'cause I, I just don't think it came up, or it's...

651
00:45:16,787.8971694 --> 00:45:25,287.8938125
And, I'm actually involved in a paper researching masking with a Japanese colleague who's come up with a masking, ADHD masking scale.

652
00:45:26,177.8962539 --> 00:45:27,697.9005263
And it's not been submitted yet.

653
00:45:27,697.9005263 --> 00:45:29,587.899916
We're getting ready to submit it for publication.

654
00:45:30,647.8974746 --> 00:45:37,27.9023574
But, and I don't know if this will make the final draft, but I was saying, you know what? There's, y- it's like Goldilocks and the three bears.

655
00:45:37,27.9023574 --> 00:45:38,787.8968642
It can be too little or too much.

656
00:45:39,7.9011367 --> 00:45:43,927.8993056
'Cause there are times that we don't go in telling everybody, "Oh, I had to pull an all-nighter on this," and whatever.

657
00:45:43,927.8993056 --> 00:45:45,517.9078505
So you're like, it's okay, I did it.

658
00:45:45,517.9078505 --> 00:45:48,257.9133437
Or I guess just to be masking a little bit.

659
00:45:48,257.9133437 --> 00:45:51,27.9023574
We're under the weather, but we still do work or whatever.

660
00:45:51,27.9023574 --> 00:45:58,907.9072402
Yeah, we don't wanna go to the office and infect everybody, but we go, "I'd really like to be just sleep in today, but let me do this," or, "I wanna see my clients.

661
00:45:58,907.9072402 --> 00:45:59,777.9023574
It'll be easier.

662
00:45:59,777.9023574 --> 00:46:03,457.8919814
There's some who I really should see today, and it's easier than rescheduling."

663
00:46:03,457.8919814 --> 00:46:06,217.901747
So I might be masking a little bit.

664
00:46:06,407.9041884 --> 00:46:07,867.8956435
Now, there can be an extreme.

665
00:46:07,867.8956435 --> 00:46:16,397.8944228
I think with the masking that they're talking about is to the degree that it's covering up things that can be treated and really coming at a detriment.

666
00:46:16,567.8925918 --> 00:46:16,737.9060195
Yeah.

667
00:46:16,787.9060195 --> 00:46:20,882.9121516
It's, it's- Almost like depriving care that...

668
00:46:20,912.912123 --> 00:46:28,672.9128287
And we have the, the treatments for ADHD, medications and the psychosocial are among the most effective we have in all clinical psychology and psychiatry.

669
00:46:29,242.9127143 --> 00:46:32,2.9129432
So and especially if we go working together sometimes.

670
00:46:32,2.9129432 --> 00:46:45,52.9129146
And I would say that, like, how friends and colleagues who did, at Penn, we never had external funding for our studies, so they were open, unfunded studies.

671
00:46:45,52.9129146 --> 00:46:57,802.9138682
So we didn't do randomized controls of our CBT, but it's- we, I've kept modifying it and adding things in even for things that may not have been studied in ADHD, but seem like they're effective in, with with adults.

672
00:46:58,302.9138682 --> 00:47:03,52.9138682
But the ones who have, "Okay, here's the 12 or 14 session over 12 or 14 weeks.

673
00:47:03,52.9138682 --> 00:47:04,902.9142497
Session one, session two, session three."

674
00:47:06,142.9159282 --> 00:47:08,612.9142497
They will say that's a creature of funding."

675
00:47:08,612.9142497 --> 00:47:12,342.9137919
They're not gonna say, "Oh, we'd really like to spread this out over 30 weeks."

676
00:47:12,392.9151652 --> 00:47:14,102.9142497
No, we're only gonna fund you for this much."

677
00:47:14,312.9163859 --> 00:47:17,672.9169963
But they will say it is meant to be flexible, used in the community.

678
00:47:18,292.9159282 --> 00:47:24,722.9162333
So if you need to spend three weeks on procrastination or the planner or go back to it or go beyond this time, that is fine.

679
00:47:24,722.9162333 --> 00:47:25,462.9140971
It's not cheating.

680
00:47:25,462.9140971 --> 00:47:27,62.9163859
It's not violating the protocol.

681
00:47:27,62.9163859 --> 00:47:34,772.9154704
There are certain things in there that they go this is what seemed to work in these studies, so yeah, use it," but there's a lot of flexibility in there.

682
00:47:34,772.9154704 --> 00:47:37,62.9163859
But I think sometimes they get u- used too rigidly.

683
00:47:37,62.9163859 --> 00:47:39,172.9169963
There's actually data on this from the UK where...

684
00:47:39,462.9179118 --> 00:47:51,192.90601
And probably clinicians, very well-trained cognitive behavioral therapists just who are not familiar with adult ADHD- It's that- sitting with clients and understanding this is the cliché, but here's the planner.

685
00:47:51,192.90601 --> 00:47:52,482.8992961
Go forth and use.

686
00:47:52,722.9002116 --> 00:47:54,102.9050944
Okay, I have the planner.

687
00:47:54,102.9050944 --> 00:47:55,242.9044841
I have it set somewhere.

688
00:47:55,492.8999064 --> 00:47:58,582.9038737
Maybe I'll remember where it is, but even if I know where it is, I'm not using it.

689
00:47:58,642.9044841 --> 00:47:59,952.9020427
Or whatever the case may be.

690
00:48:00,422.8986857 --> 00:48:02,552.8959392
Even if it makes sense logically.

691
00:48:03,2.8959392 --> 00:48:05,652.897465
So the results were awful but, one of the...

692
00:48:05,842.8999064 --> 00:48:06,752.8959392
in that study.

693
00:48:07,92.8999064 --> 00:48:12,702.9005168
But the cl- at least one client who was interviewed who worked with a therapist familiar with ADHD said it was transformative.

694
00:48:12,792.8968547 --> 00:48:13,122.8986857
Yeah.

695
00:48:13,422.8941081 --> 00:48:13,532.8947184
Yeah.

696
00:48:13,532.8947184 --> 00:48:21,432.8916667
So I think that's where, it depends, like, where somebody's getting CBT, and this is true of a lot of things probably with coaching as well.

697
00:48:21,432.8916667 --> 00:48:27,532.8962443
Somebody goes coaching really doesn't work," but somebody else goes, "And I know who you trained with," and, I, you know some of the, my favorite people.

698
00:48:27,942.8953288 --> 00:48:31,392.9075358
But so y- you know how the reputation, it depends who what.

699
00:48:31,392.9075358 --> 00:48:37,492.9136393
But so- it's, at least in the approach in the book, it's sh- showing the evolution over the years and where things are at right now.

700
00:48:37,832.913029 --> 00:48:40,742.9166911
So all this going back to the whole masking thing.

701
00:48:41,122.9093669 --> 00:48:46,32.913029
Part of good coping sometimes is masking or putting ourselves out a little bit.

702
00:48:46,502.8989909 --> 00:48:46,662.902653
Yeah.

703
00:48:46,662.902653 --> 00:48:48,22.9032634
Yeah but I don't think I...

704
00:48:48,62.9118083 --> 00:48:55,892.9014323
At least it is not designed to be like denying ADHD or just ignoring it or refusing- But what I'm hearing- any of the other things.

705
00:48:55,892.9014323 --> 00:48:58,152.9111979
Yeah it's more to you're paying attention to it.

706
00:48:58,152.9111979 --> 00:49:04,642.905247
You're becoming more- intentional- Yeah, that's it versus that reactivity, right? And ma- and making informed decisions.

707
00:49:04,642.905247 --> 00:49:04,742.9051516
Yeah.

708
00:49:04,742.9051516 --> 00:49:09,282.9051135
Th- there might be a way I pre- like I s- say, I present things a certain way or at some point...

709
00:49:09,312.9048465 --> 00:49:10,452.9061435
I liken this to a recipe.

710
00:49:10,452.9061435 --> 00:49:12,522.9058383
You might say, "Oh, I don't like that ingredient.

711
00:49:12,522.9058383 --> 00:49:13,752.9053805
I'm gonna replace this- That's it with that."

712
00:49:13,752.9053805 --> 00:49:14,462.9054187
And that was it.

713
00:49:14,462.9054187 --> 00:49:16,422.9064105
Or, "This is vegan," or things like that.

714
00:49:16,422.9064105 --> 00:49:16,812.9058001
Totally.

715
00:49:16,812.9058001 --> 00:49:17,602.9048083
So that's the ideal.

716
00:49:17,602.9048083 --> 00:49:23,792.9053424
With your book, with every chapter, you could just pick it up and pick one chapter and experiment with those.

717
00:49:23,792.9053424 --> 00:49:23,852.9048083
Yeah.

718
00:49:23,912.9061816 --> 00:49:27,942.9068683
There wasn't this prescriptive, "Thou shall follow a framework, and this is the framework."

719
00:49:27,992.9068683 --> 00:49:29,222.9064105
I did not get that at all.

720
00:49:29,602.9055713 --> 00:49:29,672.9052661
Yeah.

721
00:49:29,672.9052661 --> 00:49:36,842.9103015
And you have no idea how much th- this is such a gift, because it gives us language and it gives us- the explanation.

722
00:49:37,212.9092334 --> 00:49:39,912.9099963
Your approach I like because it also gives me agency.

723
00:49:39,912.9099963 --> 00:49:40,22.9106067
Good.

724
00:49:40,652.9116748 --> 00:49:42,642.9133532
That, I am in control of this.

725
00:49:42,702.9109118 --> 00:49:44,672.9121325
There, there's things that, that could be done.

726
00:49:44,952.9109118 --> 00:49:47,372.9136584
So if, even if I'm masking with intent.

727
00:49:47,372.9136584 --> 00:49:47,572.9106067
There you go.

728
00:49:48,12.9130481 --> 00:49:50,292.9118274
Which is less exhausting for me, right? Yeah.

729
00:49:50,292.9118274 --> 00:49:58,652.909386
Because if I'm coming in knowing I, I need to tone Cathy down a bit, I'm doing it in a way that makes sense for me, and I don't- have to resent or whatever.

730
00:49:59,242.9133532 --> 00:49:59,492.9133532
Yeah.

731
00:49:59,562.9130481 --> 00:50:08,922.9090808
Before we leave, is there anything that I, you wish that I would've asked that I didn't? Is there anything? I think we covered all the high points, all the things.

732
00:50:08,922.9090808 --> 00:50:12,572.9106067
It's rewarding to hear that the things I hoped would come across are getting across.

733
00:50:12,572.9106067 --> 00:50:20,692.9194568
And, and hopefully it'll be a book that, you read through it o- I know my experience, I'll reread books that I liked and, 'cause you never read the same book twice.

734
00:50:20,822.9167102 --> 00:50:21,32.9157946
Yeah.

735
00:50:21,462.9160998 --> 00:50:23,962.9160998
It's just like seeing a movie and it's "Oh, I didn't catch that the first time through."

736
00:50:23,962.9160998 --> 00:50:28,232.9127429
So hopefully it is there as a resource and there are things that could be helpful to other people.

737
00:50:28,232.9127429 --> 00:50:33,752.9170154
Or like the diagnostic assessment, if somebody's ADHD curious or something like that, it's what do I...

738
00:50:33,752.9170154 --> 00:50:47,702.921593
How would you do this? Do you do that? And, just try, even if there are still skeptics, and, I'm open for discussions, but at least with the executive functioning piece, let's get on the same page about what ADHD is rather than what's on TikTok or whatever.

739
00:50:47,732.9203723 --> 00:50:48,122.9197619
Yes.

740
00:50:48,232.9203723 --> 00:50:48,362.9176257
Cool.

741
00:50:48,362.9176257 --> 00:50:51,592.9133532
So at least we can, the, hopefully a more productive discussion.

742
00:50:51,622.9121325 --> 00:50:54,442.9240344
And no, so I think we covered everything.

743
00:50:54,442.9240344 --> 00:50:56,762.9160998
No- Amazing very insightful questions, and I appreciate the feedback.

744
00:50:57,22.9258655 --> 00:50:58,272.9258655
Thank you so much, Doctor.

745
00:50:58,272.9258655 --> 00:51:00,242.9240344
Th- this was truly a pleasure to have you.

746
00:51:00,302.921593 --> 00:51:01,132.923424
Oh, likewise for me.

747
00:51:01,132.923424 --> 00:51:02,000
Thank you for having me, Cathy.