Therapy for ADHD Burnout

Megan Anna Neff, Neurodivergent Insights

how ADHD BURNOUT presents

Caused by long-term, unmanaged ADHD symptoms and stressors including prologued stress and excessive demands, burnout can present as extreme fatigue, demotivation, cynicism, detatchment and hopelessness, thus bringing clients to therapy with these symptoms of depression. Other symptoms include difficulties with focus, managing tasks, emotional regulation, being unable to ‘switch off’, anxiety, irritability, self-isolating and physical symptoms of stress (aches, tension, gut issues, insomnia).

Supporting Recovery

set expectations

ADHD burnout recovery can be a long process, requiring the establishment and maintenance of healthy routines, habits and boundaries, which can be especially difficult for people with ADHD and even more so for those who are already burned out. It also requires self compassion, another challenge for some neurodivergent people due to experiences of rejection and criticism. Identify whether self compassion needs to be nurtured in therapy.

identify and reduce triggers

What experiences are triggering overwhelm or leaving the client feeling drained or ‘wired’?

  • Spending time with certain people

  • Sensory overload (e.g. multiple noises in the room, bright lights)

  • Transitions (e.g. from work to parenting, getting out of bed)

  • Changes in routine or structure

  • Having to concentrate for extended periods

  • Masking (e.g. having to be still, eye contact)

Explore what support they could put in place to reduce or make these circumstances more manageable.

executive functioning

Psychoeducation can be helpful about executive functioning and its role in burnout. Areas to explore include: people-pleasing and over-committing; decision fatigue; outsourcing. Many clients will come to therapy hoping for strategies to feel motivated, stop procrastinating, achieve more, but striving more at this stage may actually worsen burnout.

boundaries

Removing the major stressor (e.g. a bad work situation) may have the biggest impact but is not always possible. Make note of the client’s reasons for not doing so as these may be usefully revisited later.

Explore the impact of relationships, the current impact of social time and boundaries that may be helpful to set around how much social time/with whom/where/what. Explore family, partners, friends, children, colleagues, etc. Look at the need for downtime and relaxation. Explore the factors leading to over-scheduling and saying yes to too many plans, if these are the case.

This may lead to an exploration of Rejection Sensitive Dysphoria and fear of setting boundaries.

It may also lead to an exploration of perfectionism and imposter syndrome. Take a look at conditions of worth, core beliefs, inner critics and inner saboteurs. Examine how all of these prevent the setting of boundaries, resting, prioritising self care, etc.

sensory regulation

Explore sensory needs and restorative activities and create a list or sensory toolbox to remind them of what works. Explore how best to keep this list/tool box in their awareness over the long term.

support the nervous system

Explore relaxation. Provide psycho-education on the parasympathetic nervous system and its role in recovering from burnout. Suggestions include:

  • Yoga, especially forward folds, inversions and other exercises with the head below the heart

  • Meditation

  • Breathing exercises

  • Time in nature

self awareness

Explore practices to tune-in to their emotions and body signals so that they can sense overwhelm approaching.

passion activities

Explore what they feel passionate about, skilled at and can enjoy a flow state while doing. How can the quality and quantity of these be increased in their lives on a regular basis?

  • Spending time in nature

  • Exercise/sport

  • Creativity

unMASKING

Explore masking and which circumstances are most optimal for being their authentic selves, taking a break from the mask. Explore who they can be themselves around, potentially away from neurotypical spaces, and the restorative nature of this.

accomodations

Explore accomodations that could be put in place at work/home/in education, to support them. Access to Work awards grants for ADHD coaching among other things.

screen time

Explore the impact of screen time on dopamine levels, focus, energy and mood. Explore how much, when and how they are using it and support them to set goals for a healthy balance. Include when to stop phone use before bed and consider banning phones from the bedroom. Encourage the client to stop multi-tasking (e.g. scrolling while watching TV).

sleep

  • Explore sleep quality, sleep hygiene and bedtime routines.

  • ‘Revenge bedtime procrastination’ can leave some people staying up too late to make the most of the evening after working late, leading to sleep deprivation.

  • Suggest ‘brain dumping’ using journalling or a mind map to mentally declutter before bed.

self compassion

Affirmations (taken from Rising from ADHD Burnout)

  • Even though I’m feeling overwhelmed, exhausted, and burned out, I’m going to send myself some love…I choose to meet myself where I am. I accept how I’m feeling. I choose to believe that my situation will improve.

  • It’s safe to rest.

  • I’m allowed to relax.

  • I’m exactly where I’m meant to be.

  • Whatever I have done today is enough.

  • I am defined beyond my career.

  • I am learning to release control and surrender more.

For Women with ADHD

Kate Moryouseff, ADDtitude

causes of burnout

In addition to executive dysfunction, emotional dysregulation, masking and dopamine chasing, hormonal fluctuations including perimenopause can contribute to burnout - PMS and PMDD disproportionately affect women with ADHD - as well as gender roles and expectations such as perfectionism.

symptoms

In addition to those at the top of the article, some women experience a sense of wanting to run away.

hormones

  • Invite clients to track their cycle for energy levels and ADHD symptoms, and explore scheduling important work and social events for high oestrogen days and prioritising rest during low oestrogen days. Follicular phase (period to ovulation) is usually high oestrogen. Luteal phase (ovulation to period) is usually high progesterone, low oestrogen.

  • Alongside exploring HRT with their doctor, ADHD medication may need to be adjusted during perimenopause and menopause.