Saturday, June 15, 2013

If You Think Fear-Based Management Works for You—Think Again


Prior to being diagnosed with ADHD at age 37, my husband says his best coping tool was "Fear-Based Management"—fondly referred to as FBM. What sometimes seems to help us cope in the short term can, in the long-term be our undoing. And, for many adults with late-diagnosis ADHD, it's hard to distinguish between helpful and counterproductive coping skills.;

As regards my husband's long top go-to strategy, FBM, he swears it got him through graduate school. The way it worked then: He nurtured thoughts of disastrous consequences if he didn't finish that paper on time and complete that research project. 

FBM may have helped him to earn a tough advanced degree in the hard sciences. But, looking back, with the advantage of diagnosis and better treatment, he sees now that "self-medicating with fear" did little for his nervous system or, ultimately, his ability to relax and enjoy life.

Anyone following the online headlines and heated commentary these days, on any topic, gets the feeling we're all relying a little too heavily on FBM and the rest of the limbic system. Being a little too quick to react, without fully taking in details, and often in anger. A little too willing to let our "primitive" and fear-based brains overcome higher-order, more rational thinking. 

I was pondering about this very topic when I ran a piece by writer Susan Schorn, author of Smile at Strangers and Other Lessons In the Art of Living Fearlessly. I found her essay "Tigers, Tigers" wise and thought-provoking. She has graciously allowed me to reprint below. Enjoy—and check out the video sharing Susan's fascinating journey from a "small child with a small personality" into a powerful writer and martial-arts instructor who teaches violence prevention. 

I do apologize for my long absence from this blog. After the CHADD conference last fall, I barely had time to catch my breath before I accepted a highly respected professional publisher's request to produce a guide for couple's therapists treating ADHD-affected couples. Look for it in 2015! 

 —Gina Pera


Tigers Tigers

  by Susan Schorn

Ever since I turned forty, I’ve forgotten how to sleep. That is, I can fall asleep with no trouble, but I have a lot of trouble staying that way. Instead I wake up in the middle of the night for no apparent reason. And when I say “wake up,” I mean that I WAKE UP, as Russell Hoban described it, “like a man trapped in a car going over a cliff.” My heart gives a spasmodic lurch and I’m instantly wide-eyed and alert, listening, muscles poised. It can take hours for my pulse to subside and my brain to admit that there’s really nothing much to worry about at the moment.

My husband is accustomed to these episodes, but I suspect they’re taking years off my life. I know too that I make things worse on these nights by humoring my nervous system, lying there and mulling over everything that might have caused me to awaken in full-on berserker mode. There is nothing more fruitless than confronting your worst fears when you’re sleep-deprived and pumped full of surplus adrenaline, yet I do it anyway: I replay contentious office meetings and analyze dark alleys I might have to walk down in the future. Fun stuff, but not very soothing.

Rather than inducing me to slip back off into dreamland, this kind of antagonistic thinking gets me even more riled up. It takes the erroneous chemical message that some glitch of physiology dumped into my bloodstream and converts it to rational thoughts. It leaves me with mental images that tend to heighten my sense of powerlessness and persecution. In short, when I lie in the dark and dread things, I’m allowing my limbic system to exploit and bully my rational mind. And I don’t like bullies.

Still, it’s not entirely my limbic system’s fault. The hindbrain, as the limbic system is sometimes called, consists of the hypothalmus, the amygdala, and quite a few other highly specialized but not especially well-understood parts of the brain. Together they control our physiological response to stress, stimulating or suppressing our hormones, regulating our heart rate, dilating our pupils and elevating our blood sugar levels. In a crisis, all these physiological changes increase our odds of survival by helping us fight, flee, or freeze. The limbic system keeps us alive in the most primal way imaginable, and it does so with very little input from the cognitive centers of the brain.

But, as I’ve learned, you can’t overindulge it. I spend way too much quality time with my limbic system. I don’t get into many dangerous situations requiring immediate fight or flight, but imagining catastrophe in minute detail is a hobby of mine. As hobbies go, this is slightly less destructive than heroin addiction but worse than say, karaoke, which I have seen cause considerable strain in other people’s marriages.

When your default thought patterns are a non-stop dress-rehearsal for disaster, you spend far more time fighting within yourself than you do addressing outside threats. Whether I’m awake or half-awake, I devote an excessive amount of mental energy to refighting old battles and gaming out potential ones. I bring dead conflicts back to life over and over again, even when there’s nothing more I can learn from them. I extrapolate about possible future conflicts out of sheer habit. I have to be very careful that I don’t skew my worldview in the process.

Because the hindbrain, while dependable in emergencies, isn’t very smart. So quite often my analytical, speculative musings about danger will fool it into thinking there’s an actual threat, and my body will start reacting to the crisis I’ve envisioned as if it were real: Elevated pulse, rapid breathing.

And unfortunately the limbic system remembers physical stress responses whether they were warranted or not; it aggregates them and uses them to predict what might threaten us in the future. Which is probably why I wake up in the middle of the night as if I’m crouched in a foxhole on the Western Front: My mind and body are stuck in a feedback loop where hypothetical danger has been nurtured as an academic exercise, and is now mistakenly treated as the real thing. Both instincts are trying their best to keep me safe, but they’re actually making things worse.

It’s something I’m working on—I’ve found that it gets better when I spar regularly—but I know I’m not alone in feeling caught in the middle between my “thinking” and “reacting” brains. It’s a common problem in the peculiar environment we now live in.

Carmel, a social worker who trains at my dojo, gave me this explanation of how our limbic systems are supposed to keep us safe: If you live near tigers, you’ll quickly become attuned to environmental cues that signal the presence of tigers. You’ll be sensitive to growls, for example, and the color orange, and stealthy movements in the underbrush. Those cues will trigger immediate defensive responses—running, hiding, grabbing a torch. You won’t stop to think about these responses. They are instinctive, reflexive physical reactions to sensory information, and if you give them free rein they’ll keep you alive.

Problems can arise, Carmel noted, if you move somewhere new where there aren’t any tigers. When you get there, your limbic system is still wired to react to the old cues. You may know, in your rational brain—the one that bought the train ticket to the tiger-free neighborhood—that there are no more tigers in your vicinity. But your rational brain didn’t have the primary responsibility for keeping you alive when you lived with tigers. The neo-cortex is not a first responder. That burden fell to your hindbrain, the feeling and reacting brain. And that part of your brain doesn’t “know” that tigers are out of the picture now.

If you’ve experienced prolonged exposure to really hungry tigers—or if you’ve served in combat, or survived rape, or been traumatized as a child—your hindbrain may become hypersensitized to certain cues. Loud noises, specific locations, voices, words, and other stimuli can trigger a full-on stress reaction, even if the actual threat is no longer present. When people have extreme forms of this sensitivity, we call it post traumatic stress reaction. (Or sometimes “disorder,” but that isn’t strictly accurate. A hypersensitive limbic system isn’t out of order; it’s merely out of context).

My overactive hindbrain isn’t anywhere near as bad as PTSR; I’ve never (knock on wood) had anything particularly awful happen to me. Which I’m quite happy about, thank you. Yet I find myself imagining tigers everywhere. And what I’ve discovered in teaching self defense is that a lot of other women do too, in the form of stalkers, and rapists, and masked gunmen. All of which do exist in the real world, just as there are real tigers out there. But some of the women I’ve talked to, like me, spend extraordinary amounts of time and energy obsessing about these threats, given the odds that they’ll actually encounter any of them.

Why do we do this? I think it’s because there’s a new kind of threat in our modern environment that is much harder for us to recognize than a tiger: We live in a culture that uses fear to manipulate people, that exploits and abuses our survival instincts, and prevents them from working as they should.
In the normal course of events, a hypersensitive hindbrain can be rewired, though it learns to relax much more slowly than it learns to scream “Run!” It can’t think through problems rationally. It can’t take the cognitive shortcut of looking at a map and realizing “No tigers here.” Unlike our “thinking brain,” the limbic system requires experiential knowledge, repeated patterns of this-happens-then-that-happens: I see orange, but it’s only my neighbor’s marigolds, which don’t eat me. After trauma, the hindbrain usually regains an even keel if given time and space and a little peace and quiet.

Sometimes it’s more complicated—if there is physical injury to the brain, for example. But for most people, once they’re in a tiger-free environment and experiencing repeated cycles of seeing-orange-not-getting-eaten, the limbic response to the old triggers gradually cools down.

But look at the culture we live in. Like my hyperactive imagination, it throws potential dangers at us from every direction, nonstop, and spins them out into detailed narratives: Gruesome crimes are lovingly resurrected years after they were solved and turned into hour-long television shows. Missing white women dominate the news cycle for days. We’re hypersensitized to threats, via television, movies, news, advertisements, and office gossip. There’s no tiger-free region for us to move to, no way to escape from the danger. It’s a closed system, a feedback loop, and it’s very destructive.

What’s the result? People buy guns, and mace, and next-to-worthless home security systems, trying to calm their fears. They buy overpriced homes in gated communities, in the hope that a five-foot brick wall will protect them. They buy gasoline to drive themselves everywhere because they don’t feel safe walking. They spend money their rational minds could tell them they’re wasting, in an effort to appease their hopelessly duped limbic systems.

“Trust your instincts,” we tell people in self defense workshops. It’s good advice. But be careful too, about what you feed your instincts on. The hindbrain and the neo-cortex often come into conflict when we have to make complex choices about safety, and since the limbic system is in charge of our most basic survival instincts, it’s used to getting its way. Which is why the less scrupulous elements of our culture have learned to appeal to it.

So it’s important, if we don’t want to be bullied and manipulated, that we keep our threat responses in proportion to the actual threats we face. We can discipline our fighting instinct in the sparring ring, or get out of the car and walk somewhere. We can look for reliable information about risk, or turn off the TV. And if we wake up in the middle of the night, we can do ourselves a favor by telling the hindbrain it’s off duty, and counting sheep instead of tigers.

As always, I welcome your comments.


  1. I promise I will read many times your article. I need to continue understanding and grasping ADHD problem in an adult. I live in South America. I heard about ADHD for 1st time few months ago. when my loving and incredible boyfriend of 34 years old. broke me up. He broke our serious relationship in its best moment. all seemed be so happy and doing in good way. I am an Spanish speaker. I have been trying to overcome my sadness, I have been suffering a lot.. and wondering if... being married or in a relationship with and adult with ADHD is a REAL BIG problem ..AND HE was good with me when he broke my heart... HE said..ITS MY PROBLEM. IT'S ME..NOT YOU..your wonderful woman, beautiful and kind...but my heart is not settle down. When he told me that..i was really impressed..How a person can say that loves you..and be happy.. and then drastically change..? and inmature, and needing of time at his age. So I started reading books and articles.. and I got to the conclusion that THE problem was not me..not him probably..WAS ADHD. possible being sooooo unhappy loving someone with this problem. someone very loving, smart. ..but not focus sometimes with forgetfulness and having problems with relationships... How a person with this problem..can start a relationship and love a girl and then... whe he wants..take the girl off of his life.
    I need help to undersand... I will be very greatfull if you reply to my questions regarding ADHD and relationships broken.
    Kind regards. PD I live in south America I am 28. my ex is north American.

    1. Hi PD,

      The best advice I can give to you is to keep learning about ADHD and why these things might happen. You can start by reading all of the past posts on this blog.


  2. Interestingly, I live in Johannesburg, South Africa, the crime capital. But it's not just crime that's given prominence in society, it's status and labels, and health and life insurance ('What will your family do when you die?' etc) and I've known that it's wrong but not why. I don't lie awake fearing criminals, though I live alone, I lie awake wondering how to make more friends (be more interesting, make more money so I can buy a better car, clothes, do fascinating stuff), find a man (be slimmer/ sexier/ prettier/ younger), avoid cancer/ stroke. Consciously I reject all of that, but unconsciously, my limbic system is obviously taking it all pretty seriously.

    1. Great point. What is that saying - Fear Sells! But we don't have to buy it.


  3. Gina,
    Thank you for explaining your absence and I look forward to that book. I'm intrigued because of its subject matter.
    I have found that aerobic physical exercise for at least 30 mins a day can help. If you cant schedule it then, I've heard that meditation has helped people. Meditation is simply sitting and consciously allowing your mind to wipe away thoughts. It's hard at first but, with time people have had success.
    I hope that at least one person reads this and tries the change. Good luck!

    1. Hi,

      Yes, exercise, meditation, even a leisurely walk with a friend—all those things can help to calm the reactive brain.

      For some people, stimulant medication, too, helps to "strengthen" the prefrontal cortex and its connections, the better to "talk down" an irrational limbic system.

      thanks for your comment,

  4. It's sad that the pace of our lives can be so intense what with all the things that vie for our attention. Advocating a relaxing walk as part of a balanced mind-body is spot on. I truly enjoy my walks and secretly like them better without my pwADHD. We usually do well but often my partner wants to get into her anxiety frame of mind which is counterproductive to the relaxation aspect of the walk. When it's just me and my little dog I go to a good place, I breath deep and just revel in how good things can be.

  5. Thank you so much for this--& for your Blog, Ms. Pera, which I only today have discovered.

    I am at my wit's end & had one of those class ADHD "Aha!" moments (followed by the overwhelmingly rush join every ADHD-support group & buy every Adult ADHD book I can find) yesterday when listening to a re-play of an old Kojo Nandi (NPR) program featuring Timothy Denevi, author of "Hyper: A Personal History of ADHD."

    My life has been on a down-ward spiral in recent years...& my ADHD untreated & living without involvement in any ADHD support groups or therapy (e.g., CHADD Adult Groups).

    And I have fallen into such despair & self-loathing after social failure following social failure (barely able to keep myself going even in the workplace).

    Even though I one had remarkable improvement with medication & generally therapy, I never took the next step & sought direct help with the Adult ADHD (never before heard of CHADD).

    I do not know what I will I see that where I live in Montgomery County, MD there is a monthly Adult CHADD support group.

    And getting back on medication will also be important.

    And i will now read your Blog religiously.

    Hopefully this will not simply be another spectacular...start & failure (even remembering to take the medication or believing that it is really helpful will be enough of a challenge).

    Thank you so much.

    1. Unfortunately, support groups don't help much. There's only so much people can do. We're always 3-steps behind developmentally, and our best isn't enough. Most of us don't have enough money for therapy, and that doesn't help either. I'm sick of being told to get "more organized" or be "more consistant", when I'm doing the best I can. Everyday is another chance to disappoint other people.

    2. Hi there,

      You wrote, "Every day is another chance to disappoint other people."

      What a tremendously difficult phenomenon to face. I am sorry it's so hard for you.


  6. HI Shoshin, and thanks for writing.

    You know, yours is a story I hear frequently. The challenge is to keep the momentum going.

    With the group that I moderate in Palo Alto, the folks who come very month typically enjoy the most sustained progress. So, try to get to that group every month. Just make the commitment.

    Get to know people there, so they will know when you are missing! "Hey, where's Shosin?" The support and encouragement that you can give is as helpful as that you receive.

    I also encourage you to become a member of CHADD. That way, you will receive regular e-mails on special events and you will also receive the magazine Attention in the mail.

    Remember that one important strategy for folks with ADHD is creating a supportive environment. And that includes reminders that you do indeed have ADHD and need to keep strategies in place. Because yes, it can be easy to forget, until it comes to bite you in the ... behind.

    Happy New Year!

    1. Thank you again, Ms. Pera. If you could--& would, recommend one book...that would help, organize, & live my daily ADHD-afflicted life, what would that be (I humbly ask-& not one that is dedicated exclusively to describing the syndrome...but one that also lays out day-to-day coping guidance)? Anticipatory thanks, Shoshin (& I am reinstating my long-dormant zazen practice & 3 x weekly fitness schedule...both of which have helped immensely in the past).

    2. HI Shoshin,

      I'll recommend two books:

      1. "Is it You, Me, or Adult A.D.D." by yours truly.

      This book goes far beyond "day-to-day coping" by detailing the success strategies that form the foundation of functioning well with ADHD.

      2. Taking Charge of Adult A.D.D., by Russell Barkley

      This book, by the preeminent expert on ADHD, tackles various issues, such as financial management and worklife, chapter by chapter.

      These two books, read closely and put into practice, will take you a long way.

      Good luck!


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