บทถอดความฉบับเต็มของ Breaking down ADHD Neuroscience, Menstrual Cycles, Hormones and Anxiety

happened And I don't know if you're aware of Dr. Kate Moore Youssef 00:02:32 Ned Halliwell. Kate Moore Youssef 00:02:33 He's at the forefront of ADHD and he has been for many, many years. Kate Moore Youssef 00:02:37 And he said that the most profound sort of discovery now with ADHD and helping his clients and his patients is for them to understand the DMN and why we have this in our brain and why we're more prone to this being kind of like the driving force. Kate Moore Youssef 00:02:53 So could you speak a little bit about how we can activate the TPN a little bit more and kind of suppress the dmn? Nicole Vignola 00:03:01 Yes, I love that you've mentioned that. Nicole Vignola 00:03:03 And it is the forefront of science and it's. Nicole Vignola 00:03:06 So let me just give you a little bit of a background on the DMN and the tpn, which. Nicole Vignola 00:03:10 The TPN falls within the Central Executive Network, which is responsible for decision making, problem solving, et cetera. Nicole Vignola 00:03:17 But just to backtrack a little bit, the Default Mode Network resides in a big area of the brain, and it's essentially what the name says, default mode of thinking. Nicole Vignola 00:03:26 So what are you thinking about when you're not really thinking, thinking about anything? Nicole Vignola 00:03:29 Now, the DMN is responsible for rumination, internal wandering, also responsible for autobiographical memories, but also creativity. Nicole Vignola 00:03:39 Now, whichever way it has been wired is what's going to dominate. Nicole Vignola 00:03:44 So the way that I explain it is the Default Mode network is like a garden, and if you allow it to overgrow with weeds, it will override everything. Nicole Vignola 00:03:55 It will kind of be like a negative place that you don't want to go into. Nicole Vignola 00:03:58 And that's a typical feeling of, I don't want to sit alone with my thoughts. Nicole Vignola 00:04:01 I'm just going to keep myself super busy so I don't have to deal with that. Nicole Vignola 00:04:04 The problem with that is that you get into bed at night and that's when all those thoughts start arising and you're going, oh, my goodness, now I can't sleep. Nicole Vignola 00:04:10 So the more time we spend in the DMN and cultivate a positive garden, if you will pull out the weeds and plant the flower beds with gratitude and all the wonderful things you mentioned, then we can wire this place to be a comfortable place of quote, unquote, happiness and maybe even creativity. Nicole Vignola 00:04:27 It should be a wonderful place of mind wandering. Nicole Vignola 00:04:30 When we're children, it's more active in a creative and imaginative way. Nicole Vignola 00:04:33 I don't know if you can resonate with that, but I do recall having times where I'd come home and just daydream on my bed, which I don't do ever, ever anymore. Nicole Vignola 00:04:42 And now the central executive network or the task positive network responsible for more

outward thinking tasks. Nicole Vignola 00:04:48 So what you're probably active in right now. Nicole Vignola 00:04:51 Now from my understanding, there's sometimes an asynchrony in the way that these two networks fire, which means overlap when they perhaps shouldn't or one comes on when the other one shouldn't be on, et cetera. Nicole Vignola 00:05:03 So that's when you get kind of like attention redirection when you're supposed to be doing a task at hand, particularly if you find it boring. Nicole Vignola 00:05:12 Now we can actually strengthen the central executive network through things like meditation, which can help you actually change the connectivity between how the frontal cortex communicates with the rest of the brain so that you have more control over redirecting your attention back to central executive network or back to task positive function rather than dmn. Nicole Vignola 00:05:35 So you're kind of saying yes, we know that this is more active, but we can pull it back. Nicole Vignola 00:05:40 We can strengthen the central executive network through focusing on things like deep work, et cetera. Nicole Vignola 00:05:46 Of course the caveat is that we have to be a one motivated or primed I think is the correct sort of way to describe it, to want to do work for an extended period of time. Nicole Vignola 00:05:57 So removing distractions, starting small, you know, whether it's five minutes of focused work because you know, there are days where I sit down and I actually can't even do something for five minutes without thinking, oh, I need to check something or I need to get up and make a coffee. Nicole Vignola 00:06:11 You know, those are those self interruptions. Nicole Vignola 00:06:14 And there was a study that was done and unfortunately they didn't differentiate between neurodivergent and neurotypical. Nicole Vignola 00:06:21 They weren't purely neurotypical. Nicole Vignola 00:06:23 There was a, you know, pool that was mixed, they just didn't specify, which is unfortunate. Nicole Vignola 00:06:29 But it showed that 51% of our interruptions are self governed. Nicole Vignola 00:06:33 So they self initiated, which means that we'll sit down to work and we'll go, oh, I need to make that coffee. Nicole Vignola 00:06:40 Oh, what about that email? Nicole Vignola 00:06:41 Oh, the dog needs to do this. Nicole Vignola 00:06:43 Yeah, you know, so you know, through things like meditation, which again catch 22 because it requires quite a lot of focus to be able to drive that. Nicole Vignola 00:06:55 Not the quiet, because I think people have got meditation a bit twisted over the years and rightly so. Nicole Vignola 00:07:00 I think the, I think the wellness industry has just completely confused people, you know, but we can't be quiet. Nicole Vignola 00:07:07 Our brains cannot be quiet. Kate Moore Youssef 00:07:08 That's really validating. Kate Moore Youssef 00:07:10 Yeah, that's validating to hear. Kate Moore Youssef 00:07:12 So

I mean what would you say, meditation wise? Kate Moore Youssef 00:07:14 I mean, I'd love to hear from a neuroscientist. Kate Moore Youssef 00:07:17 What is the most effective for a neurodivergent brain? Nicole Vignola 00:07:21 I would say, so focusing on breath. Nicole Vignola 00:07:23 So we have something called exteroception, which is you're sensing everything from the outside. Nicole Vignola 00:07:28 And then we have interoception, which is, you know, thinking about your lungs expanding, thinking about your breath, thinking about how you feel internally and doing something where you're introspective and checking on your senses from the inside. Nicole Vignola 00:07:41 So maybe focusing on your breath going from top to bottom. Nicole Vignola 00:07:44 I sort of visualize my breath going from toes all the way through to the top of my head all the way back down. Nicole Vignola 00:07:50 And the purpose of meditation? Nicole Vignola 00:07:53 To allow thoughts to come in if they do, because they will. Nicole Vignola 00:07:57 That's the way the thoughts work. Nicole Vignola 00:07:58 They're spontaneous, they will arise at any point, and they should. Nicole Vignola 00:08:01 That's how we're wired. Nicole Vignola 00:08:02 But it's not attaching yourself to those thoughts. Nicole Vignola 00:08:05 So if you think of the email, you don't go, oh, my goodness gracious. Nicole Vignola 00:08:09 And then you start going this whole route of why you didn't send the email or XYZ or actually, even worse, get up and send the email midway. Nicole Vignola 00:08:16 It's about conflict resolution in the brain, which can then help you with conflict resolution in real life. Nicole Vignola 00:08:24 So when you're sat down to do work and you've got a competing sound outside, you can then train your brain to redirect back to the task at hand. Kate Moore Youssef 00:08:33 See, that's really powerful. Kate Moore Youssef 00:08:34 And that leads me onto actually something that I wanted to finish with, because I wanted to finish with something quite powerful and uplifting, and that is being able to use our brains to visualize and to kind of use it as an amazing tool for creating and desiring and really honing in on what's important to us and being able to kind of filter out the noise. Kate Moore Youssef 00:08:58 So, yes, you know, we talk about manifestation. Kate Moore Youssef 00:09:00 We talk about kind of like the power of visualization and calling things to us. Kate Moore Youssef 00:09:05 But what I'd like to know is, from a neuroscience perspective, we've got something from. Kate Moore Youssef 00:09:10 I think I'm right in saying it's the reticular activating system. Kate Moore Youssef 00:09:14 And when we use that to our benefit, we can hone in. Kate Moore Youssef 00:09:18 And which is why people, a lot of people say, you know, vision boards or action boards can be very powerful. Kate Moore Youssef 00:09:24 What's your take on that? Nicole Vignola 00:09:25 Yes, I alluded to it earlier when I was talking about how we have information in our periphery. Nicole Vignola 00:09:30 And if you choose to Focus on the negative. Nicole Vignola 00:09:32 That is everything you're going to see. Nicole Vignola 00:09:34 So if I said to you now, Kate, how many blue things are in your room right now? Nicole Vignola 00:09:40 And you start looking at all the blue things, and I say, okay, great. Nicole Vignola 00:09:42 How many red things were there? Nicole Vignola 00:09:43 You didn't pay attention to the red things. Nicole Vignola 00:09:45 You were only looking for the blue things. Nicole Vignola 00:09:47 And that's kind of how this vision board and manifestation works. Nicole Vignola 00:09:51 If you've got your eyes on a goal and you, you're blocking out everything else, you're not going to see the other stuff. Nicole Vignola 00:09:57 You're just going to be focusing on what you want, which means that it will then also be amplified from your environment, so you see something else that then confirms your bias around what you want. Nicole Vignola 00:10:07 So there's so much science around it. Nicole Vignola 00:10:10 And we know that it can rewire part of the cerebellum which is responsible for motor function. Nicole Vignola 00:10:17 So athletes that would practice, say, a golf shot, for example, in their mind would then be able to execute it even better when they came to it. Nicole Vignola 00:10:26 So we know that visualization is grounded in data. Nicole Vignola 00:10:29 We can also sort of create pathways through thought alone. Nicole Vignola 00:10:33 So there was a wonderful study done in 1995. Nicole Vignola 00:10:36 This is kind of like the basis of, oh, okay, our thoughts are pretty powerful and can create synapses. Nicole Vignola 00:10:41 Is. Nicole Vignola 00:10:42 Dr. Nicole Vignola 00:10:42 Pasqualeone took two groups of individuals. Nicole Vignola 00:10:45 He told one group to imagine that they were playing a five finger piece on the piano. Nicole Vignola 00:10:49 They had never played the piano before. Nicole Vignola 00:10:51 And he told the other group again, who had never played the piano before, to learn the five finger piece. Nicole Vignola 00:10:55 Actually physically use their hands. Nicole Vignola 00:10:57 And. Nicole Vignola 00:10:57 And both groups had similar levels of plasticity in the motor cortex, which is amazing. Nicole Vignola 00:11:04 So they basically saw and realized that through thought we can start to prime that area, the motor cortex, in response to how your hand is then going to move, which is, I don't know. Nicole Vignola 00:11:15 It blew my mind when I read that study. Nicole Vignola 00:11:19 Basically the way that visualization works is it helps to create a blueprint for what it is that you want. Nicole Vignola 00:11:26 Because the brain also likes to keep us safe. Nicole Vignola 00:11:29 I actually can resonate with that. Nicole Vignola

00:11:31 I have a client in New York who would really like to live by the beach. Nicole Vignola 00:11:34 But before we started working together, it was almost like impossible for her to think that because her job is in New York, her life is in New York. Nicole Vignola 00:11:42 She was born in New York. Nicole Vignola 00:11:43 And it takes a lot to think about wanting to live in, say, Miami, for example. Nicole Vignola 00:11:48 But through visualizing, she has started to kind of see what life would be like. Nicole Vignola 00:11:53 So you're teaching your brain and body, how you could feel in a place like that so that you can start to assimilate your life with something else. Nicole Vignola 00:12:01 Because the brain wants to keep you safe and it wants to keep you where you are, even if where you are it doesn't align with you anymore. Nicole Vignola 00:12:08 It would prefer the known, the comfort of the known versus the fear of the unknown, even if the fear of the unknown is better. Nicole Vignola 00:12:16 And that's generally why people also tend to stay in toxic relationships. Nicole Vignola 00:12:20 Because the fear of the unknown is sometimes worse than the comfort of the known. Nicole Vignola 00:12:26 And the brain doesn't know the difference between right and wrong. Nicole Vignola 00:12:29 Not really. Nicole Vignola 00:12:29 Our conscious brain can tell us morally, but on a neurobiological level, whatever's been repeated is the sequence of events that it's going to take every time the path more traveled. Nicole Vignola 00:12:40 And it's only when we start breaking out of that and creating new pathways that we can start moving towards a different future. Nicole Vignola 00:12:47 And through visualization we can start priming that pathway to say, okay, this is the route we've always taken, but what if we actually went this way? Nicole Vignola 00:12:55 And how would you feel if you started going down this way? Nicole Vignola 00:12:58 So when you start doing it, it's not as scary and slowly you can kind of move towards this new version or new place. Kate Moore Youssef 00:13:08 Okay, so we now have Dr. Kate Moore Youssef 00:13:10 Lotta Borg Skoglin. Kate Moore Youssef 00:13:11 Now, Lotta is an amazing expert in adhd. Kate Moore Youssef 00:13:15 She is also an associate professor in psychiatry at the Department of Women's and Children's Health at Uppsala University. Kate Moore Youssef 00:13:22 And she's also a researcher of clinical neuroscience at Karolinska Institute. Kate Moore Youssef 00:13:27 And her scientific and research work targets intersection of ADHD and all the different comorbid or co occurring traits of adhd, including mood disorders. Kate Moore Youssef 00:13:38 She's also the author of six popular science books on ADHD and addiction. Kate Moore Youssef 00:13:43 And her book ADHD Girls to Women Getting on the Radar has been translated into several European languages. Kate Moore Youssef 00:13:49 Now Dr. Kate Moore Youssef 00:13:50 Lotta is really beginning that foundational research and getting it across to the masses about ADHD and hormones. Kate Moore Youssef 00:13:58 And it's so important that we understand this. Kate Moore Youssef 00:14:01 So now let's listen to Dr. Kate Moore Youssef 00:14:02 Lotta Borg Skogland. Dr. Lotta Borg Skogland 00:14:05 And that is also something that we are trying to do in Lectner life, trying to build this community where we can share these stories and experiences with each other and learn from that. Dr. Lotta Borg Skogland 00:14:16 So just pool the kind of knowledge and experience that we have and collect that and then see what can we harvest from that. Kate Moore Youssef 00:14:28 Yeah, and I think that's when being ADHD informed, understanding the mood regulation, the emotional, all of that and the Impulsivity, where our energy levels are. Kate Moore Youssef 00:14:39 So many of us are very good in the morning, like sort of late morning till early afternoon, and then it tails off. Kate Moore Youssef 00:14:47 All these different little nuances are so powerful. Dr. Lotta Borg Skogland 00:14:52 That's also why you need to know your ADHD brain and your ADHD profile, right? Dr. Lotta Borg Skogland 00:14:57 Because if you have a profile of. Dr. Lotta Borg Skogland 00:15:01 As a psychiatrist, you often see that if you have a lot of anxiety as comorbidity or as part of your ADHD profile, that is. Dr. Lotta Borg Skogland 00:15:11 Can be somehow protective against the worst impulsivity thing, right? Dr. Lotta Borg Skogland 00:15:17 Because you are anxious that things are going to be happening to you or you're thinking a lot, catastrophic thoughts in advance. Dr. Lotta Borg Skogland 00:15:24 And then you tend to get. Dr. Lotta Borg Skogland 00:15:25 It's very painful and you may struggle and suffer a lot, but it kind of protects you against the things that can be very impulsive. Dr. Lotta Borg Skogland 00:15:34 So if you have that kind of adhd, then actually the period around ovulation where estrogen levels are peaking can be the worst for you because then you. Dr. Lotta Borg Skogland 00:15:47 Or it can be, sorry, it can be better for you because then you have the kind of lift of the mood and the thing by the estrogen and then you suffer really, really, really during the pmds, pms. Dr. Lotta Borg Skogland 00:16:02 But if you don't have this anxiety trait, then you might be susceptible for impulsivity and then you might be susceptible just around ovulation because then the estrogen level can reinforce the impulsivity. Dr. Lotta Borg Skogland 00:16:20 That can be perceived as kind of done in a positive, like in a positive manner. Dr. Lotta Borg Skogland 00:16:28 So it is like, oh, yeah, I feel like, you know, going out, seeing people, I feel like doing this. Dr. Lotta Borg Skogland 00:16:33 I feel like buying this. Dr. Lotta Borg Skogland 00:16:34 I feel like driving really fast in my car. Dr. Lotta Borg

Skogland 00:16:36 It's like, yay. Dr. Lotta Borg Skogland 00:16:37 So that part of ADHD HD can be really, really, you know, increased and be very dangerous for you, right? Dr. Lotta Borg Skogland 00:16:46 So if, if that kind of positive, positively driven impulsivity increases around ovulation because estrogen levels are high. Dr. Lotta Borg Skogland 00:16:58 And then you also add on to that by, you know, your, your ADHD medication that might also work more effectively during that time and further trigger actually the impulsivity. Dr. Lotta Borg Skogland 00:17:12 If the levels get too high, then that can be the worst part of your month. Dr. Lotta Borg Skogland 00:17:18 So you have to kind of break it down to, okay, there are the hormonal fluctuation. Dr. Lotta Borg Skogland 00:17:25 So there are different part of the hormonal cycle, but then there is the individual ADHD profile. Dr. Lotta Borg Skogland 00:17:32 So it's not like all women with ADHD have the worst consequences of their ADHD and their hormonal suffering during PMS, PMDs. Dr. Lotta Borg Skogland 00:17:44 For some people, it is the increased impulsivity around ovulation that actually makes so much ripple, have so many ripple effects that you have to sort out the mess that you create during one or two days when you are extremely impulsive and that takes the rest of the month to kind of mend and sort that out. Kate Moore Youssef 00:18:09 Yeah, I mean that's so beautifully described and like you say it's, you can relate to it in so many different ways and. Kate Moore Youssef 00:18:15 But I know also from a psychiatric perspective, if you do really struggle with the PMDD alongside the ADHD medication it's possible to take, I'm just asking antidepressants or anti anxiety medication just for that last two months, months to sort of bolster ourselves. Kate Moore Youssef 00:18:32 Is that something that you help women with as well? Dr. Lotta Borg Skogland 00:18:35 Yeah. Dr. Lotta Borg Skogland 00:18:36 So that, that kind of strategy we've, we've used for a long time for PMS, PMDD, PM, PMDS to just use like cyclic SSRI treatment 10 days before your, your, you have your period to just even out or to reduce the anxiety and depressive symptoms during pms. Dr. Lotta Borg Skogland 00:19:04 So that is something that you can use. Dr. Lotta Borg Skogland 00:19:07 But I think it's really important to try to disentangle if what you are experiencing is distinct comorbidity. Dr. Lotta Borg Skogland 00:19:16 So is this pms, pmds, is this distinct anxiety? Dr. Lotta Borg Skogland 00:19:21 Is it a anxiety disorder? Dr. Lotta Borg Skogland 00:19:23 Is it a depressive disorder? Dr. Lotta Borg Skogland 00:19:25 Because then you probably also need some kind of treatment for that distinct comorbid condition. Dr. Lotta Borg Skogland 00:19:33 It is not certain that the ADHD medication then will help. Kate Moore Youssef 00:19:44 I really hope you enjoyed this week's episode. Kate Moore Youssef 00:19:47 If you did and it resonated with you, I would absolutely love it if you could share on your platforms or maybe leave a review and a rating wherever you listen to your podcasts. Kate Moore Youssef 00:19:57 And please do check out my website, adhdwomenswellbeing.co.uk for lots of free resources and paid for workshops. Kate Moore Youssef 00:20:06 I'm uploading new things all the time and I would absolutely love to see you there. Kate Moore Youssef 00:20:11 Take care and see you for the next episode.