Why the ADHD Brain Chooses the Less Important Task — and How CBT Improves Prioritization Skills
Facing a to-do list top-heavy with critical, complex tasks, adults with ADHD often tackle the easier items — ones that keep them busy but not productive. Called “procrastivity,” this self-defeating ADHD time-management habit can be helped by cognitive behavioral therapy approaches that teach patients how to prioritize tasks.
“Procrastivity” and its Role in ADHD
A combination of “procrastinate” and “activity,” the term “procrastivity” aptly describes a tussle common among adults with ADHD who are always busy but never seem to make headway on life’s important goals. At its root is an implementation problem: the individual knows what they need to do, but they won’t or can’t do it, so they keep occupied with more palatable but less critical tasks.
Filing taxes, for example, is a high-priority, strict-deadline task that an adult with ADHD might put off for re-seeding the lawn. While a worthwhile activity if the grass is indeed bare, this gardening is not critical, especially when April 15 looms. If tending to the lawn is the priority task, on the other hand, some adults with ADHD might find opting to watch or read the news in a bid to stay informed. Productive? Yes, but low on the scale of priorities.
Procrastivity can especially affect people with attention deficit disorder (ADHD or ADD), as the disorder, at its core, is a struggle with executive functions and self-regulation. Completing everyday tasks and learning how to prioritize is often more difficult for people with ADHD compared to their neurotypical peers — and all that back up effectively creates a breeding ground for procrastivity.
Why do some tasks that would be otherwise avoided suddenly become more appealing in the face of higher priority to-do items? And can the ADHD mind be trained to steer clear of this low-hanging, time-wasting fruit? This is the conundrum of procrastivity and the promise of its match: cognitive behavioral therapy.
Using CBT to Address Procrastivity
Cognitive behavioral therapy — a type of brain training — has been shown to help patients manage their ADHD symptoms and improve functioning. CBT as an ADHD therapy aims in part to reframe the often negative perceptions patients with ADHD have of themselves — a result of living the ADHD experience in a neurotypical world — by providing coping strategies, tools to manage negative expectations and emotions, and analysis of behavioral patterns that interfere with the strategies.
Sometimes, however, procrastivity prevents patients with ADHD from following through on the strategies and approaches discussed in CBT sessions, thereby rendering fallow the very tools they need to solve the underlying problem. But by dissecting procrastivity into its root causes and manifestations, its elements can be used to employ CBT techniques that help ADHD patients actualize the important work.
Procrastivity Inside the ADHD Brain
What are the key differences between the small, unimportant tasks that ADHD patients tend to choose over the more critical, deferred ones?
- Manual focus: Often, the lower-priority task is physical and less cognitively demanding than the higher-priority task. Getting the lawn mower out of the shed, starting it up, and pushing it to the lawn is less cognitively challenging than preparing taxes — a nebulous and mentally taxing, so to speak, activity. This also explains why some patients opt to read when faced with a daunting writing task.
- Familiar script: Individuals are more likely to tackle tasks with a pre-existing “menu”. Laundry and other household chores that can be done on auto-pilot tend to fall under this umbrella, but writing a research paper does not.
- Time frame: Procrastivity tasks often have a more firm and predictable time frame; there is little doubt how long they will take. Deleting unread e-mails may take 10 minutes, but the same cannot be said for preparing a work presentation.
- Task progress: Procrastivity tasks often have a clear measure of a beginning, middle, and end. Lawn mowing starts with removing the mower from the shed, and you’re halfway through when half of the grass blades are cut. It ends with the mower going back in the shed. But a task like studying for a final exam does not have crisp progress points; it’s more difficult to tell if you’re making progress, and how much.
Preferred procrastivity tasks tend to align with a patient’s own perceived efficacy. They will opt for it even if the activity being avoided may actually take less time and effort.
Harnessing Procrastivity Insights in CBT
With procrastivity pulled apart, clinicians can harness the attributes that draw patients to low-priority tasks in order to create a CBT-based priority task plan that includes behavioral, emotional, and other implementation strategies:
Behavioral Approaches to Productivity
- Attach manual, step-by-step descriptions to must-do tasks. This strategy allows the individual to engage steadily and progressively in the priority task. “To study,” therefore, becomes “go to the study station” followed by “remove item from backpack” or “open the document on the computer” and “re-read the last two paragraphs you wrote.”
- Lower the bar on progress. This strategy associates the priority task with time, another task, or terrain. This can mean working on the task during commercial breaks only, or focusing on the activity for 600 seconds rather than 10 minutes. The goal of the technique is to make the priority task “do-able” by changing how time around it is conceptualized.
- Define time by start and end. The aim in creating a “bounded” work period is to reduce the cognitive load associated with priority tasks for patients. Ambiguous work periods are more overwhelming than the work itself. But having your patient work only until the hourglass (probably the best tool because of the ability to “see” time) needs to be turned over can help.
Emotional Approach to Productivity
- Reframe discomfort. Another cognitive reframing technique that helps remind your patients that they do not have to be in the mood to do something in order to do it. Having patients acknowledge their discomfort aloud can also help, as it demonstrates that the feeling isn’t necessarily tied to action.
Implementation Strategies for Productivity
- If x then y. Studies show that putting tasks in this structure can help patients develop executive functioning cues. If I can sit at my desk, a patient might say, then I can work on math homework for 10 minutes. The desk may eventually become a visual cue for patients, where they associate it with being able to work for 10 minutes.
- Tipping point. Create a plan that helps patients identify and handle points during a task that maintain workflow. This includes the starting point, a method for handling interruptions, and thinking of how to re-engage in a task after a break.
Russell Ramsay, Ph.D., is a member of the ADDitude ADHD Medical Review Panel.
The content for this article came from J. Russell Ramsay’s “Turning Intentions Into Actions: Implementation-Focused CBT For Adult ADHD” presentation delivered for APSARD’s 2018 Symposium. “Procrastivity” will also be covered in Dr. Ramsay’s forthcoming book, “Rethinking Adult ADHD: Helping Clients Turn Intentions into Action.” (APA).
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