Case Studies

Beta with ADHD Users - Results

January 10, 2025
Figure 1 – correlation matrix centred around inattention. Red arrows – referring to correlations calculated based on participants changes in self-reported surveys after one month’s use of Verenigma (n = 59). Blue arrows – referring to correlations calculated based upon participants self-reported experience of their ADHD symptoms (n = 183).

Verenigma End of Month 1 Results

59 individuals with ADHD and classified as being alexithymic (scoring ≥18 on the TAS-DIF scale) regularly used Verenigma for month 1, completing both ‘introduction’ and ‘end of month 1’ surveys. These surveys assessed alexithymia using TAS-DIF, emotional regulation using DERS-16, ADHD prevalence using ASRS, and anxiety using GAD-7, with these results illustrated by the red arrows in Figure 1.

Changes in alexithymia (emotional blindness/numbness) are correlated with changes in ADHD inattention severity (r = 0.5066, p<.01), and emotional regulation (r = 0.4254, p<.001). Specifically, it is the changes in emotional clarity, as a subscale of DERS-16, which demonstrate a stronger correlation to alexithymia severity (r = 0.6374, p<.0001). Emotional clarity is additionally correlated with anxiety severity (r = 0.4235, p<.001) and ADHD inattention severity (r = 0.5268, p<.001).

Such data highlights the prevalence of emotional blindness within ADHD, and the extent to which this impacts upon one’s mental wellbeing, driving emotional dysregulation/confusion, which in turn drives anxiety and worsens inattention symptomology.

Verenigma’s results are supported by the current literature, with a well-established role for alexithymia and emotional dysregulation in ADHD. Until recent years, emotional dysregulation was considered as an associated feature in ADHD, rather than a core component1. However, increasing numbers of reports are now showing those with ADHD to exhibit a higher prevalence of emotional dysregulation (25-45% for children, and 42-72% for adults with persistent ADHD)2. It is thought that such impairments in regulating emotions, in particular emotional clarity, may contribute to the three core symptoms – inattention, impulsivity, and hyperactivity3,4 and in many cases have a more negative impact on wellbeing and self-esteem2.

In line with emotional dysregulation, alexithymic traits are closely linked to emotion processing difficulties and social anxiety symptoms5. Conducted in a sample of German adults with ADHD, 22% were identified as being highly alexithymic and 40% meeting the DSM-IV diagnostic criteria for social anxiety disorder5. In our initial sample of participants completing the introduction survey, 221/275 (80%) of individuals with ADHD, had a TAS-DIF score of ≥18, with 190/221 (86%) scoring ≥10 on the GAD-7 scale, indicating moderate to severe anxiety. Of the 59 alexithymic participants with ADHD who regularly used Verenigma for one month, 45/59 (76%) scored ≥10 on the GAD-7 scale, indicating moderate to severe anxiety. As above, these prevalence rates highlight the extent to which both symptoms of alexithymia and anxiety impact upon individuals with ADHD.

In terms of neurobiology, imaging studies have revealed that the strength of functional connectivity between the amygdala, rostral anterior cingulate cortex and prefrontal cortices are significantly correlated with reports of emotional dysregulation in ADHD6, suggesting inadequate top-down regulation of emotional activity in these higher cortical networks7. With emotion reappraisal and affect labelling techniques shown to boost neuro-activation in these brain regions8, the use of Verenigma can help promote healthy and functional connectivity, and thus reduce symptoms of emotional dysregulation, and alexithymia in individuals with ADHD.

Self-Reported Participant Symptom Experiences

183 individuals with ADHD completed a self-report questionnaire, assessing which classical ADHD symptoms they believed affected them in their daily lives. Represented by the blue arrows in Figure 1, the results were largely centred around inattention (this is supported by 61% of the previous cohort reporting increased inattention symptomology compared to impulsivity/hyperactivity at the time of their introduction survey).

As with the cohort using Verenigma for one month, alexithymia was correlated with emotional clarity (r = 0.6287, p<.0001), and inattention (r = 0.6489, p<.0001). Interestingly, a correlation was also found between alexithymia and relationship stress (r = 0.6086, p<.0001). Prior studies have revealed a negative relationship between alexithymia and relationship satisfaction, with a proposed explanation relating to fear of intimacy, difficulties with attachment security, and difficulties in recognising bodily sensations such as arousal9,10.

Inattention was strongly correlated with anxiety (r = 0.9047, p<.0001), brain fog (r = 0.8844, p<.000), and relationship stress (r = 0.6841, p<.0001), highlighting the extent to which ADHD symptomology can manifest itself in other areas of wellbeing. In turn, anxiety was also highly correlated with brain fog (r = 0.8474, p<.0001), and relationship stress (r = 0.7027, p>.0001), indicating the presence of ADHD to not only impact upon the individual diagnosed.

Previous research has highlighted the extent to which emotional dysregulation in ADHD can negatively impact upon relationships11. The presence of such stress can contribute to further issues of emotional exhaustion and burnout, which itself is highly correlated (r = 0.637) with a difficulty in identifying emotions12, and anxiety (r = 0.460)13. Therefore, as illustrated above, while alexithymia is contributing to experiences of relationship stress in the individual with ADHD, the presence of this stress may also be contributing to the development of emotional burnout and alexithymia in a partner.

Verenigma Efficacy

Verenigma’s results are in line with the proposed neurobiology of reappraisal and affect labelling boosting neural connectivity and improving mental health – after only one month’s usage, 55% of the cohort demonstrated a reduction in alexithymia severity and 58% demonstrated a decrease in emotional dysregulation severity. In terms of emotional clarity, 73% demonstrated either an improvement or no change. As a result of improvements in emotional clarity, 53% demonstrated a decrease in anxiety severity and lastly 33% of the cohort showed a reduction in their ADHD severity.

Given the aforementioned relationships, we can infer that an improvement in emotional clarity through using Verenigma, directly benefits symptoms of inattention and anxiety, which in turn aids in dispelling brain fog (improving focus) and alleviating relationship stress. This beneficial cycle can lead to further improvements in concentration, productivity and overall happiness.

Future Work

With these results enforcing a need to monitor emotional regulation, alexithymia, and anxiety in individuals with ADHD, further methods by which this can be easily achieved in daily life need to be established. Heart rate variability (HRV) measurements can be used as an indicator of general and emotional wellbeing, with lower HRV recordings often signalling deteriorating mental and/or physical health14. Autonomic dysfunction and disrupted HRV has been shown in ADHD15,16,17. Thus, through combining psychological data outputs from Verenigma and physiological data through HRV recordings, this would provide further insight into individuals mental wellbeing. Additionally, individuals will be able to visualise the positive effects that reappraisal and affect labelling has on their HRV, furthering the ease of self-management. Implementing this feature and collecting participant feedback is a vital next stage for the development of Verenigma.

A limitation of this current analysis is that we have not distinguished between participants taking medication, and those who are not. Therefore, regarding further analysis, it would be interesting to compare the effects, and to identify whether the addition of Verenigma to pharmaceutical treatment has any beneficial effects. 105/183 (57%) of participants in the second cohort reported to be taking medication, with 126/183 (69%) reporting to be likely/very likely looking for new information on ADHD management/handling.

Larger samples of ADHD participants will also be required to collect longitudinal data on the efficacy of Verenigma. A more in-depth analysis in terms of participant demographics could also provide interesting results – sex and age differences in terms of symptom improvements and frequency of app usage for instance.

Lastly, with such an apparent effect of ADHD symptomology on relationship stress, which is likely to further worsen anxiety and brain fog, it is vital to investigate the extent to which partners may be affected. Expected issues arising may be the development of anxiety, emotional exhaustion/burnout, alexithymia, and emotional avoidance. Establishing this connection, we can begin to test the efficacy of Verenigma Amicus in alleviating this stress, benefiting the relationship, and improving general mental wellbeing for all.

References

  1. Hamerman, R., & Cohen, N. (2022). Emotion control training enhances reappraisal success among individuals with reported ADHD symptoms. Scientific Reports.12(1): 14058. doi: 10.1038/s41598-022-18441-z.
  2. Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014) Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry. 171(3): 276-93. doi: 10.1176/appi.ajp.2013.13070966.
  3. Seymour, K. E., Chronis-Tuscano, A., Iwamoto, D. K., Kurdziel, G., & Macpherson, L. (2014). Emotion regulation mediates the association between ADHD and depressive symptoms in a community sample of youth. Journal of Abnormal Child Psychology. 42(4):611-21. doi: 10.1007/s10802-013-9799-8.
  4. Albesisi, S., & Overton, P. G. (2023). Relationship Between ADHD-Like Traits & Emotion Dysregulation in the Adult General Population. Advances in Neurodevelopmental Disorders. https://doi.org/10.1007/s41252-023-00381-y
  5. Edel, M. A., Rudel, A., Hubert, C., Scheele, D., Brüne, M., Juckel, G., Assion, H. J. (2010). Alexithymia, emotion processing and social anxiety in adults with ADHD. European Journal of Medicinal Research. 15(9): 403-9. doi: 10.1186/2047-783x-15-9-403.
  6. Hulvershorn, L. A., Mennes, M., Castellanos, F. X., Di Martino, A., Milham, M. P., Hummer, T. A., et al. (2014). Abnormal amygdala functional connectivity associated with emotional lability in children with attention deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 53(3): 351–361. doi: 10.1016/j.jaac.2013.11.012
  7. Soler-Gutiérrez, A. M., Pérez-González, J. C., & Mayas, J. (2023).  Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. PLoS One.18(1): e0280131. doi: 10.1371/journal.pone.0280131.
  8. Braunstein, L. M., Gross, J. J., & Ochsner, K. N. (2017). Explicit and implicit emotion regulation: a multi-level framework. Social Cognitive & Affective Neuroscience. 12(10): 1545-1557. doi: 10.1093/scan/nsx096.
  9. Humphreys, T., Wood, L., & Parker, J. (2009). Alexithymia and satisfaction in intimate relationships. Personality and Individual Differences. 46: 43-47. 10.1016/j.paid.2008.09.002.
  10. Lyvers, M., Pickett, L., Needham, K., & Thorberg, F. A. (2022). Alexithymia, Fear of Intimacy, and Relationship Satisfaction. Journal of Family Issues. 43(4): 1068-1089. https://doi.org/10.1177/0192513X211010206
  11. Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. The Journal of Adolescent Health. 46(3): 209-217. doi: 10.1016/j.jadohealth.2009.09.009.
  12. Tei, S., Becker, C., Kawada, R., Fujino, J., Jankowski, K. F., Sugihara, G., Murai, T., & Takahashi, H. (2014). Can we predict burnout severity from empathy-related brain activity? Translational Psychiatry. 4(6): e393. doi: 10.1038/tp.2014.34.
  13. Koutsimani, P., Montgomery, A., & Georganta, K. (2019). The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Frontiers in Psychology. 10: 284. doi: 10.3389/fpsyg.2019.00284.
  14. Mather, M., & Thayer, J. (2018). How heart rate variability affects emotion regulation brain networks. Current Opinions in Behavioural Sciences. 19: 98-104. doi: 10.1016/j.cobeha.2017.12.017.
  15. Christiansen H, Hirsch O, Albrecht B, Chavanon ML. Attention-Deficit/Hyperactivity Disorder (ADHD) and Emotion Regulation Over the Life Span. Current Psychiatry Reports. 21(3): 17. doi: 10.1007/s11920-019-1003-6.
  16. Kvadsheim, E., Fasmer, O. B., Osnes, B., Koenig, J., Adolfsdottir, S., Eichele, H., Plessen, K. J., & Sørensen, L. (2020). Lower Cardiac Vagal Activity Predicts Self-Reported Difficulties With Emotion Regulation in Adolescents With ADHD. Frontiers in Psychiatry. 11. doi: 10.3389/fpsyt.2020.00244
  17. Bellato, A., Arora, I., Kochhar, P., Hollis, C., & Groom, M. J. (2022). Indices of Heart Rate Variability and Performance During a Response-Conflict Task Are Differently Associated With ADHD and Autism. Journal of Attention Disorders. 26(3): 434-446. doi: 10.1177/1087054720972793.

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