May 08, 2026

Why Knowing Isn't Doing: Adult ADHD Through a CBT Lens | Dr. Russell Ramsay

51 minutes

"I know what I need to do, but I don't trust that I'll do it when I need to do it."

If that sentence lands, this conversation is for you.

In this episode of Refined Leadership: ADHD Lens, I sit down with Dr. Russell Ramsay, one of the leading voices in adult ADHD and Cognitive Behavioral Therapy. We talk about his new book, Once I Get Started, and the cognitive theme he believes runs beneath much of adult ADHD: self-mistrust.

This is not a productivity conversation. It is a conversation about what actually happens between knowing what to do and doing it — and why that gap shows up so often for capable, high-performing professionals.

What we explore:

Self-mistrust as a possible central cognitive theme of adult ADHD, and how it shapes self-worth, decisions, and follow-through

Why ADHD is better understood as a performance problem than a knowledge problem

Motivation as an emotion, and why deadline pressure stops being a sustainable strategy

Self-regulatory efficacy: why some people disengage early, and what protects against it

How thoughts, feelings, and behaviors operate as a braided cord rather than a linear chain

People-pleasing, social capital, and why ADHD professionals may overestimate their relational debts

Procrastivity, or productive procrastination — when it is adaptive, and when it is avoidance

Taskidermy tasks: the items that keep reappearing on your to-do list without moving forward

The SAP Method: Specific, Actionable, Pivot Points for getting unstuck

How CBT for adult ADHD differs from CBT for depression or anxiety, and why the implementation focus matters

Masking, intentional self-presentation, and the difference between coping and concealment

This episode offers language for patterns that often go unnamed at work — and a more grounded way to think about why standard advice keeps falling short.

About Dr. Russell Ramsay: Dr. Russell Ramsay is a psychologist who specializes in the assessment and psychosocial treatment of adult ADHD. He has lectured internationally, published widely, and authored six books on adult ADHD, including his most recent, Once I Get Started. He is a CHADD Hall of Fame inductee.

Pre-order Once I Get Started by Russell Ramsay, Ph.D.: https://www.penguinrandomhouse.com/books/783710/once-i-get-started-by-russell-ramsay-phd/

Connect with Cathy Rashidian: ReadySetChoose.com

Resources:

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist Instructions

https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf

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🔖 Timestamps

0:00 — Introduction and grounding quotes from the book

1:30 — Self-mistrust as a central cognitive theme

4:15 — What makes Once I Get Started different, and ADHD as a performance problem

6:30 — How CBT for ADHD differs from CBT for depression or anxiety

11:00 — Beyond the DSM list: executive function and the lived reality of ADHD

14:00 — Motivation as emotion, and the cost of running on adrenaline

17:30 — Self-mistrust, self-efficacy, and self-regulatory efficacy

21:00 — Thoughts, feelings, and behaviors as a braided cord

23:00 — Permission-giving beliefs and avoidant automatic thoughts

25:00 — Cognitive rehearsal and the pause that creates choice

27:30 — Automatic compliance and the cost of saying yes too quickly

28:30 — People-pleasing, social capital, and overestimating relational debts

31:30 — Emotional impulsivity and the externalization of self-worth

36:00 — Procrastination, procrastivity, and what makes some tasks easier to start

40:30 — ADHD as an uncertainty generator

41:30 — Taskidermy tasks and what to do with them

42:30 — The SAP Method: Specific, Actionable, Pivot Points

44:30 — CBT, masking, and intentional self-presentation

48:30 — Closing reflection

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By Cathy Rashidian, Certified Coach

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