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Phone anxiety and ADHD

The call takes two minutes and has been on the list for two weeks. Here is what the research says about why, and a way to practice that follows it.

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Start with the calls
marked easy.

The scenarios list: dispute a charge, ask for what you need, ask for a raise, ask a neighbor for a favor

ADHD and anxiety often arrive together

In the US National Comorbidity Survey Replication, 47.1% of adults with ADHD had an anxiety disorder in the past 12 months. 29.3% had social phobia, the fear of being judged in social situations, about five times the odds of adults without ADHD.1

The survey did not ask about phone calls. A call is a social situation with a stranger and no time to edit, so it sits inside that fear for a lot of people.

Why a live call costs more than a text

On a call you hold what you came to say, listen to the answer and plan the next sentence at the same time. That is working memory. A meta-analysis of 38 studies found moderate working-memory deficits in adults with ADHD.2

Linking that finding to phone calls is our reading. The study measured memory tasks, not calls.

What exposure therapy does

Avoiding a call brings relief today and makes the next call harder. Exposure reverses that: you meet the situation on purpose, in steps, starting with a version you can manage.

The current account of why it works is inhibitory learning. The old fear is not erased. You build a second memory, "I made the call and it was fine", that competes with it. It forms best when the outcome differs from what you predicted, so the method is to name the prediction first and check it afterwards.3

For social anxiety disorder, NICE recommends individual cognitive behavioural therapy built for social anxiety as the first treatment for adults.4 One of the two models it names, Heimberg's, is organised around exposures in session and as homework.5

Does practice with a simulation count?

A 2019 meta-analysis pooled 30 randomized trials with 1,057 participants. Virtual reality exposure did about as well as exposure in person (g = −0.07), and eight of the trials were on social or performance anxiety.6

Those trials used VR with a therapist. murmur is a voice call with an AI and has not been tested in a trial. We built it as a place to do the first rungs of the ladder.

A ladder for phone calls

Before each call, write one line: what do you expect to go wrong? After it, write what happened.

  1. One goal, friendly voiceRepeat one until it is boring.
    Book a TableCall a restaurant and secure that perfect dinner spot with confidence. Schedule a HaircutBook that appointment and get the look you actually want. Order FoodMaster the art of calling in your food order like a pro.
  2. Something you need from themThey may ask a question you did not plan for.
    Talk to Your DoctorAdvocate for your health and get the answers you need from your doctor. Fix an IssueGet your problem solved without losing your cool or your time. Negotiate Rent with LandlordTry to lower your rent or negotiate terms like a grown-up.
  3. A call with something at stakeDo these after the first two feel routine.
    Ask for a RaiseKnow your worth and get paid what you deserve with confidence. Set a BoundaryStand up for yourself while keeping the relationship intact. Negotiate First SalaryNegotiate your first real job offer without fumbling the bag.

All calls   Build a call script

Things that lower the cost of starting

  • Write the first line. The first sentence is the hardest one to get out.
  • Keep the goal to one thing. murmur shows the objectives before the call begins.
  • Pick tomorrow's call tonight. Tomorrow's Call in murmur lets you commit to one, warm up for it and say afterwards whether you made it.

murmur is practice, not treatment, and it does not diagnose or treat ADHD or an anxiety disorder. If avoided calls are costing you work, money or health, talk to a doctor or a therapist.

Sources

  1. Kessler RC et al. The prevalence and correlates of adult ADHD in the United States. American Journal of Psychiatry, 2006. Full text
  2. Alderson RM et al. ADHD and working memory in adults: a meta-analytic review. Neuropsychology, 2013. Abstract
  3. Craske MG et al. Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 2014. Full text
  4. NICE. Social anxiety disorder: recognition, assessment and treatment (CG159). Guideline
  5. Hope DA, Heimberg RG, Turk CL. Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach. Workbook summary
  6. Carl E et al. Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials. Journal of Anxiety Disorders, 2019. Abstract

Questions

Is anxiety common with ADHD?

Yes. In the US National Comorbidity Survey Replication, 47.1% of adults with ADHD had an anxiety disorder in the past 12 months, and 29.3% had social phobia. The survey did not measure phone calls on their own.

Does practicing phone calls help with phone anxiety?

Planned, graded practice of the feared situation is the core of exposure, which is part of the therapy guidelines recommend for social anxiety. murmur is a rehearsal tool and has not been tested in a clinical trial.

Where should I start if I avoid every call?

With a call that has one goal and a friendly person on the line, such as booking a table. Say what you expect to go wrong before the call and check it afterwards.

Rehearse the call before you dial

murmur is on the App Store, for iPhone.

Download murmur on the App Store
  • AppleApp of the Day
  • App StoreBest New Apps