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CBT Model of Perfectionism
Perfectionism is not the same thing as conscientiousness.
For example, in a recent study of older adults, perfectionism was both associated with increased risk of mortality whereas conscientiousness was associated with decreased risk of mortality (Fry & Debats, 2009).
Perfectionism often results in avoidant coping – leading to people being less contentiousness!
Perfectionism is not only a risk factor for developing psychological disorders like depression, anxiety and eating disorders, but it can also be a poor prognostic factor for treatment success (unless it is actually dealt with in treatment, which we can do).
Cognitive Behavioral (CBT) Model of Clinical Perfectionism
I thought I’d explain some of the psychological mechanisms involved in clinical perfectionism:
– The person’s self worth is often overly dependent on one area (e.g., Person’s self worth is almost solely dependent on academic success, career success, or shape/weight/eating).
– Perfectionists often have inflexible standards and dichotomous thinking (e.g., getting one B grade among many A grades feels like evidence of being a complete failure).
– When clinical perfectionists meet their standards, they typically reappraise the standards as having been insufficiently demanding (and therefore never feel good enough).
– When clinical perfectionists fail to meet their standards, they typically engage in self criticism rather than self compassion. We know from research studies that self criticism depletes willpower (hence a possible pathway from: higher perfectionism > higher self criticism > lower conscientiousness)
– Clinical perfectionists often use counterproductive safety behaviors that actually make their situation worse. For example, they may do some or all of the following:
– constantly compare their performance relative to others
– get stuck on details that don’t matter that much
– avoid objective performance feedback
– do excessive checking (which increases perceptions of possible danger and can impair memory).
(It’s common for people to do a combination of excessive checking/comparing and avoiding feedback. For example, sometimes excessively weighing self and sometimes avoiding weighing self).
– Clinical perfectionists sometimes avoid situations and tasks when they fear they might not be able to meet their own standards (this can result in missing out on opportunities or might create problems in their life or relationships).
Cognitive Behavioral Therapy Treatment for Perfectionism
– Treatment for perfectionism doesn’t necessarily involve reducing your own standards (e.g., a very capable student might still aim to get As) if the standards are attainable without causing distress or impairment.
It does typically involve:
– Reducing the extent to which self evaluation is exclusively based on meeting your own personal standards.
– Reducing the extent to which self esteem is based on only one or very few domains (e.g., work performance and weight/shape/eating) (Try some self help right now with this simple exercise).
– Helping the person reduce dichotomous thinking, selective attention, and other cognitive biases, and increase cognitive flexibility.
– Helping the person reduce self criticism.
– Helping the person learn how to resolve tension between goal striving and avoidance tendencies.
– Helping the person shift focus and effort away from unattainable goals.
– Experimenting with investing time & energy into goals that are not performance related.
– Doing behavioral experiments so that the person can see what it’s like to not use their current safety behaviors.
– Addressing underlying Assumptions & Negative Core Beliefs.
– Because perfectionism can get in the way of treatment for depression, anxiety, and eating disorders, it should typically be addressed early in treatment.
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Author: Alice Boyes, PhD.