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Cognitive Behavioral Therapy For Perfectionism
Joseph E. Caloiero, M.S.
Department of Psychiatry
Milton S. Hershey Medical Center
“People whose standards are high beyond reach or reason and who strain compulsively and unremittingly toward impossible goals and who measure their own worth entirely in terms of productivity and accomplishment.” -David Burns, M.D.
“Tyranny of the shoulds” (Horney, 1950)
“Musterbation” (Ellis & Harper, 1961)
“Normal vs. neurotic perfectionism” (Hamamacheck, 1978)
Domains of Perfectionism
Performance at work or school
Relationships, friendships and family life
Leisure and recreation
Neatness and aesthetics
Organization and ordering
Health and personal cleanliness
Perfectionism vs. Conscientiousness
Perfectionism IS NOT the same as conscientiousness
In a recent study, perfectionism was both associated with increase 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 conscientious
Perfectionism is maintained in a vicious cycle
Society values the pursuit of high standards and perfectionism
There may be positive consequences of ones perfectionism
Makes sense to question whether one wants to change their behavior
Essential Features of Perfectionism
Setting high standards – extreme need for control
Critical self evaluation – strive to control emotions, thoughts, behaviors, performance and appearance
Often associated with other problems such as anxiety and depression
Questions to Determine Whether Standards are Overly Perfectionistic
Are my standards higher than those of other people?
Am I able to meet my standards? Do I get overly upset if I don’t meet my own standards?
Are other people able to meet my standards? Do I get overly upset if others don’t meet my standards?
Do my standards help me to achieve my goals or do they get in the way (e.g., by making me overly disappointed or angry when my standards are not met; by making me get less work done, etc.)?
What would be the costs of relaxing a particular standard or ignoring a rule that I have?
What would be the benefits of relaxing a specific standard or ignoring a rule that I have?
Examples of Perfectionists
A woman struggles to be a perfect parent, a perfect wife, and a perfect employee, often to the detriment of her own emotional and physical health
A graphic artist constantly seeks reassurance that his works is of the highest quality, and that he is well respected and well-liked by others.
A student constantly strives to meet excessively high academic standards, and who is devastated when she receives a grade that is less than perfect.
An individual spends hours planning every aspect of every day, and who becomes very distressed when things do not go according to his plans.
Multidimensional Definitions of Perfectionism
Self-oriented perfectionism –
self-imposed standards that are
unrealistically high and impossible to
Other-oriented perfectionism – unable to delegate tasks to others for fear of being disappointed by a less than perfect performance of the job.
Socially prescribed perfectionism – the assumption that others have expectations of you that are impossible to meet.
Hewitt and Flett Multidimensional Perfectionism Scale
When I am working on something, I cannot relax until it is perfect
I demand nothing less than perfect of myself
I seldom criticize my friends for accepting second best.
The people who matter to me should never let me down.
Socially Prescribed Perfectionism
To gain approval from those around me, high standards must be met.
My family expects me to be perfect.
Cognitive View of Perfectionism
Perfectionism stems from biases, beliefs, assumptions, and predictions, for example:
Anything less than sticking to my diet perfectly is a failure. If I eat one cookie, I may as well have eaten 10 cookies.
I always need to look perfect in front of other people.
If I don’t get an A+ in this course, I don’t deserve to be in this program.
I seem to be the only person in this house who knows how to clean things properly.
Thinking in shades of grey…. Wiping the kitchen counters daily
Changing Perfectionistic Thinking
Designed to promote more flexible, adaptive and realistic thinking
The harder people work, the better they will do.
To get ahead, you have to be single minded and give up all the outside interests.
The more you put into something, the more you get out of it.
People can’t be happy if they’re not successful.
If I avoid it, it tends to sort itself out.
If a job’s worth doing, then it is worth doing right.
People notice every little detail and are quick to form critical judgements.
Egan, Wade, Shafran & Antony, 2014
Unrealistic and inflexible standards
Raising the bar when standards are met
Overestimating likelihood of negative events
Underestimating one’s ability to cope with negative events
Being overly focused on details
Examine the evidence
Compromising with self and others
Changing social comparison habits
Looking at the big picture
Tolerating uncertainty and ambiguity
Using Emotional Shifts to Elicit Thoughts
Questions to ask oneself
What was going through my mind just before I started to feel this way?
What was I saying to myself?
What images did I have?
What was I predicting would happen in this situation?
What does this say about me?
Examining the Evidence
What facts, data and experiences support my beliefs, predictions or interpretation?
Have I had any experiences to show that this thought is not completely true all the time?
If my best friend had this thought, what would I tell him or her?
If someone who loved me knew I was thinking this thought, what would he or she say to me?
When I am not feeling this way, does this sort of situation look different to me?
Examining the Evidence cont.
Are there small things that contradict my thoughts that I might be discounting?
Five years from now, as I look back on this, will I think about it any differently?
Am I blaming myself for something over which I have no control?
Changing Perfectionistic Behavior Behavioral Features/Self Handicapping (Jones & Berglas, 1978)
Overcompensating and over preparing
Excessive checking. Reassurance seeking
Trying to change the behavior of others
Excessive organizing and list making
Not knowing when to quit
Avoiding situations where there is a risk of failing
Failure to delegate
Avoiding feared situations
Lack of effort (not persisting though challenges)
Not taking opportunities to practice
Changing Perfectionistic Behavior
Exposure to feared situations
Preventing safety behaviors
Sample In Vivo Exposures
Take an exercise class and work out in front of others
Say something incorrect
Spill a drink
Talk about unfamiliar topics
Ask for help in a store
Drop something in front of others
Make a mistake in public
Ask for help
Perfectionism CBT Self-Help Books
Antony, M.M., & Swinson, R.P. (2009). When perfect isn’t good enough: Strategies to coping with perfectionism, second edition. Oakland, CA: New Harbinger Publications.
Shafran, R., Egan, S., & Wade, T. (2010). Overcoming perfectionism: A self-help guide using cognitive behavioral techniques. London, UK: Constable & Robinson.
Perfectionism Books for Professionals
Egan, S.J., Wade, T.D., Shafran, R., & Antony, M.M. (2014). Cognitive-behavioral treatment for perfectionism. New York, NY: Guilford Press.
Flett, G.L., & Hewitt, P.L. (2002). Perfectionism: Theory, research, and treatment. Washington, DC: American Psychological Association.
Perfectionism Treatment DVD
Antony, M.M. (2008). Cognitive behavioral therapy for perfectionism over time (DVD Video). Washington, DC: American Psychological Association.
Use multiple points, if necessary.
Use brief bullets and discuss details verbally.
on in this house who knows how to clean things properly.