CBT : How Perfectionism Can Lead To Depression

Perfectionism can mean many things to many people. It can be seen as striving for excellence. It can mean a controlling attitude but more often it means holding on to unattainable standards that demand unyielding compliance from self, others and situations. This is more than just having an eye for details or suffering disappointment due to not reaching a target, it is an attitude that promotes stress and psychological strain, ultimately, depression. When depression is involved, a cycle of negative emotions and states such as high expectations, fear and anxiety, fear of rejection and blame and procrastination come into play. This causes a barrage of self-talk ( I must, should) with blame ( I am awful, terrible) and promotes and maintains depressive thoughts.

Let’s look at how this works. perfectionists often dread the thought of failing to meet their lofty targets with a passion. This causes them to experience anxiety at the thought of performing poorly and having to deal with inevitable missing of goals. The paradox is that this thinking leads to a focus on perceived imperfections that apparently caused the failure. This results in negative self-talk, self-downing and a downward depressive spiral, affecting self-worth and self-esteem. Perfectionists often find it difficult to allow themselves breathing space in their pursuit of perfection and the fact that human fallibility is a normal part of life gets lost on them. The sad truth is that perfectionists judge their self-value on their own idea of success and failure. Some very successful people berate themselves constantly for not achieving more than they have. For many people, perfectionism is total. It is not enough to do as well as others, they have to stand out. It is not enough to perform typically, they MUST be the best. It is not enough to have a tidy home, it MUST be spotless. When perfection becomes a condition for personal worth, it inevitably leads to a slippery slope of predictable emotional consequences and responses.

Perfectionists are often identified by the language they use. Words like “should”, “must”, “have to” “require” “expect” are all part of a perfectionist’s vocabulary. These words can, of course be used without making demands but added them to lofty expectations, trouble is in store. They often provoke guilt and shame because unrealistic rigid demands were not met. In therapy, one of the approaches against this is to replace these demanding words with ones less threatening and emotional. “Expect” becomes “would prefer”, “must” becomes “aspire to”, “should” becomes “hope to” and so on. The use of softer language and taking a more realistic approach to life (and self) is key to lessening the demands of perfectionism.

Realism as a Counter to Perfectionism

As a CBT therapist, I deal in realism. What that means is that in therapy, my clients come to realize that life is not always easy with various ups and downs and things are not going to be great all the time. It is how we deal with the downs that determine how good the ups will be. This is an essential mindset to take if recovery from perfectionism is to take place. If we can be mostly satisfied with who we are, what we are doing and who with are with most of the time, then life is really not so bad. Contrast that with the unreal, perfectionist world where the prize of achievement is never reached.

When I take on a new client with signs of perfectionism, one of the first assignments they get is to fill in Daily Mood Sheets. This is a wonderful instrument that charts reaction to perfectionist thinking, looks at the automatic thoughts and behavior that follows and then gives the client a chance to look at the situation from a different angle. The biggest hurdle to these sheets is the ability to look at things realistically.  Once this is learnt, ( and it can take some time) a mindset clicks in that is one of acceptance that things won’t and can’t always go our way. This is the idea behind realistic thinking, that we accept that life will not always be as we want it to be . However, only replacing vocabulary in your mind is not likely to do the trick. Part of this process means moving from being self-absorbant to self-observant, questioning the very things that are driving perfectionist values. If you think that you must have or do something, the question could be “why is this the case? Is there an alternative, can I accept less?”. Perfectionist thoughts can also be logged on a continuum. For example, If you didn’t reach a target, you can use terms such as ” I got 60% of what I aimed for”, much better than “I failed”.

Perfectionism is addressable by using and applying cognitive tools. Positive change can be had when thinking is changed and self worth is separated from the requirement to do things perfectly. If you constantly hear your inner critic berating you for not getting or doing that extra 20%, you have noticed your perfectionist beliefs. Discrediting and disputing these values and finding realistic evidence to prove them wrong is a key part of recovery. As humans, we are inherently imperfect. We have the ability to fail without ever being a failure. We sometimes just need to think it and believe it.

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