Moving Beyond the Anxiety and Perfectionism Feedback Loop

Moving Beyond the Anxiety and Perfectionism Feedback Loop

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Forget everything you thought you knew about anxiety and perfectionism. Here’s an inside look at what actually works.

We all feel the need to be accepted, to fit in, feel loved, and that we matter to someone or something.

As someone who struggles with anxiety myself, I understand how hard it is to combat the anxiety feedback loop. As a psychologist who has worked with this material for nearly a decade, I supposedly know all the tricks in the book. I have a tool kit 10 pages deep ready to go whenever I experience a bout of anxiety. Even still, I struggle to practice what I preach.

Moving beyond this feedback loop induced by perfectionism, fueled by people pleasing tendencies, and manifested with anxiety is challenging. Over time, I eventually learned to manage this perfectionism induced anxiety by cognitively restricting my thoughts, practicing exposure therapy and learning how to recognize my panic triggers. It is somewhat counterintuitive, but I have found that rather than pushing away intrusive thoughts, our anxiety melts away when we hold space for these overwhelming thoughts. It is the ultimate paradox of anxiety, and the theory that is at the roots of exposure therapy (often used for social anxiety, phobias and PTSD).

In my practice, I hear clients doting on their status as a “perfectionist.” Pulling all-nighters as if it were a badge of honor. Settling for nothing less than outstanding. Entering into a competition solely to win. While on the outside, shooting for the stars may seem like a good idea. After all, we live in a meritocracy that values outputs overall. But there is a darker side to perfectionism that I would like to explore.

So, what is perfectionism and why is it dangerous?

Perfectionism is the act of aiming to achieve totally irrational standards; doing everything better than everyone else. A perfectionist is driven solely by the expectations of others and derives their entire self-worth from external standards. They have fallen prey to overly harsh self-criticism and struggle to free themselves from the people pleasing paradigm.

As a psychologist, coach and anxiety healer I work with young, brilliant, high-achieving women who nearly all describe themselves as “perfectionists.” They inevitably share one or some of the following personality traits:

  • All or nothing thinking. The perfectionist is the ultimate black or white thinker; a pattern that is very common in people with anxiety and depression. The all or nothing thinker will settle for nothing in-between and will often dwell on self-defeating thoughts. This is a dangerous cognitive distortion that puts the person into one of two camps: a success or a failure.
  • Fear of failure. Also called atychiphobia, there is complete paralysis experienced when we let fear stop us from moving forward. Oftentimes I see bright, capable young women shy away from attempting a task because it comes at the cost of “a chance of failure.” They can justify inaction, but not a failure. Fear of failure is deeply rooted in one’s sense of worth and can stem from having critical parents.
  • Behavior rigidity. This is defined as complete and utter inflexibility when it comes to food, choices, outcomes, school, career, and friendships. In a person with behavior rigidity, every relationship, every interaction, everything we eat propels us closer towards this ideal standard. Researchers have discovered one of the strongest predictors of developing an eating disorder is behavior rigidity (Arlt et. al., 2016). One reason for this is that disordered eating and perfectionism share some common features: fear of social evaluation and inability to adapt to new situations.
  • Inability to trust others to handle a task. No one can do it as well as the perfectionist. This is why we so often see the perfectionist agreeing to take on 100% of the project or rejecting inputs from others, even if it costs them their sanity. The fear of relinquishing even the slightest bit of control is too powerful, so the perfectionist pushes other attempts at help away.
  • Waiting until the last minute to get things done. Because, if you fail, there’s an easy excuse. “I did not get started until last night at mid-night, so I did not expect my work to be recognized.” Placing the blame on something outside (but ultimately within your wheelhouse of control) is the absolute perfectionist tendency. Failure can then be attributed to lack of effort rather than lack of skill.

It is no secret that increased levels of “perfectionism” lead to higher levels of depression, lower self- esteem, and disordered eating. Several studies have examined the relationship between perfectionism and anxiety (Alden, Ryder, & Mellings, 2002), revealing strong links between the two traits. So, is there hope? Are perfectionists doomed to repeat this cycle of anxiety, fueled by external validation and high levels of self-criticism? Not at all.

The good news is when we learn how to foster a sense of intrinsic motivation, we can shift our focus TOWARDS pleasing ourselves and AWAY from pleasing others. So, how do we develop intrinsic motivation? And why is it so challenging?

1. Spend some time alone.

Take a day, heck — maybe even a week, off from consuming any sort of media. When you experience a down moment, turn inward rather than outward. Sit with your thoughts. My guess is you have probably never done this. And if you have, these moments are few and far between.

The connection between what you desire and what the world desires from you will become illuminated when you take the time to quiet your mind. Listen to your thoughts. What comes up when you spend time alone? What do you like? What fills your soul? Let this energy seep in.

Spend a few hours each day reflecting on this newfound spark and let this energy fuel your identity and self-worth. You will be delighted to see how drowning out the external noise can do wonders for your ability to create your own light.

2. Recognize no one is watching.

No one is paying attention to the details of your life like you are. A harsh wake-up call, but incredibly liberating once you actually realize. I love it when my young clients actually embrace the profundity of this. Once you begin to recognize this truth you are liberated from the grip and expectations of others. Embracing this truth provides you with the space to dive into your talents, desires, and creativity — free from the expectations of others.

When I am working with women to overcome their anxiety, we focus on creating space between a thought and a reaction. (This is the premise of Cognitive Behavior Therapy (CBT)). Harnessing this truth that is hidden in plain sight is what gives so many of my clients the space to sit with discomfort and look inward rather than out.

3. Pay attention to others and actually listen.

Counter to what I just mentioned above, 99% of our time spent with others is consumed by conversations about ourselves or distracted by social media. When you are in the presence of another human ask questions, dive in deep, and don’t be afraid to show your vulnerability. You will be AMAZED at how opening up about your insecurities can actually alleviate the drive for perfectionism. As I mentioned above, this is the ultimate paradox of anxiety. When we give in to this feeling of fear, self-doubt, and self-consciousness by admitting its grip to ourselves and eventually to others a powerful flip is switched. If perfectionism needs to be recognized, loved, seen, and worthy — stop trying so hard to get there. Lean into vulnerability with others and you will be returned with recognition and worthiness.


Alden, L. E., Ryder, A. G., & Mellings, T. M. B. (2002). Perfectionism in the context of social fears: Toward a two-component model. In G. L. Flett & P. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (p. 373–391). American Psychological Association

Arlt, J., Yiu, A., Eneva, K., Drymam, M., Heimberg, R., & Chen, E. (2016). Contributions of cognitive inflexibility to eating disorder and social anxiety symptoms. Contributions of Cognitive Inflexibility to Eating Disorder and Social Anxiety Symptoms, 21, 30-32.

Music, Neurology, and Neuroscience: Evolution, the Musical Brain, Medical Conditions, and Therapies

1 Definition

Music performance anxiety (MPA) describes a particular state of arousal, which regularly occurs when musicians present themselves before an audience in performance situations. MPA is, thus, part of the exercise of music performance and of the career reality for professional musicians and as such an important topic in the field of Psychology and Psychosomatic Medicine in Performing Arts Medicine.

It is known from many biographies of musicians that MPA may occur with completely different characteristics ( Spahn, 2012 ). MPA extends along a continuum of varying severity, in which the performance may be better, worse, or even be impossible, and the person may suffer in various ways. If it is a strong, performance-impairing, afflicting form of MPA, then it is considered to be pathological and requiring therapy. When MPA is diagnosed, it is classified as belonging to the group of social phobias, according to the Diagnostic and Statistical Manual of Mental Disorders ( American Psychiatric Association, 2000 ).

Behavior change in 15-minute sessions?

Researchers are exploring promising new treatments to modify cognitive biases that underlie common mental health conditions.

November 2011, Vol 42, No. 10

Imagine a method to treat anxiety and other mental health disorders that was inexpensive, effective after a few short treatments, and didn't require drugs or trained mental health professionals. "It does sound like science fiction, doesn't it?" says Colin MacLeod, PhD, a psychologist at the University of Western Australia.

Yet that's the hope of experts studying cognitive bias modification (CBM), a new technique that aims to alter harmful thought patterns. The technique isn't ready for prime time yet. "This is quite a young field of science," says Emily Holmes, PhD, a clinical psychologist and cognitive neuroscientist at the University of Oxford. But she and others say the nascent field has great promise.

Holmes describes cognitive biases as "habits of thought." "Some people might have a habit of looking at a teacup and seeing it as half empty, and others see it as half full," she says. That example is what's known as an interpretation bias. The glass-half-full type has a positive interpretation bias, while the glass-half-empty type interprets the same information with a negative bias. People with anxiety are more likely to interpret ambiguous information in a negative way — ascribing disapproving or unfriendly intentions to neutral facial expressions, for instance.

Then there are attention biases — things you notice subconsciously and automatically in the world around you. One person coming into a colleague's office might immediately take in the images on a computer screen, Holmes says, while someone with a spider phobia would be instantly drawn to a web in the corner of the window. Similarly, a person with anxiety is more likely to be tuned in to any potential (or perceived) threats in his or her environment.

To date, most studies of cognitive bias have centered on attention biases in anxiety. Numerous studies have demonstrated a link between the two, MacLeod says. The classic method of ferreting out these biases is the use of computerized dot-probe tests. In these tests, probes such as slanting lines or patterns of dots are alternately flashed on the screen near to or far from emotional images (such as disgusted versus neutral faces) or words (with negative or neutral meanings). Subjects are asked to identify the probes as quickly as possible when they appear.

Individuals with anxiety are faster to spot probes that pop up in that region of the screen where negative words or images had just been, indicating that's where the subjects had focused their attention. In other words, anxious individuals are automatically drawn to negative information.

The discovery of these negative attention biases hatched a chicken-and-egg problem: Does anxiety cause a negative attention bias, or does the bias cause anxiety? "It's kind of like a feedback loop, where the fears feed into the cognitive biases and those cognitive biases may maintain or even exacerbate the fears over time," says Brad Schmidt, PhD, who directs the anxiety and behavioral health clinic at Florida State University.

Intriguingly, though, studies show that by altering the bias, one can dial emotional vulnerability up or down. Most of these studies simply use a modified version of the dot-probe test. In a 2002 study, for instance, MacLeod and colleagues used a dot-probe task to train students either to attend to or avoid negative words. Seeing the probes flash repeatedly in particular areas of the screen, the subjects learned where to focus their attention — either on or away from the negative stimuli. Later, subjects were given a stressful anagram task to complete. Immediately following the stress test, the students who were trained to focus on negative stimuli showed increased anxiety compared with the students trained to avoid them (Journal of Abnormal Psychology, Vol. 111, No. 1).

"That was the start of showing this could be useful," MacLeod says, not only as a treatment, but also as a tool to study the cognitive roots of anxiety and other mental health conditions. "We can modify one facet of attention or another specifically so we can see which have an emotional impact in the laboratory," he says.

Moving beyond anxiety

Of course, CBM also has considerable appeal as a potential therapy. Most studies so far have been small, but initial results are positive. In a 2009 study described in the Journal of Abnormal Psychology (Vol. 118, No. 1), Schmidt and colleagues tested attention bias in 36 people with social anxiety disorder. Half completed a repetitive dot-probe task designed to train attention away from images of disgusted faces. By repeatedly flashing probes in the locations where neutral faces had appeared, Schmidt reasoned, the subjects would learn to focus their attention away from the negative images. Meanwhile, participants in the control group were shown probes that replaced neutral and disgusted faces with equal frequency.

After just eight 15-minute sessions — a mere two hours of active treatment — 72 percent of patients in the treatment group no longer met diagnostic criteria for social anxiety disorder, compared with 11 percent of patients in the control group. Even more startling, the diagnostic differences were still evident at a follow-up exam four months later.

Other studies have also had positive results. A 2010 meta-analysis of 12 studies (Biological Psychiatry, Vol. 68, No. 11) concluded that attention-bias modification "shows promise" as a treatment for anxiety. "When we look at the studies collectively, we see that attentional bias modification really seems to work for anxiety disorders," says study co-author Yair Bar-Haim, PhD, a clinical psychologist and neuroscientist at Tel Aviv University.

As far as cognitive bias goes, anxiety has been studied much more thoroughly than any other condition, Bar-Haim says. Still, it's not the only condition in which such habits of thought are believed to play a role. He's currently exploring the connection between attention biases and post-traumatic stress disorder in soldiers. On the battlefield, being tuned in to threats is advantageous. "That's how you survive," he says. "But eventually, when you come back home, these biases are not adaptive." The research isn't published yet, but so far, he says, there appears to be a "rather clear link" between PTSD and negative attention bias.

Negative bias has also been implicated in depression, though the association isn't quite as clear as it is for anxiety. "It remains to be determined whether extended attentional bias training is beneficial in depression," MacLeod says. Interpretation bias (rather than attention bias) probably plays a stronger role in depression, he says. Indeed, depressed individuals are more likely to interpret ambiguous information in a negative way (Cognition and Emotion, Vol. 16, No. 3).

Compared with attention bias, interpretation bias has thus far received less research focus, he adds. Still, some early studies have indicated that depressed people may be good candidates for CBM. A small study by Holmes and her Oxford colleague Simon Blackwell, PsyD, found four of seven depressed volunteers had improvements in mood and/or mental health after one week of CBM training in their homes (Applied Cognitive Psychology, Vol. 24, No. 3).

Meanwhile, other investigators are beginning to apply CBM to problems such as addiction. Reinout Wiers, PhD, of the University of Amsterdam and colleagues developed a CBM technique that involves moving a joystick to zoom in or out to approach or avoid images on a screen. Initially he found that alcoholics zoomed toward images of alcoholic beverages faster than did people without that addiction. In four 15-minute sessions, Wiers and his team trained recovering alcoholics to "push away" the virtual images of alcohol. A year later, 46 percent of the CBM-trained group had relapsed, in contrast to 59 percent of the control subjects (Psychological Science, Vol. 22, No. 4).

No insight required

A picture is worth a thousand words, as the saying goes, and to Holmes it makes sense to tap into the visual system that humans rely on so heavily. "When we do therapy, people usually just focus on the words," she says. Yet our brains process words and images very differently. In a 2009 study, she found that healthy volunteers who created mental images of positive events felt better, while those who thought about the same events verbally actually felt worse (Journal of Abnormal Psychology, Vol. 118, No. 1). Images — such as those presented in CBM training — "can be very powerful," she says.

A definite buzz is emerging around CBM. Still, it's not yet known how CBM stacks up against current treatments or how best to deliver it as therapy. So far, most of the training programs are just modified versions of the dot-probe test — a format originally designed for assessment, not intervention. "It's almost certain that we're not training attention as effectively as we could do," MacLeod says. "A lot of the work will be refinements of the training methodology."

Another big unknown, MacLeod says, is how CBM should be integrated with existing treatments, such as cognitive-behavioral therapy (CBT), which has a wealth of data demonstrating its effectiveness. He suggests that the two approaches might be more beneficial together than either therapy is on its own. While CBT excels at teaching patients to deal with negative thoughts as they arise, CBM could target the basis of such negative thoughts earlier in the cognitive process, at a more subconscious level. "The delivery of the intervention requires nothing in the way of insight," he says.

In fact, adds Schmidt, CBM usually doesn't feel like therapy at all. In his studies of CBM, "almost no one who has been in active treatment thinks they've gotten active treatment," he says. "I don't think any patient enjoys doing cognitive behavioral therapy. They enjoy getting better but the treatment itself is hard." Targeting automatic biases instead may be a good option for patients who don't comply with CBT protocols.

CBM could also be useful for patients in underserved areas. Offering bias modification programs on the Web or even through smartphones could be inexpensive or even free, and could reach people in remote areas where mental health care is lacking, Schmidt says. Phil Enock, a doctoral candidate at Harvard University in the lab of psychologist Richard McNally, PhD, is studying attention bias modification to treat social anxiety and worry via the iPhone and Android phones.

Meanwhile, Bar-Haim is launching an international collaboration with researchers at the National Institute of Mental Health that will investigate CBM for anxiety disorders. The project will encompass randomized controlled studies at mental health treatment centers around the globe. "[CBM] sounds very promising, but we still have to do the work," he says.

No one expects CBM to replace existing treatments. But if the research pans out, mental health professionals will have good cause for celebration. As Bar-Haim says, "It's not often that a new therapy like this comes around."

#1: The three components of performance anxiety

You may recall from this article that performance anxiety (or stage fright) consists of not just one, but three elements.

While beta blockers effectively target the physical effects, the mental and emotional effects (such as focus and concentration issues, self-doubt, self-criticism, over-analysis, memory slips, and feelings of panic) are not directly addressed by the beta blockers. Though we tend to be preoccupied with the physical effects of anxiety, there are studies which suggest that the mental and emotional components of performance anxiety are more to blame for poor performances than the physical elements.

Stated another way, research suggests that one’s mental/emotional state ultimately has a bigger impact on performance quality than one’s physical state – yet beta blockers only target the physical aspects of anxiety — just 1/3rd of the equation.

Despite what you hear from people who swear by them, and even what you read in the popular press, the jury is still out on how much of an impact they have on meaningful aspects of performance. Most of the evidence supporting their use is anecdotal, as many of the controlled studies investigating beta-blockers and music performance quality fail to provide conclusive evidence supporting more widespread use.

The messy reality of perfectionism

Philip Gnilka, an associate professor of counseling and the coordinator of the counselor education doctoral program at Virginia Commonwealth University (VCU), has heard of severe cases of perfectionism at college counseling centers in which a student refuses to submit any work out of fear of being evaluated. As long as the student does not turn in work, his or her sense of self remains intact, he explains.

This raises a question: Is perfectionism a bad thing? Within the mental health professions, healthy debate is taking place on this very topic. Some therapists view all forms of perfectionism — whether self-oriented, others-oriented or socially prescribed — as negative, whereas others believe there is an adaptive component to perfectionism.

Gnilka, a licensed professional counselor (LPC) and the director of the Personality, Stress and Coping Lab at VCU, is in the latter camp. He notes that, historically, perfectionism has been considered a negative quality, so the goal was to reduce clients’ perfectionistic tendencies to make them “better.” However, he says, this black-and-white thinking — a quality of perfectionism itself — does not fully capture perfectionism.

Instead, Gnilka, a member of the American Counseling Association, argues that perfectionism is a multidimensional construct that consists of perfectionistic strivings (i.e., Do you hold high personal expectations for yourself and others?) and perfectionistic concerns, or one’s internal critic, (i.e., If you don’t meet these standards, how self-critical are you?). He says these two dimensions can help counselors determine who they are working with: an individual with adaptive, or healthy, perfectionism (someone with high standards but low self-criticism) or an individual with maladaptive, or unhealthy, perfectionism (someone with high standards and high self-criticism).

In his research, Gnilka has found that one’s perfectionistic concerns, not one’s strivings, are what correlate with negative mental health aspects. “What’s really correlating with depression, stress and negative life satisfaction is this self-critical perfectionism dimension. It’s not holding high standards itself per se,” he explains.

In fact, Gnilka argues that lowering clients’ perfectionist standards or instructing them to do things less perfectly is the wrong approach. Anecdotally, he’s found suggesting that clients lower their standards is a nonstarter and often doesn’t work. Instead, Gnilka advises counselors to focus their interventions on the self-critical voice. “Focusing on that internal critic … is where you’re going to get your most malleability because that’s the one [dimension] that’s connected with all the [negative aspects of mental health],” he says.

Beth Fier, the clinical director of SEED Services: Partners for Counseling and Wellness in New Jersey, finds perfectionism to be problematic. “It’s rigid and it’s interfering in some way, and it’s pretty unforgiving in terms of its high standards so that it actually is creating difficulty either for [people] and their experience of themselves or maybe in their relationship to others or how they’re interacting in the world.” However, she also acknowledges that many people want to be high achieving.

Because perfectionism can be limiting with its focus on being “perfect,” Fier, an LPC and an ACA member, likes the concept of excellentism. As an excellentist, people still want to do their best, but the term allows them to think more flexibly about how to do that, she explains. The focus is more on the process, which allows people to appreciate and enjoy the effort, the learning curve and their growth along the way. Perfectionism becomes problematic when people focus solely on the outcomes — on if they meet a certain goal, Fier adds.

Emily Kircher-Morris, the clinical director and counselor at Unlimited Potential Counseling and Education Center in Missouri, offers a similar perspective. Rather than using the term adaptive perfectionism, she prefers the phrase striving for excellence. Perfectionism, she explains, often implies there is no room for error, which becomes self-defeating. “All of these [perfectionistic] characteristics can be strengths,” she notes. “It’s when they go too far that they start causing disruptions to our lives.”

Despite their differences in terminology or mindset about perfectionism, Gnilka, Fier and Kircher-Morris all agree on the importance of healthy strivings and the need to intervene on the critical voice.

Kircher-Morris does this in part by having clients create realistic reframes, which is a way of changing a negative thought into something more optimistic. Counselors can draw thought bubbles and ask clients to fill in one of the bubbles with the negative thought and the other bubble with a realistic reframe. For example, the negative thought “I got an answer wrong when the teacher called on me. Now everyone thinks I’m dumb” could be rewritten as “I am allowed to make mistakes just like everyone else.” This exercise helps clients figure out a way forward without ignoring the uncomfortable emotions, Kircher-Morris adds.

However, too much reframing may cause clients to feel like counselors are imposing a “right” way to think about the situation, says Kircher-Morris, an LPC and a member of ACA. She finds that using dialectical thinking to look at and validate both sides is empowering for clients. For example, one technique she finds helpful is moving clients from either/or statements to both/and statements such as “I’m doing the best I can and I know I can also do better” and “This is going to be really hard and I know I can get through this situation.” By shifting their thinking, clients realize that two opposite statements can both be true they are not necessarily exclusive to each other, she explains.

Much of Fier’s work involves softening the critical voice. She often poses the following scenario to her clients to illustrate the potential danger of this voice: “Imagine you are put in charge of selecting a child’s kindergarten teacher. Would you want a teacher who is strict and will tell the children they are horrible as a means of motivating them to learn and grow? Would you want a teacher who lets children do whatever they want and not worry about the quality of their work? Or would you want a teacher who has high expectations but works with and supports children to help them figure out opportunities for growth and learning?”

Although the answer seems obvious in that context, it is often difficult for people to apply that same balance of high expectations and support to themselves, Fier says.

Valuing progress, not outcomes

It is common for people who possess perfectionistic tendencies to assume they can achieve something quickly and easily, Fier points out. That’s why breaking down activities into smaller step-by-step pieces that clients can build on is important, she says. This process provides opportunities for positive reinforcement allows clients flexibility in achieving their overarching aim and allows clients to focus on what they have accomplished rather than on the ultimate outcome, she explains.

Fier, the past president of the New Jersey Association for Multicultural Counseling, redirects clients from working toward goals to working toward values and aims, which allows them greater flexibility in how they address the situation. This includes asking clients the reasons they set a particular goal and why that goal matters. Shifting the focus to values and aims helps clients feel good about what they accomplish rather than beating themselves up for what they fall short of achieving, she adds.

Fier recently worked with a client who had a goal of balancing care for her mental and physical self. The client focused on outcome-based goals of diet, exercise and weight loss. By focusing on the outcome, she would berate herself whenever she didn’t make it to the gym. Fier helped the client broaden her perspective on how to achieve her aim or value of having a healthy lifestyle, which can include exercising, eating well, getting adequate sleep and pursuing good mental health.

“Some days that might be going to the gym. Some days that might be taking a quick walk outside because [she has] all of these other competing priorities,” Fier says. “It’s that intention and motivation that keeps [the client] focused on the care piece as opposed to the ‘I didn’t make it’ piece — ‘I screwed up and did it again.’”

Kircher-Morris also warns counselors to watch out for “goal vaulting.” This is when people set a goal and, as they close in on reaching that goal, they instead raise the bar. In the process, she explains, they forget about all the steps they completed to get to that point, which makes them feel like they aren’t making progress or haven’t accomplished anything.

One technique Kircher-Morris uses to address this counterproductive thinking is to have clients write down the steps they have accomplished to reach a certain goal on a graphic organizer, such as a visual symbol of stairsteps or a ladder reaching an end goal.

Kircher-Morris worked with a gymnast who was frustrated because she couldn’t seem to master a back handspring. Kircher-Morris helped the client break down all the skills she had accomplished in pursuit of that goal, such as learning how to do a cartwheel and roundoff. “You have to recognize those successes along the way because, otherwise, you’ll always feel like you’re falling short,” Kircher-Morris says. “A lot of times it’s easier to work backward — starting with the end goal but then thinking back to what were all of the things you had to do to get to that point. That, sometimes, is a little bit easier to conceptualize.”

Most people equate perfectionism with overstriving and overachieving. But this isn’t always the case. Perfectionism manifests in different ways, Kircher-Morris points out.

“When clients come in … I hear anxiety, I hear stress [and] I hear being overwhelmed,” she says. “When we get into what is causing that level of distress, I find that it’s often coming from a place of perfectionism, whether that’s manifesting as procrastination or risk avoidance or just really trying to control situations.”

Avoidance, Gnilka says, “seems to be a big coping difference between adaptive perfectionists and maladaptive perfectionists. They use the same amount of task-based coping and emotion-based coping, but the avoidance-based coping seems to be very, very high for maladaptive perfectionists compared to an adaptive one.” Thus, counselors might ask clients why they are avoiding certain things and what they are afraid of, he says.

Kircher-Morris agrees that counselors should help clients understand what they are avoiding. People often assume that avoidance is based on a fear of failure, but what they don’t realize is that avoidance can also result from a fear of success, she argues. For example, imagine a student who avoids going to medical school based on a fear of doing well at school only to discover that he or she hates being a doctor and is unhappy.

“They fear the success that then might lead to something negative in the future,” Kircher-Morris explains. “It’s not something you would typically think of when you’re thinking of perfectionism, but it can have a negative outcome in the future and lead to procrastination or avoidance of decision-making.”

The challenges children and parents face

Socially prescribed perfectionism extends beyond the microcosm of the nuclear family, Kircher-Morris says. Thanks in part to the influence of social media, children and parents alike often start to think that others have a “perfect” life and then feel the pressure to measure up to that impossible standard.

Kircher-Morris recalls a client who chose a college degree program based on the respect he thought it would garner from others rather than based on his own interests. The client had struggled in high school, so he wanted to prove to others that he was capable.

To offset these societal pressures, counselors can help clients become aware of their own personal goals and ways to measure success for themselves, Kircher-Morris suggests. This might include guiding clients to figure out what is at the root of their motivation to get into a particular school or to achieve a certain ACT score, she says.

Kircher-Morris has also noticed a connection between perfectionism and people who are gifted or of high ability. “Part of the reason why you see [perfectionism] so commonly with people who are gifted and … with talented athletes is because things come so naturally to them, so then they don’t know how to handle it when something is difficult,” she says. People who are gifted are often told that they are smart, so they internalize this quality as a part of their identity, she continues. Then, when they face something difficult or challenging, they don’t know how to handle it because it doesn’t fit with who they think they are.

Kircher-Morris builds on these clients’ strengths by using analogies about times in the past when they got through something difficult or handled a situation differently. Then she points out how they could apply those same skills to their current situation. Counselors might also encourage clients to find their own comparisons, which facilitates independence, she adds.

Many parents also feel the pressure to be perfect. Seeing other people’s children getting accepted to elite schools or competitive athletic teams (things that often get trumpeted on social media posts) can cause parents to worry about not being good enough, Kircher-Morris points out. “When they see their child fail, it feels like a reflection on them,” she says. Or there’s the “fear that if [they] don’t handle this correctly, it’s going to change the trajectory of [their] child’s life.”

Counselors can help parents reframe this negative line of thinking. One method is to have them consider how allowing children to make mistakes is actually a sign of good parenting because it helps children learn, grow and become independent, Kircher-Morris says. “You don’t have to be the parent who always has all of the answers and who always manages your emotions,” she reminds parents. “It’s OK to show that vulnerability and process through that.” In fact, she often advises parents to be vulnerable within the parent-child relationship. Rather than hide their vulnerability, parents can talk through their feelings and model how to handle the stress.

For example, if a parent is anxious about a phone call or a meeting, the parent can share that feeling with the child and show the child how he or she would handle the situation. “You’re teaching the kids that it’s OK not to be perfect,” Kircher-Morris says. “It’s OK to have worries and stresses, but also you can still work through them.”

Kircher-Morris also finds that parents sometimes unintentionally facilitate perfectionism in their children. For instance, when a child brings home a school assignment, parents might focus on the errors and have the child correct them. Parents might also offer praise whenever the child scores 100 percent but question the child otherwise (e.g., “What happened? Why wasn’t this a better grade?”).

Another common example is when a parent unloads the dishwasher after the child loads it because it was not done to the parent’s standards, Kircher-Morris says. This behavior undermines the child’s level of independence and feeling of self-efficacy, she explains. In constantly critiquing and correcting their children in such ways, parents are teaching them that there is no room for error and that they aren’t “good enough” unless perfection is attained, she says.

Instead, counselors can help parents learn to focus on the process, not the outcome, Kircher-Morris advises. For instance, rather than fixating on individual test grades, parents can ask, “What did you learn on this paper? What did you get out of the assignment? What was the area of struggle?”

In an episode last year on Kircher-Morris’ Mind Matters podcast (, Lisa Van Gemert, an expert on perfectionism and gifted individuals, discussed how teachers and schools also inadvertently engage in behaviors that increase perfectionism in students. She cited two examples of ways the educational system isn’t set up to recognize effort, persistence and diligence. First, teachers often give out stickers to reward “perfect” work. Second, having a perfect attendance award causes some children to come to school even when they are sick just to get the award. These types of rewards set up an unreasonable standard, Gemert said

“When we focus on the outcomes — the grades — then that’s going to lead to that perfectionism,” Kircher-Morris says. “When we focus on the process and the learning, then we’re going to move away from that and really focus on that striving for excellence.”

Imperfect experiments

To ease clients’ expectations of doing things perfectly, Fier often uses the word experiment: “We’re going to experiment this week with trying this [practice] and see how it goes. … This is simply a process that we’re going to test out and troubleshoot and come back to.”

The emphasis on experimenting is also a way of modeling flexibility, Fier stresses. “It doesn’t have to be all or nothing, I succeeded or I failed,” she says. “You’ve succeeded in the process of attempting.”

Rather than asking clients who expect to do mindfulness or meditation practices “perfectly” to engage in that practice every day, Fier may ask them to experiment with practicing their soothing rhythm breathing (slowing the exhale and inhale down to a rhythmical rate) twice during the week for 30 seconds. Then, the next week she may ask them to engage in this practice for five minutes every day or every other day. Again, counselors should emphasize that they are experimenting and exploring what works for the client, she says.

Kircher-Morris also finds it helpful to frame counseling activities as experiments. She often instructs her younger clients to be “scientists” with her. She tells them that together, they will come up with a hypothesis and test it out.

She has a middle school client who was deliberately not submitting work unless it was “perfect” (i.e., a completed assignment that lived up to her standards). In this situation, Kircher-Morris and the client crafted the following hypothesis: “If I turn in a math assignment and I have missed two problems, nothing will happen.” To test this hypothesis, the client intentionally missed two problems on an assignment that wasn’t worth a lot of points. In doing this, the client realized that the world didn’t fall apart when she got an 80 (instead of a 100) on this one assignment because it didn’t affect her overall A in the class. Kircher-Morris adds that this technique is similar to prescribing the symptom or systematic desensitization (a method that gradually exposes a person to an anxiety-producing stimulus and substitutes a relaxation response for the anxious one).

As scientists, clients also collect data. Kircher-Morris asks clients to document every time that they procrastinate on an assignment, think they are going to mess up or believe they have to do something perfectly. They can track these data with a phone app, in a notebook they carry with them or on an index card placed on the corner of their desk, she says.

Counselors should avoid framing this activity so that it unintentionally becomes a reward system for clients — an assignment they can “win” or “lose,” she warns. Instead, the point of the experiment is to have clients gain awareness, establish a baseline and test whether their beliefs associated with perfectionism are based on emotions or facts, she explains.

The shame of ‘falling short’

Fier doesn’t think she has ever worked with a client with perfectionistic tendencies who wasn’t also experiencing a sense of shame. She finds that perfectionism, depression and anxiety often cluster together, and the underlying thread is “this proneness toward self-conscious emotions, particularly shame, and that tendency to then get caught in a feedback loop in the brain that leads us down this road of self-criticism.”

Because clients who have perfectionistic tendencies often mask their struggles, building rapport and a trusting and open relationship with them as counselors is crucial, Kircher-Morris emphasizes. “They know that they’re in distress. They know that they’re struggling, but they don’t want it to be perceived that they can’t handle it on their own,” she says.

Perfectionism reinforces the idea that we are not enough to reach the standards we set for ourselves — the ones that are unrelenting and too high to be achieved, Fier says. “We start to have this sense of self that is based on this global sense of failure,” she explains. “It’s not that my behavior failed or that one part of me hasn’t been able to accomplish something. It’s that I’m the failure.”

In addition, shame makes people feel like they don’t belong, so they want to hide or disappear, Fier adds. In fact, some clients experience such a sense of unworthiness — to the point of self-loathing — that they often don’t feel they deserve compassion, she says. Thus, she finds compassion-focused therapy beneficial. Some compassion-focused techniques that help to regulate the body include soothing rhythm breathing, body posture changes (e.g., making the back and shoulders upright and solid and raising one’s chin to help the body feel confident) and soothing touch (e.g., placing hands on one’s heart).

Fier will also have clients imagine a compassionate image such as a color that has a quality of warmth and caring. She has clients explore their various emotional selves, such as their anxious self or their angry self, and think about how these emotions feel and sound when they speak to the client and to each other (e.g., “What does the angry self say to the anxious self?”).

Fier acknowledges that these practices and techniques do not get rid of the self-critical thoughts or difficult emotions entirely. However, over time, clients learn to pull up a compassionate self to sit alongside the difficulty, she says. “The compassionate self is the hub of the wheel that holds all these other parts of [the individual together],” she adds.

Kircher-Morris also identifies another point of emphasis. “One of the main components of perfectionism is a discomfort with vulnerability,” she says. “So, when [counselors] can facilitate that and give permission for that vulnerability, that’s where the change happens.” She recommends that counselors look for opportunities to use appropriate self-disclosures with these clients. She believes this gives clients permission to be vulnerable and reduces the power differential between client and counselor.

Being vulnerable and compassionate takes strength, Fier points out. She helps clients redefine strength — which in the United States is often viewed in terms of competition and domination — to realize that it is about being open to care and vulnerability.

Fier has also learned an important lesson: When working with clients, she doesn’t begin discussing compassion as something warm and caring. When counselors begin a session discussing compassion as a caring aspect, some clients think this emotion is too scary or difficult for them to relate to, she explains.

Instead, Fier begins by talking about accessing courage and eventually transitions into the courage it takes to be open, vulnerable and compassionate. She finds that some clients have experiences of feeling courageous or strong, but they have a difficult time connecting to experiences in which they have offered themselves any sort of care or comfort. “So, if [counselors] can start with where the client is and build up that courage, [they] can use that to help access the vulnerability and begin to redefine the strength aspects of being vulnerable,” she says.

Living with imperfection

For some counselors, perfectionism hits close to home. Counseling is a profession in which people often feel like they need to get it “perfect,” Fier says.

Kircher-Morris suggests that counselors follow the advice they often give to clients: Make the best decision based on the information you have at the time. “Our clients give us what they can, and it’s our job to connect with them and facilitate that and help them put those pieces together,” she says. “But we’re also working with what we have at the time, whether that’s our training and our professional development … [or the client] relationship and what we know about that particular client.”

Kircher-Morris says she often looks back at herself from five years ago and sees a counselor who thought she had everything figured out and knew what she was doing. Now, she says, she
realizes she was just doing what was best in the moment.

Counselors have to remember that they will not always get it “right,” and they have to learn to tolerate imperfection, Fier says. Every morning, Fier glances at the misaligned shower shelf in her bathroom, which serves as a gentle reminder that it’s OK to live with imperfection. Counselors can guide clients to find similar reminders to help them feel less threatened by imperfection, she suggests.

Perfectionism always goes back to one central issue — the self-critical voice, Gnilka asserts. “The idea that human beings are going to be able to walk around in life and not have any self-critical talk is just not possible. It’s not that healthy perfectionists are just walking around with no self-critical piece to them. It’s just that they’re walking around with no more, or maybe slightly less, than the average person of the population,” he says. “What [counselors] are trying to do is alleviate [the critical voice] so it’s not so critically depressing and keeping people from enjoying life.”

At the end of the podcast episode on perfectionism, Kircher-Morris acknowledges that if we don’t allow ourselves to admit we have flaws, then we are setting ourselves up for disappointment. “Perfectionism is the refusal to show any vulnerability,” she says. “It’s vulnerability that allows us to be authentic, who we really are, and establish those strong relationships with those around us. Giving ourselves permission to make mistakes allows us to be perfectly imperfect.”

Find a Therapist for Anxiety

When people are anxious about a decision, they often try desperately to escape that anxiety. They will fill their days to the brim with distractions—drinking, shopping, exercise, work, or household projects—to avoid it. While it’s natural to avoid discomfort, the elements of your anxiety may actually help you make a decision.

It can be useful to sit with your anxiety and let it talk to you. Feel the anxiety and allow the troubling thoughts and feelings to come to the surface. If you are an introvert and want to process this on your own, start writing. If you are more extroverted, talk it through with someone you trust. Either way, acknowledging what is underneath the anxiety is necessary.

Let’s unpack the potential concerns underlying the anxiety in scenario described above. There are many reasons that you might feel anxious about taking a promotion that involves relocation: fear of failing in the new position, worries about your family’s potential resentments as they adjust to the transition, concern over finding adequate schools, and trepidation regarding your own adjustment to the simultaneous change in job and community. These are all very natural fears and concerns. Acknowledging what lies beneath the anxiety, and further acknowledging that it is all quite normal, will likely bring some relief: taking the mystery out of anxiety is a big first step to controlling it.

With some of the anxiety alleviated, it is time to create a decision-making plan. First, you should set a deadline for when the decision must be made. Then go back to the fears and concerns you identified when exploring your anxiety and create a game plan for investigating each issue. Since this particular decision directly impacts the lives of all members of the family, engage them in this process. Ask them to investigate the schools, community resources, and activities available in the area where the new job would take you. If the children are teenagers, they can do this on their own if they are younger, they will need to be guided through the process. In addition to investigating the community with your partner and children, you should also learn more about the new job. Review the new and challenging aspects of the position and make sure they are aligned with your core competencies. If you identify some weak spots in your training or skills, work to identify resources—like classes, books, or coaches—that will help you get up to speed.

Finally, schedule a family meeting in advance of your decision deadline and have everyone present the information they have found. Segue into an open discussion about everyone’s thoughts and feelings around this potential change. Then, sit down with your partner and discuss the pros and cons of each side of the decision, based on all of the information you have collected, and work together to make the best decision for your family.

Whether you are part of a couple, part of a family, or single, life is full of decisions—some big and some small. For some, all decisions are fraught with anxiety, while others make decisions with remarkable ease. Most, however, fall somewhere in between and struggle most with major life decisions around career, family, relationships, and finances. Next time you find yourself struggling to make a decision, try following the steps described in this article—allow your anxiety to help you identify the fears and concerns around the decision, set a deadline, create a game plan for investigating those fears and concerns, and then make the best decision you can.

Associations Between Perfectionism and Generalized Anxiety: Examining Cognitive Schemas and Gender

In the current study, we extended previous research verifying significant associations between perfectionism dimensions and psychopathological outcomes. Specifically, we examined the links between perfectionism dimensions and generalized anxiety symptoms through both the context of threat and control schemas and gender. A sample of 262 university students (131 women and 131 men) completed a series of self-report questionnaires online. Univariate correlations indicated that socially prescribed perfectionism was the only dimension related to generalized anxiety symptoms. In addition, gender-specific findings emerged from the path analytic procedures implemented. Most notably, the stability in the direct effect between socially prescribed perfectionism and generalized anxiety symptoms varied by gender. For women, results revealed both significant direct and indirect effects with threat and control schemas partially mediating the socially prescribed perfectionism–anxiety symptoms link. Alternatively, the direct effect between socially prescribed perfectionism and generalized anxiety was not significant for men. These results support the position that perfectionism dimensions operate differently for women and men in the prediction of psychopathological outcomes. Gender-specific implications for mental health counselors are discussed.

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3. Take Opposite Action

Opposite action is a Dialectical Behavioral Therapy (DBT) technique that basically means making yourself do the opposite of what you feel like doing. The idea is if you do the opposite of how you feel, your emotions will shift towards the opposite. This is an action step. Don&apost over-think this one!

  • Go to the store. Suffering from agoraphobia? Make yourself drive to the store and spend 1 minute browsing the shelves as if you aren&apost anxious. Do it even if you&aposre completely terrified. Leave after 1 minute and go get your favorite snack as a reward for your courage.
  • Go for a walk. Depressed and anxious? Don&apost want to get off the couch, ever again? Go for a 20 minute walk, anywhere. I don&apost care if you live in the worst ghetto neighborhood. Go anyway and prepare to be amazed at how much better you feel 20 minutes later.
  • Stay on task𠅏or 15 minutes. I&aposm self-employed, so work paralysis is often a problem for me. If you feel stuck in anxiety, concentrate on any task𠅋ut only for 15 minutes! Even a short period of productivity makes you feel better about yourself because you got something done, or at least started it.

Genetic and environmental factors

Individual differences in sensitivity to threat or stress, and particular coping or affective styles appear to be critical predisposing factors for anxiety-related disorders. Genetic and environmental factors have been implicated, and how these factors interact during development is one of the major questions addressed by recent clinical and fundamental research.

Genetic determinants

A genetic basis for anxiety-related behaviors is now clearly established, notably through several family, twin, and adoption studies.

In mice, targeted gene mutations have shown that modifying the expression of particular genes can have a profound effect on anxiety-related behavioral phenotypes. 39,140 Some examples were mentioned in the preceding section.

Natural variations in trait anxiety, or emotionality, in inbred rat and mouse strains are being extensively studied. 27,39,141-146 Some of these strains show differences in sensitivity to anxiolytic agents such as diazepam. 147,148 Crossbreeding of inbred rodents strains has shown the quantitative nature of many anxiety-related traits. 149,150

The quantitative trait locus (QTL) method is based on a comparison between the allelic frequency of DNA markers and quantitative behavioral traits. 146,150 It has been used to assess gene effects on fear, emotionality, and anxiety-related behaviors in mice from various genetic backgrounds. 140,151 Loci on mouse chromosomes 1, 4, and 15 were found to operate in four tests of anxiety, whereas loci on chromosomes 7, 12, 14, 18, and X influenced only a subset of behavioral measures. 152 A QTL influencing anxiety has also been found recently on rat chromosome 5. 153

Selective breeding of mice and rats has also been used to create lines that show extreme behavioral characteristics within the range of the normal population. 140 Various selection criteria can be used, which may not be directly related to anxiety. Thus, rat lines initially selected for their good versus poor performance in two-way, active avoidance were subsequently shown to differ in trait anxiety, or emotionality. For instance, the Roman high- (RHA/Verh) and low- (RLA/Verh) avoidance rat lines display clear differences in emotionality and anxiety-related behaviors. 28,154 The more anxious (RLA/Verh) rats display increased neuroendocrine and autonomic reactivity to mild stressors. 28,155,156 Differences in vasopressin, oxytocin, and CRF action at the level of the amygdala, 156,157 dopaminergic and GABAergic neurotransmission, 158 basal vasopressin mRNA expression in the hypothalamic PVN, 159 and 5-HTT levels in the frontal cortex and hippocampus 160 have been reported. We have shown an increased capacity (enzymatic activities) for the production of progesterone-derived, anxiolytic neurosteroids in the frontal cortex and BNST of RHA/Verh rats, which may explain in part the differences in emotional reactivity of these two lines. 28 These two rat lines also differ in their respective coping styles and response to novelty, 154,155 and this model may therefore prove useful for studying the interaction between anxiety and defense mechanisms.

Recently, two Wistar rat lines have been selected and bred for high anxiety-related behavior (HAB) or low anxiety-related behavior (LAB) on the elevated plusmaze, a classical test for anxiety in rodents. 149 The neuroendocrine, physiological, and behavioral characteristics of these two lines are being extensively studied, and show some similarities, but also differences, as compared to the Roman rat lines. 161-167 Further comparison between lines such as the RHA/RLA and HAB/LAB rats, which have been selected on different behavioral criteria (avoidance versus anxiety in the elevated plus-maze test), but show a similar, anxiety-related behavioral phenotype, may be extremely fruitful to delineate brain mechanisms underlying specific aspects of anxiety disorders.

Environmental influences

The role of environmental influences in the etiology of anxiety is also well established. 15 Early adverse experience is a major developmental risk factor for psychopathology. 168-170

Prenatal stress in animal models has been shown to permanently alter brain morphology, anxiety-related behavior, coping, and regulation of the HPA axis in adulthood. 171 Naturally occurring variations in maternal care can also alter the regulation of genes controlling the behavioral and neuroendocrine responses to stress, as well as hippocampal synaptic development. These effects are responsible for stable, individual differences in stress reactivity, as well as the maternal behavior of female offspring. 172 They could constitute the basis of a nongenetic mechanism for the transmission of individual differences in stress reactivity and coping styles across generations. In 1958, Levine reported that rats handled for the first 21 days of life exhibit reduced fearfulness compared with nonhandled controls. Since then, several studies have shown the beneficial effects of neonatal handling and a progressive habituation to stress on adults' stress responses and anxiety-related behaviors. Neonatal handling can even reverse the behavioral abnormalities induced by prenatal stress. 173 These effects appear to be mediated essentially by the CRF/HPA axis system, 174,175 although the serotonergic and catecholaminergic systems could be also involved. 176,177 A study has shown that neonatal handling increases the expression of the peripheral benzodiazepine receptor (PBR), which has been implicated in the synthesis of endogenous, natural anxiolytic agents such as the neurosteroids, in rat adrenals, kidney, and gonads. 178 It is likely that increased adrenal production of naturally anxiolytic compounds such as allopregnanolone contributed to the decrease in anxiety reported in this study.

Sex differences in the effects of neonatal handling have been recently reported: neonatal handling may provide males with a greater capacity to actively face chronic stressors. 179 Recent data indicate that neonatal handling can also affect memory processes involved in contextual fear conditioning. 180

In the Roman rat lines, neonatal handling has been shown to alter the behavioral phenotype of the more anxious RLA/Verh rats so that, in adulthood, they behave in the same way as their nonhandled, hypoemotional RHA/Verh counterparts. Females were found to be more sensitive than males to the positive influences of early stimulation. 181 The effects of neonatal handling on RLA/Verh rats were not limited to behavioral stress responses and coping behaviors, but were accompanied by a concomitant decrease in stress-induced ACTH, corticosterone, and prolactin release, indicating that the neurochemical substrates underlying these responses were also permanently affected by early experience. 182,183

This and other examples indicate that the developmental processes that determine individual sensitivity to stressors, or emotionality, and coping behaviors involve complex interactions between genetic and environmental factors, and that anxiety-related phenotypes cannot be predicted on the sole basis of a genetic predisposition or early adverse experience.


The purpose of this article was to present three keys areas that would allow further understanding of irrational beliefs and REBT within sport with a particular focus on mental health. Due to REBT’s focus on mental health, this article examined the evidence linking irrational and rational beliefs with mental health outcomes. As part of this examination, athletic performance, emotional responding, and the development of irrational beliefs, were considered. REBT is proposed as an important framework for use with athletes. Through understanding the links between irrational and rational beliefs, and mental health, this article offered a number of research questions that should be addressed by researchers. In addition, the application of REBT should be promoted to neophyte practitioners, and the applied work of practitioners using REBT should be more frequently reported in primary research and case-study outlets, so that a shared understanding of how REBT can be applied in sport is garnered. Overall, it is hoped that this article fuels the interests of researchers, students, and practitioners, so that the value of REBT for the promotion of mental heath in sport is recognized and endorsed more widely.

Watch the video: ΜΕΓΑΛΗ ΒΕΛΟΝΕΣ ΠΛΕΚΤΙΚΗΣ ΑΝΟΙΚΤΗΣ ΕΡΓΑΣΙΑΣ. Ανεμιστήρας (July 2022).


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