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How Your Anxiety Lies to You

Changing the distorted thoughts that perfectionists have.

Key points

  • Anxiety comes at a high cost, despite the adage: better to be safe than sorry.
  • Perfectionists catastrophize, personalize, disqualify their achievements, and have excessive standards.
  • Others often have very different views of perfectionists than they have of themselves.
  • Therapy is a painstaking process rather than a series of significant revelations.

I often ask my clients with obsessive tendencies: How often do you think your anxiety is useless? They may note that they can recall moments when their fears didn't come to pass and those when they did but weren't worth investing in. If they try to quantify it, they may say that their anxiety is useful only 10 percent of the time, if that. But, then they'll say: But what's the harm? Wouldn't you rather be safe than sorry? Unfortunately, anxiety is not a victimless crime.

Individuals who struggle with perfectionism often believe it's best to worry about the details of things because they have nothing to lose by doing so, or, at the very least, the losses are minimal. But, as they obsess and the world goes on around them, they fail to notice more significant problems that require attention, that can't be neglected for much longer. In a social setting, for example, as the perfectionist focuses on every syllable she mouths, she may fail to consider her interlocutor's sense of loneliness in their conversation, feeling that he's being talked at rather than spoken to. As the perfectionist hyper-focuses on a work project, he may fail to consider health concerns and need follow-up medical tests. Our anxiety frequently lies to us. It makes us believe that the thing we're worrying about is the most important thing in the world and that terrible things will happen if we cease worrying about it.

Perfectionists are racked with fear. Anyone who takes on that much responsibility usually is.

So, much of the work in treatment revolves around their cognitive distortions or thinking patterns that are seldom associated with actual events and cause unwanted and unhelpful feelings. Perfectionists tend to engage in catastrophic thinking, predicting the worst possible outcomes and believing they're likely, and personalizing, blaming themselves harshly for their mistakes. Additionally, they engage in "should thinking," which fails to account for legitimate excuses and consistently disqualifies their positive achievements. While this latter thinking style isn't directly related to their anxiety, their inability to rest on their laurels indirectly contributes to the feeling that they always have to be useful (and perfect), in part because the past doesn't ever seem to count. So, how should we address these patterns?

Catastrophic Thinking

What's the evidence for and against it? We can ask ourselves: What's the likelihood that this terrible thing, which doesn't happen often, will happen to me? Are there indicators, outside of my boss, for example, being disappointed about one of my mistakes, that I will be fired? Am I really going to be an unhired person if I somehow am? Is it possible that my anxiety is pushing me to improve my performance because I'm seeking certainty, which will convince me that I'm undeniable and, thus, can't be fired? Can anyone become that irreplaceable? Additionally, we may ask: What's the worst outcome that's likely? This means that the anxiety isn't completely wrong but not completely right, either. I may not be fired, but I may need to improve.

Disqualifying the Positive

We can ask ourselves: Is my inability to make the past count making it harder for me to soothe myself when I worry? Here, we can explore whether our bosses, partners, friends and whoever takes into account our positive contributions when making up their minds on whether we're worth "keeping around." But, if our contributions don't count, what are the standards we're comparing them to? Statistically speaking, in any environment we find ourselves in, each one of us will probably be an average performer. So, the likelihood that we're selected to contribute to a group and continuously perform extremely poorly is incredibly low. So, what have we done to keep our jobs or relationships?

The "Shoulds"

We could ask our bosses, partners, and friends how we can improve and what they appreciate about our roles in their lives or on their teams. Perfectionists often hold themselves to excessive standards because they believe others hold them to them as well. More often than not, they learn that others think highly of them and consider their lives enriched by them. When perfectionists blame themselves for not doing or being enough, the people in their lives tend to disagree with them. These conversations help shift our standards, at least mildly. You may still keep them, but hopefully, you can now accept that they're mostly your own, meaning punishment doesn't necessarily follow each minor mistake.


Are you taking too much responsibility for what you aren't able to achieve? This goes back, in part, to your standards. Is any external reason for failure an excuse? Because perfectionists are highly self-critical, again, they assume others are as well (sometimes, obviously, this is the case). So, we often ask them: Is this an excuse for you but a justifiable reason for someone else? Perfectionists, sometimes, don't hold others to their own high standards, so it's easy to explore why there are double standards at all. If the world is supposed to be fair, why isn't it to you? Are there any good reasons for you, and only you, to be the responsible one? What happens when life gets in the way, and you can't make something happen? Is "can't" acceptable in any fashion?

A patient of mine who struggles with perfectionism said to me: “There are no major revelations that just change your life. The 'aha moment' is more like you finally accept a truth that you’ve been resisting for years, when your defenses wear off, and denial is no longer sustainable.” This individual was implying that, after years of painstaking effort, it was difficult to maintain their expectations of themselves despite how scary it was to let them go. As they challenged their beliefs, experimented with tolerating the consequences of new ones, and slowly reframed them, they realized that they could tolerate the anxiety and uncertainty of being flawed, at least at times. To me, the main purpose of treatment for some individuals is to collaboratively instill in the patient the ability to take increasingly more personal and interpersonal risks. We start this process by exploring the ways in which they tend to think about themselves and their worlds; their beliefs and the ways they're sustained form the foundation of their daily lives.

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