How to Overcome Perfectionism Anxiety with CBT

How to Overcome Perfectionism Anxiety with CBT

If You are a perfectionist, you’re likely to spend a significant amount of time in bed thinking about your to-do lists and hardly managing to get some sleep. Perhaps it’s hard for you to take criticisms from friends and family, and it can be even more complicated when it has to do with your work or school performance. Simultaneously, you may find it challenging to give yourself praises, accept compliments from others about your work, and find hardly a minute to celebrate your victories! If this is what happens to you, you are likely experiencing perfectionism anxiety. You are not alone! 

Whether perfectionism is new to you or you can’t remember it ever being different, this type of anxiety and how you react to it can take a significant toll on your quality of life, impacting not only work but also your relationships and free time. The good news is that there are proven ways to deal with perfectionism anxiety. CBT (Cognitive-Behaviour Therapy) is the elective type of therapy for this type of anxiety. CBT helps people understand and challenge their unhelpful thinking styles while generating long-lasting change in responding to situations triggering their anxiety in everyday life. Read more to find out how to overcome perfectionism anxiety with CBT!

How are Perfectionism and Anxiety Connected?

If you are a perfectionist, you are likely to experience lots of internal pressure driven by the high standards you place upon yourself in various areas of your life. Often a significant emphasis is placed upon achievement. Consequently, perfectionists push themselves to work very hard, often giving themselves little time to relax, which can be mentally and physically tiring. As a perfectionist, If you meet the high standard, any inner positive praise (if there is any) is short-lived, the achievement may be downplayed, and the efforts are focused on the next goal to reach. When the high standard is not reached, this can be highly disappointing for someone with perfectionism. It can easily be attributed to having ‘failed’ instead of the bar being too high or simply accepting that not achieving a goal is a normal part of life. 

The internal pressure that perfectionists experience can be helpful to an extent as it can drive them to work hard and perform well. However, sometimes the pressure is too high and prolonged, leaving people feeling overly stressed and anxious. 

How does CBT Help With Perfectionism Anxiety?

Cognitive Behavioural Therapy (CBT) is a common therapy approach that has shown to be effective for various emotional difficulties such as depression, anxiety, stress and anger. Therefore, it can be a useful therapeutic approach for those who experience anxiety associated with their perfectionism. Here is what CBT for anxiety associated with perfectionism often looks like.

Understanding what Keeps Perfectionism Going: CBT Formulation

At the beginning of CBT, you will work with your therapist to develop a formulation, a diagram demonstrating how the anxiety associated with perfectionism is being maintained. There are many benefits of drawing a formulation collaboratively with your therapist. They help understand how perfectionism works and, crucially, why it persists over time. Here’s an example:

Perfectionism Anxiety - Vicious Cycle

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Not Getting a Promotion at Work

I should have worked harder. I’m a failure. I’m not good enough. I’m a fraud.


Stress. Anxiety.


Body tension. Headaches. Upset stomach. Palpitations


Work long hours, give myself few breaks. Prepare lots before meetings/presentations. Check over my work several times. Procrastinate.

A formulation diagram like this one also shows a typical vicious cycle that is experienced in the present moment, showing how it is often the type of responses we adopt to deal with our difficult emotions and thoughts that lead to maintaining perfectionism. 

What Triggers Perfectionism?

A crucial aspect of drawing a formulation is to understand what your triggers are. These are event and interactions which kick-start your vicious cycle. Learning about your specific triggers with a therapist can make you feel more in control of your perfectionism. This can happen already from the initial stages of therapy. You can start to predict instances where it might manifest and begin to prevent it from taking over. Triggers are very subjective, and they will change from person to person. However, some common triggers we found with clients are as follows:

  • perceived criticism
  • failing an exam
  • making a mistake
  • not getting a promotion at work
  • not getting the job you wanted

What Causes Perfectionism?

After understanding how your perfectionism works in the present, it can be very helpful in therapy to uncover what earlier experiences have led to the development of your anxiety associated with your perfectionism. Some common factors linked with developing perfectionism we often see in therapy are: 

  • Having critical parents 
  • Growing up with parents with perfectionism
  • Only receiving praises when you did very well 
  • High pressure placed upon academics 
  • High pressure placed on getting a good job

Perfectionism Anxiety Infographic

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How Will You Benefit from a CBT Formulation for Perfectionism Anxiety?

Completing your formulation with your therapist can help you gain a more in-depth understanding of your anxiety and perfectionism, which can be empowering in and of itself. In addition, becoming more aware of how it may have developed and is persisting in the present can lead to people being more compassionate and gentle towards themselves because they face such vicious cycles and struggle with high stress and anxiety levels. 

Very importantly, the formulation reveals where it is good to make positive changes or adjustments. For example, suppose you can make good changes to one or more of the cycle areas (i.e. thoughts, feelings, behaviours and physical sensations). In that case, this can break down the cycle, leading to improvements to your emotional and physical well-being and gradually letting go of your perfectionism.

Let’s now look at ways that CBT can help to make some of these sound changes. 

What CBT Techniques Can Help with Perfectionism Anxiety?

CBT has multiple techniques in its arsenal which help deal with anxiety, including when it ties in with perfectionism. Once a formulation has been drawn collaboratively with your therapist, CBT will help via a mix of cognitive and behavioural techniques. These will target the thoughts and actions that keep you stuck in a cycle of perfectionism anxiety. For example, one of the most common techniques, known as ‘thought challenging’, aims to rebalance unhelpful thinking styles.

Thought Challenging to Help with Perfectionism Anxious Thoughts

A significant component of CBT involves examining an individual’s thinking patterns. Here are some common thinking patterns in those who are perfectionistic:

  • I should be doing better
  • I’m not good enough
  • I’m a failure
  • I should only relax after I have completed XYZ
  • I shouldn’t be struggling with this
  • If I don’t get the promotion, then it means I’m unworthy

Of course, if these thoughts are frequent, always believed, and we allow them to dictate what we do, this can lead to anxiety and stress. A crucial technique In CBT helps you catch and challenge these kinds of thoughts with the help of a therapist. One way we do this in therapy is by helping you answer questions such as: 

  • Am I being kind to myself or overly self-critical?
  • Am I placing too much pressure on myself?
  • How helpful is it to think this way?
  • What is the evidence to support these thoughts?
  • What is the evidence to contradict this thought?
  • Will this matter in 3 months’ time?

Answering such questions can help you develop more balanced, accurate and helpful thoughts. In turn, your anxiety and stress will decrease. 

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The other major component of CBT is to examine behavioural tendencies resulting from perfectionistic thoughts. Although these behaviours might be an understandable response to difficult thoughts and emotions, they can make anxiety and stress worse and ultimately keep perfectionism going. Here are some examples of unhelpful behaviours:

  • Working very hard and for long hours
  • Not asking for help or delegating
  • Avoid saying no
  • Checking work several times (reading and re-reading an email/report many times)
  • Constantly correcting work
  • Procrastinating
  • Excessive Planning and Preparation
  • Excessive reassurance seeking

In CBT, your therapist will help you identify your behavioural tendencies and analyse the extent to which they are helping and whether they have any downsides. Then, overall, you will be able to determine whether it is good to keep up those behaviours, amend them, or completely stop them. If you choose to stop them altogether, your therapist will work to help you gradually reduce them if this is difficult to do straight away.

Testing New Responses with Behavioural Experiments

We have looked at thought challenging earlier. Another way to challenge thoughts is to test them out through ‘behavioural experiments’ or our actions. Here are some ways in which we can test our thoughts through our behaviours:

Troublesome Thoughts

Behavioural Experiments

I will look stupid if I ask for clarification in a meeting

Ask for clarification in the meeting

I must check my work several times before I submit it

Try to check work two times at the maximum before submitting it

I have to put my everything into this task; otherwise, I will fail

Still, work hard but don’t put my everything into it, allow myself some breaks

It will be disastrous if there is a mistake in my work and it is not perfect

Submit work and purposefully put a spelling error in it

People who try this often discover that their troublesome thoughts turn out not to be true, and as a result, they lose strength over time.

Addressing the Challenges of Being an Over-Achiever

Perfectionists can tend to place a lot of emphasis on achievement at the detriment of other areas. When you do this, you put excessive time and energy into working hard to achieve things. However, this will add extra pressure on you. It can be particularly crushing if you face setbacks while you attempt to achieve something. 

If you recognise yourself in this, it can be helpful to list other areas in your life that give you fulfilment, for example, friends, family, hobbies, health, community, and spirituality. Then consider how much time and energy you are committing to these other areas. 

Ask yourself, could it be helpful to spend a little less time trying to achieve and, instead, spend more time and energy on these other areas of your life? If you decided to invest more in these different areas of your life, be careful not to bring the achievement element into them too much! 

Dealing with Perfectionism Anxiety with CBT in London & Online

Are you tired of spending sleepless nights thinking about work and your to-do list? Do you struggle to take in criticism even if it is constructive? Do you find it difficult to believe others when they congratulate you on your work? Do you notice not being able to celebrate your achievement and immediately start thinking about what to work on next? Are you tired of engaging in negative self-talk?

If you’re experiencing some of these issues, you may be struggling with perfectionism anxiety. Whether you’ve only recently started feeling this type of anxiety, or you feel like you’ve lived with it for your entire life, at Therapy Central, we have therapists who specialised in using CBT to treat perfectionism anxiety. We can provide you with the guidance and support you might need to take this definite change in your life, where you will be able to achieve and succeed without compromising your health, relationships, and general well-being. Contact us for a free 15 min consultation today to get started with CBT therapy.

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