A CBT Protocol for Treating Perfectionism

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This section describes an example of how CBT might be used to treat perfectionism. Although CBT has not been evaluated specifically for that purpose, these strategies are used extensively in empirically based psychological treatments for psychological disorders that are associated with perfectionism, including depression and various anxiety disorders.

Typically, the initial treatment session would begin with presenting the rationale for the therapy. This would include some discussion of the nature of perfectionism, including consideration of strategies for discriminating between high standards that are appropriate and healthy versus standards that are excessive and impairing. To facilitate this process, clients are encouraged to ask questions such as:

• 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)?

• What would be the costs and benefits of relaxing a particular standard or ignoring one of my rules?

In addition, clients are encouraged to discuss the features of their perfectionism, including the triggers, content areas, underlying beliefs, and associated behavioral responses. Goals and priorities for treatment are set, and an overview of cognitive and behavioral strategies for dealing with perfectionism is provided. Finally, potential obstacles to treatment are identified and discussed. These may include such things as poor insight by the client into the excessive-ness of his or her perfectionistic standards, extreme life stress, negative expectations regarding the effectiveness of treatment, and significant comorbidity.

In subsequent sessions, a variety of standard cognitive and behavioral methods are used. As with CBT for other problems, homework is an important component of treatment, and it may be important to include significant others or family members in homework practices. For example, family members may be encouraged to fold the laundry "incorrectly" as part of an exposure practice for a client who is excessively concerned about domestic chores being completed "just right."

Cognitive Strategies. Cognitive strategies for changing perfectionistic patterns of thinking are similar to those used for related problems such as anxiety disorders, depression, anger, and body image issues. Clients are initially taught to identify specific beliefs and predictions that are associated with their perfectionism and to examine the evidence regarding these beliefs. They are encouraged to use strategies such as perspective taking (e.g., asking "how might someone else think about this situation?"), and to look at the "big picture" instead of getting caught up in minor details.

They are also taught to tolerate uncertainty and ambiguity more easily, a strategy that has been used with some success in the treatment of generalized anxiety and chronic worry. Patterns of social comparison (e.g., the types of people to which clients choose to compare themselves) may also be explored and changed if necessary. Finally, behavioral experiments (i.e., hypothesis testing) are used to assess the validity of particular beliefs. For example, if a client is convinced that it would be a disaster to be even five minutes late for a movie, he or she might be encouraged to arrive a few minutes late to see what happens.

Behavioral Strategies. Strategies are selected to target specific behavioral excesses and deficits that are associated with perfectionism. Clients are encouraged to use exposure-based strategies to reduce anxiety and avoidance associated with concerns about not meeting particular standards. For example, they may be taught to purposely make mistakes (e.g., wash the dishes incorrectly; pronounce a word incorrectly; "forget" their wallet when standing in line to buy an item; show up for an appointment on the wrong day) or to confront situations that were previously avoided due to a fear of not being perfect (e.g., social situations). In addition, clients are encouraged to discontinue any unreasonable or excessive behaviors that are designed to prevent them from making mistakes (e.g., excessive checking for mistakes; extensive research before buying a product; repeated reassurance seeking; excessive correcting of others). Communication training may also be included in the treatment if the individual's perfectionism leads to problems in his or her relationships, and the problems appear to be associated with poor communication skills (e.g., a tendency to use aggressive language instead of being appropriately assertive). Finally, if putting off important tasks for fear of not doing them correctly is a problem, the client may be taught strategies for overcoming procrastination, including breaking down large projects into smaller, more manageable tasks.

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Responses

  • Rebekah
    Is there a cbt protocol for perfectionsism?
    2 years ago
  • amaranth
    How to treat shame in perfectionism CBT?
    1 year ago

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