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  • Writer's pictureAmy Smith

Perfectionist Anxiety: How can CBT Help?

Updated: Jun 15, 2023

What is Perfectionism and How Can it Lead to Anxiety?

Perfectionists are individuals who impose high standards on themselves across various aspects of their lives, often driven by a strong emphasis on achievement. They constantly push themselves to work tirelessly, leaving little room for relaxation, leading to mental and physical exhaustion. Even if they meet their high standards, any internal positive feedback they may experience is short-lived. They tend to downplay their achievements and quickly shift their focus to the next goal. Conversely, when they fall short of their high standards, they easily perceive it as a personal failure rather than considering that the standards themselves may be too demanding.

While the internal pressure experienced by perfectionists can serve as a motivational force, it can become overwhelming and prolonged, resulting in excessive stress and anxiety.

How Can CBT Help With Perfectionist Anxiety?

Cognitive Behavioural Therapy (CBT) is a widely used therapeutic approach known for its effectiveness in addressing various emotional challenges, including depression, anxiety, stress, and anger. For individuals who struggle with anxiety related to perfectionism, CBT can be a valuable treatment option. Here is an overview of what CBT for anxiety associated with perfectionism typically involves:


During the initial stages of CBT, you and your therapist will collaborate to create a formulation. This formulation serves as a visual representation, typically in the form of a diagram, illustrating the factors that contribute to the maintenance of anxiety related to perfectionism. Here is an illustrative example:


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.

The provided formulation serves as a representation of a common negative cycle experienced in the present moment. In therapy, you will also have the opportunity to explore with your therapist the earlier experiences that have contributed to the development of anxiety associated with perfectionism. These experiences may include factors such as critical parenting, receiving praise only when achieving exceptional results, and the pressure to excel academically or in one's career. Additionally, you will identify triggers that activate your anxiety, such as perceived criticism, making mistakes, or not receiving a promotion.

Collaborating with your therapist to complete the formulation can be empowering as it provides you with a deeper understanding of your anxiety and perfectionism. It allows you to be more compassionate towards yourself, recognising that facing these vicious cycles and struggling with high levels of stress and anxiety is challenging. Importantly, the formulation highlights areas where positive changes or adjustments can be made. By targeting and modifying thoughts, feelings, behaviors, and physical sensations within the cycle, you can disrupt its continuation, leading to improvements in your emotional and physical well-being.

Now, let's explore how CBT can facilitate these positive changes...

Tackling Thoughts

Thought Challenging

A significant aspect of CBT focuses on the exploration of an individual's cognitive patterns. Here are several typical cognitive patterns observed in individuals with perfectionistic tendencies:

· 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

Naturally, if these thoughts occur frequently, are consistently believed, and influence our actions, they can contribute to anxiety and stress. In CBT, you will receive assistance in recognising and addressing these thoughts. This may involve asking yourself the following questions as a means of challenging them:

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 this thoughts?

What is the evidence to contradict this thought?

Will this matter in 3 months’ time?

Responding to these questions can assist you in cultivating more balanced, accurate, and beneficial thoughts. As a result, this process can alleviate feelings of anxiety and stress.

Tackling Perfectionistic Behaviours

Reflect Upon Behavioural Patterns

The other significant aspect of CBT involves exploring behavioural patterns that may arise from perfectionistic thoughts. However, these behaviours can potentially worsen feelings of anxiety and stress. Here are a few examples:

· Working very hard and for long hours

· Not asking for help or delegating

· Avoid saying no

· Checking work several times

· Correcting work lots

· Procrastinate

· Prepare and plan lots

· Excessive reassurance seeking

In CBT, your therapist will assist you in recognising your behavioural tendencies and assessing their effectiveness, as well as any potential drawbacks. Together, you will evaluate whether it is beneficial to continue, modify, or completely eliminate these behaviours. If you decide to stop them entirely but find it challenging to do so immediately, you can work on gradually reducing them over time.

Behavioural Experiments

We discussed the process of challenging thoughts earlier. Another method to challenge thoughts is by conducting "behavioural experiments" or taking actions to test them out. Here are some ways in which we can test our thoughts through our behaviours:

Troublesome Thoughts and Behavioural Experiments to test them out

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

Ask for clarification in 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

Individuals who engage in this practice often find that their distressing thoughts prove to be untrue, which gradually weakens their power over time.

Extending Other Areas

Perfectionists often prioritise achievement at the expense of other aspects of their lives. This intense focus on attaining goals can result in significant time and energy being dedicated to hard work. However, this excessive pressure can be overwhelming, especially when faced with setbacks along the path to achievement.

If you find yourself in this situation, it can be beneficial to take a moment to identify other areas of your life that bring fulfillment or have the potential to do so. These may include relationships, hobbies, health, community involvement, and spirituality, among others. Reflect on the amount of time and energy you currently allocate to these areas. Consider whether it might be beneficial to reduce the time dedicated to striving for achievement and redirect some of it towards these other aspects of your life.

It is important to be cautious not to introduce the same achievement-oriented mindset into these areas. Instead, approach them with a focus on personal fulfillment and enjoyment, allowing them to flourish independently from the pressure of constant achievement.

If you would like support with tackling perfectionism and anxiety please contact me via email: or kindly complete the webform. I offer therapy in-person in St Albans/Hertfordshire and online.

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