A recent meta-analysis of over 40,000 college students from North America and the United Kingdom found that perfectionism, whether self/socially/or other prescribed is on the rise, especially among our younger generations (Curran & Hill, 2019). Societal pressures are further compounded by professions with idealized standards imbedded in their culture, setting an unsustainably high bar for its members.
Simply described, perfectionism is the dogged pursuit of absolute flawlessness (Frost et al., 1990) and the driving force behind co-worker hostility. Maladaptive perfectionism and particularly socially prescribed perfectionism can create toxically stressful environments for those who do not fit neatly into the status quo (Jahromi et al., 2012). Current healthcare culture often promotes tendencies toward perfectionism; as a result, high levels of anxiety and depression are commonplace (Jahromi et al., 2012).
Most of us will have experience with perfectionism, some may slip in and out of it in milder and more adaptive forms, while others will spend every waking hour driven by a compulsion to attain a standard that is unreasonably high. In the more adaptive form, striving for perfection can benefit us as it motivates us to complete work and produce the best product (Harari, Swider, Steed, & Breidenthal, 2018). When in its more adaptive form, we keep our high standards to ourselves as opposed to socially prescribing our ideals onto others. We are more likely to be self-motivated, goal oriented, more willing to adapt to obstacles that may delay achievements, and to find satisfaction from our accomplishments (Ellis, 2002). The downside of perfectionism, evident in its maladaptive forms, is the natural inclination to hold others to the same idealistic standards, which can cause unreasonably high expectations (Melrose, 2011). If we cannot meet these idealistic standards, detrimental mental health effects often result (Melrose, 2011). These health effects often correlate with fears of criticism and failure and when left unaddressed can lead to moral injury, emotional exhaustion, and eventual burnout (Chang, 2012; Gould, Udry, Tuffey, & Loehr, 1996; Sevlever & Rice, 2010).
Two perfect doors. There are two dimensions of perfectionism, ‘excellence-seeking,’ whereby we are driven to achieve high standards and ‘failure-avoiding,’ where we are driven to avoid shortcomings. Both versions are ultimately driven by the same core factors such as black and white thinking, a compulsive need to attain lofty standards, and self-worth evaluations contingent on one’s achievement of their idealized standard (Harari, Swider, Steed, & Breidenthal, 2018; Hewitt & Flett, 1993).
Perfectionism spilling into the workplace. When mired in perfectionism, we are likely to dissociate from emotions, often ignoring and internalizing fears of worthlessness, shame, and failure (Petersson, Perseius, & Johnsson, 2014; Shafran, Cooper, & Fairburn, 2002). Over time, this habitually defensive way of being will cause an overall lower tolerance for exposure to stress (Ellis, 2002; Petersson et al., 2014). These maladaptive forms of perfectionism lead to self-destructive behaviours, which extend into prescribing the same unrealistic expectations onto others (a phenomenon called socially prescribed perfectionism). Socially prescribed perfectionism uses shaming tactics to pressure others to live up to unrealistically high standards and when culturally reinforced, it has toxic effects on workplace morale, resulting in a chronic workplace stressor.
Perfectionism and sense of coherence (SOC) inversely link (Rennemark & Hagberg, 1997); those who have a low sense of coherence score have higher perfectionism scores; therefore, improving sense of coherence buffers us from extreme forms of perfectionism (Rennemark & Hagberg, 1997).
When we fall into states of fight-flight or freeze, we cannot objectively work through difficult thoughts and resulting emotions, often leaving them unresolved, fuelling the same old cyclical event-response behaviour. However, the theory behind exposure therapy is that by re-imagining the event at another time, when we feel safe and supported in our environment, we get another chance to work through and update the old (and often no longer true) thoughts. To feel and then release the associated emotions.
Several therapies that have shown promise in the research as tools that help us go back to the stressful event so we can re-experience from a more confident and empowered orientation (with a higher sense of coherence). As a result, we can feel the emotions that need to be felt and with practice, upgrade old belief systems that fuelled the stressor in the first place. Doing this re-exposure work after the stress response passes, is a great way to prevent future or reduce the intensity of future triggers. Others will want a more formal therapeutic environment to facilitate the feelings of safety necessary to stay present and connected (avoiding triggers that promote dissociation).
Two popular therapeutic tools that support re-exposure are EMDR and CBT.
EMDR involves eye movement desensitization and reprocessing, which as the title suggests can involve a variety of techniques to direct the eyes back and forth while re-imagining a triggering event. Cognitive Behaviour Therapy (CBT) brings awareness to the relationship between thoughts (conscious, automatic, core beliefs beneath) and behaviours. This technique works toward behaviour change through self-monitoring, scheduling, and exposure-response prevention.
In an extensive meta-analysis of studies over the past decade, researchers (Khan et al., 2018), found EMDR and CBT to be equally effective at reducing depression but EMDR was superior in its ability to reduce anxiety and PTSD symptoms.
Ultimately, re-exposure practices, whether or not part of formal therapy, are an excellent tool to work with past traumas projecting into the present day, reducing their intensity until they are no longer a perceived threat. We can practice with this tool on our own or with another, reducing our future risk of falling into fight-flight-freeze when a similar situation arises.
Kristin Neff, a seminal researcher on Self-Compassion, developed a short and affirming exercise called the self-compassion break (2019) and it is a favourite of mine. For this adapted exercise, you begin by closing your eyes and recalling a person or event that is triggering a stress response. Focus on the situation, engaging your heart and mind so that you experience the stress of that moment. From this space, you will talk to yourself just like you would talk to a dear friend. You will begin by mindfully reminding yourself that:
1. “This right now is a moment of stress” (or hurt, pain, suffering, whatever sounds most natural for you).
2. “You aren’t alone, these feelings (pain, suffering) is a normal (natural) part of life.” “Other’s struggle in this way too.”
3. Think of a phrase that you most need to hear right now, something that expresses empathy and kindness. For this, you can speak in the I, or continue to speak to yourself as you would a dear friend, whichever enables you to receive it best. For example, you might say:
“you deserve compassion in this moment”
“I fully love and accept you as you are right now”
“May you forgive yourself for not knowing then what you know now. Making mistakes and learning and growing as we go is part of life.”
“May you have the courage to be imperfect.”
“Even though I feel…. I deeply and completely love and accept myself.”
This self-compassionate exercise reminds us that difficult emotions are a part of life, that we are not alone, and that we are deserving of unconditonally positive regard.
Neff, K. (2019). The Self-Compassion Break. Retrieved from https://self-compassion.org/category/exercises/
… like a diamond, pressed down time and time again, until all that is left is a powerful gem, shining for all the world to see. May you take this journey, fully and deeply realizing that the path that led you to today, the suffering you continue to feel, is no longer a threat to you my friend, it is a vehicle to awaken to a new, more authentic, and more empowered way.
May this journey help you cultivate a community of individuals that will remind you of who you are when you forget, that provide you with a mirror that fills you up with a felt sense of unconditional positive regard, so that you can freely express your magnificent self.
May you cultivate a love so deep inside you so you can find rest in an inner home, that safe place where you are so filled with unconditional positive regard from others and for yourself that it spills into the world around you. This is the journey through suffering, awakening to a new way…
Between unresolved trauma and biological imbalances, dropping into the inner space to self-soothe can be too painful, making it difficult, and for some even impossible, without an intervention. We all have unique needs. Some people may resolve much of their anxiety and depression by removing the the emotional charge of past trauma, using cortisol lowering tools, and engaging in mindfulness, while others will need something more to drop in, to self-sooth. There is no shame in reaching out for external support to work with our biology, promoting greater contentment, optimism, and objectivity (all components of sense of coherence). In fact, many will find that when they find an intervention such as a particular therapy, a supplement or medication that works for them, they wonder how they have survived so long without it. Canadian data is limited but according to the National Health and Nutrition Examination Survey (Pratt, Brody, & Gu, 2017), 17% of Americans between the ages of 40-59 years and 19% of people over 60 use anti-depressants to treat symptoms stemming from anxiety and depression. Females are more likely to take antidepressants than males. To be clear, medications, including herbs and the supplements that provide the building blocks that enable us to produce important chemicals such as dopamine and serotonin, are not the focus of this curriculum, but they are additional and often necessary tools to manage biology and emotions, enabling a greater ability to self-soothe. For these reasons, medications and external therapies are worth mentioning.
Besides traditional pharmaceuticals and therapies, plant-based remedies are emerging in the research, many of which are showing promising results. For instance, we can support our brains ability to make serotonin (associated with happiness and contentment) and dopamine (associated with a sense of reward/pleasure) by focussing on specific foods and supplements that bolster the key amino acids necessary to support their production. We also now have access to a host of botanicals, adrenergics, and nootropics, which can reduce the production and management of stress hormones.
Though not yet mainstream (or approved by Health Canada), an emerging example of how people are using natural remedies is the use of Cannabidiol (CBD), a non-psychoactive component of hemp and marijuana, working for many to reduce the symptoms associated with anxiety and depression (Corroon, James, Mischley, & Sexton, 2017; Soares & Campos, 2017; Zuardi, Rodrigues, Silva, Bernardo, Jaime, Hallak, Guimarães, & José, 2017). An example of a supplement that can work with our biology to bolster serotonin is 5-HTP (Kious, Sabic, Sung, Kondo, & Renshaw, 2017). Among those that can bolster Dopamine are L-Dopa and Tyrosine (Lampariello, Cortelazzo, Guerranti, Sticozzi, & Valacchi, 2012).
Ultimately, if we are committed to thriving, we must be open to our unique needs, removing barriers in whatever way we can; doing so, is another way to practice self-compassion.