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Welcome to part 2 of my series on cognitive therapy, the gold standard for dealing with depression and anxiety.
You probably remember Ted, our college student friend from part one. Ted took a test a few days ago, and the teacher just posted the class grades. He studied hard and was hoping for an A, but got a B instead.
No big deal, right? After all, a B is a decent grade.
But Ted doesn’t see it that way. Ted thinks to himself, “I can’t believe I got a stupid B on that test. I totally bombed it.”
Ted’s disappointment has been amplified by a distorted belief called,
This means that Ted thinks in extreme, “all-or-nothing” terms. Everything gets boiled down to one of only two categories: black or white, terrible or wonderful, down or up, completely wrong or completely right.
Maybe you or I can relate to this. There are some telltale signs that we use this distorted belief, too.
The first is using a lot of “all-or-nothing” words in our thinking or conversation, terms that put things into extremes, like:
- “I always mess things up” or “You never listen to me”
- “Everything is wrong” or “Nothing is right”
- “I have to do well” or “I can’t do well”
These terms can create a false “either-or” view of the world: “Either I am perfect, or I am an utter failure.”
Perfectionism is another sign of “all-or-nothing” thinking.
This is an inability to accept anything less than perfection, and keeping our expectations unrealistically high.
Psychologically speaking, perfectionism has 2 parts: work and worries.
Perfectionistic work involves setting high goals and working hard to meet them. This is what world-class athletes do to make them, well, world-class.
And there’s a definite up-side to perfectionistic work: higher achievement.
But there can be a downside as well: ongoing stress, not to mention disappointment.
Perfectionistic worries happen in the mind: harsh self-criticism, self-doubt, and constant concerns about one’s mistakes or what others may think of them.
Both can be stressful. But of the two, perfectionistic worries are the more dangerous and linked to higher risk of depression and anxiety. Both are linked to other problems, too, like:
- Eating disorders,
- Body Dysmorphic Disorder,
- Social anxiety, and
- Obsessive-Compulsive Disorder.
So, our goal is to help Ted get over his “all-or-nothing,” perfectionistic view of life. Because thinking in such black and white terms doesn’t allow us to see the many shades of gray in life.
Cognitive therapy can definitely help. In my last series, I categorized these techniques into four categories, which I called the “four roads out of anxiety and depression.”
They’re easy to remember, because they all start with “R”:
Now, let’s apply these principles to All-or-Nothing thinking.
Remember that those who have these distorted thoughts use a lot of “all-or-nothing” words.
Do Your RESEARCH.
Doing our research involves asking questions like, “Are we using words that just polarize our view of things?”
“Would most others agree with these words, or would they think they are too extreme?”
Be a REALIST.
Using optimistic realism would involve asking, “Would other, less extreme words describe the situation in a more realistic way?”
One exercise Ted can try is measuring his problems on a stress scale, with zero meaning no stress and ten being major stress, like surviving a natural disaster or having a heart attack.
He may not feel great getting a B on a test, but where would this realistically fall on this scale? Probably not a ten.
Unless there was a lot riding on this test, probably not even a five.
Maybe a one or two?
Using a stress scale can often provide perspective for those of us who struggle with perfectionism, or who catastrophize our problems.
Find the Right RATIO.
Finding the right cost-benefit ratio would involve asking, “What are the relative costs and benefits of our extreme terms or perfectionistic standards? Do they sometimes cost more than they’re worth?”
I’m not saying we shouldn’t have high goals.
Aiming high helps us achieve unprecedented success in sports, school, medicine, technology, and so on. These are wonderful benefits.
But the benefits of perfectionism can be short-lived.
Our happiness and satisfaction may not last because, behind every goal reached, another one immediately looms in the distance.
The cost of perfectionism (particularly perfectionistic “worries”) can be high in terms of low self-esteem, discouragement, depression, and anxiety.
Follow the Golden RULE.
We can all learn to take more pleasure in the journey of life.
Celebrating small successes along the way will help us stay motivated to reach our end goals.
Ted may feel more comfortable in his black and white world, but maybe he could learn to hang out in the gray a bit more.
Mistakes aren’t bad. They are opportunities for learning and personal growth.
When asked about his many failed attempts to invent the electric light bulb, Thomas Edison said, “I am not discouraged, because every wrong attempt discarded is another step forward.”
 Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta‐analysis. Journal of clinical psychology, 73(10), 1301-1326.
 Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical psychology review, 31(2), 203-212.
 Fang, A., & Wilhelm, S. (2015). Clinical features, cognitive biases, and treatment of body dysmorphic disorder. Annual Review of Clinical Psychology, 11, 187-212.
 Schmidt, R. E., Courvoisier, D. S., Cullati, S., Kraehenmann, R., & Van Der Linden, M. (2018). Too Imperfect to Fall Asleep: Perfectionism, Pre-Sleep Counterfactual Processing, and Insomnia. Frontiers in Psychology, 9, 1288.
 Newby, J., Pitura, V. A., Penney, A. M., Klein, R. G., Flett, G. L., & Hewitt, P. L. (2017). Neuroticism and perfectionism as predictors of social anxiety. Personality and Individual Differences, 106, 263-267.
 Frost, R. O., & Steketee, G. (1997). Perfectionism in obsessive-compulsive disorder patients. Behaviour Research and Therapy, 35(4), 291-296.
 Shaw, R. (2005). Great inventors and Inventions. Wizard ideas. 25.
Dr. Pamela Coburn-Litvak has published research articles on exercise and stress in Neuroscience and Neurobiology of Learning and Behavior. Her latest book, Leaving the Shadowland of Stress, Anxiety, and Depression, was published in 2020.
After receiving a Ph.D. in Neurobiology and Behavior from the State University of New York at Stony Brook, she served as both Assistant Professor of Physiology & Pharmacology and Special Assistant to the Vice President for Research Affairs at Loma Linda University in Loma Linda, California. She then joined the Biology department at Andrews University and developed courses in human physiology as well as the neurobiology of mental illness. She also founded Rock @ Science LLC, a company that specializes in health and science education and web development. She co-developed the brain and body physiology segment of the Stress: Beyond Coping seminar with its creator, Dr. William “Skip” MacCarty, DMin.
Dr. Coburn-Litvak currently lives in California with her husband. Their two daughters are mostly grown and attending school elsewhere.
When she’s not studying or teaching about stress, she enjoys stress-relieving activities like puttering around the garden, taking nature walks with her family, knitting, cooking, and reading.