Archive for Perfectionism

Mar
18

Impostor Syndrome: Are You Discounting Yourself and Your Successes?

by Laura Johnson

In the Boston Globe, I read that four smart and talented students at MIT committed suicide within the past year. Among its efforts to help students cope with stress, MIT is encouraging students to talk about the psychological phenomenon called “impostor syndrome,” the feeling of being a failure despite a record of accomplishment.

What is Impostor Syndrome?

Impostor syndrome is common among high achievers, many of whom discount their successes. As a result, they do not feel confident or deserving inside of themselves even though they are objectively successful and perceived as such by other people. Psychological research done in the early 1980s estimated that two out of five successful people consider themselves impostors and other studies have found that 70 percent of all people feel like impostors at one time or another.

The impostor’s thoughts and feelings can be divided into several categories:

1. Feeling like a fake: You may believe that you do not deserve your success, academic standing or professional position. This is accompanied by a fear of being “found out”, “discovered” or “unmasked.” If you feel this way, you might identify with statements such as: “I have tricked other people into thinking that I am more competent than I really am” or “I am often afraid that others will discover I don’t really know what I am doing.”

2. Attributing success to luck: Another aspect of the impostor syndrome is the tendency to attribute success to luck or to other external reasons and not to your own internal abilities. You may refer to an achievement by saying, “I just got lucky this time” or “it was a fluke” and worry you will not be able to succeed next time. You may think you are just lucky, in the right place at the right time, and that’s why you were chosen for a particular job or role.

3. Discounting Success: The third aspect is a tendency to downplay success and discount it. You may discount an achievement by saying “it is not a big deal” or “it was not important.” For example, a student attending a prestigious university may discount the fact that they were accepted or feel like it was a mistake that they were accepted and that they don’t belong or they aren’t as smart as the other students. Or you may say “I did well because it is an easy class” or “I was promoted because my manager left” instead of attributing it to hard work or intelligence. You may also discount your accomplishments and have a hard time accepting compliments.

4. Dwelling on the Negative: You may notice every time where you think you should have done better or where you made a mistake. On the other hand, you overemphasize minor flaws in your performance. You fail to notice, or fail to put enough importance, on what you did well.

5. Unfair Comparisons: You compare yourself unfavorably to others. Frequently you pick out the most outstanding people in your school, company or field and judge your own performance as inadequate and inferior.

Women and Impostor Syndrome

Imposter Syndrome MaskThe term “impostor syndrome” first appeared in an article written by Pauline R. Clance and Suzanne A. Imes in the 1970s. They observed that many high-achieving women tended to believe they were not intelligent, and that they neither internalized nor accepted their own accomplishments. These individuals attributed their successes to luck rather than skill or talent, and were afraid others would realize they’d been deceived by a fraud.

While both men and women experience impostor syndrome, studies show that women are more often affected. According to Valerie Young, author of The Secret Thoughts of Successful Women, boys are raised to bluff and exaggerate. Girls, on the other hand, learn early to distrust their opinions and stifle their voices. Young women learn that they tend to be judged by the highest physical, behavioral and intellectual standards. Perfection becomes the goal, and every flaw, mistake or criticism is internalized—slowly reducing self-confidence.

“A real bias against female competence persists,” says Young. “Being female means you and your work automatically stand a greater chance of being ignored, discounted, trivialized, devalued or otherwise taken less seriously than a man’s.”

Sheryl Sandberg, COO of Facebook, spoke of her own feelings of insecurity in her best-selling book, Lean In: Women, Work, and the Will to Lead. When Sandberg attended her Phi Beta Kappa induction at Harvard, a woman gave a speech called “Feeling Like a Fraud.” During the talk, Sandberg looked around the room and saw people nodding. “I thought it was the best speech I’d ever heard,” she recalls. “I felt like that (an impostor) my whole life.” At school, Sandberg thought, “I really fooled them.”

Sandberg says, “Many people, but especially women, feel fraudulent when they are praised for their accomplishments. Instead of feeling worthy of recognition, they feel undeserving and guilty, as if a mistake has been made. Despite being high achievers, even experts in their fields, women can’t seem to shake the sense that it is only a matter of time until they are found out for who they really are – impostors with limited skills or abilities.”

Originally thought to be more common among women, men, too, can be victims of the imposter style of thinking. Even Albert Einstein suffered from impostor syndrome near the end of his life. A month before his death, he reportedly confided in a friend: “the exaggerated esteem in which my lifework is held makes me very ill at ease. I feel compelled to think of myself as an involuntary swindler.”

Do I have Impostor Syndrome?

Imposter Syndrome DogDr. Valerie Young developed the Impostor Syndrome Quiz (reprinted below). If you answer yes to many of these questions, you may have impostor syndrome:

  • Do you secretly worry that others will find out that you’re not as bright and capable as they think you are?
  • Do you sometimes shy away from challenges because of nagging self-doubt?
  • Do you tend to chalk your accomplishments up to being a “fluke,” “no big deal” or the fact that people just “like” you?
  • Do you hate making a mistake, being less than fully prepared or not doing things perfectly?
  • Do you tend to feel crushed by even constructive criticism, seeing it as evidence of your “ineptness?”
  • When you do succeed, do you think, “Phew, I fooled ‘em this time but I may not be so lucky next time.”
  • Do you believe that other people (students, colleagues, competitors) are smarter and more capable than you are?
  • Do you live in fear of being found out, discovered, unmasked?

Strategies for Overcoming Impostor Syndrome

1) Become aware of your thoughts. Automatic thoughts can be defined as underlying, unquestioned thoughts, which affect how you perceive an event or situation. Realize them for what they are: negative self-talk that has become a habit. Be aware when you engage in thoughts and feelings of an impostor. Awareness is the first step to change and many times we are not aware of our automatic thoughts.

2) Do a reality check. Question your automatic “impostor” thoughts and feelings and try to come up with more balanced thoughts. Understand the difference between your negative thoughts and reality. Identify the critical voice that is doubting your authenticity. It’s not You. Separate yourself from the critical and self-limiting “impostor” voice.

3) Understand the difference between feelings and reality. Some people believe that if they feel something strongly it must be right. “If I feel so stupid, it must mean that I really am stupid.” When you catch yourself thinking in this way, change it to a coping statement of “the fact that I feel stupid does not mean that I really am. It’s a feeling and not reality.”

4) Write down the steps you took to earn the success you achieved. In one column, make a list of what you accomplished on a particular task or project, and in a second column, write the names of people who helped contribute to the success. Come up with realistic responses that give you credit, but also share praise with others who contributed. For example, you could say to yourself, “I’m proud of what I did on that job, and I had the help of a great team.”

4) Replace your negative “impostor” thinking habit by practicing more realistic and helpful self-talk. Remind yourself of how you contributed to your success with thoughts like “I have proven I am capable by…” or “I prepared for this by…” Give yourself credit throughout the day for both major and minor successes. Notice and reframe “yes, but” statement such as “I brought in accounts but she brought in more” to “Even though she brought in more accounts, I brought in many myself.” Focus on your strengths. When you finish a task, you can ask yourself, “What positive qualities do I have that allowed me to do accomplish this?”

5) Be on the lookout for unhelpful coping strategies you engage in to prevent others from evaluating you negatively. For example, if you tend to hold back from sharing your opinions in meetings, take a risk and speak up in a calm and confident way.

6) Celebrate! Give yourself permission to be proud. Let your friends and family praise you. Take some of it in. Let it touch your heart. Being proud of an accomplishment is not the same as being self-centered. After you celebrate, you will probably remember that no matter what you achieved, chances are there is more to do. This can be humbling and healthy, and important to distinguish from the unhealthy internal put-downs.

7) Give yourself a little time to grow into your success, especially if success seemed to come rather easily or quickly. Sometimes you just need time for a new promotion or status to settle in so you can feel like you deserved it and earned it. However, if you think impostor syndrome is keeping you from getting the most out of your life, then you might want to find a therapist to help you work through your thoughts and feelings.

How To Get Help for Impostor Syndrome

The Cognitive Behavior Therapy Center of Silicon Valley offers counseling and therapy for women and men suffering from Impostor Syndrome. We are located in Saratoga on the border of San Jose and Saratoga just 1/2 mile from Highway 85. With our convenient location near highway 85, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Cupertino and Campbell, CA. Contact us at (408) 384-8404 for more information on how we can help you savor your accomplishments and reduce your feelings of being an impostor at school or work.

0 Categories : Anxiety, Depression, Giftedness, Perfectionism, Performance Anxiety, Social Anxiety, Uncategorized
Feb
21

Radically-Open Dialectical Behavior Therapy (RO-DBT)

by Laura Johnson

RO-DBT: Your Path to a More Flexible Life and Joyful Experiences

Laura Johnson, LMFT, LPCC, Center Director, attended a two-day workshop on Radically-Open Dialectical Behavior Therapy (RO-DBT) led by its founder, Thomas Lynch, PhD, Professor of Clinical Psychology at the University of Southampton, UK. RO-DBT is an evidence-based approach to help individuals become more flexible in their thinking and responding, more open to life experiences that create joy and happiness, and build intimacy and social connections. RO-DBT can be particularly helpful for individuals with inflexible, rigid personality styles who are susceptible to certain types of anxiety disorders, depression, OCD, perfectionism, anorexia and autism. RO-DBT includes many of the skills taught in traditional DBT but also teaches an entirely new set of skills to increase flexibility and reduce rigidity.

RO-DBT Theory

The theory behind RO-DBT is that children with an “over controlled” temperament are more likely to develop internalizing disorders such as anxiety and depression and become socially isolated as adults. “Overcontrol” is defined as an emotionally constricted, shy and risk averse temperament. In appropriate amounts, overcontrol is a positive trait. You may desire to exceed expectations and perform well, value rules and fairness, delay gratification to achieve goals, and have a high sense of duty, obligation and self-sacrifice.

On the other hand, individuals who develop a excessively overcontrolled style may have a need to appear perfect (planning ahead, being right, stressing orderliness and structure), follow rules (always doing the right thing, being prepared, smiling even when unhappy) and have high pain tolerance (able to work really hard and delay or minimize joy and fun).

Goals of RO-DBT

The goal in RO-DBT is to help individuals develop optimal control that is neither over- or under-controlled.

RO-DBT starts with defining what’s healthy and what’s not. Its interventions strive to build these positive traits including:

  • Receptivity and Openness to new experiences (as opposed to high risk aversion, hypervigilance for threat, avoidance of novelty and discounting of constructive feedback)
  • Flexible Responding to adapt to changes in the environment (instead of compulsive needs for structure and order, hyper-perfectionism, compulsive planning/rehearsal, and rigid rule-governed behavior)
  • Emotional Expression and Awareness to have genuine emotional experiences (as opposed to inhibited expressions or fake expressions and low self-awareness or minimizing of feelings)
  • Intimacy and Connection to form long-lasting bonds (instead of aloof/distant relationships, excessive social comparison, envy and bitterness, and low empathy and validation skills)

Ways to Build Flexibility, Openness and Social Connection

In addition to most of the traditional DBT skills, RO-DBT also teaches additional new skills  to build the qualities of flexibility, openness and social connection including:

Radical Oppenness Skills LegosRadical Openness Skills Module is a completely new skills module where you will learn to change your physiology, engage in new behaviors, learn from constructive feedback, validation skills, build compassion and forgiveness, stimulate positive emotions toward yourself and social connectedness with others through loving kindness meditation,verbal and non-verbal skills to signal openness and friendliness, and communication of emotions to increase social connection and reduce social isolation and loneliness.

Mindfulness Skills to recognize when you are in fixed mind vs. fatalistic mind and how to get to flexible mind and to teach self inquiry.

Emotion Regulation Skills to reduce envy, bitterness, resentment and revenge.

Some Examples of RO-DBT Skills

There are three steps involved in building the skill of Radical Openness:

  1. Acknowledge the presence of unwanted or uncomfortable feelings such as irritation, tension in the body, negative emotions or feelings of uncertainty
  2. Turn toward the discomfort and use Self-Inquiry to ask yourself, “What do I need to learn from this?” instead of automatically distracting or accepting
  3. Flexibly Respond by doing what’s needed in the moment

Practicing being open to feedback from others includes the following steps:

  1. Acknowledge the feedback
  2. Describe your emotions, sensations, thoughts and images
  3. Be Open to new information by cheerleading yourself, adopting an open body stance, and fully listening to the feedback
  4. Pinpoint what the new behavior is and confirm
  5. Try out the new behavior
  6. Self-soothe and reward yourself
How To Get Help in Building Flexibility and Other Positive Traits

The Cognitive Behavior Therapy Center of Silicon Valley specializes in helping individuals change unhelpful thinking and coping styles and build flexibility, openness and social connection. With our convenient location just a half mile from Highway 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Cupertino and Campbell, CA. We also have a CBT Online Video Therapy Program for clients in California who live to far away to drive for our specialized therapy in person. Contact us at (408) 384-8404 for more information on how we can help you manage you become more flexible, open and joyful.

0 Categories : Anxiety, Cognitive Behavior Therapy, Depression, Mindfulness, OCD, Perfectionism, Personality, Social Anxiety, Uncategorized
Oct
30

Schema Therapy: Basics and Beyond

by Laura Johnson

I just returned from a two-day Schema Therapy Workshop at the New Jersey Institute for Schema Therapy. The training was led by Wendy Behary, the Founder and Director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy and President of the International Society of Schema Therapy. While I have been using Schema Therapy concepts with some clients already, I gained a new appreciation for the complexity, depth and effectiveness of this approach. Starting in March 2015, I am participating in the Advanced Intensive Schema Therapy Training Program. In this article, I will explain some of the basics of schema therapy. Stay tuned for a lot more to come as I work through the intensive training program and get certified!

What is Schema Therapy?

Schema Therapy is an evidence-based approach for long lasting change in the personality dynamics that impact chronic emotional and relationship problems. Schema Therapy was developed by Jeffrey Young while he was at the Beck Institute for Cognitive Behavior Therapy and he eventually branched out on his own. Schema Therapy is considered an integrative model because it draws on cognitive therapy, behaviorism, attachment theory, emotion-focused and relationship-based therapies and other schools of thought. Due to its strong roots in cognitive behavior therapy, I believe it is a natural extension to CBT for helping people who want or need a more depth-oriented approach.

Schema Therapy places emphasis on:

  • Identifying and resolving self-defeating life patterns and deeply rooted emotional themes,
  • Building resiliency and productive responses to life challenges,
  • Drawing out and enabling the strong part of your personality,
  • Employing a variety of cognitive, behavioral and emotional change techniques, and
  • Using the therapeutic relationship as a vehicle for change

What Is the Theory Behind Schema Therapy?

Schema ModelIn Schema Therapy, you will learn which of your schemas are triggered when you notice a strong reaction in yourself. The schema model has identified 18 schemas, typically developed when core emotional needs are not meet in childhood. Some common schemas include abandonment, defectiveness/shame, unrelenting standards, and vulnerability to harm/illness.

In order to cope with the pain when our schemas are triggered, we may develop certain coping styles including:

  • Surrender: giving in to our schemas and repeating them over and over,
  • Avoidance: finding ways to escape or block out our schemas, and/or
  • Overcompensation: doing the opposite of what our schemas make us feel.

When triggered, we may have a strong emotional reaction or mood shift, and we then enter a coping state called a “mode.” There are four categories of schema modes: the innate Child modes (vulnerability, anger, undisciplined/impulsive, contented), the Maladaptive Coping modes (detachment, compliance, overcompensating), the Maladaptive Parent modes (punitive, demanding/critical), and the Healthy Adult mode. The goal of schema therapy is to help you get your core needs met in an adaptive manner by enhancing the Healthy Adult coping mode so your schemas are triggered less frequently and intensely and you can recover more quickly.

Is Schema Therapy Evidence-Based?

I was impressed and pleasantly surprised by the large and growing research base, primarily led by therapists in Europe, where there is support and government funding for longer-term therapies that have been proven effective for deeper and longer-lasting change. In the U.S., most research grants and insurance funding are targeted toward shorter-term therapy approaches for symptom reduction. As a result, schema therapy is not well-known in the U.S. As of this writing, there are no Certified Schema Therapists in California. I hope to change this.

Who Does Schema Therapy Help?

PersonalitySchema Therapy is particularly well suited for adults who:

  • Have recurring depression, anxiety and relationship problems and don’t understand why they stay stuck in the same patterns year after year,
  • Want deeper, more long lasting personality change and relapse prevention after their anxiety, depression and other immediate crises have been resolved,
  • Have chronic anxiety, OCD and depression that does not respond fully to standard CBT, DBT and exposure therapy protocols, or
  • Have successfully completed evidence-based treatment for anxiety, depression, OCD and other problems and want to continue to work on underlying issues in order to improve the quality of their lives and relationships.

Schema Therapy is beginning to be tailored for many populations including children, teens and families. This is an exciting development in Schema Therapy because it will help children and teens develop into healthy adults and prevent them from having chronic anxiety, depression and other problems in adulthood.

What Does Schema Therapy Entail?

Phase 1: Assessment and Education

The assessment phase generally lasts for five to seven sessions and focuses on:

  • Education about the Schema Therapy model.
  • Assessing schemas and coping styles through interviews, inventories and emotional techniques.
  • Scoring and interpreting the results of various schema inventories.
  • Activating schemas using emotional techniques such as imagery.
  • Noticing how schemas show up in the therapy relationship.

Phase 2: Schema Therapy Treatment

As a longer-term, depth-oriented treatment approach for chronic emotional and relationship problems as well as personality change, you can expect the active treatment phase to be about one to two years of weekly therapy. As mentioned earlier, Schema Therapy uses a variety of strategies to contribute to change.

  • Cognitive Techniques: schema diaries, pros and cons of schemas and coping styles, schema dialogues and flashcards.
  • Emotion-Focused Techniques: emotional change through imagery, role plays and two-chair work.
  • Therapy Relationship: empathic confrontation and analyzing schemas when triggered in sessions.
  • Behavioral Techniques: behavioral assignments, skills training and exposure tasks to overcome avoidance of trigger situations.
How to Get Started with Schema Therapy

I hope this article has wet your appetite to learn more about Schema Therapy and perhaps even partake in Schema Therapy yourself. To learn more about Schema Therapy in a self-help format, you can read Reinventing Your Life. If you are interested in starting Schema Therapy, contact the Cognitive Behavior Therapy Center of Silicon Valley at (408) 384-8404 or the Cognitive Behavior Therapy Center of Sacramento Valley at (916) 778-0771 or send us an email.

0 Categories : Cognitive Behavior Therapy, Perfectionism, Personality, Schema Therapy, Uncategorized
May
20

OCPD vs. OCD: What’s the Difference?

by Laura Johnson

What is Obsessive Compulsive Personality Disorder (OCPD)?

OCPDObsessive Compulsive Personality Disorder (OCPD) is a type of “personality disorder” with these characteristics:

  • Rigid adherence to rules and regulations
  • An overwhelming need for order
  • Unwillingness to yield or give responsibilities to others
  • A sense of righteousness about the way things “should be done”

What are the symptoms of Obsessive Compulsive Personality Disorder (OCPD)?

  • Excessive devotion to work that impairs social and family activities
  • Excessive fixation with lists, rules and minor details
  • Perfectionism that interferes with finishing tasks
  • Rigid following of moral and ethical codes
  • Unwillingness to assign tasks unless others perform exactly as asked
  • Lack of generosity; extreme frugality without reason
  • Hoarding behaviors

What is the difference between Obsessive Compulsive Personality Disorder (OCPD) and Obsessive Compulsive Disorder (OCD)

  • People with OCD have insight, meaning they are aware that their unwanted thoughts are unreasonable. People with OCPD think their way is the “right and best way” and usually feel comfortable with such self-imposed systems of rules.
  • The thoughts, behaviors and feared consequences common to OCD are typically not relevant to real-life concerns; people with OCPD are fixated with following procedures to manage daily tasks.
  • Often OCD interferes in several areas in the person’s life including work, social and/or family life. OCPD usually interferes with interpersonal relationships, but makes work functioning more efficient. It is not the job itself that is hurt by OCPD traits, but the relationships with co-workers, or even employers can be strained.
  • Typically, people with OCPD don’t believe they require treatment. They believe that if everyone else conformed to their strict rules, things would be fine. The threat of losing a job or a relationship due to interpersonal conflict may be the motivator for therapy. This is in contrast to people with OCD who feel tortured by their unwanted thoughts and rituals, and are more aware of the unreasonable demands that the symptoms place on others, often feeling guilty because of this.
  • Family members of people with OCPD often feel extremely criticized and controlled by people with OCPD. Similar to living with someone with OCD, being ruled under OCPD demands can be very frustrating and upsetting, often leading to conflict.

What causes Obsessive Compulsive Personality Disorder (OCPD)?

There is no single, specific “cause” identified. Several theories suggest that people with OCPD may have been raised by parents who were unavailable and either overly controlling or overly protective. Also, as children they may have been harshly punished. The OCPD traits may have developed as a sort of coping mechanism to avoid punishment, in an effort to be “perfect” and obedient.

Therapy for Obsessive Compulsive Personality Disorder (OCPD)

The goal of therapy is to lessen rigid expectations and learn how to value close relationships, recreation, and fun with less emphasis on work and productivity. Therapy can lead to greater insight into how someone’s OCPD symptoms affect others. It often takes the threat of the loss of a relationship or job to motivate people with OCPD seek treatment because they typically don’t think there is anything “wrong” with the way they are. If motivated to change, cognitive behavior therapy, particularly schema therapy, holds much promise.

Getting Help for Obsessive Compulsive Personality Disorder (OCPD)

The Cognitive Behavior Therapy Center of Silicon Valley specializes in long term personality change using CBT and schema therapy. With our convenient location just a 1/2 mile from highways 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Palo Alto, Cupertino and Campbell, CA. Contact us at (408) 384-8404 for more information on how we can help you overcome the rigid patterns related to an obsessive compulsive personality.

0 Categories : OCD, Perfectionism, Personality, Schema Therapy, Uncategorized
May
1

Be A More “Perfect” Perfectionist: Coping with Failure

by Laura Johnson

Perfectionism and Coping with FailureIf you are a hard core perfectionist, you’ve probably been criticized at some point for it and your perfectionism might have even annoyed or been intimidating to others. There are lots of advantages to being a perfectionist like striving to do your best, producing great work, being successful, paying attention to details, making fewer errors and being someone people can count on. Some disadvantages of perfectionism include overworking, beating yourself up for making mistakes, never feeling like you are good enough, comparing yourself to others and judging yourself on your performance and other externals. On the other hand, some perfectionists procrastinate because the thought of all the hard work required to do a “perfect” job feels exhausting or they don’t take risks because of fear of failure. When perfectionism gets out of control, it can lead to anxiety and depression.

Can You Be a More “Perfect” Perfectionist?

You can learn to be an “perfect” perfectionist by keeping the advantages of perfectionism and minimizing the disadvantages. Some strategies like positive reframing, acceptance and humor are the most effective coping skills for dealing with setbacks and helping people feel satisfied at the end of the day. In contrast, some of the least effective coping skills were venting, denial, behavioral disengagement and self-blame. Perfectionists felt worse after using these strategies.

What is Positive Reframing?

Positive reframing involves trying to see things in a more positive light and looking for something good in what happened. Positive reframing, as you’ll see below, is not about turning a negative into a positive but, rather, being able to see reality in a more helpful light. For example, the reframing skill can help you view a setback as a challenge to be overcome or see failure as a learning experience. Reframing is a way of changing the way you look at something and, thus, changing your experience of it. This can relieve stress and help you create a more positive life before you actually start making any changes in your circumstances.

Steps for Reframing a “Failure”

Positive reframing involves four steps:

  • Learn about your thinking patterns. Do you tend to fall into the same thinking traps over and over again?
  • Notice your thoughts. Catch yourself when you are slipping into overly negative or rigid thinking patterns.
  • Examine the truth and accuracy of your negative thoughts. Be a scientist. Ask yourself: What is the evidence for and against this thought? What would I tell a friend? How helpful is it to think this way?
  • Develop realistic responses to your negative thoughts about failure and setbacks. If you can’t think of a more positive response, then be more compassionate with yourself, accept the failure and put it into perspective.

If you want to be feel good about yourself and live a more satisfying life, the best way to deal with failure and setbacks may be to accept it, reframe it realistically and compassionately, and then have a good laugh about it.

0 Categories : Anxiety, Cognitive Behavior Therapy, Perfectionism