Program: Outwardly impressive, losing it on the inside? The cognitive distortions of a high achiever

Dr Mary Anderson: You are self-critical, often thinking about what you should have done or should do in the future. You worry about your performance and others' perceptions of your performance. You like to feel special instead of like most people.

Sana Qadar: Does any of this feel like it's describing you?

Dr Mary Anderson: You feel massive pressure to keep achieving big and impressive goals.

Sana Qadar: These kind of sound like affirmations, but warped ones, ones that have been run through a funhouse mirror. And so what's left is just a litany of your most anxious qualities.

Dr Mary Anderson: You experience fear of failure, of making mistakes, or of being viewed as incompetent.

Sana Qadar: What these really are are some of the hallmarks of your typical high achiever. According to Mary Anderson, she's a clinical psychologist in private practice, and many of her clients are outwardly impressive, but they're quietly losing it on the inside.

Dr Mary Anderson: High achievers often are productive, talented, goal-oriented, and skilled problem-solvers. And they love a list. So those are all really advantageous traits. But I often see some less enjoyable traits that high achievers who are struggling with anxiety and worry often grapple with. You're afraid others will find out that you're not as smart or talented as they thought you were.

Sana Qadar: This is All in the Mind. I'm Sana Qadar. If you feel like you're being knocked off your game because of your internal monologue, Mary is walking us through how she helps her patients reorient their thinking. And she says you can implement these strategies on your own as well. But does gaining balance mean losing performance? Can you be high achieving and be happy? And what if the thought that plagues you is, I should really be further ahead in my career by now? Today, how to keep your edge at work but ditch the self-flagellation.

Sana Qadar: Mary works in a part of the world that is packed with your stereotypical high achiever. She's in Boston, Massachusetts. So you've got Harvard and MIT nearby. The city's main industries are health care, finance and insurance.

Dr Mary Anderson: I would be in the office and I would have these amazing patients come in, ambitious, high achieving, hardworking patients. So a successful business professional, doctors, lawyers, grad students, a lot of law students. And they would settle in on my couch across from me. And they would really candidly and courageously describe struggling with chronic stress, anxiety, worry, perfectionism. And what I realized is they were these amazing people who really were not enjoying their excellence.

Sana Qadar: What she's noticed over the years is these types of high achieving patients seem to have three thoughts swirling in their heads, three types of cognitive distortions. They often engage in all or nothing thinking, jumping to conclusions and should statements.

Dr Mary Anderson: So cognitive distortions are unhelpful thoughts that are based on faulty beliefs, misconceptions, misinterpretations. So all or nothing sounds just like that. It's like forcing a dichotomy where there doesn't need to be. So people will say, Dr. A, everyone needs to be totally blown away by my presentation. That's a lot of pressure. And I actually call all or nothing thinking pressure cooker thinking for that very reason. And so you'll hear a lot of like everyone, always, everything or nothing, you know, or always, I'm always falling behind. So that's the all or nothing thinking that's really pervasive, so pernicious, so undermining of people's confidence because they're thinking that they need to do the impossible, which is to be perfect and flawless. Then we got jumping to conclusions. And this kind of comes in two flavors. There's negative fortune telling, which is when we assume or predict something negative will happen, but it hasn't even happened yet. You know, like a law student or grad student be like, I know, Dr. A, I know I'm not going to do well on this exam. And I'm like, the exam is still like three weeks away. And then there's mind reading. And this is where we think that people, we assume that people are judging us or thinking negatively about us, but we don't have evidence yet. So people be like, I know they, you know, I know they're not going to like me, Dr. A, you know, I'm going to sound so stupid up there giving that presentation. The project's going to be a flop. And again, that really made them stressed out and undermine their motivation and confidence behaviorally. It did not help them. And then the last type of self-talk that I often, often hear from my patients are the shoulds, right? Super pervasive. And it comes in various ways. We should ourselves. We should other people. We should situations. Big one I hear is I'm so behind. I should be farther ahead in my career. I should be farther ahead on completing my to-do list for the week. That again, put so much pressure on people. And it actually has this opposite effect that should usually keep us stuck because we don't feel good when we show ourselves. I know I should be going to the gym more, Dr. A. But is that really motivating? No, they just feel badly about themselves.

Sana Qadar: So how do you get over this kind of thinking? Well, it's a journey. And Mary uses cognitive behavior therapy with her clients. And the first step is to realize you are having these kinds of thoughts, these cognitive distortions. And then you can move on to questioning their veracity and poking holes in them before replacing them with new thoughts.

Dr Mary Anderson: The one thing we all are always in control of is the thought that we focus on. We'll have thousands of thoughts a day. You can't stop a thought. You can't control your thoughts. But you can choose which thought you want to focus your attention on. And which thought we focus our attention on directly impacts how we feel and how we behave or show up in the world.

Sana Qadar: And so here's an example of how she helped one client, a young woman named Tina, who was freaking out about a presentation she had to give at work and telling herself she couldn't do it.

Dr Mary Anderson: I'm going to sound so stupid. I suck at public speaking. I should be better at this. So the question I asked Tina was, what thought is making you feel the most stressed out, Tina? And she thought about it and she said, you know, I just keep thinking to myself over and over, "I can't do it". And so then what we do is question number two is, how is my thought not necessarily true? And so I said, well, have you never spoken at one of the meetings?

Sana Qadar: Turns out, Tina had. Not for very long, but for a few minutes. And she'd done a good job and she'd even gotten praise from colleagues and her boss.

Dr Mary Anderson: That's why the boss asked her to speak again at this meeting, which was, you know, happening next month. And so she reminded herself of all of the facts of the situation. And what it did, I call it poking holes. You got to poke holes in that unhelpful thought. You got to show yourself that it doesn't hold water. And then the last step is to ask yourself, what would be a more helpful thought to focus on? Because clearly Tina telling herself, I can't do this. Is that helping her? Not at all. So how can we then help her create a thought that's based on the evidence that we just used? So it's, it's gotta be a reality-based thought. And that's really important because the more helpful thought, I call it new and improved self-talk. For new and improved self-talk to be effective, it's got to be believable. Because why do our thoughts impact our feelings? Because we believe them. So we've got to make sure that our new and improved self-talk that we're working to practice, that that is actually a believable thought.

Sana Qadar: Mary also says it's helpful if this believable new thought is short and punchy. Because if you think about your negative self-talk, you'll notice how short and generalized it often is. Thoughts like, I can't handle this. I can't do this. I'm not good enough.

Dr Mary Anderson: These short little things that play over and over and that's why it sticks so easily. And it's, it's usually these like over generalizations, right? Like I can't handle this. This is too much. And so those are the ones, again, we have to go after and poke holes in those suckers because there's so much evidence in a high achiever's life of like, actually you have handled a lot of difficult things before. You can deal with this. It might be challenging, but you can. So Tina was able to say to herself, you know, I don't want to speak at the meeting next month, but I've spoken at meetings before and actually got some positive feedback. I can practice because again, I talked a lot with her about, you know, what's under your control. And she said, you know, I can prepare and practice and I can do my best next month.

Sana Qadar: And so to narrow down that thought into something a bit sharper and shorter, here's what Mary did.

Dr Mary Anderson: Within that balanced thought, I said, what is the part of that balanced thought that helps you the most to feel better, to get some relief, right? Cause that's what we're going after first. I always say when people walk in with anxiety, I want to help them feel relief and then joy, right? So relief and then joy. So for Tina to get some relief, she said, you know, what helps me feel relieved is I've done this before. I've done this before. Because she initially was saying, I can't do this. I can't do this. But once we helped her remember, I've done this before, that's what really helped her feel better. So we just took from the situation of Tina feeling terrified and saying, I can't do this to now getting herself to the point of I've done this before. And then we made a game plan and we helped her really plan how she would prepare and practice by the day of the meeting. Tina crushed it. She did great. She was still feeling stressed the day of, but she was able to get out there and do it. And then it built even more evidence for her to then lean on in the future. I often say, use your memories of past successes as fuel for when you're climbing your next mountain.

Sana Qadar: So that's one example of how you can use CBT to work through anxiety around an upcoming project or presentation. And you don't need a therapist for this. You can do this on your own as well. Self-guided CBT is a thing. But what if your work-related worry is broader than a single project?

Voxpop: Most people my age seem to have their careers really together. And I've had a few different careers and I just look at where everyone is and I'm so far behind them.

Voxpop: Sometimes I wonder how well I'd be doing if I was a man instead of being a woman and how much further along in my career, how much more I'd be making.

Voxpop: I feel like everyone can see that I'm having a bad day and they're going to punish me for it.

Voxpop: Oh God, like I really need to speed things up here. It really makes me feel like, I don't know, I'm not accelerating enough in my industry simply because the pay pack, it doesn't reflect that.

Sana Qadar: You mentioned earlier one type of should thought you often hear is, I should be further ahead in my career. This is something I've heard from so many friends over the years. It's something I've felt many times. And it can really gnaw at your sense of self-worth, especially if your identity is so tied up in your work. How do you help people deal with this thought?

Dr Mary Anderson: Great question. Well, first, I just want to normalize that is something that is quite common for high achievers, especially who are struggling with stress and anxiety, they'll think that to themselves. And something that you said absolutely is part of it is often we tie our self-worth to our achievements, appearance or performance. And when people do that, it really leads to chronic stress and anxiety and makes people feel less than. I always say with shoulds, we feel stuck because we're feeling deficient. And initially it's helping them remember your self-worth is not tied to your achievements, appearance or performance. So really helping them remember that their self-worth is inherent and unconditional. We got to start from there. And instead of focusing on how far you have left to go or how you're not measuring up, it's so important for people to give themselves credit for how far they already have come, how much progress they've already made. And from there, then I work on helping them set goals that are doable and that sets them up for success rather than keeping them stuck in this place of I should be doing more. I should be further ahead.

Sana Qadar: It seems in one sense straightforward, you know, untie your sense of self-worth from your work and accomplishments. Stop comparing yourself to others. Those are straightforward enough, but very difficult to do. Like I imagine you have to go on a real journey to reach the point where you do those things.

Dr Mary Anderson: I work on this actually a lot with lawyers, interestingly, because I think they're really competitive by nature as well. And so helping them remember why they do the work they do has been really helpful that they are really dedicated to moving justice forward in the world. I think that's what's been helpful when they'll see their friends becoming judges or getting promotions or, you know, becoming editors of journals and different things. And sometimes I'll also ask them, yes, that's a, you know, a huge accomplishment. Your friend became a judge or is an editor of a journal. And then I'll say, do you think you'd actually want to do that? And that's been very, very helpful. That question of, yes, it looks shiny from far away. It's that achievement. It's that trophy or that award. But then look closer and be like, would you actually want to live the daily life of a judge? And they're like, no, you know, or do you want to be a professor at that top school and think about all that would go into that? And maybe you would. And if that's the truth, then great. Let's help you set goals to get you there. But I have to say the most interesting thing is very often people say, well, I don't actually even want that for myself.

Sana Qadar: You're listening to All in the Mind. I'm Sana Qadar. Dr. Mary Anderson is a clinical psychologist and author of The Happy High Achiever, Eight Essentials to Overcome Anxiety, Manage Stress and Energize Yourself to Success Without Losing Your Edge. Now, I mentioned Mary uses CBT, cognitive behavior therapy, and she reckons this is especially effective with her high achieving clients.

Dr Mary Anderson: They like having concrete, science-based, actionable strategies and skills. So they can begin to implement.

Sana Qadar: But one element of CBT she finds she really has to emphasize with these kinds of clients is self-care.

Dr Mary Anderson: So self-care, there's this kind of myth out there, right, that self-care is like taking bubble baths or going on shopping sprees or meditation vacations, you know, and those things are great, you know, if you want to do those. But I've got to boil it down for people to how to take care of themselves. When I talk about self-care, I'm just talking about how to take good care of yourself on a regular basis. So I talk about this acronym SELF, S-E-L-F, and it's the four science-based self-care fundamentals that are most important to prioritize for really for everyone and certainly for my high achievers if they want to be high performing.

Sana Qadar: Self stands for sleep.

Dr Mary Anderson: As adults, we want to aim for seven to nine hours of sleep a night.

Sana Qadar: Exercise.

Dr Mary Anderson: You want to aim for at least 30 minutes or more of physical movement most days of the week.

Sana Qadar: Look forward.

Dr Mary Anderson: And this is really important and often surprises high achievers because I talk about have at least one pleasant activity to look forward to each week.

Sana Qadar: And actually, let's just pause here for a moment on the L in SELF, look forward.

Dr Mary Anderson: And that's because often when people come in to see me, guess how many pleasant activities they have regularly scheduled into their weeks?

Sana Qadar: Not very many.

Dr Mary Anderson: Zero.

Sana Qadar: Oh, wow.

Dr Mary Anderson: No, they have none. And so having something to look forward to is this, it provides this powerful mood boost because then life isn't just going to bed, waking up and going to work, coming home and rinse and repeat. They have something to look forward to like a meet up with a friend on Saturday or they book a massage or they even just queue up one of their favorite Netflix episodes and say, you know, no matter what on Thursday night, I know Thursday is going to be a long day. I'm going to make sure I watch a Netflix episode that I like on Thursday night.

Sana Qadar: Your clients are sounding like people that are all work, no fun. Is that what the trap that these people fall into?

Dr Mary Anderson: Sometimes that's really what can happen because their jobs are just so busy and they have back to back meetings. I have people where I'm like imploring them to take a break. I'm like, we have to help you get up from your desk. Even if they're working from home, they're just constantly in meetings. And I'm like, okay, you have to get up at the very least, take your bathroom break, do some, a few deep breaths, make sure you're so the SELF S is sleep. E is exercise. L is important. F is fuel. Right? And so this is very much relevant to what we're talking here is fuel, making sure people drink water, that they're fueling themselves with healthy nutrition. So fruits, veggies, lean protein, and making sure they also fuel themselves with some moments of quiet. So I use the calm app for meditation, but people can even just take three deep breaths. If they get outside, get some fresh air. So what I find is when people come to see me, who really, especially I've been struggling for years with chronic stress, anxiety, worry, they haven't been regularly implementing this self care. So if they're prioritizing sleep, if they're prioritizing exercise, if they're prioritizing having something to look forward to, it makes it easier for them to think and feel in healthier ways. And in terms of their self-talk, just think about if you're ever tired, hungry, and rushing, it's not usually our best time of how we're thinking about ourselves in the world. Right? So that's why self-care becomes so essential to the sustainability of both happiness and high achievement for these patients and for everyone out there.

Sana Qadar: Yeah, I was going to say, it sounds like a lot of what you're talking about is stuff that can apply to anyone's life, not just someone who potentially counts themselves as a high achiever.

Dr Mary Anderson: Absolutely. So CBT, cognitive behavioral therapy, is empirically supported for the treatment of anxiety and depression. And it really can benefit everyone out there. I think for high achievers, what I do in my book, The Happy High Achiever, is just specifically tailor the examples and the strategies for people who are living with jam-packed schedules and who are really ambitious.

Sana Qadar: One of the ways Mary does that is to break her advice down into bite-sized pieces, her essentials, as she calls them. Like, strive for excellence, not perfection.

Dr Mary Anderson: The main difference is that excellence allows for high achievement and our humanity. Which is to say, can we ever be flawless, perfect, never make mistakes? No, that's not possible. We are not machines, right? What we can do is we can do our best and to know that our best will differ by the day. So if we've just got eight hours of good sleep, we've been exercising, we're eating healthy, think of that versus for a lot of people who are doing travel. So I work with consultants or just people who are doing international travel. There's jet lag. Is it reasonable to expect yourself to be able to perform at the same level if you're dealing with jet lag or the flu or if I have people just in the middle of a recent romantic breakup? So when I talk about strive for excellence, not perfection, it's not about lowering standards where we're acquiescing to mediocrity and stagnation. That's really important because I think a lot of times people who are ambitious are so afraid of, well, why would I strive for anything less than perfection? Because paradoxically, you striving for perfection is going to be counterproductive. And usually perfection is almost entirely externally focused. It's being very much measured by what someone else's definition of success and perfection is. And that's what's so problematic. If you make your internal worth beholden to external validation, you will live with chronic anxiety and worry.

Sana Qadar: Another one of your essentials is navigate uncertainty with curiosity. What do you mean by that?

Dr Mary Anderson: Yes. Oh, uncertainty. Anytime where we're having to sit with uncertainty as human beings, we don't like that. But it's something that's really necessary to be able to cope with if we want to be high achievers, because part of high achievement is setting goals and working towards them. And is there ever a guarantee that we'll achieve every goal we set? Of course not. Right? So if we really want to be sustainably high achieving, it really behooves us to learn how with uncertainty and navigate it so that it doesn't make us so anxious and overwhelmed that we avoid it. So this is a quick, quick pro tip. When you notice you're saying, what if, you know, what if I don't get the job? What if I don't do well on the exam? What if the presentation isn't flawless? Instead of saying, what if, which is just going to, again, ratchet up your anxiety, just shifting ever so slightly to, I wonder. I wonder what's going to be on the exam. I wonder what I can do to best prepare. I wonder how I'll do. Do you see how that's so much more empowering and it gives us agency. So we still have to sit with the uncertainty. I like to be real with people. I'm an optimist, but it's so important to be real. You're still going to have to sit with uncertainty. You're still going to have some stress. But again, the thought you choose to focus your attention on is what's going to make the difference. That's the game changer for how manageable the level of stress feels.

Sana Qadar: The final essential I want to talk about is celebrate wins. Why is that one so important?

Dr Mary Anderson: It's such an important essential because unfortunately, I have found that a lot of high achievers, oftentimes, we are what I call onto the next. I'll work with patients and I'll say, so I see them usually once a week, 55 minute session. I'll be like, do you remember the presentation like Tina, that presentation that we talked about how to help prepare yourself and tell yourself I've done this before the whole thing. She's like, oh yeah, it went fine. And then she's like, oh no, but now I just had a meeting today where now I found out about XYZ. And so it's so important to pause and take in that victory because it reminds ourselves of what we're capable of. And those become the fuel to move us forward as we're aspiring to complete our next goal.

Sana Qadar: Celebrating your wins can be as simple as journaling about your wins or going out to dinner with friends.

Dr Mary Anderson: And it's a great time also to make sure they are doing some self-care because so often I hear from my patients. Yeah, yeah, Dr. A, I'll go to the gym after this project's done or if it's lawyers and they're finishing up a big trial, they'll be like, yeah, I'll take time to relax or create a time for a pleasant activity, Dr. A, like after this trial's done. But once one trial's done, guess what happens? They're on to the next trial, right?

Sana Qadar: Wondering if generally you feel like your job has become, I don't want to say easier, but people are more receptive to what you're saying now than before. Like has the tide turned on hustle culture, do you think?

Dr Mary Anderson: Yeah, I think so. Um, I think what I've noticed is post COVID, like a post COVID world, I find people are more psychologically minded. I think the focus on work-life balance is much more resonant for people. And so absolutely, it's honestly made my job a lot easier. I think, I will say this, interestingly, the thing that's been fascinating to me is there's rampant perfectionism going on, just rampant. That's been the hardest thing is seeing people just be relentlessly hard on themselves because I think the social comparison being fueled by social media, that's been the difference I've noticed. And they're just saying like, look, Dr. A, look at what this person's doing. See, I should be where they're at. And it becomes this fuel of shooting themselves.

Sana Qadar: Yeah, our brains weren't made to have this much constant information about how everyone is doing at all times, right?

Dr Mary Anderson: Absolutely. And I think that's the great thing about remembering our own humanity. There is not one person who has everything totally figured out. And so I try to help people remember that even if their colleague gets a promotion or does something well, we all have our turn in the swamp. So that colleague of yours, she either just emerged from a swamp or she's headed into one, or maybe she's even trudging through a swamp that you just don't know about. So that's the thing to remember people's humanity.

Sana Qadar: I love that so much. If they're not in the swamp now, they're probably heading there or emerging from it.

Dr Mary Anderson: That's life. I'm an optimist, but I like to be real with people that life is beautiful and wonderful, but it's also messy and gnarly. And it's kind of just navigating the vicissitudes of life, right? Those ups and downs that we all must face at different times. And I think there's really a connection that can come from that is knowing no one's perfect, no matter what their social media account looks like. No one is perfect. So shooting ourselves isn't going to be helpful, but setting doable goals and setting ourselves up for success is really what's going to move us forward.

Sana Qadar: That is Dr. Mary Anderson. She's a clinical psychologist in private practice, and she's the author of The Happy High Achiever, Eight Essentials to Overcome Anxiety, Manage Stress, and Energize Yourself to Success Without Losing Your Edge. Now, I just want to say a quick thank you to everyone who's taken the time to fill out our audience survey. We've had nearly a thousand responses, and we've gotten so much helpful feedback, so much love for the show as well, which has been really gratifying. So thank you. We really hope we can cross a thousand responses. So if you haven't taken that survey yet, and you want to, please do. Keep it live for a little bit longer, and you'll find the link to it in the description for this episode in our show notes. One thing that's been really interesting is that 70% of the people who have replied have been women. So if there's any men or gender diverse people out there who have been thinking about filling out that survey and haven't gotten around to it, go ahead and do it. We'd love to hear your thoughts as well. As I've said many times over, it's only seven questions. It's quick and snappy. That's it for All in the Mind this week. Thanks to producer Rose Kerr and senior producer James Bullen. Our sound engineer this week was Tegan Nicholls. I'm Sana Qadar. Thank you for listening. I'll catch you next time.