Sleep Talk Podcast: Episode 62

Posted November 29, 2021

In Audio, Health Professionals, Podcast, Understanding Sleep

Episode 62: Perfectionism

People who have perfectionistic behaviours are at higher risk of developing sleep problems. Why is this the case and what can be done about it? To understand all about perfectionism and it’s relationship with sleep we spoke with Dr Jennifer Kemp, Clinical Psychologist, trainer and author of ACT Workbook for Perfectionism.

Dr Moira Junge (Health Psychologist) and Dr David Cunnington (Sleep Physician) host the monthly podcast, Sleep Talk – Talking all things sleep.

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Audio Timeline / Chapters:

00:00 – 29:28 Theme – Perfectionism
29:28 – 31:32 Clinical Tip
31:32 – 34:53 Pick of the Month
34:53 – 36:20 What’s Coming Up?

Next episode:

Is sleep a luxury? Social determinants of sleep.

Links mentioned in the podcast:

Presenters:

Guest interview:

Jennifer Kemp is a clinical psychologist, author and trainer, based in Adelaide Australia. Jennifer provides professional supervision for psychologists and is an Adjunct Lecturer in the School of Psychology at the University of Adelaide.

Jennifer is the author of the ACT Workbook for Perfectionism. She presents internationally and is available for public speaking, conferences, and workshops. She provides professional consultations to therapists seeking to deepen their therapeutic skills and fluency in ACT.

Regular hosts:

Dr Moira Junge is a health psychologist working in the sleep field, who has considerable experience working with people with sleeping difficulties in a multidisciplinary practice using a team-based approach. Moira is actively involved with the Australasian Sleep Association (ASA) and a board member of the Sleep Health Foundation. She has presented numerous workshops for psychologists and is involved with Monash University with teaching and supervision commitments. She is one of the founders and clinic directors at Yarraville Health Group which was established in 1998.

Connect with Moira on Twitter – @MoiraJunge

Dr David Cunnington is a sleep physician and director of Melbourne Sleep Disorders Centre, and co-founder and contributor to SleepHub. David trained in sleep medicine both in Australia and in the United States, at Harvard Medical School, and is an International Sleep Medicine Specialist, Diplomate Behavioral Sleep Medicine and Registered Polysomnographic Technologist. David’s clinical practice covers all areas of sleep medicine and he is actively involved in training health professionals in sleep.

Connect with David on Twitter – @DavidCunnington. David also regularly posts information on sleep to his Facebook page.

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Transcript:

Welcome to Sleep Talk, the podcast about all things sleep, brought to you by sleephub.com.au. Here are your hosts, Dr. David Cunnington and Dr. Moira Junge.

Dr. David Cunnington: So welcome to Episode 62 of Sleep Talk, the podcast talking all things sleep. And hi again, Moira.

Dr. Moira Junge: Hello, Dave. Hello, everyone.

Dr. David Cunnington: So the theme for this episode is Perfectionism, and looking at perfectionism and how it may impact on sleep and some strategies for improving perfectionism so that it doesn’t impact as much potentially on sleep and other behaviors. Is that something that comes up as a bit of a theme in people that you see, Moira?

Dr. Moira Junge: Oh, yeah, absolutely. Well, particularly in females and particularly in the setting at Melbourne. So like the sort of center, like a lot of pretty high flying professionals, busy people who have used the perfectionism for good. And then all of a sudden, that comes back to bite them a little bit. Because when you start to have some difficulty with your sleep, it’s the same things you use when you’re a perfectionist, and you’re a hard worker, and you’re a self-starter, and you’re conscientious, all those things. It doesn’t work for sleep. So it’s a bit of a cruel irony that we’ve discussed before. But we haven’t ever really talked about perfectionism per se, have we on the podcast?

Dr. David Cunnington: Yeah, that’s right.

Dr. Moira Junge: So I’m really, yeah, really excited to talk about it more.

Dr. David Cunnington: And part of my interest too, is we know cognitive behavior therapy is helpful. But we know there’s a significant proportion of people who don’t respond as well as what we’d like. And so, you know, you and I are always interested in OK, well, what else could we be doing? How else can we better our therapies? And I think by targeting perfectionism, I think that might be one thing we could do better.

Dr. Moira Junge: Absolutely. And maybe it’s one of those things that sometimes you do worry about the things that we prescribe, for instance. So even things like the sleep diary or certain instructions, you can think, wow, the perfectionist has gone over the top with that.

And even though the sleep diary is a really standard thing, and if you’re doing research, you can’t do research without a sleep diary. You know, you need data. But I, as you know, over the years, sometimes in certain people, I just say way, way, way away from a sleep diary, because it becomes over the top, and it’s just too much. And I think it’s, we haven’t really talked about whether that is perfectionistic traits that have… plus anxiety that had been too over the top with the monitoring of the sleep diary.

Dr. David Cunnington: Yeah, absolutely. So to help us unpack perfectionism and give us some good tips, we spoke to Jennifer Kemp, a clinical psychologist who works in Adelaide. And amongst her work with clients and other things that Jennifer is involved with, she has authored a book, and we’ll talk a little bit more about that once we’re finished the interview.

So thanks very much, Jennifer, for helping us out.

Dr. Jennifer Kemp: Yeah, sure. I’m really pleased to be on your podcast. So I’m really curious about this topic of sort of the intersection between perfectionism and sleep. Seems like there’s a bit of overlap.

Dr. David Cunnington: Yeah, absolutely. And we’ll sort of getting into that a bit. But from your point of view, how do you actually define perfectionism?

Dr. Jennifer Kemp: Historically, perfectionism has been thought of as a personality trait. And that’s certainly one way of looking at perfectionism that I find that kind of limiting, though, because I’m a behavioral therapist, and my focus is on helping people change their behavior.

So if it’s a personality trait, then that generally means it’s kind of baked into you. There’s nothing you can do about it, you’re kind of stuck with that, and I don’t accept that. I really work with people to change their perfectionistic behaviors. And, yes, I guess they may always have some of the characteristics of perfectionism, but they can do it in a much more helpful way.

Perfectionism, for me, is a set of behaviors or patterns of behavioral responding. They develop out of… because they are kind of negatively reinforced. They developed and learned over time because these behaviors actually take away something that’s really uncomfortable for the person. So they remove those usually uncomfortable feelings.

So just to sort of leap into a definition, you know you’re looking at perfectionism when first of all, you see very high standards that there are not just high standards, there’s a rigidity about those standards. Those standards have become, they can be obsessional. I kind of view perfectionism as a bit of a continuum with OCD right out one end.

So I think if you’re seeing really the sort of perfectionism that really has someone gripped, immobile, unable to do anything, then you really need to be looking for OCD and excluding or including that in your treatment. But in that kind of more perfectionism range that you’ll see in everyday people, you’ll see this kind of stuck on needing to meet a rigid standard.

So the standard is always just out of reach. And it’s a standard, I mean, perfect is a very abstract concept, isn’t it? It’s like I could achieve that, when I have… yeah, well, anyone could have done that. I’m just going to dismiss that now. Like, the hell just going to set the bar just a little bit higher for me. So they’re constantly resetting that bar higher and higher so that it’s always just out of reach. And then how I feel about myself is very much then dependent on meeting something that is unattainable. So, of course, I feel terrible about myself most of the time. I can constantly feel like I’m failing.

The second thing you will see in people is a very strong fear of failing. So this is this idea of that– and when I say failing, I mean, like any kind of failure. I mean, in the broadest possible sense. So no one wants to make a mistake. Obviously, we’ll prefer not to. So sort of mistakes that you might make, but also maybe being rejected by someone or seen as incompetent, or have any kind of social embarrassment, all of those kinds of failures. And we’ll, as humans go a long way to avoid those things because we feel a sense of shame and embarrassment when they happen. We do all kinds of things to avoid that.

And then a third thing you will see from people who are perfectionistic is a lot of self criticism. And I’ll bet you would see this in your sleep clinics. It’s like, why can’t I do this better? I shouldn’t be doing this. Anyone could get this right that kind of nitpicking, really, constantly critiquing yourself. And because I can never meet the standards that I always set just a bit too high, and so I’ve always got plenty of things that I can kind of pick on, basically.

So naturally, if those are the kind of the three key processes of perfectionism, what you’re going to see is a lot of avoidant behaviors, a lot of frantic attempts to run, fight, or hide from mistakes and self criticism. We want to get away from those experiences as much as possible.

So I guess, by viewing perfectionism in this way, I can kind of then say, OK, is this behavior that you’re doing right now that seems to make sense right now in the short term because it’s making you feel better because it’s meaning that you don’t fail at this moment causing you long term problems.

And that’s why you can– we all can say perfectionism can cause people immense problems in their lives, but they keep doing it. And that’s where I think personality theory doesn’t offer an answer, the behavioral theory does. We keep doing it because we keep getting reinforced for doing it. We keep getting away from failure.

And so, for example, the checking and the extra checking, and the more and more checking that we’re doing is… takes us away from failure and reduces our fear of failure, so we feel relief. And so we keep doing it, even though we’re working extra long hours, even though it’s costing us in our personal life. We, that long-term problem doesn’t outweigh that kind of short-term relief that we’re chasing.

Dr. Moira Junge: That’s really interesting. So if it’s some, not a personality trait, or it’s, you know, do you feel like it’s more learned then? Do you feel like it’s a learned behavior?

Dr. Jennifer Kemp: Yeah, yeah. Look, you can definitely look at it as a personality trait. And I do think you will see it running families and so forth. I don’t, I’m not saying that that’s wrong. I’m just saying that that way doesn’t necessarily lead to pragmatic ways of actually treating it as a therapist in or in your practice. It was looking at it pragmatically as behavior and something you write that is learned over time. And it’s learned from our environment, the context varies. It’s reinforced from the context that we’re in, and it’s reinforced because it creates relief.

So yes, absolutely, a learned behavior. Just say even like, I’m a psychologist, a clinical psychologist, so I have a lot of learning history from being in psychology. And I also supervise a lot of psychology students at the moment. And it’s everywhere, it’s everywhere in our profession, and it wouldn’t surprise me if it was also in the medical profession as well.

Dr. David Cunnington: Oh, yeah.

Dr. Jennifer Kemp: Yeah, because it’s actually rewarded. In fact, you almost think it’s screened for this kind of high achieving like there’s high achieving and then there’s like just constantly continuing to raise that bar. So not everyone gets the kind of unhelpful aspects of it, but so many of us would fall into that trap, and I personally have. And that’s why I’m so interested in this topic because I still consider myself to be a recovering perfectionist. It still grabs me at times, and does not let go.

Dr. David Cunnington: And I’m not sure I’m recovering. I’m still practicing, I think. And you’re right. The things we need to do to get into any of the professions; be it in medicine, be it in a whole range of different domains, you need that attention to detail to get past the barrier, at least to get into the training for professions.

Dr. Jennifer Kemp: Yeah. Yeah.

Dr. David Cunnington: And then in a sleep sensor, one of the things, the paradoxes of sleep is it’s one of the few domains in life we can’t do better at by trying harder. And a lot of the examples you’ve given is just, OK, so how do we succeed with perfectionistic traits or perfectionistic behaviors? It’s by rechecking, redoing, ticking it off, setting a bar. And if sleep, to sleep well, you’ve really got about it to step back, I’m at ease. I’ve done my job. My body will take the sleep it needs. And that’s a very hard mindset for a perfectionist to get into to take that type of approach. And that’s often what we struggle with within a clinical sense.

Dr. Jennifer Kemp: I can imagine. Yeah, because you’re actually asking people to take a risk that they won’t sleep by trying something new. And it can get quite wedded to this, but this is the way I do it, and this is what’s going to work for me. And then like, it’s a bit of a leap of faith really, isn’t it, to try and do this imperfectly, in some way?

Dr. David Cunnington: And that is one of the challenges and that sometimes wherein treatment, we may use, for example, in my role as a medical practitioner, I might be using the medication as a holding strategy to give people that sense of safety and that sense of enough wiggle room, enough room to get it wrong, if you like, to then take on a different way of thinking about sleep. Because that’s more where more we would come in, as you know, you’ve got to be flexible, and you’ve got to be willing to look at sleep in a new way. But if you’re just hanging on by your fingertips, then it’s too hard.

Dr. Moira Junge: Yeah, a lot of shame and stigma, and like almost like such a simple thing as sleeping like how do I not know how to sleep? But they need to… people are reassured as well. Well, it’s actually a fairly complex thing. It’s, and it’s super complex when you’re trying so hard as well because it’s an awful cruel paradox that the more you try, and the harder you try, the more elusive it becomes.

But in everything else I’ve ever done, including their weight management, their fitness, and their career goals, it always makes sense that the harder you try and the more effort you put in, you get the success. But not with sleep. It’s one of those, one of the very few things in life really that doesn’t work that way. It’s a slippery, slippery thing.

Dr. Jennifer Kemp: Yeah, fascinating.

Dr. David Cunnington: You know perfectionism when you see it if you like. But if someone’s thinking for themselves, it’s much harder for us to self monitor. You know, where do I sit on a perfectionism scale? Are there tools you can recommend to people or tools you might use either for clinicians or have people use themselves?

Dr. Jennifer Kemp: Yeah. Well, if you want to use a questionnaire, I know that Aaron Frost has 8 or 10-item questionnaire. So his multidimensional perfectionism scale MPS, I think it used to have 42 items. So it’s very clunky and really not really handy to use that in a clinical sense. And it also divided those items. I’ve been to six different scales.

One of which was that sort of conscientiousness organization, which is I would have thought on the helpful side of perfectionism, generally speaking. And two of those were also about parental expectations, which may or may not be the case, and parental sort of pressure. I don’t use it clinically. Maybe I just don’t need to now, because I can kind of see it in people’s behaviors. I kind of just ask people, “Do you set very high standards for yourself?” And “Oh, yes.” “And you keep raising them when you reach them?” “Sure.” So people will pretty much self identify in that.

In ourselves, we might also notice that really strong self critical voice that you’re always kind of, “I can never feel good enough,” that you’re always kind of picking on yourself for things that you’ve done or might do in the future. And it’s like the sort of in-built hyper alert warning system protecting you from mistakes. But it can be really punitive, and really, yeah, just plain mean that kind of inner voice. And I would call that kind of your inner critic, your inner perfectionistic self critic. That’s often the thing that is causing people the most problems.

Dr. Moira Junge: How do you talk them through softening that inner critic voice?

Dr. Jennifer Kemp: I used Acceptance and Commitment Therapy as my primary focus of the work that I do. But I kind of go deeper and I’m really using clinical behavior analysis as sort of the foundation of that. So I do a functional analysis of perfectionistic behavior with people with self criticism. ACT has a lot of self-compassion kind of built into that model, and I only ramped that up, too.

So I’ve taken some strategies from Compassion Focus Therapy and sort of weave that in. So using some metaphors that help people start to understand that they can speak to themselves in a warm kind of tone. I mean, I can take you through one of those metaphors, which might be helpful. So the metaphor that seems to help people with… help the penny drop is the Two Teachers Metaphor.

So if you imagine that you are a parent of a child who may or may not have kids or small kids. This child is… your child is just starting school. So around 5 years old, and they are normally developing children, which means maybe they’ve got a few areas they’re learning that they’re not so great on. They’re struggling with their reading, or their writing, or sitting still, and they want to go out and play. And they have two teachers. Probably not uncommon in a job share situation at the moment.

Now, one of those teachers, the first teacher comes up to your child and says, “Why can’t you do this already? Everyone else has got this done. I can’t believe you can’t do this. Sit down. And do you work. This is not good enough.” Ooh! Oh, I have to shake it off a little. Like, I just… can you imagine having someone a child like that?

Dr. Moira Junge: It sounds like 9 and… It sounds like 9 and 7, it sounds like that to me.

Dr. Jennifer Kemp: Yeah. Well, yeah. I mean, and I think it probably still exists, too, right? But hope– I’m gladly, gladly… I’m glad that it’s probably in the minority now because your child also has a second teacher. This teacher’s approach is completely different. This teacher comes up to a child, kind of gets down to their level and says, “Hey, I can see you’re really struggling with this. Why don’t we go through it together? You show me where you’re coming unstuck.” “Hey, let’s just do a few more before we go out to play.”

Now, which teacher would you guys prefer to have to teach the child, the first or the second?

Dr. David Cunnington: Yeah, clearly the second, right.

Dr. Jennifer Kemp: Clearly the second, yeah? Which one of those two do you think would be more likely to help your child learn, grow, and develop as a human? So which one of those would sound more like the way you would speak to yourself?

Dr. David Cunnington: The first, of course.

Dr. Jennifer Kemp: Most of the clients. Yeah, right? Most of my clients will go, “Oh, the first.” So why is it that we feel like we should speak to ourselves in a way that we would never speak to anyone else? And that is probably not the best way that we’re actually going to learn and grow, and develop as people.

And there are a few things you can notice about that second teacher as well. The second teacher, because letting go of self criticism is hard for people, we can feel like we need to do it, you know. If we don’t, we’ll be lazy. Or, you know, if we can feel like it’s just essential, we’ll be just complete… it’s like a hassle basically if we don’t do this, don’t… you know, keep on top of ourselves.

But actually, if you listen to the second teacher, not only were they warm and kind, and helpful, so they are motivated to help, but they still kept the child on track on task, and “Let’s do a few more before you go out to play.” So there is a way that we can speak to ourselves that is kinder and warmer. And I might start with that sort of example to help people get this idea that beating yourself up all the time, isn’t as necessary, as we think.

Dr. Moira Junge: I mean, that’s some of the same thinking about when we set instructions for people with sleep. Often we might talk to them about some sleep strategies, including some sleep hygiene instructions. And, or maybe some meditation and we might want them to do a little bit of meditation in between when I see them next, and tends to be sometimes people will actually maybe obsess over that or do it too rigidly. Or, you know, when someone comes to mind where she did meditation for like eight hours when instructions are five minutes. You know, those sorts of things. So, maybe talk to our listeners about how can we get people to take on those sort of principles with less obsession of the detail.

Dr. Jennifer Kemp: Yeah. Actually, when you give me that example of that client, I can hear how the meditation has become what in actuality, we call it experience avoidance. So if I meditate more, I feel less anxious about my sleep. So five minutes is enough, still anxious. Keep going. So we want to let people kind of leg help people let go of that controlled agenda basically, that idea that in order to be OK, we must not have these kinds of the so-called negative state. So we must not feel anxious. We must not feel upset, sad, angry.

It is kind of an understanding that humans seemed to have developed that it’s bad to feel that way. And so we must do all these kinds of things to get away from those experiences. So in Acceptance and Commitment Therapy, we are teaching people that you can do the things that are important to you, even in the presence of these uncomfortable emotions, and changing a perfectionism is an example of that.

So transforming and changing your sleep habits would be an example of that. So trying something new is hard. It’s going to feel awkward, it’s going to feel clunky, and it may not work. So how can you make room for those uncomfortable experiences? How can you sit with the uncertainty that you’re going to sleep? If you can’t, I guess it’s going to happen. So we have to sort of sit with that uncertainty and then somehow allow ourselves to fall asleep, right?

It’s helping people work through that and build up. You could call it stress tolerance, or we would call that acceptance ability, that willingness to feel uncomfortable in the service of the things that are important to you in your life.

Dr. David Cunnington: In some of the work we’ve published is on mindfulness. So using mindfulness much in the same way as Acceptance, Commitment Therapy. You know, they’re both metacognitive techniques. And I think, in some respects in this area, ACT is probably more accessible and more tangible, and probably a more practical sort of solution. There is mindful… mindfulness can suffer from being a bit abstract, sometimes if you’re trying to get people to the same place if you like.

Dr. Jennifer Kemp: Absolutely. In ACT, mindfulness is part of that framework and a really, really important part of that framework is being able to be in the present moment with your experience and understand what’s going on for you.

Personally, I’ve never been able to maintain a daily mindfulness practice. So, I’m a busy person and I get very… you know, like running around and I’ve never been able to sort of sustain that effort. So I think there is a barrier there for some people. But you can practice dropping into the present moment and checking in with yourself as a form of mindfulness, just even in that moment. Like, what’s going on for me right now? And what am I experiencing right now? And that sort of, I would call everyday mindfulness is it’s probably more accessible, honestly.

Dr. David Cunnington: Yeah, and that’s what we found, actually. What mediated improvements, both in sleep and quality of life was being mindful across the day, not the minute spent in task orientated meditation. And that actually didn’t correlate so well with the outcomes.

Dr. Jennifer Kemp: Yes, absolutely. I can see that will be true. Yeah.

Dr. David Cunnington: You know, what’s the research showing that these techniques are helpful?

Dr. Jennifer Kemp: I think the research in terms of treating perfectionism is definitely emerging. It’s only relatively recently that people have sort of moved away from that kind of baked-in personality trait model and started to say, hey, what can we change about this?

So some of the earlier research in sort of last 10, 15 years was around CBT, and applying CBT. And of course, Acceptance and Commitment Therapy, and Compassion Focused Therapy as sort of third wave therapies. So they’ve sort of developed from their cognitive behavioral framework, their behavioral therapies, ultimately.

So there is research, there’s only… there are two studies, I think that randomized controlled trials. Clarissa Ong and Mike Twohig, who’ve done those. One of them focuses on Acceptance and Commitment Therapy for Perfectionism, itself. The other one has used the same group, but looked at it from a different angle and looked at it for self compassion, and the elements of self compassion that were woven into intervention and how they changed. And both of them found some significant results.

There’s a great paper called, Perfectionism as a Transdiagnostic Process, which is one that I often refer people to if…

Dr. Moira Junge: well, it’s been fantastic talking to something we talked about quite a bit in the sleep field is certainly something we’ve noticed that people do have perfectionistic tendencies and behaviors and have always I must admit, sort of thought of it as a personality trait. But obviously, it’s a different model. Just in a final sort of, I guess, the final word to you, is there anything else you’d like to just add or summarize, really, just for our listeners, as we sort of, as we close out?

Dr. Jennifer Kemp: Well, I think there’s probably one more thing that I can think of that might be helpful. And that would be that, well, you can change perfectionistic behavior. And there’s always a paradox in doing so because perfectionistic people try and change their perfectionistic behavior perfectly. Just like they’ll try and change their sleep behavior perfectly, and want to have those perfect eight hours or whatever it is that the uninterrupted sleep that they’re aiming for.

I tend to call them perfect for having a goal. So I work a lot with people with chronic illnesses. Some of them have sleep apnea, some of them have a lot of weight management clients. It is probably many of them also have sleep problems too. But they do this thing where I will say so you know, what do you think you’d like to change? What would you like to work on this? Like, I’m going to go for a walk everyday starting tomorrow, and I’m going, “No, you’re not.”

Like, not… like, if they were regularly exercising already, sure. But they’re not doing anything. So I think the same with sleep, I say, OK. I don’t actually say no, you’re not. I say, hmm, how could we set that goal in a way that’s perhaps less like aiming for perfection? Because you’re sort of setting yourself up to fail there.

The first time you don’t go for a walk, you fail that goal, because it was like all or nothing. So how about over the next two weeks between now when I see you next? You focus on increasing… well, we’ll pick this behavior going for a walk, and I’d like to see how many you can do. And let’s focus on increasing the frequency of that behavior over time.

So maybe you’ll come back to me and you’ll say, “Oh, terrible, I only walk three times.” I’ll go, “Great! Three times is lot more times than you did. How did you, how was that possible? What made that work? How can we make that four or five times?” And I’ve had a lot of success, sort of getting around that perfectionistic goal setting in that way, it sort of just bypasses that and we, and they get to still feel a sense of achievement, a greater sense of achievement, frankly from doing that. So I think that that’s a strategy that applies to all behavioral change basically. I use it for everything.

Dr. Moira Junge: Absolutely. Oh, very fantastic, great pearls of wisdom. It’s been wonderful talking to you today, Jennifer. We really appreciate your time and insights.

Dr. Jennifer Kemp: Well, great. No, it’s been great talking to you guys. I’m going to go back and check with my clients now who is struggling with this stuff, just how much they’re struggling, and how perfectionistic they are about it.

Dr. David Cunnington: What did you think about Jennifer’s way of thinking about perfectionism as being a pattern of behaviors rather than a trait?

Dr. Moira Junge: Yeah. Well, I think that was interesting. Because I must admit, it’s, I mean, all my training and all my thinking around it has been along the lines of it as a personality trait. But it’s, I guess it’s really what it is. It’s a construct really, isn’t it? And whether we, if we can, we can just call it a construct, and whether it’s sort of behaviorally based, or whether it has become something we just inherited and it’s part of the health of innate DNA, I think that’s… she indicated, too, it’s not like she’s particular saying that it’s wrong to think of it as a personality trait. It’s just that she thinks it’s more helpful.

And I agree that if you think of it as a behavioral thing, therefore, it’s much more modifiable. And I think like everything, everything we talk about in the sleep field and other things, it’s around education, isn’t it? So education and awareness and having professionals to help you point out perhaps things that might be going on, and say, you know.

And I think every single person I speak with around, I say, do… they self identify as often say, every single person, so many do identify as a perfectionist, and not so much and that they think it’s not so much that they’re grooming or that they’re perfect in every way. And it’s just that they, it’s talking about the standards, like just having very, very high standards, and really high expectations of yourself.

Brackets, are really critical as well. Like, the inner critic, which Jennifer spoke very eloquently about. I thought that was… I think it’s really helpful for people working in a sleeping field or people listening to this, if you do have this sleep problem yourself to identify how much of it could be related to your expectations and tendency towards perfectionism.

Dr. David Cunnington: If people are looking for some resources, it’s really nice resources. Jennifer herself is about to publish a book called, The ACT Workbook for Perfectionism. And having listened to Jennifer, and listening to those principles, I think that’s going to be a really helpful workbook for people. So I encourage people to look at that.

We’ve previously posted some resources from the Western Australian Government. There’s a workbook on perfectionism and some really good resources. And we’ve talked as well about the online resource of this way up, and some online mental health courses, again, on perfectionism, anxiety and stress management, and managing insomnia. They’ve got a good range of courses.

Dr. Moira Junge: Yeah, I think her book will be really useful.

Dr. David Cunnington: Thanks, Jennifer. We’re going to lean on your expertise. So what’s a clinical tip when you’re working with people with perfectionism?

Dr. Jennifer Kemp: If you’re a clinician working with people on sleep, I think you’ve got to start by what you want to model yourself. One of the key things that people who are perfectionistic struggle with is being compassionate towards themselves, being kind, and they tend instead to urge towards that sort of all-or-nothing thinking; if I don’t do it perfectly, I’ll fail.

So really, as a clinician, you can model a different way of approaching that. It’s very easy to kind of hand out a behavioral description, like go away and do this within that like this sort of implication. And it may not be coming from you, it could be definitely heard by the client, though, do this to a perfectly do it every day, you know, from now until forever.

And so people can feel that that’s not achievable. Because perfectionistic people aren’t just high achievers, they’re also people who are avoiding a lot of things in their lives, and they may not do that thing, because they just seem too hard.

So as a clinician, you can break that down and say, “Hey, I think this would be a really good idea for you to try.” “How many times you think you could try it.” And model a kind of compassionate approach. “It’s OK if you don’t do it every time, but let’s see if we can kind of increase this over time. When I next see you, come back and tell me how you went.”

And I always help people keep track and measure the things that they’re aiming towards so that we get to reward them. So how many times did you manage to do this particular sleep hygiene strategy? Rather than how many times did you not. So we really want people to be focusing on their successes, and that I think builds a sense of not just achievement, but also kind of a compassionate approach to this, that it’s OK not to do it right straight from the bat.

Dr. Moira Junge: So, up to the pick of the month already. What’s your pick of the month this time, Dave?

Dr. David Cunnington: So in continuing to explore my professional development in looking at complex trauma, borderline personality disorder, I’ve come across a really nice series of videos on YouTube, developed by McLean Hospital. McLean Hospital is one of the satellite hospitals from Harvard Medical School. And a couple of years ago, they had a grant to develop a series of videos for family and people with borderline personality disorder on complex trauma, just explaining what the condition is, strategies for dealing with it.

And the particular video that I like is the application of mindfulness in the treatment of borderline personality disorder. And it’s really practical, really well, quite well grounded. And, you know, I really enjoyed not just that particular video, but I wanted to highlight that one, but the whole series that just runs through. That’s a great resource, not only for people who may have that issue themselves but for friends and family to help them with this thing.

Dr. Moira Junge: Yeah, great, excellent. Thanks! You sent it to me and I’ve had a little look at it. I think it’s really, I highly recommend it to our listeners.

Dr. David Cunnington: What about for you, Moira?

Dr. Moira Junge: Well, my pick of the month, I think I’m big-time for at the moment. So pretty much that goes on the theme, any kind of reading I’m doing, preparing for the podcast. So again, my one is about the theme, and I do think it’s a really elegant paper from Cele Richardson. I’m not sure how I should go ahead and pronounce his name, a well known researcher in Australia, and Michael Gradisar. Cele used to be in South Australia, now she was in WA, and was supervised, I think, by Michael Gradisar.

They certainly have… I love their papers together. It’s in the Journal of Adolescents from last year. And I didn’t notice… I actually noticed it last year, but it’s good. I was looking up again recently around people who’ve been publishing in the area of sleep and perfectionism. So they had a paper, Perfectionism and Insomnia in Adolescence: The Role of Vulnerability to Stress and Gender. So it was really good.

I looked at 291 Australian participants, like young people aged between 13 and 19. And I did find that vulnerability to stress accounted for the relationship between self-oriented striving perfectionism, which we see all the time, self-oriented critical perfectionism, and insomnia symptom severity in females, but not males. The younger the people are when we can identify and have early intervention, I think people are far better off.

So I think I will put that in the show notes the link to this paper, because it’s just a really good thing. And it can, you know, really, at least partly explain that preponderance of insomnia in adolescent females particularly. And I guess we’re really interested in that link with sleep and mental health, really looking at the protective role of sleep. That’s what we’re sort of always striving for. So the more we know about that, the better.

And I guess that’s, you know, because really what we’re all about. Especially, my focus is on a lot of public health and prevention. So yeah, it will really help us with both sorts of prevention and treatment of insomnia in young people. So, well done.

Dr. David Cunnington: Yeah, I sort of saw that too and thought, you know, it’s the grip that we see of coming into the last couple of years of high school, high expectations on themselves and that perfectionism can really sort of ramp that up and we’re seeing them when they sleep starts to not get well.

Dr. Moira Junge: So what’s coming up in future episodes, Dave?

Dr. David Cunnington: So I’ve been promising an episode on fatigue, it’s still something I’m working on. So that’s a work in progress. And next episode is going to be on Social Determinants of Sleep. So looking at is the luxury or a sense of privilege. Is sleep only something that some people can access? So up your alley, Moira.

Dr. Moira Junge: Yeah, absolutely. I look forward to that one.

Dr. David Cunnington: And given what we talked about in this episode, I think we do need to get someone on to talk about Acceptance and Commitment Therapy. So that’s going to be on my hit list of episodes to develop as well.

Dr. Moira Junge: I got just a guy in mind. So, thanks for listening. Remember to send us any suggestions at podcasts@sleephub.com.au. And you know, we’re always keen to talk to early career researchers and help people hear about your work.

Dr. David Cunnington: And if you like the podcast, review us on iTunes, subscribe, and tell others about the podcast. Thanks a lot.

Dr. Moira Junge: Bye!

This podcast is not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider within your country or place of residency with any questions you may have regarding your medical condition.

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Dr David Cunnington

Dr. David Cunnington is a specialist sleep physician delivering quality healthcare to clients with complex sleep problems and promoting sleep health through education, research and advocacy.