Many people who struggle with anxiety and perfectionism find themselves constantly replaying conversations, analyzing decisions, or trying to “figure everything out” in their head. While this often feels productive or protective, overthinking usually increases anxiety and makes decisions feel even harder.

In our work together, we focus on identifying rumination loops and understanding the difference between problem solving and overthinking. We work on learning how to respond differently when your mind starts spiraling, how to tolerate not having all the answers, and how to reduce the amount of time spent mentally replaying situations. Over time, this helps quiet the constant mental noise and reduces anxiety and decision fatigue.

Perfectionism is often driven by beliefs like:

• “If I make a mistake, it means I’m not good enough.”

• “I should always be doing better.”

• “If I don’t do this perfectly, people will think less of me.”

• “I can’t relax until everything is done.”

Perfectionism often leads to procrastination, overworking, burnout, and harsh self-criticism.

Using CBT, we identify the beliefs and rules you have for yourself, understand where they came from, and gradually work on tolerating mistakes, imperfection, and discomfort. This often includes behavioral work such as doing things imperfectly on purpose, setting more realistic standards, reducing overchecking or overpreparing, and learning how to evaluate yourself more fairly instead of through an all-or-nothing lens.

Many people who struggle with anxiety and burnout also feel overly responsible for other people’s feelings, reactions, or expectations. This can lead to saying yes when you want to say no, avoiding conflict, overextending yourself, and feeling guilty for setting boundaries.

In CBT, we explore the beliefs that drive people-pleasing, such as:

• “It’s my job to keep everyone happy.”

• “If I disappoint someone, I did something wrong.”

• “If I say no, people won’t like me.”

• “I should be able to handle everything.”

We work on boundary setting, assertiveness, and learning how to tolerate the discomfort that comes with not always meeting everyone’s expectations. Over time, this helps clients feel more confident, less resentful, and more in control of their own time and energy.

Many of the people I work with appear very capable, responsible, and successful on the outside, but internally feel anxious, overwhelmed, and exhausted from constantly trying to keep up with responsibilities, expectations, and pressure to perform.

High-functioning anxiety often looks like:

• Constant productivity pressure

• Difficulty relaxing

• Feeling guilty when resting

• Taking on too much responsibility

• Feeling like you’re always behind

• Being very hard on yourself

• Difficulty turning your brain off

Using CBT, we look at both the thinking patterns and behavior patterns that contribute to burnout. This may include working on unrealistic expectations, all-or-nothing thinking, difficulty delegating, overworking, and not allowing time for rest. We also work on building more balanced routines, setting limits, and redefining productivity and success in a more sustainable way.

One of the biggest drivers of anxiety is difficulty tolerating uncertainty. Many people feel like they need to have everything figured out, make the “right” decision, or be prepared for every possible outcome in order to feel calm.

This often leads to:

• Overthinking decisions

• Constantly seeking reassurance

• Trying to predict the future

• Avoiding situations with unknown outcomes

• Difficulty making decisions

• Feeling anxious when things are not planned or certain

CBT helps by gradually building tolerance for uncertainty, rather than trying to eliminate uncertainty (which is impossible). We work on decision-making skills, reducing reassurance seeking, facing uncertainty in small steps, and learning that you can handle not knowing what will happen. This often significantly reduces anxiety and helps clients feel more confident in themselves.

Many people who struggle with anxiety and perfectionism also struggle with decision-making. Decisions can feel extremely high-pressure, even when they are relatively small, because of thoughts like:

• “What if I make the wrong decision?”

• “I should be able to figure this out.”

• “There is a right choice and a wrong choice.”

• “I’ll regret this.”

• “I need more information before I decide.”

• “I don’t trust myself to choose correctly.”

This often leads to overthinking, seeking reassurance from others, delaying decisions, or feeling stuck and overwhelmed.

In CBT, we work on understanding the beliefs that make decisions feel so high-stakes and learning how to approach decisions in a more flexible and realistic way. We focus on tolerating uncertainty, reducing the need for the “perfect” decision, limiting reassurance seeking, and building confidence in your ability to handle outcomes — even if things don’t go exactly as planned. Over time, this helps decisions feel less overwhelming and helps you trust yourself more.