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Writer's pictureLauren Farina-Prieto, LCSW

The Intersection of Performance and Mental Health

(Spoiler: You Can't Have One Without the Other)


Author: Lauren Farina-Prieto, LCSW


Who Do We Mean When We Talk About High Performers?


We talk a lot about high performers around these parts. In fact, after years of supporting doctors, lawyers, nurses and educators through struggles with low self-esteem, perfectionism, depression and anxiety, at Invited, we’ve found our niche working with high achievers. We’ve supported professionals in getting out of their own way and evolving to the next rung in their journey of self-actualization. We’ve learned, both through observational study and review of published literature, that what many high performers have in common is the association of exceptional achievement (in work, family, and social spheres) with self-worth (Ex. “If I don’t do ‘X’ I’m a failure"), and ultimately, emotional safety. We’ve also worked with parents, adult children, divorcees, singles, teens, and students who uphold the same narrative.


Our definition of high performers is not limited to folks in the workforce; for our purposes, we define a high performer as someone who diligently manages their behavior, role, or function, sometimes in an effort to defend against emotional pain. While perfectionism is often a hallmark of high-performing personalities, C-level executives and stay-at-home moms alike, it is not the only trait that can help to cover up pain; there are others. See the following list for other examples of high-performing traits:


  • perfectionism

  • people-pleasing

  • workaholism

  • planning, organizing

  • restrictive eating

  • overexercising

  • intellectualizing

  • overly focusing on physical appearance

  • codependency


Does this mean that anyone who has achieved great heights of success by traditional standards has done so to mask deep-rooted pain? Probably (I kid). In all seriousness, there are many self-actualized high performers, whose efforts are precipitated by authentic passion, enthusiasm and joy, rather than the need to prove something to the world. In this setting, performance can serve as an outlet for creative expression. For the rest of us, well, it gets a bit more complicated. According to Richard Schwartz, author of No Bad Parts, and founder of Internal Family Systems Therapy, perfectionism is a part that develops, usually in childhood, in response to a trauma, stressor or challenging life event. The role of this part is to manage a person’s behaviors in an effort to avoid experiencing that kind of pain. This perfectionism is therefore a trauma response, and protective in nature, but its work often comes at a great cost to the individual. The same is true for other high-performing parts, such as people pleasing or codependency.


For example, a child believes that his parents are fighting because of his neediness and bad behavior. This is the precipitating stressor. Later, he learns to earn their praise by bringing home straight-As. The pain of the shame is temporarily eclipsed by his parents’ pride in his performance, and his perfectionism is born. He pours himself into his academic performance in order to avoid feeling bad again, and for a short time, it works, until one day, he earns a less-than-perfect score. The perfectionism fails to protect him from the original wound, and the shame comes flooding back again. Thus, his academic performance is a tool, a protective agent, which works in the short term, but that costs the child a sense of self-worth and often, an overwhelming sense of anxiety in the long term.


In another example of a high-performing personality born from shame, a middle-school girl is teased because of her appearance. She learns that if she can flatter and appease her bullies, they go easy on her. She becomes very adept at reading people’s emotions (AKA an “empath”), anticipating their needs and catering to them, often at the expense of her own needs and preferences. Thus, her people-pleasing nature is born. This part works hard (performs) to protect her, in the short term it does, because the bullying seems to slow down. This protection, however, comes at the cost of over-investment in what other people think, the need for external validation, and a disconnection from the Self.


In both examples, the perfectionistic boy and the people-pleasing girl embody what we at Invited refer to as high performers. In both scenarios, each individual executes a task (earning perfect grades) or function (accommodating others) in an effort to defend against the pain of the original trauma. If you can relate to these cases, you are our people.


The Intersection of Mental Health and Performance


So far, we’ve covered how high performers have honed their high-performing ways, often in an effort to protect against the shame or pain from an early trauma or stressor. In some ways, such stress can propel us forward. In the examples above, both individuals adapted, either through excelling in school or tuning in socially, and these adaptations were effective. As noted, however, the problem with these adaptations is that both came at a high cost, and that cost was their mental health. Performing is, at least in theory, a tool that one can pick up when they need it (like a trial lawyer giving an opening statement) and put down when they don’t need it anymore.


At Invited, we’ve found that it’s the putting down part that most high performers struggle with. Now, why would that be? According to Richard Schwartz, performance-oriented parts like perfectionism and people pleasing are fear based. These high-performing parts remain active in fear of what may happen if they relax a bit: the boy may be confronted with his shame, and the girl might be bullied again. As Brené Brown notes, “Perfectionism is fear with designer shoes on.” It makes an awful lot of sense: if you weren’t convinced it was safe, would you leave your doors unlocked at night? Probably not, and that’s why it can be so difficult to heal patterns like perfectionism and people pleasing, which were created to protect against harm.


By now, you might be asking, "aren't academic performance and social attunement important?" Absolutely they are, but only to a certain extent. As stated, these parts have important jobs to do. What's more is that trauma can, in a way, infuse performance with ambition. Many of our clients are convinced that without perfectionism, anxiety and self-doubt, they’ll become lazy and apathetic. However, as we’ve seen in our practice time and again, high performers are often, paradoxically, at risk for performance impairment. According to the work of Brad Stulberg and Steve Magness, authors of Peak Performance and researchers in the fields of performance and motivation, “obsession, perfectionism, hypersensitivity, the need for control and high expectations are … all linked to creative burnout.” The research from the healthcare field is also compelling: according to the 2019 Medscape National Physician Burnout, Suicide and Depression Report, physicians reported that their burnout caused them to feel less motivated and more likely to commit errors. So, it’s clear that the constant demand of bigger, better, faster, stronger from high-performing personalities can actually impair performance in the long term. Simply put, self-acceptance is the key to self-actualization.


Consider also the work of Shawn Achor, Harvard Professor of Psychology and author of The Happiness Advantage. According to Achor’s research, 75% of job success is predicted by the ability to see stress as a challenge, but not a threat (recall that high-performing personalities often carry an intense fear of failure). Achor has found that when the brain is in a positive state, the individual is significantly more successful in their performance, than when the brain is stressed. In fact, the research has found that intelligence, performance and most business outcomes improve when an individual reports higher levels of happiness (Lyubimirsky, 2005). Simply put, we work more efficiently and more intelligently when positive than when stressed. By that logic, when it comes to performance, mental health matters.


Strategies for Improving Performance


Many of our coaching and therapy clients alike come to our practice for help up-leveling their performance. They are often surprised to hear us suggest that the first step towards a successful future is to address trauma and/or manage stress. This recommendation is based on the research of Stulberg and Magness, Achor and others. Almost always, this suggestion is met with resistance. It's as if we're asking our clients to show up to work naked, and to some, it does feel this way. We interpret this resistance as the expression of fear that if the high-performing parts relax, the individual will suffer. Therefore, the first step is to address this resistance by allowing the fear its full expression, rather than stifle or ignore it. The following journal prompts can be helpful for addressing the fear-based roots of high performing personalities:


  1. What does this (perfectionistic, people-pleasing, workaholic, food restricting, overexercising) part fear might happen if it were to relax? (Ex. It fears that I will make a mistake, or that I'll stop trying.)

  2. If I gave that part a microphone, what would it say? How might it justify its existence? (Ex. If I make a mistake, people will be disappointed in me. They will think I am no good. I will feel worthless.)

  3. When was the first time I remember feeling this kind of fear? (Ex. When I was a child and I broke a glass, my parents screamed at me and each other. I thought it was all my fault.)

  4. What did I really need to feel safe in that moment? (Ex. I needed my parents to reassure me that it's okay to make mistakes and that they love me no matter what.)

When you can understand the roots of your high-performing compulsions, you can recognize their true intention when they flair. Ex. "I am re-reading this email draft for the tenth time, not because the email is that important, but because a part of me fears that if it isn't perfect, I will be exposed. I'll feel ashamed.” Experiment with this perspective to see if it helps diffuse some of the pressure to perform.


Once you have given voice to the fear that drives your need to perform, consider training your brain to harness what Achor calls "The Happiness Advantage," to optimize both emotional well-being and performance in all arenas. Pick one of the following and try it for 21 days in a row.


Random Acts of Kindness

Each morning, consider sending daily positive emails praising or thanking someone in your social network.

Gratitude Practice

At the end of each day, jot down three (new) good things that happened today. These can be small, such as "I enjoyed a delicious latte" or "Today's sunset was really beautiful." Gratitude practice enhances our sense that life is good, which can enhance our sense of safety and mitigate fear.

Meditation

Meditation practice improves creativity, enhances focus and reduces performance anxiety, in addition to myriad other benefits. Check out apps such as Calm and Headspace, or the book, Stress Less, Accomplish More by Emily Fletcher.

Exercise

Exercise stimulates the secretion of endorphins, enhances a sense of mastery and builds confidence. It also helps support neurotransmitter balance. Consider 30 minutes of cardio, 3-4x a week. Walking and yoga are also fabulous choices for mental health.

Honor One Small Commitment to Yourself Daily

According to Nicole LePera, PhD, author of How to Do the Work, setting one small goal to practice daily (and by small, think drinking a class of water in the morning, or going for a ten-minute walk around the block), can increase self-trust, self-esteem and a general sense of safety in the world.


Final Thoughts

We’ve covered how high performing personalities often develop to protect against the threat of emotional pain, including shame. The performance, be it people pleasing, perfectionism, or something else, works compulsively at its job, but it’s that very compulsion that can lead to stress, anxiety and burnout. In summary, the stress of the performance ultimately impairs performance. At Invited, our inbox and caseloads are full of people who are spectacularly successful by traditional standards, but who struggle with deep-rooted depression, anxiety and low-self worth. In many cases, those struggles have begun to erode how folks show up in work, family and social spheres. The support that we offer helps to process the trauma at the root of the compulsion, relieve the individual of their fear, and empower them to use their high-performing capacity to catapult them forward, instead of self-sabotage. Reach out to us today to explore how we can help you hone the intersection of your performance and well-being (because, say it with me: you can't have one without the other).


Lauren Farina-Prieto, LCSW is a clinician and founder of Invited Psychotherapy and Coaching, a private practice outside of Chicago, specializing in helping high performers embody their highest potential.


References


Achor, S. (2010). The Happiness Advantage: The seven principles of positive psychology that fuel success and performance at work. Crown Business/Random House.


LePera, N. (2021). How to do the work: recognize your patterns, heal from your past, and create your self. First edition. New York, NY, Harper Wave, an imprint of HarperCollinsPublishers.ui


Lyubomirsky, S., King, L., & Diener, E. (2005). The Benefits of Frequent Positive Affect: Does Happiness Lead to Success? Psychological Bulletin, 131(6), 803–855. https://doi.org/10.1037/0033-2909.131.6.803


Kane, L. (2019). Medscape National Physician Suicide, Burnout and Depression Report. Medscape: https://www.medscape.com/2019-lifestyle-burnout


Schwartz, R. C. (2021). No bad parts: healing trauma and restoring wholeness with the internal family systems model . Sounds True.

Lyubimirsky, S.


Stulberg, B., & Magness, S. (2017). Peak performance: elevate your game, avoid burnout, and thrive with the new science of success. Emmaus, Pennsylvania, Rodale Books.

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