Towards the end of last year, we reached out to our social media followers with an important question in the realm of mental health:
“When working with clinical procrastination, what would you say most commonly underlies this, in your experience?”
The responses were interesting and provided valuable insights that we can explore through the lens of ACT.
The results
Here’s how our community responded:
1) Perfectionism: 48%
2) Self-doubt / criticism: 31%
3) Shame / worry: 15%
4) Poor time management: 5%
We also received some comments, mainly highlighting that all were relevant therefore hard to pick a ‘top’ reason, as well as issues relating to both neurodiversity and menopause / perimenopause.
Underneath, we will unpick some of these answers and offer an ACT perspective on each of these.
1. Perfectionism
At nearly half of the responses, perfectionism emerged as the leading underlying factor contributing to clinical procrastination according to our followers. When we unpick this, many individuals fear not meeting their own high standards or the expectations of others. This relentless pursuit of perfection can create a paralysing fear of failure, leading to avoidance behaviours; this is formulated to be the central aspect for many of our clients. However, it is worthy of also considering the importance of psychological flexibility—being open to experiences without judgment. For perfectionists, accepting that imperfection is a natural part of life can ease the pressure to achieve flawless results. Using ACT, we would be encouraging our client to focus on values rather than goals, which come with these unattainable standards. Individuals can take begin to take action aligned with what truly matters to them in a direction focused, rather than goal focused manner.
2. Self-doubt and self-criticism
Coming in second, self-doubt and self-criticism accounted for 31% of the responses. Many individuals question their abilities, which can lead to hesitation and inaction. This inner critic can create significant barriers. In ACT we would encourage individuals to observe their thoughts without getting entangled in them. This could be noticing what this inner critic is saying and thanking their mind. Techniques such as cognitive defusion allow people to recognise self-critical thoughts as mere words rather than truths. By distancing themselves from these thoughts, individuals can reduce their impact and take meaningful action despite their doubts. These self-critical thoughts that show up can also give us really important information about someone’s values; in their inner pain we can shine a light on what is important to them, and then work on aligning their actions and behaviours with this using values-based work.
3. Shame and worry
15% of respondents identified shame and worry as contributing factors. These emotions can stem from past experiences or fears of judgment, making it challenging to engage with tasks that feel vulnerable. ACT promotes self-compassion and acceptance of one’s feelings in the same way as we accept our thoughts as words / information, but not absolute truths. Understanding that shame and worry are common human experiences can facilitate greater acceptance. By acknowledging these feelings and exploring what this tells us about what is important to them, individuals can move forward with greater purpose.
4. Poor time management
Lastly, only 5% of respondents attributed clinical procrastination to poor time management. While this concern is valid, it appears to be less of a core issue compared to the emotional and psychological factors highlighted above. Yet, this is so often considered as central when working with procrastination; many interventions focus in the first instance on time management / organisational skills. While time management strategies can be useful, these may not be applicable to many of our clients. However, it is worthy of note that perhaps these more practical interventions have already been completed before clients come through the therapy door. If this is an issue for your client, under the ACT lens, we would emphasise aligning actions with values. This could be unpicking why completing this task, or university course (for example) is important to someone. This can shed light on their values and use this to explore other barriers that may be showing up. By focusing on what truly matters, individuals may find it easier to prioritise tasks, making time management feel more purposeful rather than a chore.
Other comments
Clinician’s helpfully also provided more free text comments, including all are applicable. Whilst this is true, we were curious on the most common experiences as a guide for perhaps more beginner clinicians.
Another important common comment considered neurodiversity as paramount when working with clinical procrastination. This is important, and often get tied up with this idea of poor time management. It is really key to explore potential neurodivergence, particularly with the possible impact on executive functioning skills. This can not only guide the intervention focus, but also consider any adjustments / adaptations to therapy that might help to maximise it’s effectiveness.
Other comments included lack of interest, too many competing demands, distractibility, brain fog, hormones, menopause / perimenopause.
Biological factors is another key area to consider, and one again worthy of consideration when planning intervention adjustments. Brain fog can be part of the menopause / perimenopausal experience but also through other conditions including neurological aspects as well as post-viral fatigue. It is important to remember to take a full bio-psycho-social history as part of the assessment process so as not to place all focus within the behavioural components. The intervention can then focus on making values-based adjustments to their lives, or focusing on acceptance of the difficulties, dependent on the underlying biological cause. We have a really exciting workshop focused on using ACT with menopause / perimenopause currently in development – add yourself to our mailing list to hear more about this.
The insights gathered from our community highlight the complexity of clinical procrastination. It is not merely about poor time management; rather, it is deeply rooted in emotional factors like perfectionism, self-doubt, and shame. By applying principles from Acceptance and Commitment Therapy, we can foster greater awareness and acceptance of these underlying issues, supporting ourselves and others in overcoming procrastination.
For anyone wishing to explore applying ACT to procrastination in more detail, we have an exciting workshop coming up with Patricia Zurita Ona in February 2025.
