A randomized controlled trial of Internet-Based Cognitive Behavior Therapy for perfectionism including an investigation of outcome predictors

Is repeated mistake-making an effective treatment strategy for perfectionism? Findings from a randomized controlled trial

BACKGROUND AND OBJECTIVES

Perfectionism has been linked to self-criticism, procrastination, and psychological disorders. In a previous study, an exposure-based treatment for perfectionism (ETP), which included exposures targeted at concern over mistakes, showed positive outcomes when compared to waitlist. The aim of this study was to further investigate ETP by comparing it to a stress-management condition and assessing durability of treatment effects by conducting a one-month follow-up assessment.

METHODS

Eighty-five individuals with elevated perfectionism were randomly assigned to receive ETP (n = 43) or a stress management treatment (n = 42). ETP involved repeatedly practicing mistake-making by completing computerized tasks engineered to cause individuals to make mistakes. The stress management condition included listening to videos and answering questions about healthy habits, such as diet, exercise, and sleep, as well as viewing calming videos. Participants completed eight treatment sessions as well as baseline, post-test, and one month follow-up self-report questionnaires.

RESULTS

Contrary to predictions, compared to ETP, stress management led to significantly lower overall perfectionism, depression, generalized anxiety, and social anxiety at post and significantly lower depression, generalized anxiety, and social anxiety at follow-up. Further, individuals who completed ETP did not habituate to the exposure tasks, but distress increased from the first to the last treatment session.

LIMITATIONS

The duration of treatment was relatively brief.

CONCLUSIONS

This study highlights the importance of using active psychological control conditions in treatment outcome studies and the need to test various components of treatments for perfectionism to observe what may be effective or even potentially iatrogenic.

Treating perfectionism via the Internet: a randomized controlled trial comparing cognitive behavior therapy to unified protocol

Perfectionism can be problematic when your self-worth is dependent on achievements and leads to inflexible standards, cognitive biases, and rigid behaviors. Cognitive behavior therapy for perfectionism is shown to be effective, including for targeting psychiatric symptoms and when delivered via the Internet (iCBT-P). However, few studies have compared it to an active comparator. The current study randomly assigned 138 participants seeking help for perfectionism to iCBT-P or Internet-based Unified Protocol (iUP). Both treatments provided guidance on demand from a therapist and were eight weeks in duration. The results indicated large within-group effects of Cohen's d 2.03 (iCBT) and 2.51 (iUP) on the Clinical Perfectionism Questionnaire at post-treatment, and maintained effects at 6- and 12-month follow-up, but no between-group difference (β = 0.02, SE = 1.04, p = .98). Secondary outcomes of depression, anxiety, quality of life, self-compassion, procrastination, and stress ranged from small to large, with no differences between the conditions. Both treatments were deemed credible, relevant, of high quality, and well-adhered by the participants. Further research needs to be conducted, but the findings could indicate a lack of specificity, perhaps suggesting there is no need to differentiate between different treatments that are transdiagnostic in nature.

A pilot feasibility and acceptability trial of an internet indicated prevention program for perfectionism to reduce eating disorder symptoms in adolescents

PURPOSE

Perfectionism is a transdiagnostic risk factor for eating disorders. Treating perfectionism can reduce symptoms of eating disorders. No research has examined an indicated prevention trial using internet-based Cognitive-Behavioural Therapy for Perfectionism (ICBT-P) in adolescent girls at elevated risk for eating disorders. Our aim was to conduct a preliminary feasibility trial using a co-designed ICBT-P intervention. It was hypothesised that a higher proportion of participants in the ICBT-P condition would achieve reliable and clinically significant change on perfectionism, eating disorders, anxiety and depression, compared to waitlist control.

METHODS

Twenty-one adolescent girls with elevated symptoms of eating disorders (M age = 16.14 years) were randomised to a 4-week online feasibility trial of a co-designed ICBT-P prevention program or waitlist control. Qualitative surveys were used to gain participant perspectives.

RESULTS

The ICBT-P condition had a higher proportion of participants achieve reliable change and classified as recovered on perfectionism and symptoms of eating disorders and anxiety, compared to waitlist control. Qualitative findings indicated that 100% of participants found the program helpful.

CONCLUSION

The results indicate ICBT-P is a feasible and acceptable program for adolescent girls with elevated eating disorder symptoms. Future research is required to examine outcomes in a randomised controlled trial.

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

TRIAL REGISTRATION NUMBER

This trial was prospectively registered with Australian and New Zealand Clinical Trials Registry (ACTRN12620000951954P) on 23/09/2020.

A pilot study of the perceptions and acceptability of guidance using artificial intelligence in internet cognitive behaviour therapy for perfectionism in young people

Perfectionism is a transdiagnostic process associated with a range of psychological disorders. Cognitive Behaviour Therapy for Perfectionism (CBT-P) has been demonstrated as efficacious across guided and unguided internet delivered interventions in reducing perfectionism and psychopathology. The aim of this pilot study was to understand perceptions and acceptability of an artificial intelligence supplemented CBT-P intervention (AI-CBT-P) in young people with lived experience of anxiety and depression (n = 8; age range 19-29 years, M = 24 years, SD = 3.77; 50 % female, 38 % male, 12 % non-binary). Young people reported that they were frequent users of artificial intelligence for study, work and general information, were positive about the intervention and using artificial intelligence for guidance in a self-help intervention, but also noted several concerns. Young people perceived numerous benefits to AI-CBT-P, including ease of access, low cost, lack of stigma and benefits for individuals with social anxiety. Overall, young people appear to be interested in, and have a positive view of, AI-CBT-P. Further research is now required to examine the feasibility and acceptability of the intervention.

A randomized clinical trial of a gamified app for the treatment of perfectionism

OBJECTIVES

Perfectionism is a common transdiagnostic problem that may lead to substantial distress and functional impairments. Cognitive behavioural therapy (CBT) is an effective treatment for perfectionism. However, the existing significant barriers to access and utilization of mental health services, including among college students, demand the development of low-intensity accessible interventions. The aim of the present study was to evaluate the effectiveness of a low-intensity CBT-based self-help gamified app developed specifically for perfectionism in a sample of college students.

METHODS

Participants completed assessments of perfectionism, related symptoms, emotional burden and functional impairments at pretreatment, posttreatment and at one-month follow-up.

RESULTS

Compared with the waitlist condition (n = 35), the app condition (n = 35) demonstrated a significant and greater reduction in perfectionism, obsessive-compulsive symptoms, functional impairments and subjective ratings of emotional burden.

CONCLUSIONS

Results suggest that a brief, daily app-based game-like intervention targeting maladaptive perfectionistic beliefs may be a viable, low-cost alternative to traditional CBT treatments for vulnerable populations on college campuses.

Internet interventions for perfectionism: a meta-analysis and proposals for the college setting

ObjectiveSuh et al (2019) found that treatments for perfectionism, even online, reduce perfectionism and concomitant psychopathology. This meta-analysis investigated the efficacy of Internet interventions and psychotherapeutic interventions for perfectionism as potential tools for overburdened college counseling centers where perfectionism is particularly prevalent. Method: PubMed, MEDLINE, and PsycINFO were searched for relevant treatment studies. Comprehensive Meta-analysis V3 was used to compute and pool effect sizes for perfectionism and concomitant psychopathology. Results: Psychological interventions (N = 18) for perfectionism yielded significant reductions in perfectionistic strivings (g = .394; n = 16), concerns (g = .603; n = 17), and clinical perfectionism (g = .960; n = 8). Effect sizes were small-to-medium for depression (g = .601; n = 12), anxiety (g = .399; n = 13), and eating disorder symptoms (g = .477; n = 7). Effect sizes were similar for Internet-mediated and non-Internet-mediated interventions. Most interventions used 8-10-session cognitive-behavioral therapy of perfectionism. Conclusion: Internet interventions for perfectionism reduce perfectionism and concomitant psychopathology. College counseling centers could eventually use them to reduce demand for in-person services.

The development of co-designed parent-supported cognitive behaviour therapy for perfectionism in adolescents with eating disorders: initial feasibility and acceptability

BACKGROUND

Perfectionism is significantly associated with symptoms of eating disorders in adolescents. Studies to date have not examined parent-supported CBT for perfectionism in eating disorders (CBT-P-ED). We co-designed the treatment and conducted a feasibility trial.

METHODS

Eight parents of adolescents with eating disorders (M age = 48.75 years, 100% female) engaged in three co-design workshops to create a parent-supported CBT-P-ED self-help intervention. A further 10 parents (M age 41.8 years, 50% female) and their adolescent offspring (n = 10, M age 15.4 years, 60% female, 50% with self-reported diagnosis of anorexia nervosa) participated in a feasibility trial and provided feedback on the intervention.

RESULTS

The parents who engaged in the co-design workshops suggested several areas to optimise the perfectionism intervention, including using plain language, the impact of parental perfectionism, how to engage with their adolescent in treatment and the importance of increasing eating disorder specific material. Feedback from the feasibility trial suggested that the intervention was acceptable and feasible with 100% of parents and adolescents saying it was useful, and no attrition.

CONCLUSIONS

Parent-supported CBT-P-ED appears to be feasible. Future research is now required in a randomised controlled trial.

Efficacy of transdiagnostic cognitive-behavioral therapy for assertiveness: A randomized controlled trial

Assertiveness training has been an essential component in cognitive-behavioral therapy (CBT), for example, in the treatment of social anxiety and in dialectical behavioral therapy. However, the assertiveness construct has garnered little attention in recent clinical research. The objective of this study was to investigate the efficacy of an eight-week transdiagnostic stand-alone internet-based CBT intervention specifically aimed at increasing levels of assertive behavior. Following inclusion, we randomized N = 210 participants into three groups: therapist-guided self-help, unguided self-help, and a wait-list control condition. After a one-year follow-up, we employed a linear mixed model to estimate the effects at both post-test and follow-up for the primary outcome measures of assertiveness, Adaptive and Aggressive Assertiveness Scales, the Rathus Assertiveness Schedule, and secondary outcome measures of anxiety, depression, and general well-being. We also assessed reliable clinical change. Compared to the wait list at the post-treatment, estimated between-group effect sizes on self-rated adaptive assertiveness were statistically equivalent for the two treatment groups both at the post and at the one-year follow-up time points, ranging from ES = 0.95 to 1.73, with reliable clinical recovery proportions from 19 % to 36 %. The increase in aggressive assertiveness ranged from ES = 0.62 to 0.90 compared to the wait-list condition at post. For social anxiety symptoms, the effects compared to the wait list at post-treatment ranged from ES = 0.67 to 0.93, with a reliable clinical recovery rate from 16 % to 26 %. For self-assessed well-being, the effects compared to the wait list at post ranged from ES = 0.70 to 1.05. No effects were observed for generalized anxiety, although within-group evidence was found for a medium effect on depression one year after treatment. Overall, the two treatment conditions produced similar effects. In general, participation increased healthy assertive expressions regardless of treatment condition, all the while reducing self-assessed social anxiety and, over time, possibly also depression. Participation also improved general well-being. The findings demonstrate that the assertiveness construct can be a suitable target for intervention, with reductions of both psychiatric symptoms and non-syndromal problems in daily life. The study was preregistered at ClinicalTrials.gov (NCT04240249).

Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism

It has been 21 years since the publication of the cognitive behavioural model of clinical perfectionism that underpins cognitive behaviour therapy (CBT) for perfectionism. The notion of clinical perfectionism and CBT for perfectionism has been controversial. Despite 15 randomised controlled trials which have demonstrated the efficacy of CBT for perfectionism in reducing perfectionism and symptoms of anxiety, depression and eating disorders, strong responses to this work continue to appear in the literature. In this article, we examine the evolution and controversy surrounding clinical perfectionism, the efficacy of CBT for perfectionism, and future directions for the concept of perfectionism and its treatment. Future research should aim to provide independent evaluations of treatment efficacy, compare CBT for perfectionism to active treatments, conduct dismantling trials to examine the effective components of treatment, and examine the causal processes involved in perfectionism. We provide recommendations for future pathways to support innovation in theory, understanding, and treatment of perfectionism with a view towards improving clinical outcomes.

Computerized treatment of perfectionism through mistake making: A preliminary study

BACKGROUND AND OBJECTIVES

Perfectionism has important implications for self-worth, personal standards, and psychopathology. The aim of this study was to test the efficacy of a novel two-week, computerized, exposure-based treatment for perfectionism (ETP).

METHODS

Seventy-one university students with elevated perfectionism were randomized to either the ETP group (n = 36) or the waitlist (WL) control group (n = 35). The ETP group was asked to complete the intervention at home, every three days for two weeks for a total of five treatment sessions. The tasks in the ETP condition were engineered to have participants repeatedly make mistakes. All participants returned two weeks after the baseline visit for a post-treatment assessment.

RESULTS

Compared to WL, ETP led to lower overall perfectionism, concern over mistakes, personal standards, depressive symptoms, social anxiety symptoms, and error sensitivity at post-treatment. No effects of treatment were found on trait anxiety, obsessive-compulsive symptoms, or eating disorder symptoms.

LIMITATIONS

Participants were university students of similar age and education level, which restricts generalizability. Additionally, the study relied on a waitlist control condition.

CONCLUSIONS

This study provided preliminary evidence for a novel online intervention for perfectionism.

A pilot randomised controlled trial of guided self-help cognitive behaviour therapy for perfectionism: Impact on diagnostic status and comorbidity

BACKGROUND AND OBJECTIVES

Perfectionism is associated with the development and maintenance of anxiety, mood, and eating disorders. Cognitive behaviour therapy (CBT) results in significant reductions in perfectionism and psychological symptoms however, the majority of studies have not examined clinical samples or impact on diagnostic status and comorbidity.

METHODS

Forty participants with elevated perfectionism, of whom 80% had a range of psychological disorders, were randomised to CBT for perfectionism or waitlist control.

RESULTS

The treatment group reported significant large effect size reductions in perfectionism measures of personal standards and concern over mistakes (d = 1.1-1.6), dichotomous thinking (d = 1.2), and medium effect size reductions in depression (d = 0.55) and increases in quality of life (d = 0.73), which were maintained at 4 month follow-up. The participants in the treatment group were significantly less likely to present with comorbid psychological disorders at post-treatment than the control group.

LIMITATIONS

The sample size was small, and there was no control condition at follow-up.

CONCLUSIONS

Findings lend further support for CBT for perfectionism as an efficacious transdiagnostic treatment for perfectionism and related psychopathology.

A Randomized Test of Interpretation Bias Modification for Perfectionism Versus Guided Visualization Relaxation Among High Perfectionistic Undergraduate Students

Clinical perfectionism contributes to the onset and maintenance of multiple psychological concerns. We conducted a randomized, longitudinal test of the efficacy of a web-based intervention for perfectionism (specifically, cognitive bias modification, interpretation retraining; CBM-I), compared to an active treatment comparison condition (specifically, guided visualization relaxation training) for reducing perfectionism and related psychopathology. College students (N = 167) with elevated perfectionism were randomized to one of the two study conditions and were asked to complete their assigned intervention twice weekly for 4 weeks. Participants completed measures of perfectionism and psychological symptoms at baseline, 2 weeks (midway through the intervention period), 4 weeks (at the conclusion of the intervention period), and 8 weeks (1 month follow-up). CBM-I was rated as acceptable overall, though relaxation training was rated slightly more favorably. CBM-I outperformed relaxation training on improving perfectionism-relevant interpretation biases (i.e., increasing nonperfectionistic interpretations and decreasing perfectionistic interpretations), though with small effect sizes and inconsistency across study timepoints. Self-reported perfectionism showed small decreases across time in both intervention conditions. Support was found for a key hypothesized mechanism of CBM-I, such that randomization to CBM-I had a longitudinal, indirect effect on decreasing psychopathology symptom scores through improving perfectionism-relevant interpretation biases. However, in light of small effect sizes, the present study failed to provide compelling evidence that CBM-I for perfectionism contributes meaningfully to the treatment of perfectionism.

A protocol for unguided internet self-help cognitive behaviour therapy for perfectionism in adolescents at-risk of eating disorders

Perfectionism has a strong association with eating disorders, anxiety and depression. Unguided internet cognitive behaviour therapy for perfectionism has demonstrated efficacy in female adolescents without elevated eating disorder symptoms. No research to date has examined unguided internet cognitive behaviour therapy for perfectionism for adolescents with elevated eating disorder symptoms as an indicated prevention for eating disorders and co-occurring symptoms of anxiety and depression. The protocol outlines the plan for a randomised controlled trial of a co-designed, unguided internet cognitive behaviour therapy for perfectionism with female adolescents with elevated symptoms of eating disorders. The intervention will be a 4-week programme compared to a waitlist control. Outcomes on eating disorder symptoms, anxiety and depression will be measured pre and post intervention and follow-up.

TRIAL REGISTRATION

This trial was registered on 23 September 2020 with the Australian New Zealand Clinical Trials Registry (ACTRN12620000951954P).

Online process-based training for perfectionism: A randomized trial

Process-based therapy (PBT) is model of psychotherapy designed to improve people's ability to use a variety of skills from evidence-based treatments to match environmental needs and personal goals in the moment. This randomized trial tested the effect of an online self-help intervention modeled after PBT principles for participants with perfectionism (N = 77). The intervention comprised two four-session trainings teaching skills from different evidence-based treatments (e.g., cognitive-behavioral therapy, acceptance and commitment therapy) and targeting cognitive and motivational processes: (1) cognitive training and (2) motivational training respectively. Participants completed 17 assessments throughout the intervention and at 3- and 6-month follow-up. Results indicated that the full intervention led to improvement in perfectionism, self-compassion, psychological distress, and cognitive skills targeted by the cognitive intervention (e.g., cognitive defusion; absolute βs = 0.02 to 0.66). In addition, the second four-session training (i.e., training after first four-session training) was associated with improvements in perfectionism, self-compassion, quality of life, and psychological distress (absolute βs = 0.09 to 2.90), suggesting it had incremental benefit. Whereas the cognitive training appeared to specifically impact cognitive processes, the motivational training increased both cognitive and motivational processes. These findings provide initial support for the feasibility and efficacy of a process-based approach, because they show that participants can benefit from learning skills from different orientations and applying them with reference to their goals. However, specific aspects of the PBT model, including whether interventions can precisely improve targeted skills, still need to be empirically tested in larger and more diverse clinical samples.

The impact of obsessive-compulsive personality disorder in perfectionism

OBJECTIVE

The construct of perfectionism has long been related to Obsessive-Compulsive Personality Disorder (OCPD), though research has not considered how OCPD could distinguish individuals with elevated perfectionism. The aim of this study was to evaluate clinical differences between those with and without OCPD in a sample of individuals with elevated perfectionism.

METHODS

Seventy-four university students with elevated perfectionism completed a diagnostic assessment and several self-report measures of clinical characteristics and were randomly assigned to complete an exposure-based treatment for perfectionism or waitlist. Thirty-four (45.95%) participants met DSM-IV diagnostic criteria for OCPD.

RESULTS

Compared to those without OCPD, individuals with OCPD had higher levels of general and specific domains of perfectionism and higher levels of social anxiety. OCPD diagnosis was also associated with higher rates of current anxiety disorder. Importantly, those with and without OCPD showed comparable benefits from treatment.

CONCLUSIONS

This study provides novel evidence of the role of OCPD in perfectionism and demonstrates the efficacy of a perfectionism-oriented treatment in individuals with OCPD.Key pointsWe examined the role of obsessive-compulsive personality disorder (OCPD) in a high perfectionism sample.OCPD was associated with higher perfectionism and personal standards.OCPD was also associated with higher social anxiety and higher rates of current anxiety disorder.Those with and without OCPD had comparable responses to an exposure-based treatment for perfectionism.

Internet-based CBT for adolescents with low self-esteem: a pilot randomized controlled trial

Low self-esteem is a common problem among adolescents and is related to psychiatric problems such as depression and anxiety. However, effective and available interventions primarily targeting low self-esteem are scarce, in particular for youths. To address this gap, the aim of this pilot study was to evaluate a novel internet-based Cognitive Behavioral Therapy (ICBT) program for low self-esteem in adolescents using a randomized controlled design. Fifty-two participants (15-19 years) were recruited and randomly allocated to seven weeks of therapist-supported ICBT (n=26) or to a waitlist control condition (n=26). The primary outcome was the Rosenberg Self-Esteem Scale (RSES). Secondary outcomes measured domain-specific aspects of self-esteem, self-compassion, quality of life, depression and anxiety. The treatment group showed significantly higher levels of self-rated self-esteem compared to the control group at post-treatment, with a large between-group effect-size (RSES, d = 1.18). Further, the treatment had significant positive impact on secondary measures of self-esteem, self-compassion, quality of life, depression and anxiety. The results of this pilot-RCT suggest that ICBT can be effective for treating low self-esteem in adolescents, decrease depression and anxiety levels, and increasing quality of life. Replication of the results in larger samples is needed.

Intervention for Nigerian preservice historians' maladaptive academic perfectionism: Implications for history lecturers

BACKGROUND

Individuals enrolled in a university program that will lead to a degree in history are considered preservice historians in the context of this study. Their goal is to become professional historians after graduating from the university. The purpose of this study was to determine whether cognitive behavioral coaching (CBC) had an effect on maladaptive academic perfectionism in Nigerian preservice historians.

METHOD

The study included a randomized sample of 98 preservice historians from Nigerian public universities in the country's Southeast zone [49 preservice historians were assigned to the cognitive behavioral coaching group-CBC Group, while 49 preservice historians were assigned to the waitlist control group-Waitlist control Group].

RESULTS

The finding indicate that preservice historians' maladaptive academic perfectionism decreased significantly following cognitive behavioral coaching. There was also a significant interaction effect of time and group on the reduction of preservice historians' maladaptive academic perfectionism.

CONCLUSION

This study suggests that cognitive behavioral coaching is an effective intervention for preservice historians who struggle with maladaptive academic perfectionism. The study's implications for history lecturers were discussed. Future study could investigate how maladaptive academic perfectionism affects postgraduate history students and how CBC can help them.

A self-report measure of perfectionism: A confirmatory factor analysis of the Swedish version of the Clinical Perfectionism Questionnaire

Background

Perfectionism is often defined as the strive for achievement and high standards, but can also lead to negative consequences. In addition to affecting performance and interpersonal relationships, perfectionism can result in mental distress. A number of different self-report measures have been put forward to assess perfectionism. Specifically intended for clinical practice and research, the Clinical Perfectionism Questionnaire (CPQ) was developed and is presently available in English and Persian. To promote its use in additional contexts, the current study has translated and investigated the psychometric properties of the Swedish version of the CPQ.

Method

A Confirmatory Factor Analysis was performed to examine the best fit with data, using a priori-models and a sample of treatment-seeking participants screened for eligibility to receive Internet-based cognitive behavior therapy (n = 223).

Results

The results indicated a lack of fit with data. A two-factor structure without the two reversed items (2 and 8) exhibited the best fit, perfectionistic strivings and perfectionistic concerns, but still had poor structural validity. Correlations with self-report measures of perfectionism, depression, anxiety, dysfunctional beliefs, self-criticism, quality of life, and self-compassion were all in the expected directions. Eight-week test-retest correlation was Pearson r = .62, 95% Confidence Interval [.45, .74], using data from 72 participants in the wait-list control, and the internal consistency for the CPQ, once removing the reversely scored items, was Cronbach’s α = .72.

Conclusion

The CPQ can be used as a self-report measure in Swedish, but further research on its structural validity is needed.

Conceptual replication of , "Self-efficacy as a mediator in the relationship between self-oriented perfectionism and academic procrastination"

BACKGROUND

Self-oriented perfectionism is the tendency to set high standards for oneself and evaluate one's behaviour accordingly. Based on a study of 692 students in Korea, Seo (2008) reported finding a negative relationship between self-oriented perfectionism and academic procrastination - i.e., the tendency to procrastinate on academic tasks. Furthermore, Seo reported that this relationship was completely mediated by self-efficacy. Seo's study has been influential in the literature but to our knowledge has not yet been independently replicated. In this study we report a preregistered conceptual replication testing five hypotheses based on Seo's key findings.

PARTICIPANTS AND PROCEDURE

A detailed preregistration (including data processing and analysis syntax) was lodged in advance of data collection at https://osf.io/xfvd8. Participants were 575 students recruited from OECD countries using prolific.co. Academic procrastination was measured via an adapted version of the Procrastination Assessment Scale - Students, while self-oriented perfectionism was measured via the 5-item self-oriented perfectionism subscale of the Big Three Perfectionism Scale. Self-efficacy was measured via the New General Self-Efficacy Scale. Both ordinary least squares regression and structural equation modelling were used to test hypotheses.

RESULTS

We found no evidence of a bivariate relationship between self-oriented perfectionism and academic procrastination in either set of analyses. However, we did find evidence of a small and negative indirect effect of self-oriented perfectionism on academic procrastination via self-efficacy.

CONCLUSIONS

We were only able to partially replicate Seo's key findings, having found no evidence of a negative relationship between self-oriented perfectionism and academic procrastination.

Feasibility study of respiratory function home monitoring for patients with Myasthenia Gravis

BACKGROUND

Myasthenia gravis (MG) is a rare and chronic autoimmune neuromuscular disease that causes weakness among skeletal muscles responsible for mobility and breathing. Individuals with MG who have difficulty breathing may need to schedule an emergent provider visit where a negative inspiratory force (NIF) measurement test is performed to measure respiratory strength.

PURPOSE

Examine the feasibility of individuals with MG to perform NIF respiratory function monitoring in the home setting and determine its impact on their perceived quality of life.

METHODS

This is a quantitative one-group pretest-posttest study of 30 individuals (18-75 years old) who carry the diagnosis of MG and have been stable with treatment for at least 30 days. Participants completed the Brunnsviken Brief Quality of Life Scale (BBQ-LS) and the System Usability Scale (SUS) prestudy. Participants were required to independently perform and record their NIF measurements twice daily for 14 days. After completing the 14 days, participants completed the BBQ-LS, SUS, and an end-of-study survey.

RESULTS

There was a significant difference in BBQ-LS scores at baseline (M = 62.97, SD = 17.84) and poststudy (M = 98.2, SD = 13.63) (t[29] = -5.39, p <.000). System Usability Scale scores were significantly different at baseline (M = 77.25, SD = 11.05) than at study completion (M = 94.42, SD = 5.64) (t[29], = -8.04, p = .000).

CONCLUSION

Study results indicate that it is feasible for individuals with MG to perform NIF readings in the home setting and demonstrated an increase in the perceived quality of life.

IMPLICATIONS

Future large-scale studies can help determine the adoption of handheld NIF monitoring at home for individuals with MG.

The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: a systematic review and meta-analysis

Perfectionism is a transdiagnostic process across anxiety, depression, and eating disorders. The aim of this systematic review was to examine the efficacy of self-help and face to face CBT for perfectionism in reducing perfectionism and anxiety, depression, and eating disorders. A total of 15 randomised controlled trials of CBT for perfectionism were identified (N = 912 participants; mean pooled age = 23 years) which met inclusion criteria. There were medium or large effect sizes found on perfectionism measures; personal standards (g = 0.57, 95% CI = 0.43-0.72), concern over mistakes (g = 0.89, 95% CI = 0.71-1.08) and clinical perfectionism (g = 0.87, 95% CI = 0.70-1.04). There were medium effects for symptoms of eating disorders (g = 0.61, 95% CI = 0.36-0.87) and depression (g = 0.60, 95% CI = 0.28-0.91), and a small-medium effect on anxiety (g = 0.42, 95% CI = 0.21-0.62). There was no publication bias found. Limitations included the small number of trials included and lack of active treatment comparisons. Results suggested that CBT for perfectionism is efficacious in reducing perfectionism and symptoms of depression, anxiety and eating disorders. Future research should examine comparisons of CBT for perfectionism with other psychological treatments.

A Randomised Controlled CBT Intervention for Maladaptive Perfectionism: Outcome and Predictors

Maladaptive perfectionism has been associated with certain mental health problems. Moreover, studies suggest that the development of perfectionism can be attributed to childhood experiences and, more specifically, to parenting styles. (1) Background: The aims of the present study were first to examine the relationship of perfectionism to perceived parenting and current symptoms of depression and anxiety and, secondly, to study the effectiveness of a group CBT intervention program for high perfectionism; (2) Methods: Participants were 81 young Greek adults with relatively high scores in perfectionism. They were randomly allocated to two conditions: either the intervention group (IG; n = 40) or a non-active control group (CG; n = 41). The intervention group received a CBT intervention of 10 weekly sessions, while assessments were made in two time points for both groups; (3) Results: There was significant correlation of perfectionism with perceived parental indifference, abuse, and overcontrol as well as measures of anxiety and depression. Results showed significant decrease in perfectionism and other symptoms in the IG. Although perceived paternal indifference and abuse could predict perfectionism at pre-intervention, no pre-intervention variable could predict the perfectionism intervention outcome; (4) Conclusions: Overall, the study suggests that maladaptive perfectionism is associated with perceived negative parenting and current anxiety and depression and that a group CBT intervention can address specific dimensions of maladaptive perfectionism.

The impact of internet-based cognitive behaviour therapy for perfectionism on different measures of perfectionism: a randomised controlled trial

The current study investigated the impact of an 8-module internet-based cognitive behaviour therapy for perfectionism (ICBT-P) across a variety of perfectionism subscales. Undergraduate students who identified as having a problem with perfectionism were randomized to receive the intervention (n = 41), and were free to choose the number of treatment modules they completed over a 4-week period, while the control group (N = 48) received access to treatment 8 weeks post-randomisation. Secondary measures included depression, anxiety, stress, body image and self-compassion. Assessments occurred at baseline, 2-, 4- and 8-week time points. A mean of 3.12 (SD = 2.67) modules were completed; 7 participants (17%) completed none and 6 (15%) completed all. Linear mixed modelling (with baseline observation included as a covariate) showed significant Bonferroni-adjusted post-hoc between-group differences for 5 of the 6 perfectionism measures, favouring the intervention group; the most robust between group effect sizes were for the Concern over Mistakes (d = -0.82), High Standards (d = -0.69), and Perfectionistic Standards (d = -0.47) subscales. There were no between-group differences for our secondary measures. ICBT-P was found to be an effective intervention for reducing different components of perfectionism compared to a control group. The relatively low use of modules may have contributed to a lack of effect on secondary measures.Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12620000562976.

Perfectionism and Burnout in Athletes: The Mediating Role of Perceived Stress

Perfectionism is a consistent predictor of athlete burnout. Researchers have therefore sought to examine the psychological mechanisms that may explain this relationship. In the present study, guided by Smith’s cognitive-affective stress model, we extend existing research by examining whether perceived stress is one such explanatory factor. A sample of 256 adult athletes completed measures of perfectionism (perfectionistic strivings and perfectionistic concerns), perceived stress, and burnout. Correlational analyses indicated that perfectionistic concerns was positively related to burnout, while perfectionistic strivings was either negatively related or unrelated to burnout. Tests of bias-corrected bootstrapped indirect effects showed that perceived stress mediated the positive relationship between perfectionistic concerns and burnout. This finding was evident when examining total burnout and all three burnout symptoms. It appears that athletes high in perfectionistic concerns are likely to experience heightened levels of stress in sport which may in turn render them more vulnerable to burnout.

The comparison between CBT focused on perfectionism and CBT focused on emotion regulation for individuals with depression and anxiety disorders and dysfunctional perfectionism: a randomized controlled trial

BACKGROUND

There is considerable evidence indicating that similar aetiological and maintenance processes underlie depressive and anxious psychopathology. According to the literature, perfectionism and emotion regulation are two transdiagnostic constructs associated with symptoms of emotional disorders.

AIMS

This study is the first randomized controlled trial comparing the efficacy of cognitive behavioural therapy for perfectionism (CBT-P) and the unified protocol for the transdiagnostic treatment of emotional disorders (UP).

METHOD

Seventy-five participants with a range of depressive and anxiety disorders and elevated perfectionism were randomized to three conditions: CBT-P, UP or a waitlist control (WL).

RESULTS

Repeated measures ANOVA indicated that the treatment groups reported a significantly greater pre-post reduction in the severity of symptoms of disorders, as well as a significantly greater pre-post increase in quality of life, all with moderate to large effect sizes compared with the WL group. Treatment gains were maintained at 6-month follow-up. The CBT-P group reported a significantly greater pre-post reduction in perfectionism compared with UP, and the UP group reported a significantly greater pre-post improvement in emotion regulation compared with CBT-P.

CONCLUSIONS

Findings support CBT for perfectionism and regard UP as efficacious treatments for individuals with depression and anxiety disorders who also have dysfunctional perfectionism. It appears that perfectionism cannot be a serious obstacle to UP. As this is a preliminary study and has some limitations, it is recommended that further research be conducted.

Treating perfectionism using internet-based cognitive behavior therapy: A study protocol for a randomized controlled trial comparing two types of treatment

Perfectionism is characterized by setting high standards and striving for achievement, sometimes at the expense of social relationships and wellbeing. Despite sometimes being viewed as a positive feature by others, people with perfectionism tend to be overly concerned about their performance and how they are being perceived by people around them. This tends to create inflexible standards, cognitive biases, and performance-related behaviors that maintain a belief that self-worth is linked to accomplishments. Cognitive behavior therapy has been shown to be a viable treatment for perfectionism, both in terms of reducing levels of perfectionism and improving psychiatric symptoms. Furthermore, a number of recent studies indicate that it can be successfully delivered via the Internet, both with regular support and guidance on demand from a therapist. In the present study protocol, a clinical trial for perfectionism is described and outlined. In total, 128 participants will be recruited and randomized to either a treatment that has already been demonstrated to have many benefits, Internet-based Cognitive Behavior Therapy for perfectionism (iCBT-P), or an active comparison condition, Internet-based Unified Protocol (iUP), targeting the emotions underlying depression and anxiety disorders. The results will be investigated with regard to self-reported outcomes of perfectionism, psychiatric symptoms, self-compassion, and quality of life, at post-treatment and at six- and 12-month follow-up. Both iCBT-P and iUP are expected to have a positive impact, but the difference between the two conditions in terms of their specific effects and adherence are currently unknown and will be explored. The clinical trial is believed to lead to a better understanding of how perfectionism can be treated and the specificity of different treatments.

Struggling with perfectionism: When good enough is not good enough

Perfectionism includes a tendency for high standards for self and others with a clear goal of successful performance in a variety of areas. A perfectionist often reacts with critical evaluations whenever performance falls below these standards. Moreover, perfectionists emphasize personal goals to gauge their worth, neglecting intimate bonds or openness to new experience. At the core of perfectionism lies a view of self as weak, flawed, and easily rejected. Perfectionism can result in chronic tendencies for emotional distress and interpersonal conflict. Treatment aims to explore personal views of self and others, viewing perfectionism as a form of maladaptive coping. When clients understand the role of perfectionism, they can discontinue striving to meet their extreme goals and unrealistic standards. The authors of the papers in the issue present their views on how to treat these maladaptive tendencies according to their preferred therapeutic orientation.

Guided Internet-delivered cognitive behaviour therapy for perfectionism in a non-clinical sample of adolescents: A study protocol for a randomised controlled trial

BACKGROUND

Perfectionism is elevated across a range of psychopathologies and has been shown to impede treatment outcomes. There is also evidence suggesting elevated perfectionism may contribute to the onset and maintenance of non-suicidal self-injury. There is a growing body of evidence suggesting that Internet-delivered cognitive-behavioural therapy for perfectionism reduces perfectionism and symptoms of psychological disorders and that reductions are maintained at 3-month and 6-month follow-up. There may also be reductions in non-suicidal self-injury, although no study has investigated this potential benefit. Given that associations between perfectionism and psychopathology are observed across both adults and adolescents, the need for the development of interventions targeting adolescents is essential for early intervention and prevention.

METHODS

The present study will employ a randomised controlled trial to examine the efficacy of 8-week guided Internet-delivered cognitive-behavioural therapy for perfectionism in adolescents compared to a waitlist control group. The primary outcome is perfectionism, and secondary outcomes include symptoms of psychological disorders, well-being, and non-suicidal self-injury. Outcomes will be assessed at pre-intervention, post-intervention, 1-month follow-up, 3-month follow-up, and 6-month follow-up. A minimum of 240 participants will be recruited online through social media, Australian universities, and schools across Australia. Generalised linear mixed models will be used to test for changes in outcomes between the intervention group and the waitlist control.

DISCUSSION

The outcomes of this trial will contribute to the literature on perfectionism and psychopathology in adolescents, as well as the efficacy of guided Internet-delivered interventions for adolescents.

TRIAL REGISTRATION

The trial was registered on the 20th of June 2019 at the Australia New Zealand Clinical Trials Registry (ACTRN12619000881134).

TRIAL STATUS

This is protocol version 1.0. Participant recruitment began on 31 July 2019 and is still actively running with an anticipated completion date in the fourth quarter of 2020.

Beyond perfect? A case illustration of working with perfectionism using cognitive behavior therapy

Perfectionism can result in negative consequences for those who set unattainable goals and repeatedly strive to achieve high standards. Relying on inflexible behaviors and building one's self‐worth around success can become problematic and affect performance, interpersonal relationships, and cause mental distress. In the current case illustration, perfectionism's negative implications are depicted through a client named Sara, a stressed‐out junior physician who just graduated from medical school. Struggling with issues related to self‐worth, depression, worry, independence, and interpersonal difficulties, Sara underwent cognitive behavior therapy during 15 sessions. The case illustration shows how an individualized conceptualization of perfectionism can be made and what is important to target in treatment, such as preventing the need for repeated checking, conducting surveys to refute dysfunctional beliefs, and introducing activities that are unrelated to accomplishments. Current research on the efficacy of treating perfectionism is also summarized and interventions particularly relevant for clinical practice are presented.

Effects of an automated digital brief prevention intervention targeting adolescents and young adults with risky alcohol and other substance use: study protocol for a randomised controlled trial

INTRODUCTION

Adolescence and young adulthood is a period in life when individuals may be especially vulnerable to harmful substance use. Several critical developmental processes are occurring in the brain, and substance use poses both short-term and long-term risks with regard to mental health and social development. From a public health perspective, it is important to prevent or delay substance use to reduce individual risk and societal costs. Given the scarcity of effective interventions targeting substance use among adolescents and young adults, cost-effective and easily disseminated interventions are warranted. The current study will test the effectiveness of a fully automated digital brief intervention aimed at reducing alcohol and other substance use in adolescents and young adults aged 15 to 25 years.

METHODS AND ANALYSIS

A two-arm, double-blind, randomised controlled trial design is applied to assess the effectiveness of the intervention. Baseline assessment, as well as 3-month and 6-month follow-up, will be carried out. The aim is to include 800 participants with risky substance use based on the screening tool CRAFFT (Car,Relax, Alone, Forget, Friends, Trouble). Recruitment, informed consent, randomisation, intervention and follow-up will be implemented online. The primary outcome is reduction in alcohol use, measured by Alcohol Use Disorders Identification Test total score. Secondary outcomes concern binge drinking, frequency of alcohol consumption, amount of alcohol consumed a typical day when alcohol is consumed, average daily drinks per typical week, other substance use, mental health, sexual risk behaviours and perceived peer pressure. Moreover, the study involves analyses of potential moderators including perfectionism, openness to parents, help-seeking and background variables.

ETHICS AND DISSEMINATION

The study was approved by the Swedish Ethical Review Authority (no. 2019-03249). The trial is expected to expand the knowledge on digital preventive interventions for substance using adolescents and young adults. Results will be disseminated in research journals, at conferences and via the media.

TRIAL REGISTRATION NUMBER

24 September 2019, ISRCTN91048246; Pre-results.

The Role of Trait and State Perfectionism in Psychological Detachment From Daily Job Demands

Psychological detachment has been proposed to be a mediator of the relations between an individual's responses to stressful work-related experiences and mid- and long-term health. However, the number of studies that have specifically examined the role that personal characteristics play in these associations is considerably small. One personal characteristic that might specifically interfere with psychological detachment is perfectionism, which has been considered an important vulnerability factor for the development of psychological disorders. Hence, the goal of this registered report was to extend research on psychological detachment by introducing trait and state perfectionism as moderators of the aforementioned relations. We conducted an experience sampling study with three measurement occasions per day over the course of 3 working weeks (N = 158 employees; M_age = 41.6; 67% women). Multilevel path models showed that perfectionistic concerns consistently determined strain responses at between- and within-levels of analyses even after the effects of job demands (i.e., unfinished tasks and role ambiguity) and detachment were accounted for. However, we found no evidence for the proposed moderation effects. The theoretical implications for the understanding of the processes proposed in the stressor-detachment model are discussed.

A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes

BACKGROUND AND OBJECTIVES

Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion).

METHODS

Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported.

RESULTS

The intervention led to significant decreases in symptoms of OCD (d = -0.9; CI: -1.4, -0.4) and eating disorders (d = -0.6; CI: -1.0, -0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = -0.9; CI: -1.4, -0.4), and fear of self-compassion (d = -0.8; CI: -1.3, -0.3). At follow-up changes were maintained in symptoms of OCD (d = -1.3; CI: -1.8, -0.8), disordered eating (d = -0.7; CI: -1.2, -0.2), intolerance of uncertainty (d = -0.8; CI: -1.2, -0.3), and fear of self-compassion (d = -1.0; CI: -1.5, -0.5).

CONCLUSIONS

Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.

Internet-delivered cognitive behavioural therapy for perfectionism: Targeting dysmorphic concern

Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to BDD-body, BDD-positive, and BDD-negative words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.

Perfectly imperfect: The use of cognitive bias modification to reduce perfectionism

BACKGROUND AND OBJECTIVES

Perfectionism is a transdiagnostic risk and maintenance factor for psychopathology. The current study developed and evaluated a cognitive bias modification, interpretation retraining (CBM-I) intervention targeting maladaptive perfectionistic beliefs.

METHODS

Participants were undergraduate students randomized to complete the perfectionism CBM-I (n = 33) or control condition task (n = 36) at two time points. Additionally, participants completed measures of perfectionistic interpretations and trait perfectionism, as well as an impossible anagram task designed to elicit perfectionistic concerns.

RESULTS

Results indicated that after the intervention, participants who completed the perfectionism CBM-I endorsed fewer perfectionistic interpretations than participants in the control condition. Furthermore, although the study groups self-reported comparably low confidence in their anagram task performance, participants who completed the perfectionism CBM-I reported wanting to re-do significantly fewer anagrams than participants in the control condition, suggesting greater acceptance of imperfect performance following the intervention. Moreover, supporting a key hypothesized mechanism of effect in CBM-I, reductions in perfectionistic interpretations mediated the effect of condition on the desire to re-do anagram task items.

LIMITATIONS

The study results should be viewed in light of limitations, including the short time-span of the study, and the use of a relatively small, non-clinical, and demographically homogenous convenience sample.

CONCLUSIONS

Further research and development of the perfectionism CBM-I intervention are needed, but the present findings add to a nascent evidence base that suggests CBM-I holds promise as an accessible and transdiagnostic intervention for perfectionism.

Internet-based cognitive behavioral therapy of perfectionism: Comparing regular therapist support and support upon request

Perfectionism may be a clinically relevant problem on its own or as part of the etiology and maintenance of psychiatric disorders, e.g., anxiety disorders, depression, and eating disorders. Cognitive behavior therapy has been shown to be a promising treatment for managing perfectionism and its associated problems, including when being administered via the Internet, i.e., Internet-based cognitive behavioral therapy (ICBT). In the current study, seventy-eight self-referred participants underwent ICBT after an initial eight-week wait-list period, i.e., second wave of treatment. These were randomized to receive regular support from a therapist (ICBT-support) or ICBT with support on request (ICBT-request), in an eight-week treatment of perfectionism. Assessments of perfectionism were made at pre-, mid-, and post-treatment, as well as six-month follow-up, using the Frost Multidimensional Perfectionism Scale, subscale Concern over Mistakes. Mixed effects models revealed large symptom reductions for both conditions; Concern over Mistakes, Cohen's d = 1.40, 95% Confidence Interval (CI) [0.85, 1.95] for ICBT-support, and d = 1.00, 95% CI [0.51, 1.47] for ICBT-request. The effects were maintained at six-month follow-up and there were no differences between the conditions in terms of the results, opened modules, or completed exercises. A total of 28 out of 70 participants (42.4%; ICBT-support, 37.8%; ICBT-request) were classified as improved at post-treatment. Both types of ICBT may thus be beneficial in treating perfectionism, suggesting that just having the opportunity to ask for support from a therapist, when regular support is not provided, could be sufficient for many participants undergoing ICBT. However, the study was underpowered to detect differences between the conditions. The lack of a cutoff also makes it difficult to differentiate a dysfunctional from a functional population in terms of perfectionism. In addition, the study design could have affected the participants' motivational level from start, given their initial eight-week wait-list period. Recommendations for future studies include recruiting a larger sample size, a clearer cutoff for perfectionism, and the use of a non-inferiority test with a predetermined margin of change.

Targeting Procrastination Using Psychological Treatments: A Systematic Review and Meta-Analysis

Background: Procrastination can be stressful and frustrating, but it seldom causes any major distress. However, for some people, it can become problematic, resulting in anxiety, lowered mood, physical complaints, and decreased well-being. Still, few studies have investigated the benefits of targeting procrastination. In addition, no attempt has previously been made to determine the overall efficacy of providing psychological treatments.

Methods: A systematic review and meta-analysis was conducted by searching for eligible records in Scopus, Proquest, and Google Scholar. Only randomized controlled trials comparing psychological treatments for procrastination to an inactive comparator and assessing the outcomes by a self-report measure were included. A random effects model was used to determine the standardized mean difference Hedge's g at post-treatment. Furthermore, test for heterogeneity was performed, fail-safe N was calculated, and the risk of bias was explored. The study was pre-registered at Prospero: CRD42017069981.

Results: A total of 1,639 records were identified, with 12 studies (21 comparisons, N = 718) being included in the quantitative synthesis. Overall effect size g when comparing treatment to control was 0.34, 95% Confidence Interval [0.11, 0.56], but revealing significant heterogeneity, Q(20) = 46.99, p < 0.00, and I² = 61.14%, 95% CI [32.83, 84.24]. Conducting a subgroup analysis of three out of four studies using cognitive behavior therapy (CBT) found an effect size g of 0.55, 95% CI [0.32, 0.77], and no longer showing any heterogeneity, Q(4) = 3.92, p = 0.42, I² = 0.00%, 95% CI [0.00, 91.02] (N = 236). Risk of publication bias, as assessed by the Egger's test was not significant, z = −1.05, p = 0.30, fail-safe N was 370 studies, and there was some risk of bias as rated by two independent researchers. In terms of secondary outcomes, the self-report measures were too varied to present an aggregated estimate.

Conclusions: Psychological treatments seem to have small benefits on procrastination, but the studies displayed significant between-study variation. Meanwhile, CBT was associated with a moderate benefit, but consisted of only three studies. Recommendations for future research are provided, including the use of more valid and reliable outcomes and a screening interview at intake.

A randomized controlled trial of unguided internet cognitive-behavioral treatment for perfectionism in individuals who engage in regular exercise

OBJECTIVE

Clinical perfectionism has been found to be a risk and maintaining factor in eating disorders (EDs), compulsive exercise, and athlete burnout. This study investigated whether an unguided internet cognitive-behavioral treatment (ICBT) for perfectionism would reduce ED pathology, compulsive exercise, and burnout in individuals who engage in regular exercise.

METHOD

Participants were randomly allocated to intervention (n = 38) or waitlist control (n =29). A generalized linear mixed model (GLMM) analysis was conducted pre and post treatment. A follow-up analysis was conducted with the intervention group at 3 and 6 months.

RESULTS

The intervention group experienced a significant reduction in perfectionism (FMPS-CM: F[1,117] = 17.53, p = < .001, Cohen's d = .82), ED symptomology (EDE-Q: F[1,55] = 7.27, p = .009,Cohen's d = .53) and compulsive exercise (CET: F[1,116] = 10.33, p < .001,Cohen's d = .63). The changes attained post-treatment were maintained within the intervention group at 3-month (FMPS-CM (t[1,100] = 3.67, p < . 001, Cohen's d = .85) (EDE-Q (t[1,50] = 2.20, p = .03, Cohen's d = 1.26) and 6-month follow-up (FMPS (t[1,100] = 2.74, p = 007, Cohen's d = .70) (EDE-Q (t[1,50] = 2.18, p = .03, Cohen's d = 1.26).

DISCUSSION

The results indicate unguided ICBT for perfectionism can have a significant impact on perfectionism, compulsive exercise, and ED symptomatology.

Is perfectionism associated with academic burnout through repetitive negative thinking?

Academic burnout is prevalent among university students, although understanding of what predicts burnout is limited. This study aimed to test the direct and indirect relationship between two dimensions of perfectionism (Perfectionistic Concerns and Perfectionistic Strivings) and the three elements of Academic Burnout (Exhaustion, Inadequacy, and Cynicism) through Repetitive Negative Thinking. In a cross-sectional survey, undergraduate students (n = 126, M_age = 23.64, 79% female) completed well-validated measures of Perfectionism, Repetitive Negative Thinking, and Academic Burnout. Perfectionistic Concerns was directly associated with all elements of burnout, as well as indirectly associated with Exhaustion and Cynicism via Repetitive Negative Thinking. Perfectionistic Strivings was directly associated with less Inadequacy and Cynicism; however, there were no indirect associations between Perfectionistic Strivings and Academic Burnout operating through Repetitive Negative Thinking. Repetitive Negative Thinking was also directly related to more burnout Exhaustion and Inadequacy, but not Cynicism. It is concluded that future research should investigate whether interventions targeting Perfectionistic Concerns and Repetitive Negative Thinking can reduce Academic Burnout in university students.