Does perfectionism impact adherence to homework assignment? A preliminary pilot study of perfectionism and procrastination of CBT homework

Maladaptive perfectionism can explain the inverse relationship between dispositional mindfulness and procrastination

Given the widespread occurrence of procrastination and its adverse association with well-being, investigating the individual variables that influence procrastination is a crucial matter. Previous research has identified dispositional mindfulness to be negatively associated with procrastination, but the underlying mechanisms driving this relationship remain unclear. In this study, the aim was to investigate whether the inverse relationship between dispositional mindfulness and procrastination could be explained by the mediating roles of trait anxiety and maladaptive perfectionism. In a cross-sectional survey, 126 participants (aged 18-33) completed the 15-Item Five-Facet Mindfulness Questionnaire, the State-Trait Anxiety Inventory-Trait Form, the Almost Perfect Scale-Revised, and the Pure Procrastination Scale. A parallel mediation model was tested to investigate the mediating role of self-reported maladaptive perfectionism and trait anxiety to explain the relationship between dispositional mindfulness and procrastination with a bootstrapped multivariate technique. The results revealed that maladaptive perfectionism significantly mediated the relationship between mindfulness and procrastination -indicating that dispositional mindfulness has a significant indirect effect on procrastination via decreased levels of maladaptive perfectionism. It was determined that 15% of the variance in procrastination was significantly explained by this model (R2 = .15, β =  -.39, B =  -.83, 95% CI =  [-1.18, -.48], p < .001]. As the study highlights the importance of maladaptive perfectionism to explain the link between mindfulness and procrastination, we suggest that future research could investigate the influence of mindfulness on procrastination via mindfulness-based interventions, and include measurements of both trait anxiety and maladaptive perfectionism across longitudinal or experimental designs to unpack causality with respect to our pattern of observed findings.

Predictors of engagement with between-session work in Cognitive Behavioural Therapy (CBT)-based interventions: a mixed-methods systematic review and "best fit" framework synthesis

Between-session work (BSW) acts as the vehicle to translate skills learnt in therapy sessions into adaptive changes in everyday life, a key goal in Cognitive Behavioural Therapies (CBT). Despite a well-established relationship between engagement with BSW and enhanced treatment outcomes, difficulties completing between-session tasks are common and factors affecting patient engagement with BSW are poorly understood. This mixed-methods systematic review and "best fit" framework synthesis explored predictors of engagement with BSW in CBT-based interventions. Comprehensive searches were conducted across five databases, identifying 59 eligible studies. This combined theory and empirical evidence approach depicted ten predictor themes related to between-session engagement, spanning individual, relational and contextual concepts. While ambiguous findings were generated by existing evidence, several factors emerged as relatively consistent predictors of engagement with BSW: positive patient beliefs regarding BSW and treatment such as perceived helpfulness, and practitioner competency in planning and reviewing BSW, including providing a rationale and addressing difficulties were associated with greater engagement. Conversely, patient in-session resistance, including counter change talk, was an indicator of disengagement between-sessions. The impact of patient symptomology, sociocultural environment, practitioner beliefs and the therapeutic relationship is unclear. The conceptual model presented offers a testable framework for researchers and a guideline for practitioners.

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.

Parsing within & between-person dynamics of therapy homework completion and clinical symptoms in two cognitive behavioral treatments for adults with anhedonia

OBJECTIVE

Homework is a key theoretical component of cognitive-behavioral therapies, however, the effects of homework on clinical outcomes have largely been evaluated between-persons rather than within-persons.

METHODS

The effects of homework completion on treatment response were examined in a randomized trial comparing Behavioral Activation Treatment for Anhedonia (BATA, n = 38), a novel psychotherapy, to Mindfulness-Based Cognitive Therapy (MBCT, n=35). The primary endpoint was consummatory reward sensitivity, measured weekly by the Snaith Hamilton Pleasure Scale (SHAPS), up to 15 weeks. Multilevel models evaluated change in SHAPS scores over time and the effects of clinician-reported and participant-reported homework.

RESULTS

BATA and MBCT resulted in significant, equivalent reductions in SHAPS scores. Unexpectedly, participants who completed greater mean total amounts of homework did not improve at a faster rate (i.e., no between-person effect). However, sessions with greater than average participant-reported homework completion were associated with greater than average reductions in SHAPS scores (i.e., a within-person effect). For clinician-reported homework, this effect was only evident within the BATA condition.

CONCLUSION

This study shows psychotherapy homework completion relates to symptomatic improvement in cognitive-behavioral treatments for anhedonia when session-to-session changes are examined within-person. On the contrary, we found no evidence that total homework completion predicted greater improvements between-person. When possible, psychotherapy researchers should evaluate their constructs of interest across multiple sessions (not just pre/post) to allow more direct tests of hypotheses predicted by theoretical models of individual change processes.

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.