The impact of a universal intervention targeting perfectionism in children: An exploratory controlled trial

Efficacy and Effectiveness of Universal School-Based Wellbeing Interventions in Australia: A Systematic Review

The World Health Organisation defines health in terms of wellbeing, and wellbeing has become both a construct and a measure of impact in early intervention and prevention programs in schools. In Australia, schools report on their wellbeing initiatives and there is a plethora of government-funded wellbeing programs already in place in schools. However, education systems and stakeholders worldwide are facing significant challenges with mixed evaluation results of program impact and intervention effect. To better support students, schools, school-based healthcare workers, and community, it is important to know about the effectiveness of school-based programs; yet in the last decade, there has been no national appraisal of these programs in Australia. This systematic review aims to report on the effectiveness of Australian school-based wellbeing programs through a search of 13 databases. Out of 2888 articles, 29 met inclusion criteria. The results found that seventeen interventions comprising 80% of the total number of participants reported no statistically significant intervention effect on wellbeing outcomes. We argue that supporting wellbeing through robust program intervention is important as wellbeing presents both an indication of later onset of more serious mental health issues, and an opportunity for early intervention to break the trajectory leading to full disorder.

The 'perfect' lens: Perfectionism and early adolescents' math self-efficacy development

BACKGROUND

Self-efficacy, or the beliefs learners hold about what they can do, develops largely from how learners perceive and interpret four main sources of information: mastery experiences, vicarious experiences, social persuasions and physiological and affective states. Although the relationship between these sources and self-efficacy is well-established, less is known about the factors that may influence how early adolescent learners perceive and interpret information from these sources.

AIMS

The purpose of this study was to investigate how the predisposition of perfectionism might predict how learners perceive efficacy-relevant information in the domain of math.

METHODS

Using a correlational design, this study considered whether perfectionism was associated with how middle school students (N = 1683) perceive information from the four hypothesized sources of self-efficacy. Participants completed a paper-based survey at two time points. Perfectionism was measured at Time 1. Self-efficacy and its sources were measured at Time 2. Structural equation modelling techniques were used to examine the relationship between factors.

RESULTS AND CONCLUSIONS

Students who held themselves to high standards (i.e., greater self-oriented perfectionism) reported higher levels of mastery experiences, vicarious experiences, social messages and self-efficacy. Conversely, students who felt external pressure to be perfect (i.e., socially prescribed perfectionism) reported lower levels of mastery experiences, vicarious experiences and self-efficacy, as well as higher levels of negative physiological and affective states. The relationship between perfectionism and self-efficacy was partially mediated by students' perceptions of mastery. This study extends the current literature on the sources of math self-efficacy in early adolescence by showing how a predisposition like perfectionism is associated with how adolescent learners perceive and interpret efficacy-relevant information.

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.

A Pragmatic Randomized Controlled Trial Targeting Perfectionism in Young Adolescents

Perfectionism has adverse impacts on mental health and academic outcomes. We evaluated a 5-lesson classroom intervention for young adolescents delivered by teachers for impact on perfectionism, well-being, self-compassion, academic motivation and negative affect, at post-intervention and 3-month follow-up. Classes (N = 636 students, M _age = 13.68, SD = 0.60) were randomized to intervention (n = 343) or classes as usual (n = 293). Data were analyzed using linear mixed models adjusted for baseline observation and clustering. At post-intervention no differences were found between the groups. At 3-month follow-up, anxiety showed a significant increase in the control group with no increase in the intervention group (d = 0.23; 95% CI: 0.05, 0.40); females in the control group had a significant decrease in well-being from post-intervention to 3 month follow-up compared to the intervention group (d = 0.33; 95% CI: 0.08, 0.58); students with high levels of perfectionistic concerns in the intervention had significantly lower perfectionistic strivings at 3 month follow-up than the control group ((d = 0.34, 95% CI: 0.19, 0.49). This intervention shows promising results when delivered by teachers. Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621000457842 (April 19, 2021).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12310-022-09540-3.

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).

A meta-synthesis of qualitative studies of the link between anxiety, depression and perfectionism: implications for treatment

BACKGROUND

Meta-analyses show an association between perfectionism and depression and anxiety (negative affect), and that therapy for perfectionism impacts positively on negative affect. No systematic reviews have focused on qualitative studies of perfectionism.

AIMS

Our aim was to perform a systematic, meta-synthesis of qualitative literature to (i) help inform our understanding of how perfectionism is associated with negative affect, so that we can (ii) inform future development of treatment for perfectionism in young people and to make it more effective.

METHOD

Included in the meta-synthesis were 37 qualitative studies.

RESULTS

Six themes related to perfectionism were found: (1) the association with negative affect, (2) self-worth dependent on achievement, (3) cognitive and behavioural maintaining factors, (4) the expectations of others, (5) effective elements of interventions, and (6) barriers to treatment.

CONCLUSIONS

The qualitative literature supports the notion of perfectionism as an important construct to consider in reducing negative affect. While cognitive behavioural therapy for perfectionism holds promise as a treatment to target negative affect, there was a paucity of qualitative research, particularly related to young people. A greater understanding of the views of young people are required to help tailor more effective interventions for perfectionism that can impact negative affect in this group.

Effectiveness of school-based mental well-being interventions among adolescents: A systematic review

AIMS

This systematic review aimed to identify school-based interventions for ensuring mental health and well-being of adolescents, synthesize existing interventions, and summarize the quality of identified studies.

DESIGN

A systematic review, analysis, and synthesis were performed.

DATA SOURCES

Search was performed in Cochrane Library, PsychARTICLES, Web of Science, CINAHL, and Medline.

REVIEW METHODS

Literature search was performed in March 2019 using inclusion and exclusion criteria. PRISMA guidelines were followed. Identified records were reviewed by title, abstract, and by the full text by two independent researchers. Three authors independently made a quality assessment of the included studies. Included studies were extracted and synthesized. A systematic review was registered in PROSPERO (CRD42019128919).

RESULTS

The initial search yielded 1,199 articles. Of them, 57 articles were included in the final analysis and synthesis. Only four studies were assessed as high quality. Identified themes were mental health and well-being, positive psychology, problem-solving and stress reduction, mindfulness, and physical activity. More than half (N = 32, 56.14%) interventions showed a positive outcome after implementation. Most of those interventions focused on positive psychology and mindfulness.

CONCLUSION

Mental well-being is important for the healthy development of adolescents. Countries are aware that healthy adolescents will become healthy adults who will contribute to his/her community and will lower costs of the absence of work and treatments. Thus, they support and invest in interventions that prevent mental disorders. There is a need for developing multidimensional mental well-being interventions that are effective in low- and secondary-income countries.

IMPACT

This study ensured rigorous methodology, followed PRISMA recommendations and evaluated quality of identified literature using the GRADE guidelines. A critical synthesis was performed to produce an integrated conceptualization of the evidence. The synthesis represents a list of effective school interventions for the promotion of adolescents' mental well-being.

Structure and validity of the Clinical Perfectionism Questionnaire in female adolescents

BACKGROUND

Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown.

AIMS

To assess the factor structure and construct validity of the CPQ in female adolescents.

METHOD

The CPQ was administered to 267 females aged 14-19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits.

RESULTS

The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a sample of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit.

CONCLUSIONS

The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.

A reliability generalization meta-analysis of the child and adolescent perfectionism scale

BACKGROUND

Perfectionism is a prevalent disposition of personality involved in the development and maintenance of a wide range of psychological disorders. The Child and Adolescent Perfectionism Scale (CAPS) is the most usually applied test to assess perfectionism in children and adolescents. This study aimed: (a) to conduct a reliability generalization meta-analysis to estimate the average reliability of the CAPS scores and to search for characteristics of the studies that may explain the variability among reliability estimates, and (b) to estimate the reliability induction rate of the CAPS.

METHOD

An exhaustive search allowed to select 56 studies that reported alpha coefficients with the data at hand for the CAPS.

RESULTS

The average alpha coefficients were 0.87, 0.84 and 0.83, respectively for the CAPS total score and its two subscales, Socially Prescribed Perfectionism (SPP) and Self-Oriented Perfectionism (SOP). Regarding O'Connor's version, the average reliability coefficients were 0.82, 0.74 and 0.73, respectively, for SPP, SOP-Critical and SOP-Strivings. Some study characteristics (ethnicity, language, mean age and standard deviation of the scores, psychometric vs applied) showed a statistical association with the reliability coefficients of SPP and SOP. The reliability induction rate was 29.8%.

LIMITATIONS

Due to the scarcity of studies, we could not examine the reliability scores of other versions of the CAPS and test-retest reliability.

CONCLUSIONS

In terms of reliability, the original version of the CAPS present better results than O'Connor's version. The original version of the CAPS is a reliable instrument to be employed with general research purposes, but not for clinical practice.

On the Distinction Between Personal Standards Perfectionism and Excellencism: A Theory Elaboration and Research Agenda

Research on perfectionism is flourishing, but the unspecified distinction between perfectionism and the pursuit of excellence is a lingering issue that urgently needs conceptual, theoretical, and empirical attention. In this article, excellence and perfection are defined as distinct goals that form the basis of two different but related constructs. To move this idea forward, the term excellencism is introduced. Perfectionism and excellencism are defined and their similarities and differences are illustrated using symbolic logic and adjectives from the English lexicon. A point is made to clearly indicate that excellencism is a required reference point for reassessing the healthiness or unhealthiness of personal standards perfectionism. Using the law of diminishing returns as an analogy, a theory-driven rationale is proposed, and three alternative hypotheses are formulated. Showing that personal standards perfectionism is associated with better, comparable, and worse outcomes compared with excellencism offers the needed and sufficient conditions for respectively supporting the hypothesis that perfectionism is a healthy, unneeded, or deleterious pursuit. The propositions advanced in this theoretical article are more than incremental, and their practical implications are far-reaching: If personal standards perfectionism yields no added value or deleterious outcomes over and above excellencism, then excellence rather than perfection should be promoted.

Measuring perfectionism in children: a systematic review of the mental health literature

The adverse consequences of perfectionism in the lives of youth (children and adolescents) are now widely recognised, including impact on mental health and general well-being. In order to develop interventions to prevent and treat perfectionism and promote resilience for children, rigorous testing and examination of theoretical models is needed as well as having access to valid and reliable assessment tools. The aim of the current literature review was to examine the validity and reliability of the measures currently being used to measure perfectionism in children under the age of 15. A systematic review of the literature identified six instruments that had been utilised in children. Preliminary support with respect to reliability and validity was established for each of these measures, and there was evidence supporting the existence of both perfectionistic striving and perfectionistic concerns in this population. However, many of the measures lacked evaluation of key psychometric properties by independent authors. Further work distinguishing adaptive and maladaptive perfectionism will be necessary to promote future interventions and treatment in this area.