Web-Based Cognitive-Behavioral Therapy for Perfectionism (PDF)

A dissertation that evolved into a publication Arpin-Cribbie, et al., 2012, Psychotherapy Research ¨ ¨ All participants were psychometrically assessed as high in perfectionism (N = 77); they were maladaptive perfectionists They were randomized to three groups: A) no treatment at all; (NT) B) general...

A dissertation that evolved into a publication Arpin-Cribbie, et al., 2012, Psychotherapy Research ¨ ¨ All participants were psychometrically assessed as high in perfectionism (N = 77); they were maladaptive perfectionists They were randomized to three groups: A) no treatment at all; (NT) B) general stress management (i.e. reduction); (GSM) C) cognitive behavioural therapy; (CBT) Results: Participants randomized to receive CBT experienced a significantly greater improvement psychologically than individuals randomized to receive GSM or NT While both CBT & GSM significantly reduced psychological distress, CBT participants experienced reductions in perfectionism that were significantly correlated with reductions in depression & anxiety. ¨ ¨ ¨ ¨ Why were three groups compared? What advantage was there in comparing CBT to General Stress Management? What advantage was there in comparing GSM to a no-treatment control group? What advantage was there in comparing CBT to a no-treatment control group? ¨ ¨ ¨ Of the 141 eligible participants (i.e. with Perfection Cognition Inventory scores greater than 1 SD > the mean), 83 consented to participate. Of the n = 83 who completed baseline measures, 6 did not complete the post-test measures & were excluded from the analyses. The final participants (N = 77) were distributed across all three treatment groups with n = 29 in the CBT group, n = 26 in the GSM group, and n = 22 in the NT group. ¨ ¨ ¨ ¨ ¨ ¨ ¨ CBT ? Intervention themes (a) Living in the real world (checking your interpretations ); (b) Living in the world of ‘shoulds’ (reevaluating expectations & the importance of personal choice ); (c) Working out your mind (recognizing how certain ways of thinking cause distress); (d) Dealing with negative moods (skills for changing negative-to-neutral-to-positive moods) (e) When a ‘want’ becomes ‘necessity’ (keeping perspective on & limiting desires); (f) Dealing with academic & performance anxiety (helping you do your best & feel good about it) ¨ ¨ ¨ ¨ ¨ ¨ ¨ GSM? Intervention themes (a) Recognizing & dealing with stress (recognizing how stress uniquely ‘gets to you’ & learning what helps you reduce it); (b) Reducing distractions & distractibility (seeing how stress gets you distracted & discovering how you can maintain focus); (c) Changing your stressors (learning to relax, including progressive relaxation & breath-based relaxation); (d) Exercise (initiating & monitoring progress); (e) Sleep (healthier sleep improves brain function); (f) Meditation (maintaining awareness & balance). ¨ ¨ If CBT arm is better (more effective), then CBT is the critical element The ‘structure’ of a 3-arm randomized control trial enables 3 comparisons ¨ Perfectionism – multiple scales ¨ Multidimensional Perfectionism Scale (MPS-F, [Frost et al., 1990]) - 35-items used to assess 6 dimensions of perfectionism. The subscale of interest was concern over mistakes (CM) indicating an excessive reaction to mistakes ¨ Multidimensional Perfectionism Scale (MPS-HF, [Hewitt & Flett, 1991]) - 45- items used to assess 3 dimensions of perfectionist behaviour: (a) self-oriented perfectionism (SOP), (b) other-oriented perfectionism (OOP) & (c) socially prescribed perfectionism (SPP). ¨ ¨ Perfectionism Cognitions Inventory (PCI, [Flett, Hewitt, Blankstein, & Gray, 1998]) 25-items to assess the frequency of ‘automatic perfectionistic thoughts’. The extent to which an individual engages in cognitive comparisons between the ideal perfectionistic self & the current self. ¨ Almost Perfect Scale - Revised (APSR, [Slaney, Rice, Mobley, Trippi, & Ashby, 2001]) 23 items to assess three dimensions of perfectionism: (a) discrepancy; (b) high standards; and (c) order. Special focus on discrepancy or the gap between perfectionistic standards & perceived levels of attainment ¨ ¨ ¨ ¨ Center for Epidemiologic Studies-Depression Scale (CESD, [Radloff, 1987]) - 20-items to assess depressive symptoms Beck Anxiety Inventory (BAI, [Beck, Epstein, Brown, & Steer, 1988]) - 21-items to assess clinical anxiety Automatic Thoughts Questionnaire (ATQ, [Hollon & Kendall, 1987]) - 30-items to assess automatic negative thoughts about the self through the cognitive self-statements of an individual. Anxiety Sensitivity Index (ASI, [Reiss, Peterson, Gursky, & McNally, 1986]) - 16-items to assess the fear of anxiety. ¨ ¨ Knowledge information questionnaire developed to evaluate adherence to intervention protocols This questionnaire assessed retention for specific details of both the CBT & GSM interventions SOP CBT ** OOP * SPP ** CM ** Discrepancy ** Perfectionism Cognitions. ** GSM ** * p =.05. NT ** ** ** p =.01 CBT * GSM Anxiety Sensitivity * * Automatic Thoughts ** Depression NT Beck Anxiety Inventory * p =.05. ** p =.01 ¨ ¨ Perfectionism related distress is an important consideration at post-secondary institutions given a high prevalence of this type of distress. Evidence suggests high levels of perfectionism are associated with elevated depression and anxiety levels, eatingdisorders, & reduced academic performance ¨ ¨ CBT participants scored significantly lower at posttest, relative to pretest, on nine of the measures of perfectionism, depressive symptomatology, and cognitive vulnerability to negative affect. Comparatively, GSM participants showed significant improvement on only four of the measures, whereas NT participants did not significantly improve on any of these same measures. ¨ GSM group experienced intervention benefits, as stress reduction interventions reduce stress-reactive symptoms & increase psychological well-being. The positive correlations established between Self-Oriented Perfectionism measures and symptoms of anxiety suggest stress interventions offers such benefits. ¨ The significant relationship between changes in perfectionism and changes in psychological distress for participants receiving the CBT intervention highlight that those improvements are co-dependent