A randomised controlled trial of group cognitive behavioural therapy for perfectionism

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Highlights

  • This is the first randomised controlled trial to examine the efficacy of group cognitive behavioural therapy for perfectionism (group CBT-P).

  • The group CBT-P condition displayed significantly greater decreases in perfectionism and psychopathology compared to the control condition.

  • The group CBT-P condition also exhibited significantly greater increases in self-esteem and quality of life relative to the control condition.

  • The impact of the treatment on most of these outcomes was mediated by pre-post change in perfectionism (Concern over Mistakes).

  • Treatment gains were reliable and clinically significant, and were maintained at 6-month follow-up.

Abstract

Perfectionism is associated with symptoms of anxiety disorders, eating disorders and mood disorders. Treatments targeting perfectionism may reduce the symptoms of these disorders (Egan, Wade, & Shafran, 2011). This study is the first randomised controlled trial to investigate the efficacy of group cognitive behavioural therapy (CBT) for perfectionism. Forty-two participants with elevated perfectionism and a range of anxiety, eating and mood disorders were randomised to group CBT for perfectionism or a waitlist control. The treatment group reported significantly greater pre-post reductions in perfectionism, symptoms of depression, eating disorders, social anxiety, anxiety sensitivity and rumination, as well as significantly greater pre-post increases in self-esteem and quality of life compared to the waitlist control group. The impact of treatment on most of these outcomes was mediated by pre-post change in perfectionism (Concern over Mistakes). Treatment gains were reliable and clinically significant, and were maintained at 6-month follow-up. Findings support group CBT for perfectionism being an efficacious treatment for perfectionism and related psychopathology, as well as increasing self-esteem and quality of life.

Section snippets

Participants

Participants self-referred in response to advertisements distributed to universities, GPs, psychologists, psychiatrists and workplaces throughout Perth, Australia. Participants were required to have elevated perfectionism, defined by a score greater than 24.7 on the Concern over Mistakes (CM) subscale of the Frost Multidimensional Perfectionism Scale (FMPS; Frost et al., 1990). This is the average CM score derived from previous research examining perfectionism in anxiety disorder samples

Participant flow and sample characteristics

There were 154 individuals who expressed interest; 43 were eligible and 42 were randomised, as seen in the CONSORT diagram in Fig. 1 (Moher et al., 2010). As reported in Table 2, the intervention and control groups did not significantly differ on any outcome measure at baseline.

Treatment effects on perfectionism

As seen in Table 3, there were significant Group × Time interactions for perfectionism (CM, PS, DA, CPQ, DAS-SC, distress and interference) at the Bonferroni-corrected α-level of .007. Effect sizes for the interactions

Discussion

This study provides evidence that group CBT-P effectively reduces perfectionism and this effect is maintained at 6-month follow-up. This RCT found that CBT-P reduces Concern over Mistakes, Personal Standards, Doubts about Actions and Dysfunctional Attitude Scale-Self Criticism (DAS-SC) scores in addition to Clinical Perfectionism Questionnaire (CPQ) scores to a significantly greater extent than a control group. While Riley et al. (2007) found significant Group × Time interaction effects for the

Acknowledgements

The individuals who contributed to this manuscript all met the criteria for authorship. All authors acknowledge the School of Psychology and Speech Pathology at Curtin University, Perth, Australia who provided the funding for the data collection materials.

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