Is the Devil in the Detail? Two Randomized Controlled Trials of Guided Internet Based CBT for Perfectionism

Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen’s d = 0.68–1.00, 95% Confidence Interval (CI) [0.36–1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted.

Paper two on the same topic but carried out in another country

An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see paper one). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d = 0.98 (95% CI: 0.60–1.36) and d = 1.04 (95% CI: 0.66–1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention

Read the two papers:

Rozental, A., Shafran, R., Wade, T., Egan, S., Bergman Nordgren, L., Carlbring, P., Landström, A., Roos, S., Skoglund, M., Thelander, E., Trosell, L., A, Ö., & Andersson, G. (2017). A randomized controlled trial of Internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors. Behaviour Research and Therapy, 95, 79-86. doi:10.1016/j.brat.2017.05.015

Shafran, R., Wade, T. D., Egan, S. J., Kothari, R., Allcott-Watson, H., Carlbring, P., Rozental, A., & Andersson, G. (2017). Is the devil in the detail? A randomised controlled trial of guided internet-based CBT for perfectionism. Behaviour Research and Therapy, 95, 99-106. doi:10.1016/j.brat.2017.05.014