Clinical perfectionism and its treatment through cognitive behavioural therapy

PROTOCOL: Cognitive‐Behavioural Therapies for Young People in Outpatient Treatment for Non‐Opioid Drug Use

Overall goal of Cognitive-Behavioral Therapy in Major Psychiatric Disorders and Suicidality: A Narrative Review

Cognitive behaviour therapy for anxiety disorders is a brief psychological treatment (1 to 16 sessions), based on the cognitive model of emotional disorders. Within this model, it is assumed that it is not events per se, but rather people's expectations and interpretations of events, which are responsible for the production of negative emotions such as anxiety, anger, guilt, or sadness. In anxiety, the important interpretations, or cognitions, concern perceived physical or psychosocial danger. In everyday life, many situations are objectively dangerous. In such situations, individuals’ perceptions are often realistic appraisals of the inherent danger. However, Beck argues that in anxiety disorders, patients systematically overestimate the danger inherent in certain situations, bodily sensations, or mental processes. Overestimates of danger can arise from distorted estimates of the likelihood of a feared event, distorted estimates of the severity of the event, and/or distorted estimates of one's coping resources and the availability of rescue factors. Once a stimulus is interpreted as a source of danger, an ‘anxiety programme’ is activated. This is a pattern of responses that is probably inherited from our evolutionary past and originally served to protect us from harm in objectively dangerous primitive environments (such as attack from a predator). The programme includes changes in autonomic arousal as preparation for flight/fight/fainting and increased scanning of the environment for possible sources of danger. In modern life, there are also situations in which these responses are adaptive (such as getting out of the path of a speeding car). However, when, as in anxiety disorders, the danger is more imagined than real, these anxiety responses are largely inappropriate. Instead of serving a useful function, they contribute to a series of vicious circles that tend to maintain or exacerbate the anxiety disorder. Two types of vicious circle are common in anxiety disorders. First, the reflexively elicited somatic and cognitive symptoms of anxiety become further sources of perceived danger. For example, blushing can be taken as an indication that one has made a fool of oneself, and this may lead to further embarrassment and blushing; or a racing heart may be taken as evidence of an impending heart attack and this may produce further anxiety and cardiac symptoms. Second, patients often engage in behavioural and cognitive strategies that are intended to prevent the feared events from occurring. However, because the fears are unrealistic, the main effect of these strategies is to prevent patients from disconfirming their negative beliefs. For example, patients who fear that the unusual and racing thoughts experienced during panic attacks indicate that they are in danger of going mad and often try to control their thoughts and (erroneously) believe that if they had not done so, they would have gone mad. Within cognitive models of anxiety disorders, at least two different levels of disturbed thinking are distinguished. First, negative automatic thoughts are those thoughts or images that are present in specific situations when an individual is anxious. For example, someone concerned about social evaluation might have the negative thought, ‘They think I'm boring’, while talking to a group of acquaintances. Second, dysfunctional assumptions are general beliefs, which individuals hold about the world and themselves which are said to make them prone to interpret specific situations in an excessively negative and dysfunctional fashion. For example, a rule involving an extreme equation of self-worth with social approval (‘Unless I am liked by everyone, I am worthless’) might make an individual particularly likely to interpret silent spells in conversation as an indication that others think one is boring. Cognitive behaviour therapy attempts to treat anxiety disorders by (a) helping patients identify their negative danger-related thoughts and beliefs, and (b) modifying these cognitions and the behavioural and cognitive processes that normally maintain them. A wide range of procedures are used to achieve these aims, including education, discussion of evidence for and against the beliefs, imagery modification, attentional manipulations, exposure to feared stimuli, and numerous other behavioural assignments. Within sessions there is a strong emphasis on experiential work and on working with high affect. Between sessions, patients follow extensive homework assignments. As in cognitive behaviour therapy for other disorders, the general approach is one of collaborative empiricism in which patient and therapist view the patient's fearful thoughts as hypotheses to be critically examined and tested.

Cognitive behavior therapy (CBT) is a pragmatic, action-oriented treatment approach that has become a widely used psychotherapy for major mental disorders. CBT methods were initially developed for depression and anxiety disorders (1–3), and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse; they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder (3, 4–7). This article delineates the core principles of CBT, describes procedures used in clinical practice, and notes some of the recent advances that have been made in this treatment method. The extensive research supporting the efficacy of CBT is briefly reviewed.

ABSTRACT: This article is a description of the Music Therapy Assessment of Automatic Thoughts (MTAAT), a cognitive behavioral intervention designed to help couples improve communication. This method was designed to be a part of the type of communication training exercises that may take place in marriage counseling. It involves spouses taking turns improvising on percussion instruments to depict musically what they perceive as their typical pattern of communication. While one improvises, the other writes thoughts that result from what the other is musically saying. These are designed to serve as assessments of the automatic, conscious thoughts each spouse has when communicating. The results of an initial clinical application suggest that the MTAAT may successfully enable couples to communicate musically with one another and may reveal a degree of interpersonal knowledge about their relationship and the types of automatic thoughts they have while communicating verbally with one another. The authors suggest the need for research on the applicability of the MTAAT in a marriage counseling setting and other settings where therapists use cognitive behavioral music therapy interventions. The field of marriage counseling can be traced back to the early 1930's (Nichols & Schwartz, 2004). Since that time, marriage counseling has continued to grow and expand as new treatments develop. Marriage counseling is a specialized field of family therapy designed to help individuals adequately prepare for and make adjustments during marriage Qohnson, 1961). Initially, counselors utilized behavioral techniques to help couples improve communication and other types of interactions with operant conditioning (Wetchler & Piercy, 1996). For instance, some counselors used contingency contracting to enhance communication skills and other types of reciprocal behaviors (Nichols & Schwartz, 2004). With the advent of cognitive behaviorism in the 1960's, marriage counselors began to incorporate the theories of Beck (1976) and Ellis (1962) into their methods of treatment. Since that time, marriage counselors have created different cognitive behavioral approaches such as Cognitive Behavioral Couples Therapy (CBCT). CBCT developed in the late 1980's as a formal method of treatment (Epstein, Baucom, & Daiuto, 1997). In cognitive behavioral therapy, counselors help individuals gain insight and improve their ability to recognize negative automatic thoughts and change maladaptive beliefs (Abrahms, 1983; Corey, 1996; Epstein, Baucom, & Daiuto, 1997). According to McMinn (1991), automatic thoughts are spontaneous, conscious thoughts that occur in response to specific situations. Since automatic thoughts occur in response to specific situations, they are examined by the therapist because they often reflect a person's core beliefs about those situations or events (Epstein & Baucom, 2002; McMinn, 1991). The manner in which people perceive and structure their experiences determines how they feel, behave and respond (Corey, 1996; Nichols & Schwartz, 2004). Cognitive behavioral therapy maintains that people tend to incorporate faulty thinking into their lifestyle, which leads to emotional and behavioral disturbances (Corey, 1996; Luce, 2001). With the help of the counselor, clients can begin to change false beliefs about themselves and others by recognizing and challenging automatic thoughts that influence problematic behavior. Cognitive behavioral music therapy interventions typically involve the client(s) and therapist(s) making music together within the session (Standley, Johnson, Robb, Brownell, & Kim, 2004). Clients are given the opportunity to recognize cognitions while engaging in an active, music-making process. The experiential characteristics inherent in improvisational music therapy can facilitate here and now experiences that can assist couples when using cognitive behavioral interventions to improve their ability to communicate with each other. …

Cognitive factors in women hypoactive sexual desire disorder

Introduction: Perfectionism has been identified as a transdiagnostic process, associated with various psychopathologies. Clinical perfectionism, the dysfunctional or maladaptive element of perfectionism, is defined as relying on meeting self-imposed standards, despite any adverse consequences. When addressing clinical perfectionism, cognitive behavioural therapy (CBT) is a popular intervention. However, the current literature looking at CBT outcomes on perfectionism is diverse and includes a number of delivery methods, comorbid diagnoses, and sample populations. Thus, this scoping review aims to tease apart and summarize the literature surrounding CBT outcomes on clinical perfectionism. Methods: A systematic search was conducted in University of Toronto Libraries, APA PsycInfo (Ovid), APA PsycInfo (ProQuest), PubMED, and MEDLINE using relevant search terms. Article screening and extraction was completed in three stages: 1) title/abstract, 2) full text review, 3) extraction. A total of 13 studies were included in the scoping review. Results: When looking at CBT outcomes on clinical perfectionism, there was significant reductions in perfectionism measures, including the CPQ and FMPS, which was also clinically significant and lead to reliable change. Additional outcomes include reduction in depression, anxiety, and eating disorder psychopathology. CBT interventions were generally effective and tolerated by participants, increasing reported quality of life, satisfaction, self-esteem, and self-compassion. Conclusion: Overall, the use of CBT on clinical perfectionism leads to positive results and is a feasible method to treat perfectionism in a variety of patients, including adults with anxiety disorders, depression, eating disorders, and obsessive-compulsive disorder. Future studies should investigate this topic with more diverse population and compare intervention lengths.

Meditation has a long tradition with substantial implications for many psychotherapies. It has been postulated that meditation may cultivate therapeutic processes similar to various psychotherapies. A previous study used joint factor analysis to identify five common factors of items of scales purported to capture psychological states cultivated by meditation, focusing, and cognitive behavioral therapy, namely, refraining from catastrophic thinking, logical objectivity, self-observation, acceptance, and detached coping. The present study aimed to extend previous research on these five factors by examining their longitudinal relationship to symptoms of depression, obsession and compulsion, and worrying, with two correlational surveys without intervention. Potential mediators of their effect on worrying were also explored. Longitudinal questionnaire studies from two student samples (n = 157 and 232, respectively) found that (a) detached coping was inversely related to obsessive-compulsive symptoms about 5 weeks later; (b) detached coping was inversely related to depressive symptoms about 5 weeks later; (c) refraining from catastrophic thinking was inversely related to worrying, while self-observation was positively related to worrying about 2 months later; and (d) the relation of refraining from catastrophic thinking to worrying was mediated by negative beliefs about worrying, while the relation of self-observation to worrying was mediated by negative beliefs about worrying and monitoring of one’s cognitive processes. As refraining from catastrophic thinking involves being detached from one’s negative thinking and detached coping involves distancing oneself from external circumstances and problems, the results suggest that distancing attitudes are useful for long-term reduction of various psychological symptoms.

Aim: The present study aimed to investigate the effectiveness of cognitive behavioral therapy based on health psychology on perfectionism and the quality of life (QOL). Materials and Methods: The plan of research is an experimental design by pretest–posttest and control group. The statistical population consists of all clients referring to Talie Counseling and Psychological Services Center located at region 4 of Tehran, of which 30 individuals who had higher perfectionism tendency based on the structured interview were selected as research sample and placed randomly in two: the two-test group and the control group. The test group went under group cognitive behavioral treatment for 2 months (8 sessions, 90 min/session). To evaluate perfectionism, the rate of them was applied and life quality was evaluated through a short form of life quality questionnaire of WH. Data were analyzed by descriptive statistics and covariance analysis (MANCOVA). Results: It was found that cognitive behavioral therapy reduced perfectionism and increased the QOL in the experimental group compared to that of the control group. In fact, perfectionism is rooted in dysfunctional thoughts, negative beliefs, and cognitive distortions that are reduced by cognitive behavioral therapy. When a person's perfectionism decreases, the QOL also improves due to the reduction of anxiety. Conclusion: The present study is one of the main applications of health psychology. Cognitive behavioral interventions have an appropriate effect on perfectionism and solving their related problems. It seems that perfectionism is reduced using cognitive behavioral techniques and practices, and finally, the QOL can improve.

Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders

CBT and Recovery From Psychosis in the ISREP Trial: Mediating Effects of Hope and Positive Beliefs on Activity

Burns and other injuries requiring plastic and/or reconstructive surgery (BPRS) are lifechanging, often unexpected, and increase the risk of psychiatric morbidity. There are no published studies we are aware of that explores the applicability of psychological models to BPRS patients. Cognitive behavioural therapy (CBT) is the benchmark treatment in mental health but may be less effective in physical health settings. Metacognitive therapy (MCT)can be more effective than CBT in mental health settings and shows promise in reducing anxiety and depression symptoms in people with cancer and cardiac disease. The present study explored the psychological experiences (feelings, thoughts, and coping strategies) of BPRS patients, and whether the concepts underpinning cognitive and metacognitive models can be elicited from these accounts. Semi structured interviews were conducted with 11 patients recruited from a BPRS psychology service. Data was analysed using Thematic Analysis. Patients described a range of emotions including low mood, anxiety, anger, guilt, loss, and negative thinking. From the perspective of the cognitive model, there were examples of each of 10 pre-specified distorted thinking types (cognitive distortions), and patient talk seemed to fit problem-specific cognitive models. From the perspective of the metacognitive model, all patients described the "cognitive attentional syndrome," i.e., how they engaged in repetitive negative thinking (worry, rumination) and thought-focused regulation strategies. Patient talk also demonstrated both positive and negative metacognitive beliefs. The implications of applying the findings from each model to clinical practice are discussed. The metacognitive model may offer benefits in clinical practice that should be investigated further.

The objective of the study was to investigate variables, derived from both cognitive and emotion regulation conceptualizations of social anxiety disorder (SAD), as possible change processes in cognitive behaviour therapy (CBT) for SAD. Several proposed change processes were investigated: estimated probability, estimated cost, safety behaviours, acceptance of emotions, cognitive reappraisal and expressive suppression. Participants were 50 patients with SAD, receiving a standard manualized CBT program, conducted in groups or individually. All variables were measured pre-therapy, mid-therapy and post-therapy. Lower level mediation models revealed that while a change in most process measures significantly predicted clinical improvement, only changes in estimated probability and cost and acceptance of emotions showed significant indirect effects of CBT for SAD. The results are in accordance with previous studies supporting the mediating role of changes in cognitive distortions in CBT for SAD. In addition, acceptance of emotions may also be a critical component to clinical improvement in SAD during CBT, although more research is needed on which elements of acceptance are most helpful for individuals with SAD. The study's lack of a control condition limits any conclusion regarding the specificity of the findings to CBT. Change in estimated probability and cost, and acceptance of emotions showed an indirect effect of CBT for SAD. Cognitive distortions appear relevant to target with cognitive restructuring techniques. Finding acceptance to have an indirect effect could be interpreted as support for contemporary CBT approaches that include acceptance-based strategies.

The term perfectionism is often characterized by insisting that everything should be perfect and flawless, believing in only one truth, and having difficulty transforming perspectives and thoughts. Although perfectionism is not a newly introduced concept in the literature, it has recently become one frequently aired both in research and daily life. The popularity of the concept in empirical studies stems from both its dual nature and its alleged roles in the origin, emergence, retention, and treatment of various psychological disorders. Indeed, despite the abundance of evidence that perfectionism is multifaceted within two major dimensions (perfectionist strivings and perfectionist concerns), it is still debated that the dimensions in different numbers better represent the construct. In addition, the relevant literature hosts diverse views and criticisms about which sub-dimensions the two higher-order dimensions will consist of, whether the conceptual content of a combination of these sub-dimensions is positive or negative, and how to calculate the total impact of the sub-dimensions. On the other hand, previous research consistently addressed the relationship of perfectionism with different psychopathologies and comorbidities. In this respect, it is also deemed important to discuss perfectionism in psychotherapy because even settling perfectionist traits may bring about improvements in more than one disorder associated with perfectionism. Thus, the Cognitive Behavioral Approach (CBT) conceptualized perfectionism (clinical perfectionism) and presented techniques for therapy. Moreover, the evidence is also proliferating for the efficiency of CBT for perfectionism. Therefore, in this article, the current literature on the structure, transdiagnostic nature and cognitive behavioral therapy of perfectionism has been reviewed.

The Epistemic Relevance of Cognitive Behavioral Therapy Chloe Bamboulis (bio) and Lisa Bortolotti, PhD* (bio) Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy (CBT) can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business of enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits. Validity and Utility in Depression All human agents, whether they have a mental health diagnosis or not, behave in ways that diverge from the ideal standards of epistemic and practical rationality, compromising validity and utility. Whereas validity mostly concerns the accuracy of mental representations and the correctness of explanatory hypotheses, utility concerns their adaptiveness. The goal of validity is to see the world, the self, and the future as they are, whereas the goal of utility is to enhance successful and productive behavior avoiding misery. Let's consider Ratnayake's example of a student who "performs mediocrely on a test and consequently believes that they will fail the entire course." Call her Susie. The depressive realism effect suggests that people with mild depressive symptoms are more accurate than controls when rating themselves and predicting their future, but the same epistemic advantage neither applies to those diagnosed with major depression nor extends to tasks that are not self-related. Suppose that Susie evaluates accurately her performance in the test and also accurately predicts that she will fail the entire course: she may be showing validity at the expense of utility. But what about those other thoughts Susie is likely to have due to her depression, about her social interactions and everyday situations? That the world is a cruel place and luck is always against her, that she is weak and unable to control her circumstances? These thoughts may lack both validity and utility. If we think that so-called cognitive distortions in depression only involve practical issues and [End Page 91] not epistemic issues, we may also believe that, if a therapy addresses cognitive distortions effectively, it does so because it boosts utility. But this would be misleading. Epistemic issues include generating implausible hypotheses that do not pass rigorous reality testing, but also arriving at hypotheses without taking into account the relevant evidence that is available. If Susie arrives at a self-prediction that turns out to be correct by simply accepting a negative automatic thought, this does not indicate that she has exercised epistemic rationality. Simply accepting that things will go badly due to negative biases may give rise to correct predictions, but the prediction will not reflect a careful consideration of the factors that are likely to contribute to the future outcome. This has implications for the discussion of the aims of CBT: the epistemic relevance of a therapeutic approach does not merely depend on whether it increases the overall number of accurate representations and correct hypotheses, but in whether it encourages grounding representations and hypotheses on experience and evidence. Does CBT Lead to Epistemic Improvement? The main thesis in Ratnayake's paper is that CBT does not produce more accurate self-evaluations or more reliable self-predictions but encourages a positive way of interpreting reality that, before engaging in therapy, people might not have taken advantage of. The claim, then, is that CBT does not contribute to validity but boosts utility: it may be instrumental to turning people into more practically rational agents, enabling them to navigate their environment in a more successful way. However, for Ratnayake, CBT does not turn people into more epistemically rational agents, because, instead of eliminating distortions from their reasoning, it promotes an interpretation of the facts that protects people from anxiety and depression. Take Susie who comes to believe, with high conviction, that she will fail the whole course because she performed mediocrely in one test. By inviting Susie to think about...