Abstract
BackgroundPerfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data.ObjectiveThe objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom.MethodsIn total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial.ResultsAnalysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85).ConclusionsThe results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.
Highlights
Perfectionism has many positive features, such as striving for excellence, but it can have a negative impact in many areas, including mental health [1]
Elevated levels of perfectionism can be found among athletes and specific sociodemographics [2], suggesting that there may be populations that are vulnerable to developing problems due to perfectionism, and for whom psychological intervention could prevent the development of further psychopathology
The completer analyses revealed significant differences for both clinical trials between pretreatment and follow-up, revealing a mean difference of 8.98 points (Swedish trial; 95% CI 7.07-10.89) and 10.35 points (UK trial; 95% CI 7.25-13.44) for the FMPS Frost Multidimensional Perfectionism Scale (CM)
Summary
Perfectionism has many positive features, such as striving for excellence, but it can have a negative impact in many areas, including mental health [1]. Perfectionistic strivings seem to be related to eating disorders, while perfectionism concerns are primarily associated with depression and anxiety disorders [2]. This could imply that psychological treatments targeting perfectionism might have to be adapted depending on the psychiatric disorder [3]. Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition
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