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The comparison between CBT focused on perfectionism and CBT focused on emotion regulation for individuals with depression and anxiety disorders and dysfunctional perfectionism: a randomized controlled trial

Published online by Cambridge University Press:  23 December 2020

Mohammad Mahmoodi ,
Maryam Bakhtiyari ,
Abbas Masjedi Arani ,
Abolfazl Mohammadi  and
Mohsen Saberi Isfeedvajani
Mohammad Mahmoodi
Affiliation:
Department of Clinical Psychology, Shahid Beheshti University of Medical Science, Tehran, Iran
Maryam Bakhtiyari*
Affiliation:
Department of Clinical Psychology, Shahid Beheshti University of Medical Science, Tehran, Iran
Abbas Masjedi Arani
Affiliation:
Department of Clinical Psychology, Shahid Beheshti University of Medical Science, Tehran, Iran
Abolfazl Mohammadi
Affiliation:
Department of Psychology, University of Saskatchewan (USASK), Saskatoon, Canada
Mohsen Saberi Isfeedvajani
Affiliation:
Medicine, Quran and Hadith Research Center & Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Science, Tehran, Iran
*
*Corresponding author. Email: Maryam_bakhtiyari@sbmu.ac.ir
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Abstract

Background:

There is considerable evidence indicating that similar aetiological and maintenance processes underlie depressive and anxious psychopathology. According to the literature, perfectionism and emotion regulation are two transdiagnostic constructs associated with symptoms of emotional disorders.

Aims:

This study is the first randomized controlled trial comparing the efficacy of cognitive behavioural therapy for perfectionism (CBT-P) and the unified protocol for the transdiagnostic treatment of emotional disorders (UP).

Method:

Seventy-five participants with a range of depressive and anxiety disorders and elevated perfectionism were randomized to three conditions: CBT-P, UP or a waitlist control (WL).

Results:

Repeated measures ANOVA indicated that the treatment groups reported a significantly greater pre–post reduction in the severity of symptoms of disorders, as well as a significantly greater pre–post increase in quality of life, all with moderate to large effect sizes compared with the WL group. Treatment gains were maintained at 6-month follow-up. The CBT-P group reported a significantly greater pre–post reduction in perfectionism compared with UP, and the UP group reported a significantly greater pre–post improvement in emotion regulation compared with CBT-P.

Conclusions:

Findings support CBT for perfectionism and regard UP as efficacious treatments for individuals with depression and anxiety disorders who also have dysfunctional perfectionism. It appears that perfectionism cannot be a serious obstacle to UP. As this is a preliminary study and has some limitations, it is recommended that further research be conducted.

Keywords

anxiety disorderscognitive behavioural therapydepressionemotion regulationperfectionismtransdiagnostic
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 4 , July 2021 , pp. 454 - 471
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Agras, W. S., Walsh, B. T., Fairburn, C. G., Wilson, G. T., & Kraemer, H. C. (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57, 459–466.CrossRefGoogle ScholarPubMed
Aldao, A. (2012). Emotion regulation strategies as transdiagnostic processes: a closer look at the invariance of their form and function. Revista de Psicopatología y Psicología Clínica, 17, 261–277.CrossRefGoogle Scholar
Aldao, A., & Dixon-Gordon, K. L. (2014). Broadening the scope of research on emotion regulation strategies and psychopathology. Cognitive Behaviour Therapy, 43, 22–33.CrossRefGoogle ScholarPubMed
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: a meta-analytic review. Clinical Psychology Review, 30, 217–237.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic Criteria from DSM-IV-TR. American Psychiatric Publishing.Google Scholar
American Psychiatric Association (2009). Practice guideline for the treatment of patients with major depressive disorder (3rd edn). http://psychiatryonline.org/guidelines.aspx Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Publishing.Google Scholar
Barlow, D., Farchione, T., Fairholme, C., Ellard, K., Boisseau, C., Allen, L., & Ehrenreich-May, J. (2011). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. Oxford, UK: Oxford University Press.Google Scholar
Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230.CrossRefGoogle Scholar
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., … & Boswell, J. F. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 74, 875–884.CrossRefGoogle ScholarPubMed
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893.CrossRefGoogle ScholarPubMed
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II . San Antonio, TX, USA: Psychological Corporation.Google Scholar
Bieling, P. J., Summerfeldt, L. J., Israeli, A. L., & Antony, M. M. (2004). Perfectionism as an explanatory construct in comorbidity of axis I disorders. Journal of Psychopathology and Behavioral Assessment, 26, 193–201.CrossRefGoogle Scholar
Blatt, S. J., Zuroff, D. C., Bondi, C. M., Sanislow, C. A. III, & Pilkonis, P. A. (1998). When and how perfectionism impedes the brief treatment of depression: further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 66, 423.CrossRefGoogle ScholarPubMed
Borjali, A., Sohrabi, F., Dehshiri, G., & Golzari, M. (2010). Psychometrics particularity of farsi version of Pennsylvania State Worry Questionnaire for college students. Applied Psychology, 4, 67–75.Google Scholar
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585.CrossRefGoogle Scholar
Bullis, J. R., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Carl, J. R., & Barlow, D. H. (2015). The unified protocol for transdiagnostic treatment of emotional disorders: preliminary exploration of effectiveness for group delivery. Behavior Modification, 39, 295–321.CrossRefGoogle ScholarPubMed
Carpenter, R. W., & Trull, T. J. (2013). Components of emotion dysregulation in borderline personality disorder: a review. Current Psychiatry Reports, 15, 335.CrossRefGoogle ScholarPubMed
Chang, E. C., Watkins, A., & Banks, K. H. (2004). How adaptive and maladaptive perfectionism relate to positive and negative psychological functioning: testing a stress-mediation model in Black and White female college students. Journal of Counseling Psychology, 51, 93.CrossRefGoogle Scholar
Cohen, J. (1988). Statistical Power Analysis for the Social Sciences. Lawrence Erlbaum Associates.Google Scholar
Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): new self-rating scale. British Journal of Psychiatry, 176, 379–386.CrossRefGoogle ScholarPubMed
Dunkley, D. M., Sanislow, C. A., Grilo, C. M., & McGlashan, T. H. (2006). Perfectionism and depressive symptoms 3 years later: negative social interactions, avoidant coping, and perceived social support as mediators. Comprehensive Psychiatry, 47, 106–115.CrossRefGoogle ScholarPubMed
Egan, S. J., & Hine, P. (2008). Cognitive behavioural treatment of perfectionism: a single case experimental design series. Behaviour Change, 25, 245–258.CrossRefGoogle Scholar
Egan, S. J., van Noort, E., Chee, A., Kane, R. T., Hoiles, K. J., Shafran, R., & Wade, T. D. (2014a). A randomised controlled trial of face to face versus pure online self-help cognitive behavioural treatment for perfectionism. Behaviour Research and Therapy, 63, 107–113.CrossRefGoogle ScholarPubMed
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: a clinical review. Clinical Psychology Review, 31, 203–212.CrossRefGoogle ScholarPubMed
Egan, S. J., Wade, T. D., Shafran, R., & Antony, M. M. (2014b). Cognitive-Behavioral Treatment of Perfectionism. Guilford Press.Google ScholarPubMed
Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., Wales, J. A., & Palmer, R. L. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166, 311–319.CrossRefGoogle ScholarPubMed
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy, 41, 509–528.CrossRefGoogle ScholarPubMed
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., … & Barlow, D. H. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior Therapy, 43, 666–678.CrossRefGoogle ScholarPubMed
Feingold, A. (2009). Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological Methods, 14, 43.CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. New York, USA: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449–468.CrossRefGoogle Scholar
Gratz, K. L., Weiss, N. H., & Tull, M. T. (2015). Examining emotion regulation as an outcome, mechanism, or target of psychological treatments. Current Opinion in Psychology, 3, 85–90.CrossRefGoogle ScholarPubMed
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348.CrossRefGoogle ScholarPubMed
Handley, A. K., Egan, S. J., Kane, R. T., & Rees, C. S. (2015). A randomised controlled trial of group cognitive behavioural therapy for perfectionism. Behaviour Research and Therapy, 68, 37–47.CrossRefGoogle ScholarPubMed
Harris, K. R., & Norton, P. J. (2019). Transdiagnostic cognitive behavioral therapy for the treatment of emotional disorders: a preliminary open trial. Journal of Behavior Therapy and Experimental Psychiatry, 65, 101487.CrossRefGoogle ScholarPubMed
Harvey, A. G., Murray, G., Chandler, R. A., & Soehner, A. (2011). Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clinical Psychology Review, 31, 225–235.CrossRefGoogle ScholarPubMed
Harvey, A. G., Watkins, E., & Mansell, W. (2004). Cognitive Behavioural Processes Across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment: Oxford University Press.CrossRefGoogle Scholar
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239.CrossRefGoogle Scholar
Hilbert, K., Kunas, S. L., Lueken, U., Kathmann, N., Fydrich, T., & Fehm, L. (2020). Predicting cognitive behavioral therapy outcome in the outpatient sector based on clinical routine data: a machine learning approach. Behaviour Research and Therapy, 124, 103530.CrossRefGoogle ScholarPubMed
Kaviani, H. (2008). Validity and reliability of hospital anxiety and depression scale (HADS), general health questionnaire (GHQ-28), Mood Adjectives Checklist, and BDI in clinical population in comparison with healthy group; Research report . Tehran: Tehran University of Medical Sciences.Google Scholar
Kaviani, H., & Mousavi, A. (2008). Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal TUMS Publications, 66, 136–140.Google Scholar
Kendler, K. S. (1996). Parenting: a genetic-epidemiologic perspective. American Journal of Psychiatry, 153, 11–20.Google ScholarPubMed
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.CrossRefGoogle ScholarPubMed
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.CrossRefGoogle ScholarPubMed
Kothari, R., Barker, C., Pistrang, N., Rozental, A., Egan, S., Wade, T., … & Shafran, R. (2019). A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: effects on psychopathology and transdiagnostic processes. Journal of Behavior Therapy and Experimental Psychiatry, 64, 113–122.CrossRefGoogle ScholarPubMed
Kraemer, H. C. (2013). Discovering, comparing, and combining moderators of treatment on outcome after randomized clinical trials: a parametric approach. Statistics in Medicine, 32, 1964–1973.CrossRefGoogle ScholarPubMed
Kring, A. M., & Sloan, D. M. (2009). Emotion Regulation and Psychopathology: A Transdiagnostic Approach to Etiology and Treatment. Guilford Press.Google Scholar
Leichsenring, F., & Salzer, S. (2014). A unified protocol for the transdiagnostic psychodynamic treatment of anxiety disorders: an evidence-based approach. Psychotherapy, 51, 224.CrossRefGoogle Scholar
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: a meta-analysis. Journal of Clinical Psychology, 73, 1301–1326.CrossRefGoogle ScholarPubMed
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343.CrossRefGoogle ScholarPubMed
Mansell, W., Harvey, A., Watkins, E., & Shafran, R. (2009). Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy, 23, 6–19.CrossRefGoogle Scholar
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.CrossRefGoogle ScholarPubMed
Mitchell, J. H., Newall, C., Broeren, S., & Hudson, J. L. (2013). The role of perfectionism in cognitive behaviour therapy outcomes for clinically anxious children. Behaviour Research and Therapy, 51, 547–554.CrossRefGoogle ScholarPubMed
Mohajerin, B., Bakhtiyar, M., Olesnycky, O. S., Dolatshahi, B., & Motabi, F. (2019). Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: a randomized controlled trial. Journal of Affective Disorders, 245, 637–644.CrossRefGoogle ScholarPubMed
Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gøtzsche, P. C., Devereaux, P., … & Altman, D. G. (2010). CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Journal of Clinical Epidemiology, 63, e1–e37.CrossRefGoogle ScholarPubMed
National Collaborating Centre for Mental Health (2011). Common Mental Health Disorders: The NICE Guideline on Identification and Pathways to Care. National Clinical Guideline Number 123.Google Scholar
National Institute for Health Care and Excellence (2013). Social Anxiety Disorder: The NICE Guideline on Recognition, Assessment and Treatment.Google Scholar
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110.CrossRefGoogle ScholarPubMed
Norton, P. J., & Mehta, P. D. (2007). Hierarchical model of vulnerabilities for emotional disorders. Cognitive Behaviour Therapy, 36, 240–254.CrossRefGoogle ScholarPubMed
Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: a quantitative review. Psychotherapy: Theory, Research, Practice, Training, 45, 214.CrossRefGoogle ScholarPubMed
O’Connor, R. C., Rasmussen, S., & Hawton, K. (2010). Predicting depression, anxiety and self-harm in adolescents: the role of perfectionism and acute life stress. Behaviour Research and Therapy, 48, 52–59.CrossRefGoogle ScholarPubMed
Pearl, S., & Norton, P. (2016). Transdiagnostic versus diagnosis specific therapies cognitive behavioural for anxiety: a meta-analysis. Journal of Anxiety Disorders, 7, 1–14.Google Scholar
Peterson, R. A., & Heilbronner, R. L. (1987). The anxiety sensitivity index: construct validity and factor analytic structure. Journal of Anxiety Disorders, 1, 117–121.CrossRefGoogle Scholar
Richardson, J. T. (2011). Eta squared and partial eta squared as measures of effect size in educational research. Educational Research Review, 6, 135–147.CrossRefGoogle Scholar
Riley, C., Lee, M., Cooper, Z., Fairburn, C. G., & Shafran, R. (2007). A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: a preliminary study. Behaviour Research and Therapy, 45, 2221–2231.CrossRefGoogle ScholarPubMed
Rosellini, A. J., Boettcher, H., Brown, T. A., & Barlow, D. H. (2015). A transdiagnostic temperament-phenotype profile approach to emotional disorder classification: an update. Psychopathology Review, 2, 110–128.CrossRefGoogle Scholar
Rozental, A., Shafran, R., Wade, T., Egan, S., Nordgren, L. B., Carlbring, P., … & Thelander, E. (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.CrossRefGoogle ScholarPubMed
Saghaei, M. (2004). Random allocation software for parallel group randomized trials. BMC Medical Research Methodology, 4, 26.CrossRefGoogle ScholarPubMed
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017). Current definitions of ‘transdiagnostic’ in treatment development: a search for consensus. Behavior Therapy, 48, 128–138.CrossRefGoogle ScholarPubMed
Shafran, R., Cooper, Z., & Fairburn, C. G. (2002). Clinical perfectionism: a cognitive-behavioural analysis. Behaviour Research and Therapy, 40, 773–791.CrossRefGoogle ScholarPubMed
Shahar, G., Blatt, S. J., Zuroff, D. C., Krupnick, J. L., & Sotsky, S. M. (2004). Perfectionism impedes social relations and response to brief treatment for depression. Journal of Social and Clinical Psychology, 23, 140–154.CrossRefGoogle Scholar
Shannon, A., Goldberg, J. O., Flett, G. L., & Hewitt, P. L. (2018). The relationship between perfectionism and mental illness stigma. Personality and Individual Differences, 126, 66–70.CrossRefGoogle Scholar
Sharifi, V., Assadi, S. M., Mohammadi, M. R., Amini, H., Kaviani, H., Semnani, Y., … & Shooshtari, M. H. (2009). A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders: psychometric properties. Comprehensive Psychiatry, 50, 86–91.CrossRefGoogle ScholarPubMed
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: a systematic review. Clinical Psychology Review, 57, 141–163.CrossRefGoogle ScholarPubMed
Steele, A. L., & Wade, T. D. (2008). A randomised trial investigating guided self-help to reduce perfectionism and its impact on bulimia nervosa: a pilot study. Behaviour Research and Therapy, 46, 1316–1323.CrossRefGoogle ScholarPubMed
Steele, S. J., Farchione, T. J., Cassiello-Robbins, C., Ametaj, A., Sbi, S., Sauer-Zavala, S., & Barlow, D. H. (2018). Efficacy of the Unified Protocol for transdiagnostic treatment of comorbid psychopathology accompanying emotional disorders compared to treatments targeting single disorders. Journal of Psychiatric Research, 104, 211–216.CrossRefGoogle ScholarPubMed
Stumpf, H., & Parker, W. D. (2000). A hierarchical structural analysis of perfectionism and its relation to other personality characteristics. Personality and Individual Differences, 28, 837–852.CrossRefGoogle Scholar
Talkovsky, A. M., & Norton, P. J. (2018). Negative affect and intolerance of uncertainty as potential mediators of change in comorbid depression in transdiagnostic CBT for anxiety. Journal of Affective Disorders, 236, 259–265.CrossRefGoogle ScholarPubMed
Tran, L., & Rimes, K. A. (2017). Unhealthy perfectionism, negative beliefs about emotions, emotional suppression, and depression in students: a mediational analysis. Personality and Individual Differences, 110, 144–147.CrossRefGoogle Scholar
Wade, T. D., Kay, E., de Valle, M. K., Egan, S. J., Andersson, G., Carlbring, P., & Shafran, R. (2019). Internet-based cognitive behaviour therapy for perfectionism: more is better but no need to be prescriptive. Clinical Psychologist, 23, 196–205.CrossRefGoogle Scholar
World Health Organization (1996). WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. Retrieved from: https://www.who.int/mental_health/media/en/76.pdf Google Scholar
Xie, Y., Kong, Y., Yang, J., & Chen, F. (2019). Perfectionism, worry, rumination, and distress: a meta-analysis of the evidence for the perfectionism cognition theory. Personality and Individual Differences, 139, 301–312.CrossRefGoogle Scholar
Zetterberg, M., Carlbring, P., Andersson, G., Berg, M., Shafran, R., & Rozental, A. (2019). Internet-based cognitive behavioral therapy of perfectionism: comparing regular therapist support and support upon request. Internet Interventions, 17, 100237.CrossRefGoogle ScholarPubMed
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