Category: Perfectionism

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An RCT on Mindful Compassion for Perfectionism

Mindful Compassion for Perfectionism

An RCT on Mindful Compassion for Perfectionism has been published. Mindful Compassion for Perfectionism is a recently developed group format for those struggling with perfectionism. We previously tested its feasibility in two cases series and then designed a randomized controlled trial (RCT).

Mindful Compassion for Perfectionism (MCP) is an 8-week group intervention that integrates Compassion Focused Therapy and Dynamic Relational Therapy. During the sessions, a specific psychoeducation on perfectionism is presented and numerous experiential practices are conducted.

Seventy-two post-graduate students with clinically high perfectionistic traits were randomly assigned either to a control group (wait-list) or two different formats of MCP (online or in-person). Primary outcomes were feasibility (safety, completion, adherence) of MCP and change in perfectionistic cognitions between active treatments and control group. Secondary analyses explored pre-post changes and differences between the two active groups in perfectionistic cognitions, psychosocial distress, group functioning and self-soothing. The picture shows the flow diagram of the RCT design.

No drop-outs or unwanted adverse events were reported, 6.25% of participants missed a single session and 8.33% were excluded from the study for having missed more than one. MCP treatments – both individually and as a unique group – showed a greater reduction of perfectionistic cognitions and psychosocial distress than wait-list (partial η2 ranging between .565 and .591). In-person MCP indicated a greater reduction of perfectionistic cognitions and psychosocial distress and a greater increase of group functioning and self-soothing than online MCP (partial η2 ranging between .157 and .394).

These findings suggest the feasibility and efficacy of MCP in reducing perfectionistic cognitions and psychosocial distress. The in-person format is seemingly more effective than the online format. A new RCT on Mindful Compassion for Perfectionism is an important step.

Further research should explore the efficacy of MCP in respect to other evidence-based treatments. Moreover, the brief format of MCP and its specific focus on experiential practices may support the possibility of including it in modular or stepped-care protocols for those struggling with perfectionism.

Cheli, S., Cavalletti, V., Goldzweig, G., Bui, S., Petrocchi. N., Flett, G., & Hewitt, P. (2024). A three-arm randomized controlled trial to evaluate the efficacy and feasibility of mindful compassion for perfectionism in reducing perfectionistic cognitions. Journal of Psychotherapy Integration. https://doi.org/10.1037/int0000349

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Cross-cultural invariance of perfectionism

Cross-cultural invariance of perfectionism has been tested in a study of Canadian and Italian samples. In this study we got interesting findings.

Perfectionism measures developed in English-speaking populations have become frequently used in many non-English contexts, including in Italy. Establishing structural and measurement equivalence of instruments between Canadian and Italian samples is therefore important in establishing the validity of these concepts and instruments in Italian contexts, and to allow for direct cross-cultural comparisons.

The current study investigated the measurement equivalence between a Canadian and an Italian sample for the commonly used measures of perfectionism constructs based on the Comprehensive Model of Perfectionistic Behavior. The Hewitt & Flett Multidimensional Perfectionism Scale, the Perfectionistic Self-Presentation Scale, and the Perfectionism Cognitions Inventory were examined for configural, metric, and scalar invariance via equivalence testing of multigroup confirmatory factor analysis models.

The results showed some evidence for configural and metric equivalence for the three measures, thus facilitating cross-cultural interpretation of pattern of associations. However, there was no consistent evidence for scalar invariance, thus suggesting that direct comparisons of perfectionism levels between the two contexts cannot be meaningfully interpreted. This highlights the need for research in both Canadian and Italian contexts to understand cross-cultural invariance of perfectionism.

These findings further highlight the complexity of translating instruments developed in one culture into another, even in two industrialized, “Western” countries. Further research, particularly collaboration by Canadian and Italian researchers using multi-method approaches, would be useful for elucidating the similarities and differences between these two cultures in how perfectionism manifests, how participants respond on perfectionism questionnaires, and the implications of such for understanding psychological difficulties and their treatment.

Cai, N., Dang, S. S., Cheli, S., Cavalletti, V., Flett, G. L., & Hewit, P. L. (2024). Examination of Measures of Perfectionism for Structural and Measurement Invariance in an Italian and a Canadian Sample. Journal of Psychoeducational Assessment, 0(0). https://doi.org/10.1177/07342829241273166

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Automatic Self Recriminations and Perfectionism

Automatic self recriminations place an important role in perfectionism. Persons with perfectionistic traits usually experience internal dialogues in the form of elf-condemnatory, self-blaming spiraling.

In a new article published on the Journal of Personality Assessment, we present a new measure to assess this kind of internal dialogue. The new Automatic Self-Recrimination Scale (ASRS) has been tested in clinical and nonclinical sample showing it is best understood as a multidimensional measure.

Our findings highlight that the measure is composed of one higher-order factor and four lower-order facets: Not Mattering, Self as Failure, Undeserving Self, and Loathsomeness. The overall scale and four subscales demonstrated acceptable internal consistency and test-retest reliability.

Moreover, we show how Automatic Self-Recrimination Scale significantly correlates with measures of perfectionism, self-criticism, and dysfunctional attitudes. In short, we confirm how automatic self recriminations and perfectionism are two intertwined experiences.

Indeed perfectionism involves self-recrimination and an overgeneralized sense of the self as blameworthy and responsible that distinguishes it from other related constructs. Automatic self-recriminations are a unique and important element not only for research purposes but also as a key emphasis for clinical interventions.

As I have discussed elsewhere, Compassion Focused Therapy may cultivate – for example – a more compassionate self by promoting a healthier dialogue between parts of the self and starts with a focus on self-criticism. That is, if the goal is to help people with perfectionistic traits, an intervention that helps them reduce self-recriminations and increase a self-compassionate attitude is probably an effective choice.

Moreover, it is noteworthy how self recriminations (and interventions targeting these processes) are not only related to perfectionism. We have shown how they are pivotal – for example – in traits such as schizotypal ones.

Paul L. Hewitt, Sabrina Ge, Martin M. Smith, Gordon L. Flett, Simone Cheli, Danielle S. Molnar, Ariel Ko, Samuel F. Mikail & Thalia Lang (2024) Automatic Self Recriminations: Development and Validation of a Measure of Self-Condemnatory Internal Dialogue, Journal of Personality Assessment, DOI: 10.1080/00223891.2024.2303429

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Mindful Compassion for Perfectionism: A new RCT!

Mindful compassion for perfectionism

Last week I posted about Roz Shafran’s paper on perfectionism, now I’m again here talking about the same topic! Another interesting news, so I hope I won’t bore you! Clinicaltrial.gov (the worldwide database of funded clinical studies) has reviewed and published today our protocol of the new randomized controlled trial (RCT) on Mindful Compassion for Perfectionism (MCP).

As Shafran suggested, there are only three interventions specifically tailored on perfectionistic traits: cognitive behavioral therapy for perfectionism (Shafran et al., 2023), dynamic relational therapy (Hewitt et al., 2019), and MCP (Cheli et al., 2022). MCP is a form of group psychotherapy that integrates the conceptualization model of dynamic relational therapy with experiential techniques informed by or directly derived from Compassion Focused Therapy (Gilbert et al., 2014). Veronica Cavalletti and I developed this integrative intervention with the scientific support of Paul Hewitt.

To date, some case series have confirmed the feasibility of the MCP. This new RCT is aimed at pilot-testing the effectiveness of the proposed intervention. The study is a waiting-list controlled trial. We are going to start recruiting by nex Monday and have the first group as soon as possible!

National Library of Medicine (U.S.). (2023, January- ). Mindful Compassion for Perfectionism (MCP). Identifier NCT00103181. https://clinicaltrials.gov/ct2/show/NCT00103181

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Effective treatments for perfectionism

Perfectionism

Roz Shafran and colleagues just published an overview of existing effective treatments for perfectionism. They presented their own model and then discussed the existing alternatives.

I was very surprised and happy to see how our protocol was one of the three interventions specifically tailored on perfectionistic traits! In short, Shafran was summarizing evidence and roots of the model with strongest evidence: that is, Cognitive Behavioral Therapy for Perfectionism. This is a tailored form of CBT targeting maladpative beliefs and biases in those struggling with perfectionism. The second model reviewed was the Dynamic Relational Therapy developed by Paul Hewitt and colleagues. Hewitt suggests to consider perfectionism as a set of interpersonal styles comprising of spefici traits, interpersonal and intrapersonal components. Finally, Shafran presented our Mindful Compassion for Perfectionism that integrates the Dynamic Relational Therapy with Compassion Focused Therapy.

As I anticipated, our model is far from being considered evidence-based. We published two cases series (see pubblications) where reporting preliminary evidence for the feasibility of the model, and we are now outlining a randomized controlled trial to better understand its clinical utility. Cavalletti, Hewitt, Flett and I published a first paper introducing the group format and its rationale, and then a second cases series about.

I appreciated Shafran’s recognition, which confirms the importance of specific interventions for specific traits or psychopathological manifestations.

Shafran, R., Egan, S.J., & Wade, T.D: (2023). Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism, Behaviour Research and Therapy,
104258. https://doi.org/10.1016/j.brat.2023.104258

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The link between narcissism and perfectionism

I am ready for the upcoming congress of the European Society for the Study of Personality Disoders (ESSPD) where I join a symposium chaired by Elsa Ronningstam (Harvard Medical School) on recent advances in narcissism.

My team and I just concluded a study on the interwined path of narcissism and perfectionism. In a sample of healthy young adults we explored over time wheter perfectionistic traits and strategies explained the relationship between narcissim and psychopathology.

We found that the higher the perfectionistic strategies the higher the psychopathology associated with narcissistic traits. But perfectionism did not predict variation of narcissism over time. We interpret these results through an evolutionary perspective. Those with prominent narcissistic traits are often triggered by a social rank motive. We hypothesize that perfectionistic strategies are the “tools” used to pursue or recover a desidered social rank. This would be consistent with a common fluctuation of mental states in narcissism and with weak or non significant mediating role of perfectionism in the relationship between past and present narcissism.

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