ACT + CBT Bibliotherapy for Perfectionism

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Utah State University

Disqualifiers: Non-student, Non-English speaker, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 10 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests the effectiveness of self-help books using two methods: ACT (Acceptance and Commitment Therapy) and CBT (Cognitive Behavioral Therapy) for adults dealing with perfectionism. It aims to determine if these books can reduce perfectionist tendencies and improve overall well-being compared to a waitlist group. Participants will read either an ACT or CBT self-help book over 10 weeks and complete several surveys. University students who struggle with perfectionism and have access to online library resources make good candidates for this trial.

As an unphased study, this trial offers a unique opportunity to explore new self-help strategies for personal growth and well-being.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that bibliotherapy is safe for adults with perfectionism?

Research shows that self-help books for ACT (Acceptance and Commitment Therapy) and CBT (Cognitive Behavioral Therapy) safely treat issues like perfectionism, anxiety, and depression. Studies have found that ACT effectively reduces unhealthy perfectionism. Another study demonstrated that CBT helps lower perfectionism and its related symptoms.

Both therapies are generally well-tolerated, with most people experiencing no serious side effects. Research supports their safety, particularly because these methods involve self-help books, which are usually low-risk. Participants can read at their own pace, minimizing stress. Overall, ACT and CBT self-help books appear safe for managing perfectionism. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for perfectionism because they offer a new way to tackle the condition through bibliotherapy, which involves reading specifically tailored self-help books. Unlike traditional therapy sessions that require in-person meetings, these treatments allow individuals to engage in cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) on their own schedule, making it more accessible and flexible. The CBT bibliotherapy uses the book "When Perfect Isn't Good Enough," while the ACT bibliotherapy uses "The Anxious Perfectionist," each targeting perfectionism with different therapeutic techniques. This innovative approach could help more people access effective treatment by reducing barriers like cost and availability of therapists.

What evidence suggests that this trial's treatments could be effective for perfectionism?

This trial will compare the effectiveness of ACT (Acceptance and Commitment Therapy) and CBT (Cognitive Behavioral Therapy) in bibliotherapy form for reducing symptoms of perfectionism. Participants in the ACT Bibliotherapy arm will read "The Anxious Perfectionist" over 10 weeks. Studies have indicated that ACT is more effective than simply waiting for improvement, as it helps people with perfectionism and enhances their mental flexibility and well-being. Participants in the CBT Bibliotherapy arm will read "When Perfect Isn't Good Enough" over 10 weeks. CBT has a strong history of reducing perfectionism, anxiety, and depression, with reviews of multiple studies showing its effectiveness in reducing perfectionism symptoms. Both therapies, when used in book form, show promise in helping individuals manage perfectionism. ^{3 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for adults over 18 who are university students, can read English, have access to the university's online library, and score high on a perfectionism scale. There are no specific exclusion criteria listed.

Inclusion Criteria

Access to the university's online library resources

The ability to understand and read English

Endorse high perfectionism (29 or more on the concerns over mistakes Frost Multidimensional Perfectionism Subscale)

Exclusion Criteria

N/A

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants read self-help books (ACT or CBT) over 10 weeks and complete 4 surveys over 3.5 months

10 weeks

4 surveys (virtual)

Follow-up

Participants are monitored for changes in perfectionism, distress, well-being, and affect

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Acceptance and commitment therapy (ACT)
• Cognitive behavioral therapy (CBT)

Trial Overview The study tests whether self-help books based on Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT) help with perfectionism. Participants will either use one of these self-help methods or be placed in a waitlist group as a control.

How Is the Trial Designed?

Group I: CBT Bibliotherapy Experimental Treatment 1 Intervention

Participants will read 8 chapters (149 pages) of When Perfect Isn't Good Enough by Martin Antony over the course of 10 weeks.

Group II: ACT Bibliotherapy Experimental Treatment 1 Intervention

Participants will read 10 chapters (140 pages) of The Anxious Perfectionist by Clarissa Ong and Michael Twohig over the course of 10 weeks.

Group III: Waitlist Control Active Control 1 Intervention

Waitlist condition; assessment only

Acceptance and commitment therapy (ACT) is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Acceptance and Commitment Therapy for:

• Anxiety
• Depression
• Perfectionism
• Substance Abuse
• Trauma

Approved in European Union as Acceptance and Commitment Therapy for:

• Anxiety Disorders
• Mood Disorders
• Personality Disorders
• Substance Use Disorders

Approved in Canada as Acceptance and Commitment Therapy for:

• Anxiety Disorders
• Mood Disorders
• Personality Disorders
• Substance Use Disorders

Who Is Running the Clinical Trial?

Utah State University

Lead Sponsor

Trials

48

Recruited

5,200+

Published Research Related to This Trial

Acceptance and Commitment Therapy (ACT) is gaining recognition as an effective treatment for obsessive-compulsive disorder (OCD), particularly for cases involving scrupulosity, which is a form of OCD focused on religious or moral concerns.

ACT offers a unique approach to Exposure and Response Prevention (ERP), making it a suitable option for individuals with OCD who may be hesitant to participate in traditional ERP methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy for a case of scrupulosity-related obsessive-compulsive disorder. Lee, EB., Ong, CW., An, W., et al.[2019]

Cognitive Behavioral Therapy (CBT) for perfectionism has been shown to significantly reduce perfectionism and related symptoms in a systematic review of 15 randomized controlled trials involving 912 participants, with medium to large effect sizes for various perfectionism measures.

The review also found medium effects of CBT on reducing symptoms of eating disorders and depression, and a small-medium effect on anxiety, indicating that addressing perfectionism can have broader mental health benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: a systematic review and meta-analysis. Galloway, R., Watson, H., Greene, D., et al.[2022]

Internet-based cognitive behavioral therapy (ICBT) significantly reduces perfectionism symptoms, with large effect sizes observed in both therapist-supported and request-based support groups, indicating its efficacy as a treatment option.

Both ICBT conditions showed sustained improvements at a six-month follow-up, suggesting that even minimal therapist interaction (support on request) can be effective for many individuals dealing with perfectionism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based cognitive behavioral therapy of perfectionism: Comparing regular therapist support and support upon request. Zetterberg, M., Carlbring, P., Andersson, G., et al.[2020]

This study aims to evaluate the effectiveness of an Internet-based guided self-help cognitive behavioral therapy (CBT) intervention for reducing perfectionism and associated psychological disorders, using a randomized controlled trial with participants assessed at three time points over 24 weeks.

The results will provide insights into how well this online intervention works compared to a waiting list control group, potentially enhancing access to effective treatment for perfectionism and its related issues like depression and anxiety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Overcoming Perfectionism: Protocol of a Randomized Controlled Trial of an Internet-Based Guided Self-Help Cognitive Behavioral Therapy Intervention. Kothari, R., Egan, S., Wade, T., et al.[2022]

A 26-year-old woman with Major Depressive Disorder and perfectionistic traits underwent a successful 6-month integrative psychotherapy treatment, combining individual and group therapy approaches.

At the end of the treatment, she showed remission from both her depression and personality pathology, suggesting that this integrative approach may be effective for similar cases, warranting further research with larger groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perfectionism unbound: An integrated individual and group intervention for those hiding imperfections. Cheli, S., Cavalletti, V., Flett, GL., et al.[2022]

A randomized trial with 77 participants showed that an online self-help intervention based on process-based therapy (PBT) significantly improved perfectionism, self-compassion, and psychological distress after two four-session trainings focused on cognitive and motivational skills.

The second training session provided additional benefits, enhancing quality of life and further reducing psychological distress, indicating that combining different therapeutic approaches can effectively address perfectionism and related issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Online process-based training for perfectionism: A randomized trial. Ong, CW., Lee, EB., Levin, ME., et al.[2022]

Bibliotherapy should be clearly defined as a structured reading program guided by a physician, potentially with the help of a trained librarian, to treat psychiatric patients.

It can be beneficial for self-motivated neurotic patients by promoting emotional expression and constructive thinking, although it is not a cure-all and requires further scientific study to validate its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bibliotherapy: a critique of the literature. Favazza, AR.[2018]

Acceptance and Commitment Therapy (ACT) has shown effectiveness in improving outcomes for patients with chronic pain and may also benefit those with mild to moderate depression, making it a valuable tool for general practitioners.

ACT employs mindfulness and acceptance strategies to help patients align their behaviors with their values, and it has shown preliminary benefits in various conditions, including obsessive-compulsive disorder and emotional issues after gastric band surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy - pathways for general practitioners. Smout, M.[2012]

Internet-based Acceptance and Commitment Therapy (iACT) shows small effects in reducing depressive symptoms, anxiety, stress, psychological distress, and improving quality of life, based on a systematic review of 39 randomized controlled trials.

While iACT was effective compared to passive control groups, it did not show significant advantages over active control groups, indicating the need for further high-quality studies to compare its efficacy with other established therapies like cognitive behavioral therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Internet-Based Acceptance and Commitment Therapy for Depressive Symptoms, Anxiety, Stress, Psychological Distress, and Quality of Life: Systematic Review and Meta-analysis. Han, A., Kim, TH.[2022]

A preliminary randomized controlled trial involving 20 participants showed that cognitive-behavioral therapy (CBT) for clinical perfectionism was effective, with 75% of participants experiencing significant clinical improvement after 10 sessions over 8 weeks.

The treatment effect was substantial, with a large effect size of 1.8, and improvements were maintained at both 8-week and 16-week follow-ups, indicating lasting benefits of the therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: a preliminary study. Riley, C., Lee, M., Cooper, Z., et al.[2020]

The study demonstrated that an 8-module internet-based cognitive behavior therapy for perfectionism (ICBT-P) significantly reduced various aspects of perfectionism in undergraduate students, with strong effects observed in the Concern over Mistakes and High Standards subscales.

Despite the effectiveness of ICBT-P in addressing perfectionism, the low completion rate of treatment modules (average of 3.12 out of 8) may have limited its impact on secondary measures like depression and anxiety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of internet-based cognitive behaviour therapy for perfectionism on different measures of perfectionism: a randomised controlled trial. Grieve, P., Egan, SJ., Andersson, G., et al.[2022]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40544719/

A randomized controlled trial of self-help acceptance and ... Participants assigned to ACT and CBT showed significantly improved perfectionism, psychological inflexibility, cognitive reappraisal, well-being ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2211364919300120

A randomized controlled trial of acceptance and ... Our findings indicate ACT was superior to a waitlist control condition on clinical perfectionism, psychological functioning, and processes of change.

3. digitalcommons.usu.edu digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1431&context=etd2023

A Randomized Controlled Trial of Self-Help Acceptance and ... Moreover, our results are comparable to a previous mindfulness bibliotherapy for perfectionism study reporting significant decreases in negative affect but did ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11267127/

Application of Acceptance and Commitment Therapy (ACT) ... Results: Our findings indicate consistent effectiveness for ACT and related interventions across various delivery formats, including in-person, group, and ...

5. withpower.com withpower.com/trial/phase-perfectionism-8-2023-1b555

ACT + CBT Bibliotherapy for Perfectionism Both ICBT conditions showed sustained improvements at a six-month follow-up, suggesting that even minimal therapist interaction (support on request) can be ...

6. digitalcommons.usu.edu digitalcommons.usu.edu/context/etd/article/8837/viewcontent/PSYCHetd2019Dec_Ong_Clarissa.pdf

Treatment of Clinical Perfectionism Using Acceptance and ... The aim of this dissertation was to test the effect of acceptance and commitment therapy (ACT), a cognitive-behavioral therapy, on 53 individuals with clinical ...

7. karger.com karger.com/ver/article/34/1/1/862136/Cognitive-Behavioral-Treatment-of-Perfectionism-An

Cognitive-Behavioral Treatment of Perfectionism: An ... In another study, Acceptance and Commitment Therapy (ACT) was shown to be effective in reducing maladaptive perfectionism – more precisely, an ...

8. self-compassion.org self-compassion.org/wp-content/uploads/2021/11/Ong-et-al.-Is-perfectionism-always-unhealthy-Examining-the-m.pdf

Is perfectionism always unhealthy? Examining the ... The Comprehensive Assessment of ACT Processes (CompACT) is a 23‐item self‐report measure of psychological flexibility. It consists of three ...

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9139700/

The Applicability of Acceptance and Commitment Therapy for ... ACT made statistically significant progress in the Yale–Brown Obsessive–Compulsive Scale (YBOCS) compared with control conditions. Conclusion: ...