ACT + CBT Bibliotherapy for Perfectionism

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Utah State University

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

Compensation: Varies

Number of Visits: 4

Duration: 10 weeks

120 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment ACT + CBT Bibliotherapy for Perfectionism?

Research shows that cognitive behavioral therapy (CBT) is effective in reducing perfectionism and related issues like anxiety, depression, and eating disorders. Studies have found that both face-to-face and internet-based CBT can significantly reduce perfectionism symptoms, suggesting that similar approaches like ACT + CBT Bibliotherapy could also be beneficial. ^{1 2 3 4 5}

Is ACT + CBT Bibliotherapy safe for humans?

ACT and CBT, including their online versions, have been used safely in various studies for conditions like perfectionism, anxiety, and depression. These therapies focus on improving mental health through skills training and have not shown significant safety concerns in the research available. ^{2 6 7 8 9}

How does the ACT + CBT Bibliotherapy treatment for perfectionism differ from other treatments?

The ACT + CBT Bibliotherapy treatment is unique because it combines Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) with bibliotherapy, which involves guided reading as part of the therapy. This approach allows patients to engage with therapeutic materials at their own pace, potentially enhancing self-motivation and personal insight, which is different from traditional face-to-face therapy sessions. ^{2 4 6 10 11}

What is the purpose of this trial?

The goal of this clinical trial is to test self-help books for adults with perfectionism. The main questions it aims to answer are: 1. Are the self-help books (ACT and CBT) effective, compared to a waitlist control condition? 2. What are the processes of change for perfectionism in ACT vs. CBT bibliotherapy? 3. Do the self-help books (ACT and CBT) affect change in general distress, well-being, and affect? 4. Is bibliotherapy an acceptable and feasible intervention for perfectionism? Participants will be randomized into either the ACT self-help condition, CBT self-help condition, or waitlist control condition: 1. Participants in both intervention conditions will be asked to read the respective self-help book over the course of 10 weeks and complete 4 surveys over 3.5 months. 2. Participants in the waitlist condition will be asked to complete 4 surveys over 3.5 months, and will receive access to both self-help books once the study is complete.

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: a systematic review and meta-analysis. [2022]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Internet-based cognitive behavioral therapy of perfectionism: Comparing regular therapist support and support upon request. [2020]

3. England pubmed.ncbi.nlm.nih.gov

A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: a preliminary study. [2020]

4. Canada pubmed.ncbi.nlm.nih.gov

Overcoming Perfectionism: Protocol of a Randomized Controlled Trial of an Internet-Based Guided Self-Help Cognitive Behavioral Therapy Intervention. [2022]

5. England pubmed.ncbi.nlm.nih.gov

The impact of internet-based cognitive behaviour therapy for perfectionism on different measures of perfectionism: a randomised controlled trial. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Online process-based training for perfectionism: A randomized trial. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy for a case of scrupulosity-related obsessive-compulsive disorder. [2019]

8. Australia pubmed.ncbi.nlm.nih.gov

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

9. Canada 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. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Bibliotherapy: a critique of the literature. [2018]

11. United States pubmed.ncbi.nlm.nih.gov

Perfectionism unbound: An integrated individual and group intervention for those hiding imperfections. [2022]