ACT and CBT Bibliotherapy for Perfectionism

September 25, 2023 updated by: Utah State University

A Randomized Controlled Trial of Self-Help Acceptance and Commitment Therapy and Cognitive Behavioral Therapy for Perfectionism

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.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Perfectionism is a multidimensional construct where individuals develop unrealistically high standards and attribute self-value to meeting these expectations. Perfectionism has also been shown to be a risk and a maintenance factor for a range of psychological difficulties such as depression, social anxiety, eating disorders, and obsessive-compulsive related disorders (Limburg et al., 2017). Furthermore, the prevalence of perfectionism is increasing in undergraduate students according to a recent meta-analysis (Curran & Hill, 2019), highlighting the need to expand accessible treatment options. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) have both demonstrated clinical effectiveness in targeting unhelpful perfectionism, but it is unclear how effective these psychotherapies are at decreasing perfectionism when applied in a bibliotherapy format.

The present study aims to assess the feasibility and efficacy of ACT and CBT self-help books for perfectionism over a 10-week intervention period and one month follow-up assessment, in comparison to a waitlist control condition. Additionally, this study will examine the impact of bibliotherapies on processes of change (i.e., psychological acceptance and cognitive reappraisal) as well as general distress, well-being, and affect. Participants will be adult students recruited from two universities in the mountain and midwestern regions of the United States and participants will complete self-report assessments at pre-, mid-, post-intervention, and follow-up. For the primary aim evaluating efficacy, we predict both ACT (The Anxious Perfectionist) and CBT (When Perfect Isn't Good Enough by Martin Antony) self-help books will decrease unhelpful perfectionism from pre-intervention to follow-up, in comparison to a waitlist control group. For the secondary aim evaluating processes of change, we predict that (1) ACT will increase psychological flexibility more than CBT, and (2) CBT will increase cognitive reappraisal more than ACT, from pre-intervention to follow-up. For our third aim evaluating changes in distress, well-being, and affect, we predict that (1) both ACT and CBT will decrease distress and general negative affect, and (2) ACT will outperform CBT on increases in well-being and general positive affect from pre-treatment to follow-up. For our fourth aim assessing bibliotherapy acceptability and feasibility, we predict no differences between adherence and satisfaction ratings between the ACT and CBT reading conditions.

Study Type

Interventional

Enrollment (Estimated)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Utah
      • Logan, Utah, United States, 84321
        • Recruiting
        • Utah State University
        • Contact:
        • Contact:
        • Principal Investigator:
          • Michael P Twohig, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • an adult (18 years and older) student at the university
  • the ability to understand and read English
  • access to the university's online library resources
  • endorse high perfectionism (29 or more on the concerns over mistakes Frost Multidimensional Perfectionism Subscale)

Exclusion Criteria:

  • N/A

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: ACT Bibliotherapy
Participants will read 10 chapters (140 pages) of The Anxious Perfectionist by Clarissa Ong and Michael Twohig over the course of 10 weeks.
Behavioral: Acceptance and commitment therapy (ACT)
ACT is a psychological intervention that aims to improve psychological flexibility, the ability to hold thoughts and emotions lightly in a given context and pursue valued ends (Hayes et al., 1999; Twohig & Levin, 2017).
Experimental: CBT Bibliotherapy
Participants will read 8 chapters (149 pages) of When Perfect Isn't Good Enough by Martin Antony over the course of 10 weeks.
Behavioral: Cognitive behavioral therapy (CBT)
CBT is a psychological intervention which targets cognitions and behaviors in attempt to change emotions.
No Intervention: Waitlist Control
Waitlist condition; assessment only

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Frost Multidimensional Perfectionism Scale-Brief (FMPS-Brief)
Time Frame: 14 weeks
The Frost Multidimensional Perfectionism Scale-Brief (FMPS-Brief) is an 8-item self-report measure assessing perfectionism with two sub-scales: evaluative concerns and striving. Total scores range from 8 to 40, where higher scores indicate higher perfectionism.
14 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Acceptance and Action Questionnaire 3 (AAQ-3)
Time Frame: 14 weeks
The Acceptance and Action Questionnaire 3 (AAQ-3) is a 7-item self-report measure assessing psychological inflexibility. Total AAQ-3 scores range from 7 to 49, where higher scores indicate greater psychological inflexibility.
14 weeks
Emotion Regulation Questionnaire - Cognitive Reappraisal Subscale (ERQ-CR)
Time Frame: 14 weeks
The Emotion Regulation Questionnaire - Cognitive Reappraisal Subscale (ERQ-CR) a 5-item self-report measure assessing use of cognitive reappraisal as an emotional regulation strategy. Total ERQ-CR scores are averaged and range from 0 to 7, with higher scores indicating greater use of cognitive reappraisal.
14 weeks
Depression Anxiety Stress Scale (DASS-21)
Time Frame: 14 weeks
The Depression Anxiety Stress Scale (DASS-21) is a 21-item self-report measure that assess general distress with three sub-scales: depression, anxiety, and stress. Sum scores are calculated by adding the subscale items and multiplying by two, so total scores range from 0 to 120, with higher scores indicating more distress.
14 weeks
Mental Health Continuum-Short Form (MHC-SF)
Time Frame: 14 weeks
The Mental Health Continuum-Short Form (MHC-SF) is a 14-item self-report measure assessing emotional, social, and psychological well-being. Total scores range from 0 to 70 where high score indicate greater levels of positive well-being.
14 weeks
Positive and Negative Affect Schedule (PANAS)
Time Frame: 14 weeks
The Positive and Negative Affect Schedule (PANAS) is a 20-item self-report measure assessing state affect with 10 positive affect (e.g., attentive, active, alert, excited, enthusiastic, determined, inspired, proud, interested, and strong) and 10 negative affect (e.g., hostile, irritable, ashamed, guilty, distressed, upset, scared, afraid, jittery, nervous) items. Total scores are calculated separately for positive and negative affect subscales, both range from 10 to 50 where higher scores indicate higher affect.
14 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Utah State University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 12, 2023

Primary Completion (Estimated)

September 1, 2025

Study Completion (Estimated)

September 1, 2025

Study Registration Dates

First Submitted

August 25, 2023

First Submitted That Met QC Criteria

September 25, 2023

First Posted (Actual)

September 28, 2023

Study Record Updates

Last Update Posted (Actual)

September 28, 2023

Last Update Submitted That Met QC Criteria

September 25, 2023

Last Verified

September 1, 2023

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 13518

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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