Cognitive Behavioral Therapy for Perfectionism Case Study

In this paper, I will attempt to summarize the article written by Sarah J. Egan and Paula Hine of the Curtin University of Technology, Australia. This study focused on the value that Cognitive Behavioral Therapy (CBT) has in treating perfectionism in 4 adults diagnosed with an anxiety disorder or depression. According to the case study, perfectionism can obstruct the treatment of psychological disorders (Shafron & Masell, 2001). CBT is used to examine and cure numerous psychological disorders, however, perfectionism has never been immensely explored and few studies of CBT have been of a controlled design nature.

The conductors of this case study chose the A-B single case experimental design series to conduct this study. This particular study measures the degree of the behavior targeted for change through repetitive observations across two phases of study: A=baseline and B=treatment. The subjects are also observed before and after the manipulation of the independent variable (Comer, 2008). The independent variable in this study is the therapy.

The four participants chosen for the study were selected from a Clinic waitlist. Seventeen of the 45 adults on the waitlist, who received dispersed information about the study, completed the Beck Depression Inventory, which evaluates depressive symptoms and the Multidimensional Perfectionism Scale which measures perfectionism with the implementation of subscales: Concern over mistakes (CM), Personal Standards (PS), Parental Expectations (PE), Parental Criticism (PC), Doubts about Actions (DA), and Organization (O). An assessment interview was conducted, devising CB maintaining
mechanisms and administering the Mini International Neuropsychiatric Interview to establish the DSM-IV diagnosis. From this diagnosis is how the subjects were chosen.

The participants as follows:
Participant A. A 60 year old married female diagnosed with Obsessive Compulsive Disorder who was scared of saying anything incorrect and that catastrophic events were more likely to occur if she thought certain thoughts.
Participant B. A 59 year old divorced female diagnosed with panic disorder with agoraphobia and bipolar I in remission.
Participant C. a 39 year old married male with diagnosed with Obsessive Compulsive Disorder and secondary diagnosis of panic disorder with agoraphobia.
Participant D. A 62 year old divorced female diagnosed with major depressive episodes and panic disorder with agoraphobia.

Treatment was conducted by a clinical psychologist trainee under the supervision of an experienced clinical psychologist. Treatments were arranged into 1 hour sessions, once per week for 8 weeks and a follow up session after 2 weeks. Sessions were videotaped and 2 were indiscriminately selected for adherence rating by an independent psychologist who determined if the study stayed focused on the topic at hand.

Treatments were comprised of cognitive behavioral techniques such as dichotomous thinking (Shafran et al., 2002; Egan, Piek, Dyck, & Rees, 2007), rigid, achievement-oriented goals (Burns, 1980, Shafran et al.), hyper vigilant and biased monitoring of performance (Shafran, et al.) and a plan for assessment of self worth (DiBartolo, Frost, Chang, LaSota, & Grills, 2004; Shafran et al.). The clinical psychologists also implemented different strategies such as behavioral experiments to test negative cognitions and thought records to challenge selective attention and self criticism.

Once all treatments and follow-ups were completed, only two out of four participants had significant clinical reduction scores for total perfectionism. There were no significant reductions in anxiety and depressive symptoms. The area CBT for perfectionism needs further study to determine its effectiveness and benefit as treatment for perfectionism, depression and anxiety disorders.

This article proved to be a great example of the use of the cognitive model of therapy. The clinical psychologists zoned in on the mind of the participants in an attempt to “reprogram” their thinking about themselves. One “flaw” I noticed was the selection of candidates for this study. I didn’t feel the variation was large enough. All participants were of the same age group. Perhaps a person from each of the decadal age groups after 20 years old would have offered better exposure. Another issue I found with the CBT treatment for perfectionism is that it doesn’t affect the depressive and anxiety disorders, thus requiring further treatments for patients. Treatments may have to be broken out in to CBT for Perfectionism and then another session for CBT for Anxiety and Depressive Disorders, possibly causing the patient to become “bored” and abandon the treatments. An all inclusive treatment will have to be established to avoid this.

References

Burns, D.D. (1980). Feeling good: The new mood therapy. New York: New American Library.

Comer, R.J. (2008). Fundamentals of Abnormal Psychology.

DiBartolo, P.M., Frost, R.O., Chang, P., LaSota, M., & Grills, A.E. (2004). Shedding light on the relationship between personal standards and psychopathology: The case for conditional self-worth.
Journal of Rational–Emotive and Cognitive–Behavior Therapy, 22, 241–254.

Egan, S.J., Piek, J.P., Dyck, M.J., & Rees, C.S. (2007). The role of dichotomous thinking and rigidity in perfectionism. Behavior Research and Therapy, 45, 1813–1822.

Shafran, R., & Mansell, W. (2001). Perfectionism and psychopathology: A review of research and treatment. Clinical Psychology Review, 21, 879–906.

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