A Cognitive-behavioral Intervention of Rumination for Perfectionists

NCT ID: NCT05385289

Last Updated: 2023-02-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

13 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-03-14

Study Completion Date

2022-11-24

Brief Summary

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This study aims to investigate the mediating role of rumination in the relationship between perfectionism and psychological distress, by proposing a cognitive-behavioral intervention targeting rumination. This intervention aims at decreasing - or even neutralizing - the effect of the mediator and then examining how this decrease impacts the relationship between perfectionism and psychological distress.

A randomized, concurrent, multiple-baseline single-case design will be applied.

Detailed Description

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Perfectionism is defined as "exceedingly high standards of performance accompanied by critical evaluations of oneself and others and a fear of negative social evaluation if not perfect". Factorial analyses of the two main perfectionism scales have identified two overarching dimensions: Perfectionistic Strivings and Perfectionistic Concerns. The perfectionistic concerns dimension is generally associated with negative outcomes and psychopathology, while perfectionistic strivings have been found to yield both positive outcomes and negative outcomes.

Perfectionism is a central transdiagnostic phenomenon involved in the maintenance of multiple psychological disorders (e.g., anorexia nervosa, obsessive compulsive disorder, chronic fatigue, and depression). After decades of research focusing on scales development or relying exclusively on correlational studies, the experimental investigation of the processes underlying perfectionism is just emerging. On a theoretical basis, two processes related to emotional information processing seem particularly relevant: rumination and autobiographical memory. The objective of this study is to investigate with a randomized, concurrent, multiple-baseline single-case design the contribution of these processes to perfectionists' psychological vulnerability.

Rumination is defined as a mental process characterized by repetitive, prolonged, and recurrent thinking about one's concerns and one's experience. The control theory suggests that individuals engage in rumination when perceiving a discrepancy between their goals and their current condition, and stay in this mode of thinking until the goal is either attained or abandoned. Based on this theoretical background, recent research suggests that rumination could be one of the processes explaining the perfectionistic vulnerability to psychological distress, by perseveringly focusing on the discrepancy between high and demanding standards and the actual performance. However, only few study has experimentally manipulated this process, thus precluding from any causal inference.

Autobiographical memories are "memories about personal experiences that go beyond the mere factual description of the event to include personal beliefs, emotions, and thoughts". One feature of those memories is the specificity level defined as "the extent to which retrieved autobiographical memories are specific or not (i.e., memory of a particular event that happened at a particular time and place that lasted no more than one day). Difficulty with retrieving such specific memories is called overgeneral autobiographical memory".

The perfectionism cognition theory aims to clarify how autobiographical memory and working memory might be affected by perfectionist tendencies. It especially postulates retroactive loops between (a) repetitive thinking, (b) an overdeveloped memory for mistakes, failures, and stressful experiences, and (c) a hypervigilance and cognitive bias toward related cues that signal the possibility of failure, mistakes, and negative social evaluation. These authors suggested that perfectionists are characterized by deficits in attentional capacity and working memory during times of stress. This promising cognitive approach has partially been supported. For example, a recent meta-analysis states that perseverative cognitions (i.e., worry and rumination) mediate the relationship between perfectionism and distress in non-clinical samples. However, empirical evidence of an experimental nature is still needed, in particular for the postulated autobiographical memory and working memory biases.

To overcome those limitations, the present study will manipulate rumination with a clinical intervention, to block its mediational role on the relationship between perfectionism and psychological distress (here operationalized by mood state and anxio-depressive symptoms). Moreover, this study aims to go further than identifying a true mediator: its aims to explain the mechanism "through which change come about", namely through a concreteness training to overcome overgeneral mode of processing. Indeed, even if the main focus of the study is to identify mediators that may statistically account for the relationship between perfectionism and psychological distress, a ideal purpose is to propose a therapeutic intervention that may target mechanisms of change underlying hypothesized mediator.

Conditions

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Perfectionism Rumination - Thoughts Anxiety Depression

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The final sample will comprise 12 participants.

The initial sample size was based on Shadish \& Sullivan's (2011) study reporting that the median and modal number of participants in single-case designs is three. Therefore, recruiting 6 participants allowed for a direct intrasubject replication (i.e., a "replication of the experimental effect within the design") while ensuring that three participants were retained despite possible dropout. Moreover, using two waves of six participants (resulting in a total sample of 12 participants) allowed for a direct inter-subject replication (i.e., "repeating the same study but with additional individuals"). Those two replications were used to demonstrate that changes on target behaviors systematically arrives after the intervention introduction, hence controlling for external variables.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

A computerized version of the Autobiographical Memory Test (AMT; Williams et Broadbent, 1986) will be used to assess the overgeneral processing. This task focused on retrieving past memories of personal events.

AMT raters will be not involved in any other aspect of the study procedures. The memories will also be presented to the raters in a randomized order, so that there was no possibility of guessing who completed them or when.

Study Groups

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First wave with 6 participants

Once selected, an individual online information session will be scheduled with each selected participant to explain the project and its practical implications. At this time, six of the twelve participants will be provided a link to complete online measures as the A-baseline phase, to constitute their own non-intervention control condition on the target behavior (i.e., rumination) and on positive and negative emotions. The other six participants will be entered into a 3-week waiting list period with a sequential introduction, to provide another non-intervention control condition.

The A-baseline phase length will include at least 5 measures and most 10 measures, resulting in 10 potential starting point for the B-experimental phase. This range will be determined to estimate autocorrelation and its associated bias.

Group Type EXPERIMENTAL

A cognitive-behavioral approach of rumination as intervention for overgeneral mode of processing in perfectionism

Intervention Type BEHAVIORAL

The B-experimental phase consists in a 6-session intervention targeting rumination and lasting for 3 weeks. The intervention was derived from 3 manuals: Rumination-Focused Cognitive-Behavioral Therapy for Depression (Watkins, 2016), Overcoming Perfectionism (Shafran et al., 2010), and Cognitive-Behavioral Treatment of Perfectionism (Egan et al., 2014). Participants will attend 2 sessions per week at home. Each week will end with an individual 30 minutes-debriefing session with an experimenter, to ascertain understanding of session content and homework.

Intervention sessions will be given in paper format to participant after the A-baseline-phase. A paper diary was also provided for homework, in addition to the session content caneva. Each session contains (a) theoretical content on ruminations linked to perfectionism, (b) exercises to create alternative habits to ruminations, and (c) homework to become aware of ruminations and to experiment with alternatives.

Second wave with 6 other participants

After three weeks, the six participants on the waiting list will also begin the same A-baseline phase as the six participants of the first wave.

Group Type EXPERIMENTAL

A cognitive-behavioral approach of rumination as intervention for overgeneral mode of processing in perfectionism

Intervention Type BEHAVIORAL

The B-experimental phase consists in a 6-session intervention targeting rumination and lasting for 3 weeks. The intervention was derived from 3 manuals: Rumination-Focused Cognitive-Behavioral Therapy for Depression (Watkins, 2016), Overcoming Perfectionism (Shafran et al., 2010), and Cognitive-Behavioral Treatment of Perfectionism (Egan et al., 2014). Participants will attend 2 sessions per week at home. Each week will end with an individual 30 minutes-debriefing session with an experimenter, to ascertain understanding of session content and homework.

Intervention sessions will be given in paper format to participant after the A-baseline-phase. A paper diary was also provided for homework, in addition to the session content caneva. Each session contains (a) theoretical content on ruminations linked to perfectionism, (b) exercises to create alternative habits to ruminations, and (c) homework to become aware of ruminations and to experiment with alternatives.

Interventions

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A cognitive-behavioral approach of rumination as intervention for overgeneral mode of processing in perfectionism

The B-experimental phase consists in a 6-session intervention targeting rumination and lasting for 3 weeks. The intervention was derived from 3 manuals: Rumination-Focused Cognitive-Behavioral Therapy for Depression (Watkins, 2016), Overcoming Perfectionism (Shafran et al., 2010), and Cognitive-Behavioral Treatment of Perfectionism (Egan et al., 2014). Participants will attend 2 sessions per week at home. Each week will end with an individual 30 minutes-debriefing session with an experimenter, to ascertain understanding of session content and homework.

Intervention sessions will be given in paper format to participant after the A-baseline-phase. A paper diary was also provided for homework, in addition to the session content caneva. Each session contains (a) theoretical content on ruminations linked to perfectionism, (b) exercises to create alternative habits to ruminations, and (c) homework to become aware of ruminations and to experiment with alternatives.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Being native French speakers
* Reporting significant levels of (1) perfectionism, (2) abstract and evaluative repetitive thinking, and (3) anxio-depressive symptoms.

Exclusion Criteria

* Being involved in a therapeutic treatment.
* Being under 18 years old.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Université Catholique de Louvain

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Pierre Philippot

Role: PRINCIPAL_INVESTIGATOR

[email protected]

Locations

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Université catholique de Louvain

Louvain-la-Neuve, Brabant Wallon, Belgium

Site Status

Countries

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Belgium

Other Identifiers

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2022/17JAN/016

Identifier Type: -

Identifier Source: org_study_id

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