Applying process-oriented hypnosis to treat perfectionism-related depression.

This paper brings together concepts, tools, and case examples that provide guidance for ways to use process-oriented clinical hypnosis to shift perfectionistic tendencies to help resolve depression and enhance well-being. Perfectionism is a transdiagnostic risk factor for clinical and subclinical suffering of many types including depression. Over time, perfectionism is becoming more widespread. Perfectionism-related depression can be effectively treated when clinician attention is directed toward core skills and themes. Case examples illustrate how to help clients moderate overly extreme thinking, create and use realistic standards, and develop and apply a balanced self-evaluation. A variety of clinician styles and approaches, especially when tailored to individual client characteristics, preferences, and needs, are compatible with process-oriented hypnotic interventions for perfectionism and depression.

Orthorexia nervosa versus healthy orthorexia: Anxiety, perfectionism, and mindfulness as risk and preventative factors of distress.

BACKGROUND: Orthorexia nervosa is a recently conceptualised pathological entity presenting as an obsessive focus on healthy eating with associated psychosocial impairment. AIMS: The present study investigated the differential associations between orthorexia nervosa and healthy orthorexia with distress and impairment. MATERIALS & METHODS: With a community sample (N = 268) multiple measures of orthorexia nervosa and health orthorexia were compared as explanatory variables in mediation structural equation modelling (SEM). Outcome variables assessed and investigated were psychological distress while demographic variables were controlled. The mediating roles of perfectionism and health anxiety on orthorexia nervosa were examined with further preventative mediation role of mindfulness on distress. RESULTS: Distinctive to other eating disorders, gender showed no significant effects on orthorexia nervosa and healthy orthorexia. Signalling measurement issues for this disorder, the different measures of orthorexia nervosa resulted in mixed findings regarding body mass index and age. Findings supported perfectionism and health anxiety as risk factors, as well as mindfulness acceptance as a preventative factor in both orthorexia nervosa and healthy orthorexia. Orthorexia nervosa and healthy orthorexia assessed by most measures, contrary to the expectations, had significant positive associations with psychological distress indicated by stress, anxiety, and depression. DISCUSSION & CONCLUSION: The complexity in differentiating orthorexia nervosa from healthy orthorexia calls for further investigation. This research effort should serve to substantiate the status of orthorexia nervosa as a distinct clinical disorder.

Feasibility and efficacy of an online compassion-focused imagery intervention for veterinarian self-reassurance, self-criticism and perfectionism.

BACKGROUND: Veterinarians report high levels of psychological distress and self-criticism. However, there is minimal research investigating psychological interventions for veterinarians. Evidence suggests that compassion-focused therapy is effective at reducing distress in those with high self-criticism. This study aimed to investigate the feasibility and preliminary effectiveness of a 2-week online compassionate imagery intervention for veterinarians. METHODS: A one-group repeated measures design was used with 128 veterinarians. Participants completed measures of perfectionism, self-criticism, self-reassurance and fears of compassion four times, at 2-week intervals (at baseline, pre-intervention, post-intervention and 2-week follow-up). Participants answered written questions about their intervention experience post-intervention. RESULTS: Content analysis of the qualitative data found the intervention to be acceptable and beneficial to participants. Overall, study attrition was 50.8%, which is reasonable for a low-cost intervention. Minimal differences were found between participants who dropped out compared to those who completed the intervention. Perfectionism, work-related rumination and self-criticism were significantly reduced post-intervention, and these effects were maintained at follow-up. Resilience and self-reassurance remained unchanged. Fears of compassion reduced over the baseline period and pre-post intervention, questioning the validity of the measure. CONCLUSION: Overall, in the context COVID-19, the intervention showed impressive feasibility and preliminary effectiveness. Randomised control trials are recommended as the next step for research to establish the intervention's effectiveness.

Does self-esteem mediate the association between perfectionism and mindfulness among Lebanese university students?

OBJECTIVES: To evaluate the associations between mindfulness, self-esteem and perfectionism in a Lebanese sample of university students, as well as the indirect effect of self-esteem between mindfulness and perfectionism was investigated. METHODS: This cross-sectional study was carried out between July and September 2021. A total of 363 university students were recruited through convenience sampling through several universities in Lebanon's governorates. An online survey that included a part that collected sociodemographic information, the Freiburg Mindfulness Inventory to assess mindfulness, the Rosenberg Self-Esteem Scale to assess self-esteem and the Big Three Perfectionism Scale to assess perfectionism was completed by participants. RESULTS: Higher self-esteem (Beta = 1.30) was significantly associated with more mindfulness, whereas higher self-critical perfectionism (Beta = - 0.61) was significantly associated with less mindfulness. Self-esteem mediated the association between self-critical and narcissistic perfectionism and mindfulness. More perfectionism was significantly and directly associated with less mindfulness and lower self-esteem, whereas higher self-esteem was significantly associated with more mindfulness. CONCLUSION: This study provides valuable findings that enable practitioners to effectively identify people needing interventions to improve psychological health through mindfulness, self-esteem and perfectionism. The conclusions that can be deduced from this study can help educational psychologists and counselors guide university students towards effective mindfulness practices that can increase self-esteem levels and balance maladaptive perfectionism that can cause distress and impairment in the social and academic settings.

The Relationship between Perfectionism and Social Anxiety: A Moderated Mediation Model.

Social anxiety is one of the mental health problems associated with perfectionism. The present study investigated the possible mediation of perceived stress in the relationship between perfectionism and social anxiety, and whether this mediation depends on the level of trait mindfulness. A total of 425 college students (female: 82.9%; mean age: M = 19.90 ± 1.06 years old) completed the Multidimensional Perfectionism Scale (MPS), the Chinese Perceived Stress Scale (CPSS), the Interaction Anxiousness Scale (IAS), and the Five-Facet Mindfulness Questionnaire (FFMQ). After controlling for age and gender, the moderated mediation analysis suggested that perfectionism significantly and positively predicted social anxiety and that perceived stress mediated the link between perfectionism and social anxiety. In addition, the indirect effect of perfectionism on social anxiety was moderated by trait mindfulness. Specifically, the indirect effect was weaker among the individuals with a high level of mindfulness compared to those with a low level of mindfulness. The findings of this study suggest that trait mindfulness significantly moderates the indirect effect of perfectionism on social anxiety via perceived stress.

Eating and body image characteristics of those who aspire to the slim-thick, thin, or fit ideal and their impact on state body image.

The slim-thick ideal is characterized by a small waist and flat stomach, but large hips, thighs, and butt. Little research to date has examined the impact of this body-ideal on women's body image. The purpose of the current study was to investigate: 1) the impact of slim-thick, thin-, and fit-ideal imagery on women's body image, 2) the body ideals women most aspire to, and 3) eating and body image characteristics of women who aspire to each ideal. Participants were 123 female undergraduate students. Results revealed that experimental exposure to slim-thick- and fit-ideal imagery resulted in lower body satisfaction. Participants reported aspiring more to the fit and slim-thick-ideal than to the thin-ideal, and rated the slim-thick-ideal as the most attractive and desirable. Women who aspired to the thin- or slim-thick-ideal reported the greatest overall disordered eating. Women who aspired to the slim-thick-ideal reported greater dietary restraint, eating, shape and weight concerns, appearance ideal internalization, body image investment, and physical appearance perfectionism than those who aspired to the fit-ideal. Findings show that beauty ideals are shifting away from the thin-ideal toward a slim-thick-ideal. Slim-thick internalization may be harmful to women's well-being and should be addressed in body image and eating disorders interventions.

A Randomized Test of Interpretation Bias Modification for Perfectionism Versus Guided Visualization Relaxation Among High Perfectionistic Undergraduate Students.

Clinical perfectionism contributes to the onset and maintenance of multiple psychological concerns. We conducted a randomized, longitudinal test of the efficacy of a web-based intervention for perfectionism (specifically, cognitive bias modification, interpretation retraining; CBM-I), compared to an active treatment comparison condition (specifically, guided visualization relaxation training) for reducing perfectionism and related psychopathology. College students (N = 167) with elevated perfectionism were randomized to one of the two study conditions and were asked to complete their assigned intervention twice weekly for 4 weeks. Participants completed measures of perfectionism and psychological symptoms at baseline, 2 weeks (midway through the intervention period), 4 weeks (at the conclusion of the intervention period), and 8 weeks (1 month follow-up). CBM-I was rated as acceptable overall, though relaxation training was rated slightly more favorably. CBM-I outperformed relaxation training on improving perfectionism-relevant interpretation biases (i.e., increasing nonperfectionistic interpretations and decreasing perfectionistic interpretations), though with small effect sizes and inconsistency across study timepoints. Self-reported perfectionism showed small decreases across time in both intervention conditions. Support was found for a key hypothesized mechanism of CBM-I, such that randomization to CBM-I had a longitudinal, indirect effect on decreasing psychopathology symptom scores through improving perfectionism-relevant interpretation biases. However, in light of small effect sizes, the present study failed to provide compelling evidence that CBM-I for perfectionism contributes meaningfully to the treatment of perfectionism.

Orthorexia nervosa, mindful eating, and perfectionism: an exploratory investigation.

PURPOSE: Research has drawn associations between Mindful Eating (ME) and perfectionism in the aetiology and treatment of eating disorders (ED), but understanding into the relationship between these factors and Orthorexia nervosa (ON) is limited. The purpose of this research is to explore the relationship between perfectionism, ME, and ON. METHOD: Participants (n = 670) completed the Düsseldorf Orthorexia scale, the Mindful Eating Behavior scale, and the Big-Three Perfectionism scale Short-form, to reveal the relationship between ON, ME, and perfectionism. The relationship was assessed using correlational and regression analyses. RESULTS: A positive association was observed between perfectionism and ON. Moreover, perfectionism demonstrated a significant negative correlation with three out of four ME facets, with "eating without distraction" displaying the highest correlation. The "eating with awareness" facet of ME demonstrated a significant relationship with ON, in a negative direction. An unexpected relationship was observed between the focused eating facet of ME and ON, with a positive association being found. A further regression analysis revealed both perfectionism and ME to predict orthorexic tendencies. CONCLUSION: These findings identify a relationship between ON, ME, and perfectionism. It offers suggestion for the complexity of ME, and how it should be recognised by its different components, estimating a differential predictability and estimation of ON. Further research is required to clarify the direction of causality in the relationships observed, to inform the clinical diagnoses and intervention of ON. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Maladaptive perfectionism and adolescent NSSI: A moderated mediation model of psychological distress and mindfulness.

OBJECTIVES: Maladaptive perfectionism has been shown to be associated with non-suicidal self-injury (NSSI) in adolescents. Based on the functional model of self-injury, we predicted that this association is due to the mediating effect of psychological distress. We also tested the assumption that being mindful-that is, being able to accept rather than escape the psychological distress-would be a protective factor in this process. METHODS: Eight hundred and forty-one Chinese adolescents completed online questionnaires concerning maladaptive perfectionism, psychological distress, mindfulness, and NSSI. RESULTS: Regression-based analyses showed that maladaptive perfectionism predicted adolescents' NSSI through the indirect effect of psychological distress. Mindfulness weakened the indirect effect. CONCLUSIONS: These findings suggest that self-injury serves a function in emotion regulation and the communication of distress. The results also have implications for practice: Maladaptive perfectionism should be assessed as a risk factor for NSSI, and teaching mindfulness may be an effective intervention for adolescents who engage in this high-risk behavior.

The effect of physical appearance perfectionism and social comparison to thin-, slim-thick-, and fit-ideal Instagram imagery on young women's body image.

Body image research to date has examined the impact of thin- and fit-ideal media on women's body image, however cultural trends in Western media have recently shifted towards a curvier body type called slim-thick, which is characterized by a large butt and thighs and small waist and flat stomach. We experimentally examined the impact of forced social comparison to slim-thick-, thin-, and fit-ideal imagery on women's body image relative to a control condition, and whether physical appearance perfectionism moderated these findings. Participants were 402 female undergraduate students. Results revealed that comparison to body-ideal imagery resulted in greater weight and appearance dissatisfaction and less overall body satisfaction, relative to the control condition. Those exposed to slim-thick imagery experienced more weight and appearance dissatisfaction and less body satisfaction than those in the thin-ideal condition. Physical appearance perfectionism moderated these results, such that women who reported moderate or high levels of physical appearance perfectionism experienced greater weight and appearance dissatisfaction and lower body satisfaction in the slim-thick condition, than in the thin-ideal, fit-ideal, or control conditions. It was concluded that drive to achieve body ideals is shifting to a slim-thick body, which maybe more detrimental to women's body image than thin-ideal imagery.

Relations among Socially Prescribed Perfectionism, Career Stress, Mental Health, and Mindfulness in Korean College Students.

Korean young adults are exposed to higher career stress than ever before, and such stress exerts a negative impact on mental health outcomes. The present study aimed to understand the mediating effect of career stress on the relationship between socially prescribed perfectionism and mental health using a sample of 420 Korean college students. The present study also investigated the moderating role of mindfulness in the mediated pathways across gender groups. This study's results showed that there are considerable gender differences in this relationship. Career stress significantly mediates the relationship between socially prescribed perfectionism and depression and life satisfaction only for females. Study findings also indicated that the moderating effect of mindfulness was more remarkable for female students than for male students. Implications and future directions are discussed.

Building the alliance and using experiential techniques in the early phases of psychotherapy for avoidant personality disorder.

Individuals experiencing avoidant personality disorder (AvPD) tend to make sense of social interactions via maladaptive self-and other attributions. They also experience difficulties in recognizing emotions. A further feature of AvPD psychopathology is the tendency to resort to maladaptive coping strategies, such as behavioral avoidance and perfectionism. Despite its impact, psychological treatments for AvPD remains poorly investigated. Herein, we describe the first five sessions of Metacognitive Interpersonal Therapy with a 28-year-old woman, whose treatment goal was to reduce social avoidance. We describe how this goal was achieved through a combination of working through the therapeutic relationship, alongside experiential techniques such as guided imagery, rescripting, and bodily work. Through this treatment configuration, the patient was able to increase self-awareness of her own emotions, enabling her to realize that she was guided by rigid schemas; specifically seeing herself as inadequate and others as judgmental. Finally, implications for the treatment of AvPD are discussed.

Self-critical perfectionism and lower mindfulness and self-compassion predict anxious and depressive symptoms over two years.

This study of 124 community adults examined whether perfectionism interacts with mindfulness and self-compassion to predict anxiety and depressive symptoms over two years. Participants completed measures of self-critical (SC) and personal standards (PS) higher-order dimensions of perfectionism at Time 1; mindfulness and self-compassion domains and facets at Time 2 one year later; and general distress (i.e., shared between depression and anxiety), anxious arousal, and anhedonic depressive symptoms at Time 1, Time 2, and Time 3 two years after baseline. In contrast to PS, SC perfectionism was associated with lower mindfulness and self-compassion domains and facets. Hierarchical regression analyses of moderator effects demonstrated that individuals with higher Time 1 SC perfectionism and lower Time 2 domain mindfulness or self-compassion had higher Time 3 general distress symptoms than others, adjusting for the effects of Time 1 and Time 2 symptoms. SC perfectionism also interacted with specific facets of mindfulness (i.e., observing, nonreactivity) and self-compassion (i.e., self-kindness, mindfulness, over-identification) to predict Time 3 general distress and/or anxious arousal symptoms. These findings highlight the importance of fostering mindfulness and self-compassion to reduce vulnerability to anxious and depressive symptoms in individuals with higher SC perfectionism.

The intertwined path of perfectionism and self-criticism in a client with obsessive-compulsive personality disorder.

Psychotherapy for obsessive-compulsive personality disorder (OCPD), where perfectionism is a defining criterion, is understudied. Despite a high prevalence few evidence-based treatments are available for the presentation. Here we describe the course of a 6-month program of metacognitive interpersonal therapy with an OCPD patient with prominent perfectionism and self-criticism, which were considered primary outcomes of the case study. Therapy aimed initially at increasing awareness of maladaptive interpersonal schemas and promoting a healthy self. First, behavioral experiments were used to try and counteract perfectionism. Second, experiential techniques, such as guided imagery and rescripting, were used to help the client in connect with different, healthier aspects of the self, thus increasing personal and interpersonal wellbeing. Qualitative and quantitative outcomes at the intervention end and at 1-month follow-up are summarized. Finally, we reflect on how this case study can inform treatment of perfectionism in OCPD.

Profiles of Perfectionistic Ruminations in Undergraduates: Impact on the Spontaneous Use of Mental Images.

Perfectionistic Automatic Thoughts (PAT) negatively affects people who present it. Hence the importance of their study to determine possible ways of reduction. The current study tried to identify PAT profiles and specify the statistically significant differences in the Spontaneous Use of Mental Imaging in 647 undergraduates. For this the Perfectionism Cognitions Inventory and the Spontaneous Use of Imagery Scale were used. The cluster analyses showed three groups of PATs; low (LPAT), moderate (MPAT) and high (HPAT). An analysis of variance revealed moderate size differences in the visual-spatial capacity as well as in the total of the Spontaneous Use of Mental Images for MPAT and LPAT. Implications for the training of future teachers related to the use of mental imagery that can reduce maladaptive PAT are discussed.

Cardiovascular effects of brief mindfulness meditation among perfectionists experiencing failure.

Research links perfectionism, the tendency to hold and pursue unrealistically high standards, to negative mental health outcomes such as eating disorders, anxiety, and depression. Previous research used high frequency heart rate variability (HF-HRV) to measure recovery from stress during a mindfulness meditation in perfectionistic university students and found that only nonperfectionists demonstrated HF-HRV recovery from stress, suggesting that mindfulness was not effective for perfectionists. However, the mindfulness meditation did not incorporate a nonjudgment element, which may be a key component for perfectionists. In the current study, we examined whether mindfulness with a focus on nonjudgment helps university student perfectionists (n = 120) recover from failure (measured by heart rate (HR), HF-HRV, pNN50). Students were randomly assigned to one of four meditation groups: nonjudgment mindfulness, general mindfulness (i.e., attentional awareness without a nonjudgment component), progressive muscle relaxation, and nothing. Cardiac data were recorded during a 5-min baseline, failure task, and 10-min meditation session. HR results suggest that both mindfulness conditions and "nothing" encouraged cardiovascular recovery, but that the mindfulness conditions showed even further recovery during the last five minutes of the meditations. HF-HRV results indicated that participants in the nonjudgment mindfulness condition had marginally higher HF-HRV during the last five minutes of the meditation than at baseline, while participants in the other conditions did not. Therefore, mindfulness with a focus on nonjudgment of emotions may be especially important to help perfectionists improve HF-HRV after failure.

Psychosocial student functioning in comprehensive dental clinic education: A qualitative study.

INTRODUCTION: The aims were to describe first-year clinical dental students' psychosocial experiences in a known well-functioning comprehensive clinic teaching group (F+Grp) and a known dysfunctional group (Dys-Grp) and, thus, discover and describe phenomena related to psychosocial functioning of students. These groups were compared and contrasted regarding negative stress symptoms, perfectionism and coping with stress. METHODS: Eight female dental students (mean 26 years old), four in each group, were interviewed after the first clinical year about learning and emotional experiences. The students also rated their perceived stress using a 0-10 scale, where 0 is no stress, and 10 is highest stress. Qualitative analyses involved searching for recurring themes and discovery of categories of clinical and social functioning. All 8 students were revisited as dentists after 8 years and filled out a 15-item survey as longitudinal validation of their first-year clinical experiences and to estimate group consensus and informant accuracy. RESULTS: Both groups suffered from negative stress symptoms attributed to lack of time for clinical tasks, worries about work quality with confusion about their own expectations and worries about how others perceived them. Dys-Grp experienced higher negative stress and maladaptive perfectionism and described crying behaviours, withdrawal and unwillingness to cooperate with others. In contrast, students in F+Grp provided rich content about mutual cooperation related to social networking and positive support. The 8 subjects exhibited high internal consistency (α  =  .98) in their responses to the follow-up survey about their first year of clinic. CONCLUSIONS: The comprehensive care teaching clinic environment with students working in groups appeared to provide a possibility for students to support each other for improved stress coping. Unfortunately, the opposite also occurred. Positive, supportive teacher supervision of student challenges related to perfectionism and stress is crucial and requires specific attention.

Perceived Perfectionism from God Scale: Development and Initial Evidence.

In this study, the Perceived Perfectionism from God Scale (PPGS) was developed with Latter-day Saints (Mormons) across two samples. Sample 1 (N = 421) was used for EFA to select items for the Perceived Standards from God (5 items) and the Perceived Discrepancy from God (5 items) subscales. Sample 2 (N = 420) was used for CFA and cross-validated the 2-factor oblique model as well as a bifactor model. Perceived Standards from God scores had Cronbach alphas ranging from .73 to .78, and Perceived Discrepancy from God scores had Cronbach alphas ranging from .82 to .84. Standards from God scores were positively correlated with positive affect, whereas Discrepancy from God scores was positively correlated with negative affect, shame and guilt. Moreover, these two PPGS subscale scores added significant incremental variances in predicting associated variables over and above corresponding personal perfectionism scores.

A Mindfulness Practice for Communication Sciences and Disorders Undergraduate and Speech-Language Pathology Graduate Students: Effects on Stress, Self-Compassion, and Perfectionism.

PURPOSE: The purpose of the present study was to explore the effects of a mindfulness practice on participants' levels of self-compassion, perfectionism, attention, and perceived and biological stress. METHOD: This was a between-groups design. Experimental participants engaged in a short mindfulness practice weekly for one academic semester; control participants did not. All participants completed three self-report scales measuring perceived stress, self-compassion, and perfectionism before and after mindfulness sessions. In addition, electrophysiological measures were taken before and after to determine changes in biological markers of stress and attention. Experimental participants also kept reflective journals that were analyzed qualitatively. RESULTS: Compared with control participants, by the end of the semester, experimental participants' perceived stress levels and potentially negative aspects of perfectionism decreased and biological markers of stress and self-compassion improved. Experimental participants' reflective writings indicated they perceived the sessions to be beneficial. Although the results are promising, no significant effect was found for attention. CONCLUSIONS: Engaging in a 20-min mindfulness practice using simple yoga posture and breath work across an academic semester appears to be effective in reducing students' perceived and biological stress levels and maladaptive aspects of perfectionism and in increasing their self-compassion. These are all factors that can improve students' overall well-being.

Therapeutic Alliance, Client Need for Approval, and Perfectionism as Differential Moderators of Response to eHealth and Traditionally Delivered Treatments for Comorbid Depression and Substance Use Problems.

PURPOSE: This study sought to undertake an exploratory analysis of the impact of therapeutic alliance and dysfunctional attitudes (perfectionism and need for approval) on outcomes for participants receiving therapist-delivered and eHealth interventions for comorbid depression and alcohol/cannabis use problems. These factors have been shown in previous research to moderate response to psychological treatment for depression and related disorders. METHOD: Participants (N = 274) with concurrent depression and alcohol/cannabis misuse were randomized to 10 sessions of therapist-delivered cognitive behavior therapy/motivational interviewing (CBT/MI), computer-delivered CBT/MI with brief therapist assistance (SHADE CBT/MI), or supportive counseling (PCT). Follow-up occurred at 3, 6, and 12 months post-baseline. Exploratory moderator analyses examined changes in depression, alcohol use, and cannabis use over the 3-12-month follow-up timepoints, adjusting for baseline, as a function of treatment allocation, and the hypothesized moderators of therapeutic alliance, perfectionism, and need for approval. RESULTS: The sample size and number of comparisons in the analysis mean that the results are considered preliminary and need replication in larger trials. The analysis revealed that "client initiative," a subscale of therapeutic alliance, moderated change in depression scores between 3- and 12-month follow-up for the PCT group, with higher scores associated with decreases in depression over time. Higher therapeutic "bond" early in treatment for SHADE CBT/MI participants was associated with reduced cannabis use over time. Participants with higher "perfectionism" scores at baseline who received therapist CBT/MI reported increases in depression over the follow-up period, but reductions in depression if they received SHADE CBT/MI. Therapist CBT/MI participants high on "need for approval" at baseline reported better alcohol use outcomes over time. CONCLUSION: The preliminary nature of these results do not justify firm conclusions. However, the specific variables of perfectionism, need for approval, and client initiative show promise as moderators of treatment efficacy for comorbid depression and alcohol/cannabis use problems. Further research is justified to determine whether these factors can assist in tailoring the modality and strategies offered in the delivery of psychotherapy to this population.