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studies have evaluated CBT for perfectionism in non-clinical samples (Arpin-Cribbie et al., 2008; Arpin-Cribbie, Irvine, & Ritvo, 2012; DiBartolo, Frost, Dixon, &

Almodovar, 2001; Ferguson & Rodway, 1994; Pleva & Wade, 2006; Radhu et al., 2012). In these studies, the CBT administered was not based on Shafran et al.’s (2002) model of clinical perfectionism as most of these non-clinical studies occurred before Shafran et al.’s (2002) article. The remaining non-clinical studies utilised other CBT strategies for perfectionism such as Antony and Swinson’s (1998) guided self-help book. Nevertheless, these studies are still worthy of discussion as they provide support for CBT targeting perfectionism being effective. Ferguson and Rodway (1994) employed an ABA design to investigate the effectiveness of CBT for perfectionism in nine adults with elevated scores on Burns’ Perfectionism Scale (Burns, 1980a). The CBT centred upon identifying, challenging and restructuring perfectionist thoughts as well as changing perfectionist behaviours (Burns, 1980b). Visual inspection of the data suggested decreases in perfectionism on the Burns’ Perfectionism Scale, decreases in perfectionist cognitions (Irrational Values Scale; McDonald & Games, 1987) and decreases in self-rated perfectionist behaviours (Self-Anchored Scales; Ferguson & Rodway, 1994) for all clients following the intervention. However, there was no control group and no official statistical analyses, which prevent these changes from being confidently attributed to the intervention (Ferguson & Rodway, 1994).

DiBartolo et al. (2001) used a 2 x 2 factorial design to evaluate the effectiveness of an eight minute CBT treatment for perfectionism in 30 female students. These participants were selected as they had obtained CM scores in the upper quartile or lower quartile of a sample of 138 students. Participants were randomised to receive a CBT intervention or be in a distraction condition before giving an oral presentation. The CBT intervention focussed on challenging

about the oral presentation (DiBartolo et al., 2001). The distraction condition

involved crossing out letters in a textbook. After the CBT treatment, individuals high in CM and those low in CM exhibited significant decreases in their ratings of the probability and cost of their feared predictions about the oral presentation; however, this decrease was greater for individuals high in CM. One limitation was that the researchers did not assess whether the changes in probability and cost ratings demonstrated by the treatment condition were greater than those occurring in the distraction condition. Even so, participants who had received the CBT did report significantly lower anxiety prior to the speech than those from the distraction condition. This intervention was very short and a sufficient follow-up assessment was not provided (DiBartolo et al., 2001).

Four RCTs have evaluated the efficacy of CBT for perfectionism in non- clinical samples (Arpin-Cribbie et al., 2008; Arpin-Cribbie et al., 2012; Pleva & Wade, 2006; Radhu et al., 2012). These designs have greater internal validity than the previous studies reviewed in this section; however, the findings still do not generalise to clinical populations. Arpin-Cribbie et al. (2008) used a sample of 83 students with elevated PCI scores to examine the efficacy of a 10-session online treatment for perfectionism. This treatment contained stress management techniques as well CBT techniques for perfectionism that focused on altering perfectionist beliefs and the impact of these beliefs on mood (Arpin-Cribbie et al., 2008). This treatment was compared to a pure stress management condition that did not incorporate cognitive components, as well as a control condition. Students in the combined stress management plus CBT for perfectionism condition displayed significantly greater reductions in SPP and depression compared to those in the pure stress management and control conditions. Those in the combined condition also

exhibited significantly greater reductions in CM, SOP and PCI scores compared to the control condition. Structural equation modelling indicated that greater level of treatment was a significant predictor of greater reduction in perfectionism (SOP, SPP, CM, PCI scores) and distress. Greater reduction in perfectionism (SOP, SPP, CM, PCI scores) was also significantly associated with greater decreases in distress. This study provides support for online CBT for perfectionism significantly reducing perfectionism and psychological distress in a non-clinical sample.

Arpin-Cribbie et al. (2012) evaluated the stress management plus CBT for perfectionism treatment relative to pure stress management and control conditions in 77 participants with elevated PCI scores. Participants in the combined stress

management and CBT for perfectionism condition demonstrated significantly greater reductions in CM, SOP, SPP and PCI scores compared to those in the stress

management and control conditions; and significantly greater decreases in anxiety and depression compared to the control condition. For participants in the CBT for perfectionism plus stress management condition, changes in SOP, SPP, CM and PCI scores were significantly associated with changes in anxiety, anxiety sensitivity and depression. Radhu et al. (2012) compared an online CBT intervention for

perfectionism to a waitlist control condition in 24 adults with elevated PCI scores. The treatment focused on reframing beliefs associated with perfectionism and the influence of these beliefs on mood (Radhu et al., 2012). Participants in the

intervention condition exhibited significantly greater reductions in automatic thoughts and anxiety sensitivity relative to those in the waitlist control condition. Collectively, these studies indicate that web-based CBT interventions can produce reductions in dimensions of perfectionism and psychopathology; however, the non-

clinical samples prevent generalisations to clinical populations (Arpin-Cribbie et al., 2008; Arpin-Cribbie et al., 2012; Radhu et al., 2012).

Pleva and Wade’s (2007) RCT evaluated the efficacy of guided self-help CBT for perfectionism compared to pure self-help CBT for perfectionism in a non- clinical sample. Forty nine adults with elevated total FMPS scores were randomised to a guided self-help or a pure self-help condition. In the guided self-help condition, participants read and completed exercises from Antony and Swinson’s (1998) cognitive behavioural self-help book for perfectionism with minimal therapist guidance. In the pure self-help condition, participants read and completed exercises from Antony and Swinson’s (1998) book in line with written guidelines.Adults receiving guided self-help exhibited significantly greater reductions in obsessive- compulsive symptoms relative to adults receiving pure self-help. Both guided and pure self-help conditions displayed decreases in perfectionism and depression between pre- and post-treatment; however, there were no significant differences between conditions. Specifically, participants receiving guided self-help

demonstrated significant pre-post decreases in CM, PS, DA, depression and obsessive-compulsive symptoms. These decreases were maintained at 3-month follow-up with the exception of depression; however, this still remained at a lower level than pre-treatment depression scores. Individuals receiving pure self-help exhibited significant pre-post decreases in CM and depression, which were

maintained at 3-month follow-up. There was also a significant decrease in DA and obsessive-compulsive symptoms between post-treatment and 3-month follow-up. Thus, while there are improvements in dimensions of perfectionism and depression following both guided and pure self-help, it appears that guided self-help is more effective than pure self-help in the treatment of obsessive-compulsive symptoms. A

greater percentage of participants from the guided self-help condition tended to demonstrate reliable change in PS and obsessive-compulsive symptoms; however, tests of the significance of these differences were not conducted. This study did not include a pure control group. It also did not control for differences in reading and homework compliance that may have occurred between groups and accounted for any interaction effects (Pleva & Wade, 2007). The non-clinical sample prevents generalisation to clinical populations.