Prevention of anxiety symptoms in children: results from a universal school-based trial

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.     

The Role of Perfectionism in Relation to an Intervention to Reduce Anxious and Depressive Symptoms in Children

Research has demonstrated an association between perfectionism and depressive and anxious symptoms in children. We examined whether a school-based program targeting anxious and depressive symptoms would reduce perfectionism, and whether perfectionism would interfere with intervention outcomes. The participants were 78 school-age children identified as at-risk for anxiety and/or depression. At-risk children took part in a randomized controlled trial of a school-based intervention program. Levels of perfectionism, depression, and anxiety were assessed at pre-treatment (Time 1) and again at post-treatment (Time 2) after participating in either a cognitive behavioral group or a structured activity group. Participation in either group was associated with significant reductions in overall levels of self-oriented perfectionism, anxious symptoms, and depressive symptoms. Supplementary analyses indicated that pre-treatment self-oriented perfectionism influenced post-treatment depression scores, suggesting that perfectionism interferes with treatment outcome. Perfectionism in children appeared amenable to group-based intervention, and identifying perfectionism may be important for treating children with depressive symptoms.     

The Interactive Effects of Chronic Pain, Guilt, and Perfectionism on Work Outcomes

Two studies were conducted examining the interactive effects of chronic pain, perceived perfectionism (e.g., self- and socially prescribed), and guilt on job tension and job satisfaction. It was hypothesized that chronic pain would have its most adverse effects on these work outcomes when concurrently coupled with high levels of perceived perfectionism and guilt. In both studies, the results supported the interaction effect of Chronic Pain × Socially Prescribed Perfectionism × Guilt on tension and satisfaction in the expected direction. As predicted, the results also indicated a Chronic Pain × Guilt × Self-Oriented Perfectionism interaction on job tension. Implications for theory and practice, strengths and limitations, and avenues for future research are provided.     

Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial

Perfectionism has been proposed as a transdiagnostic process that maintains depression and anxiety through shared cognitive and behavioral processes. The purpose of this study was to investigate the efficacy of a brief, guided cognitive behavioral treatment (CBT) for perfectionism delivered via a self-help booklet in reducing perfectionism and symptoms of depression and anxiety during the antenatal period. Pregnant women in their third trimester were randomly allocated to self-help (n = 30) or waitlist control (n = 30). There were significant reductions in perfectionism and symptoms for participants who received CBT for perfectionism from pre- to post-treatment, which were maintained at 3-month follow-up, while the waitlist control group demonstrated no significant changes. Path analysis demonstrated a significant indirect effect of treatment condition on post-treatment depression and anxiety scores via perfectionism, controlling for pre-treatment scores, suggesting changes in perfectionism were associated with decreases in symptoms. The findings suggest that it would be useful for future research with larger samples to further investigate the efficacy of CBT for perfectionism for perinatal depression and anxiety.     

Perfectionism, self-consciousness and anxiety

The relation between perfectionism, anxiety, and self-consciousness was studied in a normal sample. The perfectionism dimensions of Concern over Mistakes, Doubts about Action, and Socially Prescribed Perfectionism showed a pattern of correlations not only with measures of social anxiety, but also with measures of agoraphobic fears, and fears of bodily injury, death and illness. Public self-consciousness also correlated with various measures of anxiety, but these correlations disappeared when the relevant dimensions of perfectionism were controlled for. It is concluded that perfectionism is a more relevant construct in the study of anxiety than is public self-consciousness. The results are discussed in terms of possible causal relationships between perfectionism and anxiety.     

The Escape Theory of Suicide in College Students: Testing a Model That Includes Perfectionism

A model of the escape theory of suicide was tested, using the following measures: the Life Experiences Survey, the Socially Prescribed Perfectionism subscale, the Self-Rating Depression Scale, the Hopelessness Scale, the Reasons for Living Inventory, and the Scale for Suicide Ideation. College students (N = 114) completed all of these measures, and results were correlated. LISREL path analysis failed to validate the proposed model. All proposed paths were significant, except for the reciprocal path proposed between negative life events and socially prescribed perfectionism. Two residual paths were also significant: from socially prescribed perfectionism to suicide ideation, and from hopelessness to suicide ideation. A revised model constructed from these significant paths had a good overall fit, which suggests that an interactional model is more appropriate than a linear one.     

Perfectionism as a Predictor of Post-event Rumination in a Socially Anxious Sample

Socially anxious individuals tend to have elevated levels of perfectionism and engage in excessive rumination following social situations. The present research aimed to examine perfectionism, in both state and trait forms, as a predictor of post-event rumination. Socially anxious students (N = 104) completed measures of trait perfectionism prior to, and state perfectionism following, an anxiety inducing speech task. Post-event rumination was assessed 2 days later. State and trait perfectionism were significant predictors of post-event rumination (2 days later), while controlling for baseline social anxiety, depression and state anxiety. These results support the need to target perfectionism in treatments for social anxiety disorder.     

Parent perfectionism and psychopathology symptoms and child perfectionism

Perfectionism is a multidimensional construct associated with various psychological problems. Studies regarding risk factors for perfectionism are scarce but evidence suggests that parents may be highly involved in their child’s perfectionism. The present study included 160 children aged 8–17 years (67 males, 93 females) and their parents. Relationships between parent and child perfectionism and between parent psychopathology and child perfectionism were examined across 5 age groups (8–9 years, 10–11 years, 12–13 years, 14–15 years, 16–17 years). Self-oriented perfectionism was highest among children aged 16–17 years. Maternal perfectionism and maternal psychopathology predicted child self-oriented and socially prescribed perfectionism. Maternal anxiety mediated the relationship between maternal other-oriented perfectionism and socially prescribed perfectionism in children aged 8–12 years. Maternal perfectionism and psychopathology may constitute risk factors for child perfectionism. Findings are discussed in terms of their implications for theories of perfectionism.     

Perfectionism,Components of Stress Reactivity,and Depressive Symptoms

The current study examined the associations among dimensions of perfectionism, facets of stress reactivity, and self-reported depressive symptoms in 191 university students. Participants completed the Multidimensional Perfectionism Scale, the Perfectionism Cognitions Inventory, the Perceived Stress Reactivity Scale (PSRS), and a measure of depressive symptoms. The PSRS is a relatively new instrument that measures several distinguishable facets of stress reactivity including prolonged stress reactivity, reactivity to failure, and reactivity to social evaluation. Analyses confirmed that most of the perfectionism measures were associated with stress reactivity to failure experiences. Socially prescribed perfectionism and perfectionistic automatic thoughts were also associated with prolonged stress reactivity and reactivity to social evaluation. Moreover, all facets of stress reactivity were correlated with depressive symptoms. Finally, prolonged stress reactivity and reactivity to social evaluation mediated the links between perfectionism dimensions and depressive symptoms. The current findings provide general support for models of perfectionism and stress, and suggest that perfectionists have heightened sensitivities to stressors related to their self-definitions that are activated when threatening stressors involving these themes are experienced.     

A Pilot Feasibility Open Trial of an Interpretation Bias Intervention for Parents of Anxious Children

Interpretation bias is a transdiagnostic mechanism underlying anxiety. Theoretical models highlight the role of parental interpretation bias in predicting and maintaining child anxiety. However, very few studies have examined parent interpretation bias as a treatment target. The current pilot study tested the feasibility and acceptability of an interpretation bias intervention delivered by a smartphone app, called HabitWorks, in parents of anxious children who self-reported at least mild symptoms of anxiety and negative interpretation bias.Parents of anxious youth (ages 8 to 16) were recruited from the waitlists of three child anxiety clinics. They were asked to complete interpretation modification exercises via the HabitWorks app 3 times per week for 1 month. Participants completed assessments at pre- and post-intervention and 1-month follow-up to assess changes in interpretation bias, anxiety symptoms, and overall perceptions of HabitWorks.Participants (N = 14) (M_age = 44.36; 14.29% men, 85.71% women) completed an average of 13.29 exercises out of the 12 prescribed. Acceptability ratings were high. Interpretation bias, as measured by an assessment version of the intervention exercise, significantly improved from pre- to posttreatment, and these improvements were maintained at the 1-month follow-up. Anxiety symptoms significantly improved from the “mild” severity range to the “none to minimal” range.In this pilot feasibility study in parents of anxious youth, HabitWorks was a feasible and acceptable low-intensity intervention. These preliminary results support a future controlled trial of HabitWorks for parents. Future studies are also needed to test whether targeting interpretation bias in parents has downstream effects on maladaptive parent behaviors and ultimately, child interpretation bias and anxiety.     

Examining the Role of Perfectionism and Intolerance of Uncertainty in Postevent Processing in Social Anxiety Disorder

Postevent processing (PEP) is proposed to be a key maintenance factor of social anxiety disorder (SAD; e.g., Clark and Wells 1995). The goal of the current study was to examine the independent roles of two transdiagnostic variables, namely perfectionism and intolerance of uncertainty (IU), as unique predictors of PEP in SAD above and beyond social anxiety and depressive symptoms. Fifty-six adults with SAD and high levels of speech anxiety completed measures of perfectionism, IU, social anxiety, and depression. They gave an impromptu speech to induce PEP, and completed measures assessing degree of PEP and its associated distress. Significant positive correlations were found between perfectionism and negative PEP degree and distress, as well as between IU and negative PEP distress. The perfectionism subscales of parental expectations and parental criticism significantly predicted negative PEP degree and distress over and above social anxiety and depressive symptoms. Perfectionism, as well as IU, were significantly and positively correlated with positive PEP distress, and significantly predicted positive PEP distress above and beyond social anxiety and depressive symptoms. The study design was cross-sectional; hence, experimental and longitudinal studies are needed to further understand the roles of perfectionism and IU as they relate to PEP. Individuals with SAD who are high in perfectionism or IU appear to be more prone to engaging in, or experiencing distress associated with, negative PEP. Specific strategies for decreasing negative PEP in this vulnerable population, especially for those high in perfectionism, may be necessary for optimal treatment outcome.     

Dimensions of Perfectionism and Anxiety Sensitivity

The current study investigated the extent to which dimensions of perfectionism are associated with components of the anxiety sensitivity construct. A sample of 177 undergraduate students completed the Multidimensional Perfectionism Scale, the Perfectionism Cognitions Inventory, the Perfectionistic Self-Presentation Scale, and the Expanded Anxiety Sensitivity Index developed by Taylor and Cox (1998). The results confirmed that automatic thoughts involving perfectionism and the interpersonal aspects of the perfectionism construct are associated with anxiety sensitivity. Examination of the Anxiety Sensitivity Index factors showed that perfectionism cognitions were associated primarily with anxiety sensitivity involving fears of cognitive dyscontrol, while socially prescribed perfectionism and perfectionistic self-presentation were associated primarily with fears of publicly observable anxiety reactions in a manner suggesting that the interpersonal perfectionism dimensions are linked closely with an anxious sensitivity to negative social evaluation and subsequent panic attacks. The theoretical and treatment implications of the link between perfectionism and anxiety sensitivity are discussed.     

Predicting Response to an Internet-Delivered Parenting Program for Anxiety in Early Childhood

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3–6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules.     

A cluster analysis of perfectionism among competitive athletes

In the present study, the ways in which athletes may experience perfectionism in a sport context were examined. The question of interest was whether self-confidence, intensity, and direction of cognitive and somatic precompetitive anxiety would differ across identifiable profiles of perfectionism. Competitive athletes (N= 166) completed the Sport-Multidimensional Perfectionism Scale, the French-Canadian Hewitt Multidimensional Perfectionism Scale, and the Competitive State Anxiety Inventory-2 Revised, including a Direction scale. Results of the cluster analysis indicated that athletes could be classified into three groups labelled Nonperfectionists, Adaptive perfectionists, and Maladaptive perfectionists. Perfectionism profiles differed significantly on Cognitive and Somatic Anxiety Intensity and on Cognitive Anxiety Direction. The importance of considering all dimensions of perfectionism simultaneously when examining the functional nature of this construct in sport is discussed.     

Perfectionism Cognitions, Rumination, and Psychological Distress

The current study examined the extent to which dimensions of perfectionism are associated with a ruminative response orientation and the experience of cognitive intrusions in response to stressful events. Our main goal was to test the hypothesis that individuals characterized by frequent automatic thoughts involving perfectionistic themes would also be characterized by a ruminative response orientation when distressed and they would report intrusive thoughts and images following the experience of a stressful event. A sample of 65 students completed several measures, including the Perfectionism Cognitions Inventory, the Multidimensional Perfectionism Scale, the Response Styles Questionnaire, the Impact of Events Scale, and indices of depression and anxiety. Correlational analyses confirmed that high scores on the Perfectionism Cognitions Inventory were correlated with a ruminative response orientation and the reported experience of intrusive thoughts and images following the experience of a stressful event. High levels of perfectionism cognitions, socially prescribed perfectionism, and rumination were also correlated with measures of depression and anxiety representingthe tripartite model. The results support the view that there is a salient cognitive aspect to perfectionism and the experience of frequent perfectionistic cognitions and related forms of rumination contribute to levels of psychological distress.     

Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n = 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionism-striving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.     

Understanding perfectionism and depression in an adult clinical population: Is outcome expectancy relevant to psychological functioning?

Perfectionism is a personality trait defined by high standards of performance, which has been identified as a risk factor for major depressive disorder (MDD). The present study examined if outcome expectancy involved in perfectionism differs for individuals with depression compared to non-depressed controls, and how outcome expectancy relates to depression symptoms. This study included 49 depressed and 42 non-depressed participants. Perfectionism and depression severity were measured via self-report instruments. This study is the first to provide preliminary evidence that outcome expectancies involved in perfectionism may be related to psychological functioning in depression. Individuals with depression demonstrated higher negative and lower positive outcome expectancies associated with perfectionism compared to non-depressed participants. Perfectionism outcome expectancies are also related to depression severity and symptoms. Future research should prospectively investigate relationships of outcome expectancy involved in perfectionism in individuals at risk for depression.     

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n?=?118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p?<?.001), purging (p?=?.005), restrictive eating (p?<?.001), and body checking (p?<?.001) frequency, depressive (p?<?.001) and anxiety (p?<?.001) symptoms, and negative (p?=?.001) and positive (p?<?.001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.     

The influence of comorbidity on treatment outcome for children and adolescents with anxiety disorders

There have been a growing number of studies showing that cognitive behavioural treatment packages for children with anxiety disorders are highly effective. Clinically, it is often assumed that treatment outcome is less successful, or that treatment needs to be altered when faced with the existence of comorbid conditions. To date, only one study has directly addressed this question in the child anxiety literature. The present study compared the treatment outcome and maintenance following a brief, group program for the reduction of child and adolescent anxiety disorders in anxious children with versus without comorbid disorders. There was no significant difference in response to treatment at the end of the program and few differences at 12-month follow-up. The only indication of an impact of comorbidity was a suggestion that children with a comorbid condition did not do as well at follow-up. However, this result was only shown on some parent-report measures and not on self-report measures. Overall, the results indicate that treatment for child and adolescent anxiety disorders produces broadly comparable results regardless of the existence of comorbid disorders.     

Perfectionism and negative repetitive thoughts: Examining a multiple mediator model in relation to mindfulness

Perfectionism is known to be associated with various maladaptive outcomes, yet little research has examined mechanisms underlying perfectionism or potential protective factors. This study investigated worry and rumination as mediators between perfectionism and psychological distress in university students (N = 213), and related the multiple mediator model to a five-facet conceptualization of mindfulness. Socially prescribed perfectionism was related to higher levels of distress, including negative affect, depression, anxiety, and stress, while self-oriented perfectionism and other-oriented perfectionism appeared unrelated to distress. Mindfulness facets of acting with awareness, non-judging of inner experience, and to a lesser extent non-reactivity to inner experience, were the strongest independent contributors to perfectionism, negative repetitive thoughts, and distress. Worry and rumination mediated the relationship between socially prescribed perfectionism and negative affect; however, the mediating effect of rumination was absent in those high in mindfulness. These findings suggest that a mindfulness disposition may mitigate distress related to socially prescribed perfectionism by removing the mediating effect of ruminative thought. Future research might explore a mindfulness-training program to target negative repetitive thoughts underlying socially prescribed perfectionism.