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The aim of this study is to confirm the feasibility of an integrative form of group psychotherapy in treating perfectionism. In a previous pilot study we suggested that this new treatment is safe and feasible, also reporting a significant reduction of perfectionism at final assessment. The intervention integrates the Paul Hewitt relational model of perfectionism and the Paul Gilbert Compassion Focused Therapy. We will explore the feasibility of the proposed group therapy through a three-arm waiting-list randomized controlled trial. Our hypothesis is that those in the treatment groups (either online or in presence format) will show at the end of the intervention a lower level of perfectionsm than those in the control group.
After being informed about the study and potential risks, all partecipants giving written informed consent will undergo a psychological assessment so as to determine eligibility for study entry. Patients who meet the eligibility requirements will be randomized in a double-blind manner in a 1:1 ratio to (i) new integrative group psychotherapy through an in presence format, (ii) the same integrative group psychotherapy through an online format, (iii) a waiting-list control group. At the end of active experimental groups treatment (2 months), all the partecipants will have access to the final follow-up assessment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Group | No Intervention | The control group is made up of participants who are eligible but not assigned to the treatment. For ethical reasons they will be able to access the intervention once the experimental group has concluded the study. During the waiting-list phase, participants can access a mental health intervention, but in this case they are excluded from the study. Participants are told that there is only one possible active group and therefore a waiting-list is created. This explanation is given to reduce a worsening symptom bias for feeling "excluded" from treatment. | |
| Experimental Group 1 - Online Format | Active Comparator | The experimental intervention is an integrative mindful compassion group therapy as manualized by Cheli, Cavalletti, Flett & Hewitt (2020). The structure was outlined on the base of standard mindfulness-based interventions, comprising eight 2-hour online group sessions and one day of silence lasting 4 hours. The contents and the phases of the intervention were rooted in two different frameworks. On the one hand, the sequence of and the types of practices were defined in accordance with the mindful compassion protocol (Gilbert & Choden, 2014). On the other hand, the shared conceptualization of perfectionism and its role in triggering, maintaining, and inducing relapses in personality disoders was proposed through the relational model by Hewitt and colleagues (2017). The hybrid format (online weekly sessions plus an in presence half-day of silence) has been developed in accordance with existing COViD-19 emergency and rules. |
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| Experimental Group 2 - Online Format | Active Comparator | The experimental intervention is an integrative mindful compassion group therapy as manualized by Cheli, Cavalletti, Flett & Hewitt (2020). The structure was outlined on the base of standard mindfulness-based interventions, comprising eight 2-hour in presence group sessions and one day of silence lasting 4 hours in presence. The contents and the phases of the intervention were rooted in two different frameworks. On the one hand, the sequence of and the types of practices were defined in accordance with the mindful compassion protocol (Gilbert & Choden, 2014). On the other hand, the shared conceptualization of perfectionism and its role in triggering, maintaining, and inducing relapses in personality disoders was proposed through the relational model by Hewitt and colleagues (2017). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mindful compassion for perfectionism | Behavioral | The intervention is a 8-week group psychotherapy in a hybrid format: 8 weekly online sessions lasting 2 hours plus an in presence half-day of silence lasting 4 hours. |
| Measure | Description | Time Frame |
|---|---|---|
| Feasibility (adverse events; adherence) | Feasibility is defined on the basis of two criteria: absence of adverse events (i.e. dropouts; hospitalization; etc.) and adequate adherence (i.e. maximum 1 skipped session per participant) | 2 measurements: one at baseline assessment; one at final assessment. Initial assessment will be 1 month priori the intervention, the final assessment at the end of the intervention (2 months after the beginning of the intervention). |
| Betwen-groups effectiveness (perfectionism) | At the final assessment, the experimental group's Perfectionistic Cognitions Inventory (PCI) scores are significantly lower than those of the control group (the differences in the initial assessment must be insignificant). Higher scores of PCI (ranging between 0 to 100) are indicative of higher perfectionistic worry | 2 measurements: one at baseline assessment; one at final assessment. Initial assessment will be 1 month priori the intervention, the final assessment at the end of the intervention (2 months after the beginning of the intervention). |
| Measure | Description | Time Frame |
|---|---|---|
| Withing-group effectiveness (perfectionism) | In the experimental group the scores on the Perfectionistic Cognitions Inventory (PCI) must show a significant difference between initial and final assessment. Higher scores of PCI (ranging between 0 to 100) are indicative of higher perfectionistic worry | 2 measurements: one at baseline assessment; one at final assessment. Initial assessment will be 1 month priori the intervention, the final assessment at the end of the intervention (2 months after the beginning of the intervention). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Simone Cheli, PhD | Tages Onlus | Principal Investigator |
| Paul L Hewitt, PhD | British Columbia University | Study Chair |
| Gil Goldzweig, PhD | The Academic College of Tel-Aviv Yaffo | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centro di Psicologia e Psicoterapia Tages Onlus - Firenze | Florence | FI | 50137 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Cheli S, Cavalletti V, Flett GL, Hewitt PL. Mindful compassion for perfectionism in personality disorders: A pilot acceptability and feasibility study. BPA - Applied Psychology Bulletin (Bollettino di Psicologia Applicata). 2020; 68(287): 55-65. https://doi.org/10.26387/bpa.287.5 | ||
| 33245562 | Background | Hewitt PL, Mikail SF, Dang SS, Kealy D, Flett GL. Dynamic-relational treatment of perfectionism: An illustrative case study. J Clin Psychol. 2020 Nov;76(11):2028-2040. doi: 10.1002/jclp.23040. Epub 2020 Aug 15. | |
| 31107049 |
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The study protocol will be made available at the beginning of the active treatment phase and the raw data at the end of the study. All information will be uploaded to the Open Science Foundation.
The study protocol, SAP, ICF and CSR will be available before the end of February 2023
All material will be freely accessible to anyone on the Open Science Foundation (see link below).
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Pragmatic waiting-list randomized controlled trial with blinded outcome assessment
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The study design reflects an external, third-party evaluation. The evaluation team (i.e. the researcers conducting the analysis) will be independent from both the application vendor (i.e. the therapists conducting the intervention) and the recruitment team (i.e. the researchers recruiting and randomly allocating the participants).
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| Background |
| Hewitt PL, Qiu T, Flynn CA, Flett GL, Wiebe SA, Tasca GA, Mikail SF. Dynamic-relational group treatment for perfectionism: Informant ratings of patient change. Psychotherapy (Chic). 2020 Jun;57(2):197-205. doi: 10.1037/pst0000229. Epub 2019 May 20. |
| 31999191 | Background | Hewitt PL, Smith MM, Deng X, Chen C, Ko A, Flett GL, Paterson RJ. The perniciousness of perfectionism in group therapy for depression: A test of the perfectionism social disconnection model. Psychotherapy (Chic). 2020 Jun;57(2):206-218. doi: 10.1037/pst0000281. Epub 2020 Jan 30. |
| 33556805 | Background | Smith MM, Sherry SB, Ray C, Hewitt PL, Flett GL. Is perfectionism a vulnerability factor for depressive symptoms, a complication of depressive symptoms, or both? A meta-analytic test of 67 longitudinal studies. Clin Psychol Rev. 2021 Mar;84:101982. doi: 10.1016/j.cpr.2021.101982. Epub 2021 Jan 26. |
| 33362650 | Background | Gilbert P. Compassion: From Its Evolution to a Psychotherapy. Front Psychol. 2020 Dec 9;11:586161. doi: 10.3389/fpsyg.2020.586161. eCollection 2020. |
| 16236231 | Background | Gilbert P. Evolution and depression: issues and implications. Psychol Med. 2006 Mar;36(3):287-97. doi: 10.1017/S0033291705006112. Epub 2005 Oct 20. |
| 29907988 | Background | Petrocchi N, Dentale F, Gilbert P. Self-reassurance, not self-esteem, serves as a buffer between self-criticism and depressive symptoms. Psychol Psychother. 2019 Sep;92(3):394-406. doi: 10.1111/papt.12186. Epub 2018 Jun 15. |
| 26454144 | Background | McEwan K, Gilbert P. A pilot feasibility study exploring the practising of compassionate imagery exercises in a nonclinical population. Psychol Psychother. 2016 Jun;89(2):239-43. doi: 10.1111/papt.12078. Epub 2015 Oct 10. |
| Background | GILBERT, P. & CHODEN, K. (2014). Mindful compassion: How the science of compassion can help you understand your emotions, live in the present, and connect deeply with others. New Harbinger Publications. |
| Background | HEWITT, P.L., FLETT, G.L. & MIKAIL, S.F. (2017). Perfectionism: A relational approach to conceptualization, assessment, and treatment. New York:The Guilford Press. |