The Evidence
Many scientific studies of the cognitive behavioural treatment for perfectionism have been conducted. Together they provide strong research evidence that the treatment is effective at improving perfectionism. The treatment also improves anxiety, depression, and disordered eating. The research shows that the treatment is effective when people have the help of a therapist but also if they use the self-help book either alone or with support. It is effective when delivered in schools or in groups, and for all different ages.
Perfectionism Self-Help Treatment Books and Brief Guides for the Public
Egan, S.J, Shafran, R., & Wade, T.D. (2012). Changing perfectionism. Oxford, UK: Oxford Cognitive Therapy Centre. Available at https://www.octc.co.uk
Shafran R, Egan S, Wade TD. (2018). Overcoming Perfectionism. Second Edition. London: Little, Brown Book Group. Available at https://overcoming.co.uk/604/Overcoming-Perfectionism---ShafranEganWade
Shafran, R., Wade, T., & Egan, S.J. (2023). Perfectionism: A guide for when striving for excellence becomes unhealthy. Charlie Waller Institute, Reading University, UK. https://charliewaller.org/media/bi2pa0xq/0044-perfectionism_a5-180123_digi.pdf
Descriptions of the Treatment and Theory for Clinicians
Egan, SJ, Wade TD, Shafran R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31, 203-212. doi: 10.1016/j.cpr.2010.04.009
Shafran R, Egan SJ, Wade TD. (2023). Coming of age: A reflection on the first 21 years of cognitive behaviour therapy for perfectionism. Behaviour Research and Therapy, 161, 104258. doi: 10.1016/j.brat.2023.104258
Egan S, Wade TD, Shafran R, Antony, M. (2014). Cognitive-behavioural treatment of perfectionism. New York: Guilford.
Shafran R, Egan S, Wade TD. (2018). Overcoming Perfectionism. Second Edition. London: Little, Brown Book Group.
Egan, S.J., Shafran, R., & Wade, T.D. (2022). A clinician’s quick guide to evidence-based approaches: perfectionism. Clinical Psychologist, 26(3), 351-353. https://doi.org.10.1080/13284207.2022.2108315
Efficacy and effectiveness
Face to face
Riley, C., Lee, M., Cooper, Z., Fairburn, C.G., & Shafran, R. (2007). A randomized controlled trial of cognitive-behaviour therapy for clinical perfectionism: A preliminary study. Behaviour Research and Therapy, 45(9), 2221-2231. https://doi.org/10.1016/j.brat.2006.12.003
Egan, S.J., & Hine, P. (2008). Cognitive behavioural treatment of perfectionism: A single case experimental design series. Behaviour Change, 25, 245-258. https://doi.org/10.1375/bech.25.4.245
Glover, D.S., Brown, G.P., Fairburn, C.G., & Shafran, R. (2010). A preliminary evaluation of cognitive-behaviour therapy for clinical perfectionism: A case series. British Journal of Clinical Psychology, 46(1), 85-94. https://doi.org/10.1348/014466506X117388
Steele AL, Waite S, Egan SJ, Finnigan J, Handley A, Wade TD. (2013). Psycho-education and group cognitive-behavioural therapy for clinical perfectionism: A case series evaluation. Behavioural and Cognitive Psychotherapy, 41, 129-143. doi: 10.1017/S1352465812000628
Egan SJ, van Noort E, Chee A, Kane RT, Hoiles KJ, Shafran R, Wade TD. (2014). A randomised controlled trial of face to face versus pure self-help cognitive behavioural treatment for perfectionism. Behavior Research and Therapy, 63, 107-113. doi: org/10.1016/j.brat.2014.09.009
Sadri, S.K., Anderson, R.A., McEvoy, P.M., Kane, R.T., & Egan, S.J. (2017). A pilot investigation of cognitive behavioural therapy for clinical perfectionism in Obsessive Compulsive Disorder. Behavioural and Cognitive Psychotherapy, 45, 312-320. doi.org/10.1017/s1352465816000618.
Internet therapy
Kothari R, Egan S, Wade TD, Andersson G, Shafran R. Overcoming Perfectionism: A Randomised Controlled Trial of an Internet-Based Guided Self-help CBT Intervention. (2016). Journal of Medical Internet Research Protocols, 5(4), e215. doi:10.2196/resprot.6378
Rozental A, Shafran R, Wade TD, Egan S, Bergman Nordgren L, Carlbring P, Landström A, Roos S, Skoglund M, Thelander E, Trosell L, Örtenholm A, Andersson G. (2017). A randomized controlled trial of Internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors. Behaviour Research and Therapy, 95, 79-86. doi: 10.1016/j.brat.2017.05.015
Shafran R, Wade TD, Egan S, Kothari R, Allcott-Watson H, Carlbring P, Rozental A, Andersson G. (2017). Is the Devil in the Detail? A Randomized Controlled Trial of Guided Internet Based CBT for Perfectionism. Behaviour Research and Therapy, 95, 99-106. doi: 10.1016/j.brat.2017.05.014
Rozental A, Shafran R, Wade TD, Kothari R, Egan S, Ekberg L, Wiss M, Carlbring P, Andersson G. (2018). Guided web-based cognitive behavior therapy for perfectionism: Results from two different randomized controlled trials. Journal of Medical Internet Research, 20(4): e154.
Valentine, E. G., Bodill, K. O., Watson, H. J., Hagger, M. S., Kane, R. T., Anderson, R. A., & Egan, S. J. (2018). A randomised controlled trial of unguided internet cognitive-behavioral treatment for perfectionism in individuals who engage in regular exercise. International Journal of Eating Disorders, 51(8), 984-988. https://doi.org/10.1002/eat.22888
Kothari R, Shafran R, Rozental A, Egan SJ, Andersson G, Wade TD, Pistrang N, Barker C, Allcott-Watson H. (2019). A Randomised Controlled Trial of Guided Internet-Based Cognitive Behavioural Therapy for Perfectionism: Effects on psychopathology and transdiagnostic processes. Journal of Behavior Therapy and Experimental Psychiatry, 64, 113-122. doi: 10.1016/j.jbtep.2019.03.007 doi:10.2196/jmir.9823
Johnson S, Egan SJ, Andersson G, Carlbring P, Shafran R, Wade TD. (2019). Internet-delivered cognitive-behavioural therapy for perfectionism: Targeting dysmorphic concern. Body Image, 30, 44-55. doi: 10.1016/j.bodyim.2019.05.002
Wade TD, Kay E, de Valle MK, Egan SJ, Andersson G, Carlbring P, Shafran R. (2019). Internet-based cognitive behaviour therapy for perfectionism: More is better but no need to be prescriptive. Clinical Psychologist, 23, 196-205. doi: 10.1111/cp.12193
Shu CY, Watson HJ, Anderson RA, Wade TD, Kane RT, Egan SJ. (2019). A randomized controlled trial of unguided Internet cognitive behaviour therapy for perfectionism in adolescents: Impact on risk for eating disorders. Behaviour Research and Therapy, 120, 103429. doi: 0.1016/j.brat.2019.103429
Rozental A, Kothari R, Wade T, Egan S, Andersson G, Carlbring P, Shafran R. (2020). Reconsidering perfect: A qualitative study of the experiences of Internet-based cognitive behaviour therapy for perfectionism. Behavioural and Cognitive Psychotherapy, 48, 432-441. doi: 10.1017/S1352465820000090
Grieve P, Egan SJ, Andersson G, Carlbring P, Shafran R, Wade TD. (2022). The impact of internet-based cognitive behaviour therapy for perfectionism on different measures of perfectionism: A randomised controlled trial. Cognitive Behaviour Therapy, 51, 130-142. doi: 10.1080/16506073.2021.1928276
Traditional self-help book format
Steele, A. L., & Wade, T. D. (2008). A randomised trial investigating guided self-help to reduce perfectionism and its impact on bulimia nervosa: A pilot study. Behaviour Research and Therapy, 46(12), 1316-1323. https://doi.org/10.1016/j.brat.2008.09.006
Lowndes T., Egan, S.J., & McEvoy, P.M. (2018). Efficacy of a brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: A randomized controlled trial. Cognitive Behaviour Therapy, 1-15. doi:10.1080/16506073.2018.1490810.
Hoiles, K.J., Rees, C.S., Kane, R.T., Howell, J., & Egan, S.J. (2022). A pilot randomised controlled trial of guided self-help cognitive behaviour therapy for perfectionism: Impact on diagnostic status and comorbidity. Journal of Behavior Therapy and Experimental Psychiatry, 76, 101739. http://doi.org/10.1016/j.jbtep.2022.101739.
Schools
Nehmy T, Wade TD. (2015). Reducing the onset of negative affect in adolescents: Evaluation of a perfectionism program in a universal prevention setting. Behaviour Research and Therapy, 67, 55-63. doi: 10.1016/j.brat.2015.02.007
Fairweather-Schmidt AK, Wade TD. (2015). Piloting a perfectionism intervention for pre-adolescent children. Behaviour Research and Therapy, 73, 67-73. doi: 10.1016/j.brat.2015.07.004
Vekas E, Wade TD. (2017). The impact of a universal intervention targeting perfectionism in children: An exploratory controlled trial. British Journal of Clinical Psychology, 56, 458-473. doi: 10.1111/bjc.12152
Osenk I, Johnson C, Wade TD. (2023). A pragmatic randomized controlled trial targeting perfectionism in young adolescents. School Mental Health, 15, 151-164. doi: 10.1007/s12310-022-09540-3
Parent-supported and delivered for children and adolescents
Egan SJ, Neal J, Ure S, Callaghan T, Ho P, Shafran R, Wade TD. (2023). The development of co-designed parent-supported cognitive behaviour therapy for perfectionism in adolescents with eating disorders: Initial feasibility and acceptability. Journal of Eating Disorders, 11:138. doi: 10.1186/s40337-023-00860-
Co-designed treatment
Egan SJ, Neal J, Ure S, Callaghan T, Ho P, Shafran R, Wade TD. (2023). The development of co-designed parent-supported cognitive behaviour therapy for perfectionism in adolescents with eating disorders: Initial feasibility and acceptability. Journal of Eating Disorders, 11, 138. doi: 10.1186/s40337-023-00860-
O’Brien, A., Anderson, R., Mazzucchelli, T., & Egan, S.J. (2022). A protocol for unguided internet self-help cognitive behaviour therapy for perfectionism in adolescents at-risk of eating disorders. Internet Interventions, 29, 105565. https: doi.org/10.1016/j.invent.2022.105565.
Systematic reviews and Meta-analyses
Limburg, K., Watson, H.J., Hagger, M.S., & Egan, S.J. (2017). The relationship between perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73, 1301-1326. https://doi:10.1002/jclp.22435.
Osenk I, Williamson P, Wade TD. (2020). Does Perfectionism or Pursuit of Excellence Contribute to Successful Learning? A Meta-Analytic Review. Psychological Assessment, 32, 972-983. doi: 10.1037/pas0000942
Robinson K, Wade TD. (2021). Perfectionism interventions targeting disordered eating: A systematic review and meta-analysis. International Journal of Eating Disorders, 54, 473-487 doi: 10.1002/eat.23483
Wade TD, Egan SJ, Wleklinski M, O’Brien A, Fitzallen G, Shafran R. (2021). A realist synthesis of websites containing content on perfectionism: Are the descriptions and advice empirically supported? BMC Psychology, 9, 119. doi: 10.1186/s40359-021-00620-8
Egan SJ, Wade TD, Fitzallen G, O’Brien A, Shafran R. (2022). A meta-synthesis of qualitative studies of the link between anxiety, depression and perfectionism: Implications for treatment. Behavioural and Cognitive Psychotherapy. 50, 89-105. doi:10.1017/S1352465821000357
Galloway, R., Watson, H.J., Greene, D., Shafran, R., & Egan, S.J. (2022). The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 51(2), 170-184. https://doi.org/10.1080/16506073.2021.1952302.
Stackpole, R., Greene, D., Bills, E., & Egan, S.J. (2023). A systematic review and meta-analysis of the relationship between perfectionism and eating disorder symptoms in adults. Eating Behaviors, 50, 101769. https://doi.org/10.1016/j.eatbeh.2023.101769
Bills, E., Greene, D., Stackpole, R., & Egan, S.J. (2023). Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis. Appetite, 187, 106586. https://doi.org/10.1016/j.appet.2023.106586.
Lunn, J., Greene, D., Callaghan, T., & Egan, S.J. (2023). Associations between perfectionism and symptoms of anxiety, obsessive-compulsive disorder and depression in young people: A meta-analysis. Cognitive Behaviour Therapy, https://dx.doi.org/ 10.1080/16506073.2023.2211736.
Measurement and Questionnaires
Egan, S.J., Shafran, R., Lee, M., Fairburn, C.G., Cooper, Z., Doll, H.A., Palmer, R., & Watson, H.J. (2016). The reliability and validity of the Clinical Perfectionism Questionnaire in eating disorder and community samples. Behavioural and Cognitive Psychotherapy, 44, 79-91. https://doi.org/10.1017/S1352465814000629
Hoiles, K., Kane, R.T., Watson, H.J., Rees, C.S., & Egan, S.J. (2016). Preliminary investigation of the reliability and validity of the Clinical Perfectionism Questionnaire in a clinical sample. Behaviour Change, 33, 127-135. https://doi.org/10.1017/bec.2016.6
Leone EM, Wade TD. (2018). Measuring perfectionism in children: A systematic review of the mental health literature. European Child & Adolescent Psychiatry, 27, 553-567. doi: 10.1007/s00787-017-1078-8
Prior, K.L., Erceg-Hurn, D.M., Raykos, B.C., Egan, S.J., Byrne, S & McEvoy, P.M. (2018). Validation of the clinical perfectionism questionnaire in an eating disorder sample: A bifactor approach. International Journal of Eating Disorders, 51, 1176-1184. https://doi.org/10.1002/eat.22892
Shu CY, O’Brien A, Watson HJ, Anderson RA, Wade TD, Kane RT, Lampard A, Egan SJ. (2020). Structure of the Clinical Perfectionism Questionnaire in Female Adolescents. Behavioural and Cognitive Psychotherapy, 48, 268-279. doi: 10.1017/S1352465819000729
Howell, J., Anderson, R.A., Egan, S.J. & McEvoy, P.M. (2020). One Factor? Two Factor? Bi-factor? A psychometric evaluation of the Frost Multidimensional Scale and the Clinical Perfectionism Questionnaire. Cognitive Behaviour Therapy, 49(6), 518-530. https://doi.org/10.1080/1650673.2020.1790645
Roth, I., Cludius, B., Egan, S.J., & Limburg, K (2021). Evaluation of the factor structure and psychometric properties of the German version of the Clinical Perfectionism Questionnaire: The CPQ-D. Clinical Psychology in Europe, 3(2), 1-16. https://doi.org/10.32872/cpe.3623