A randomized controlled trial of self-help acceptance and commitment therapy and cognitive behavioral therapy for perfectionism

The prevalence of perfectionism is increasing in undergraduate students, highlighting the need to expand accessible treatment options for this population. Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) are effective interventions for perfectionism, but have yet to be examined when delivered in a bibliotherapy format. This randomized controlled trial (NCT06057740) assessed the efficacy of ACT and CBT self-help books for perfectionism compared to a waitlist control. University students with high perfectionism (N = 110) were randomized to ACT (n = 37), CBT (n = 37), or waitlist (n = 36). Participants completed self-report assessments at pre-, mid-, post-intervention, and 1-month follow-up. Analyses were run with multilevel linear modeling with the intent-to-treat sample. Participants assigned to ACT and CBT showed significantly improved perfectionism, psychological inflexibility, cognitive reappraisal, well-being, and stress, compared to the waitlist participants. There were no significant differences between ACT and CBT on total perfectionism scores, cognitive reappraisal, well-being, and stress, except for psychological inflexibility scores, where ACT demonstrated stronger improvements in evaluative concerns and psychological inflexibility scores compared to the CBT and waitlist conditions over time. No intervention effects were found for anxiety or depression. The high adherence rates and satisfaction ratings indicate bibliotherapy for individuals with perfectionism is a feasible intervention. Bibliotherapy for perfectionism may be effective in reducing perfectionistic symptoms, potentially increasing access to evidence-based interventions for perfectionism among undergraduate students.