A Meta-Analytic Test of the Efficacy of Cognitive Behavioural Therapy for Perfectionism: A Replication and Extension

Meta-analyses conclude that cognitive behavioural therapy (CBT) for perfectionism is efficacious without addressing indices of efficacy such as reliable improvement, deterioration, dropout, and change at follow-up. We addressed this through a reanalysis of the 16 randomized controlled trials included in Galloway et al. (2022), Robinson and Wade (2021), and Suh et al. (2019). At posttreatment, small-to-large effects favouring CBT were found for certain perfectionism measures: high standards (g = -0.40), doubts about actions (g = -0.49), personal standards (g = -0.50), concern over mistakes (g = -0.85), and clinical perfectionism (g = -0.97). Small-to-medium posttreatment effects were found for symptoms of eating disorders (g = -0.29), anxiety (g = -0.37), and depression (g = -0.62). In contrast, self-oriented perfectionism (g = -0.60; 95% CI [-1.96, 0.78]), other-oriented perfectionism (g = -0.36; 95% CI [-1.15, 0.43]), socially prescribed perfectionism (g = -0.53; 95% CI [-1.58, 0.51]), perfectionistic cognitions (g = -0.70; 95% CI [-1.57, 0.17]), discrepancy (g = -0.48; 95% CI [-1.83, 0.87]), life satisfaction (g = -0.59; 95% CI [-1.02, 0.01]), and self-esteem (g = -0.53; 95% CI [-1.25, 0.18]) did not differ between treatment and control conditions. Risk ratios for reliable improvement were significant for perfectionistic cognitions (RR = 1.46), concern over mistakes (RR = 2.36), and clinical perfectionism (RR = 3.07). Dropout was 27.0% and higher in treatment than control conditions (RR = 1.78). At follow-up, all between-group effects were nonsignificant. Findings support the efficacy of CBT for certain perfectionism features while underscoring crucial limitations and areas for improvement.