A Preliminary Evaluation of an Exposure-Based Treatment for Perfectionism
Phase: NA
Conditions: Perfectionism
Sponsor: Florida State University

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An Exposure-Based Treatment for Perfectionism 
 
NCT04500457 
 
Document Updated: October 28, 2020 
 

PROTOCOL TITLE: An Exposure-Based Treatment for Perfectionism 
 
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PROTOCOL TITLE: 
An Exposure-Based Treatment for Perfectionism 
HSC#: 2019.27351 
PRINCIPAL INVESTIGATOR: 
Sarah A. Redden 
Department of Psychology 
616-780-8405 
redden@psy.fsu.edu 
VERSION NUMBER/DATE: 
Version 6: 10/28/20 
 
REVISION HISTORY 
 
Revision 
# 
Version Date 
Summary of Changes 
Consent 
Change? 
1 
7/11/19 
Additional treatment task added and addition of 
community sample 
No 
2 
7/30/19 
Change in inclusion criteria and addition of 
behavioral tasks 
Yes 
3 
9/12/19 
Change in exclusion criteria, sample size, and 
questionnaires 
Yes 
4 
7/17/20 
Adapt study to be administered online, add 
study personnel, increase sample size 
Yes 
5 
10/28/20 
Change in cutoff for contacting people from 
mass screener for recruitment and addition of 
SONA screener for recruitment 
No 
 
 
 

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Table of Contents 
1.0 
Study Summary ........................................................................................................ 4 
2.0 
Objectives* ............................................................................................................... 5 
3.0 
Background* ............................................................................................................. 5 
4.0 
Study Endpoints* ...................................................................................................... 6 
5.0 
Study Intervention/Investigational Agent ................................................................. 7 
6.0 
Procedures Involved* ............................................................................................... 7 
7.0 
Data and Specimen Banking* ................................................................................ 10 
8.0 
Sharing of Results with Subjects* .......................................................................... 10 
9.0 
Study Timelines* .................................................................................................... 10 
10.0 Inclusion and Exclusion Criteria* .......................................................................... 10 
11.0 Vulnerable Populations* ........................................................................................ 10 
12.0 Local Number of Subjects ...................................................................................... 11 
13.0 Recruitment Methods ............................................................................................. 11 
14.0 Withdrawal of Subjects* ........................................................................................ 11 
15.0 Risks to Subjects* ................................................................................................... 11 
16.0 Potential Benefits to Subjects* ............................................................................... 13 
17.0 Data Management* and Confidentiality ................................................................. 13 
18.0 Provisions to Monitor the Data to Ensure the Safety of Subjects* ........................ 13 
19.0 Provisions to Protect the Privacy Interests of Subjects .......................................... 13 
20.0 Compensation for Research-Related Injury ........................................................... 14 
21.0 Economic Burden to Subjects ................................................................................ 14 
22.0 Consent Process ...................................................................................................... 14 
23.0 Process to Document Consent in Writing .............................................................. 15 
24.0 Setting ..................................................................................................................... 15 
25.0 Resources Available ............................................................................................... 15 
26.0 References .............................................................. Error! Bookmark not defined. 
 
 
 

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1.0 
Study Summary 
 
Study Title 
An Exposure-Based Treatment for Perfectionism 
Study Design 
Randomized Intervention Trial 
Primary Objective 
Evaluate the efficacy of an exposure-based treatment for 
perfectionism. 
Secondary 
Objective(s) 
Evaluate the effect of the treatment on depressive, anxiety, 
obsessive-compulsive, and eating disorder symptoms. 
Research 
Intervention(s)  
Exposure-Based Treatment for Perfectionism (see details 
below) 
Study Population 
FSU student subject pool participants and participants from 
the community 
Sample Size 
80 
Study Duration for 
individual 
participants 
2 weeks 
Study Specific 
Abbreviations/ 
Definitions  
Exposure-based perfectionism treatment (EPT) 
 
 

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2.0 
Objectives* 
2.1 The purpose of this study is to test the efficacy of an exposure-based 
treatment for perfectionism. The aims of the study include: 
• Evaluating whether a short-term computerized intervention 
can decrease perfectionism symptomatology (as measured 
by the Frost Multidimensional Perfectionism Scale 
(FMPS). 
• Seeing if this intervention also decreases levels of anxiety 
and depression, and possibly other symptoms related to 
obsessive-compulsive disorder (OCD) and eating disorders.  
2.2 We hypothesize that the intervention group will have significantly 
lower levels of perfectionism symptoms than the wait-list control 
group at post-test. We also hypothesize that the intervention group 
will have decreased levels of anxiety and depression at post-test than 
those in the wait-list control group, after controlling for baseline 
scores. 
3.0 
Background* 
3.1 Perfectionism can be defined as refusing to accept standards less than 
perfection, or the state of being flawless, sometimes leading to distress and 
functional impairment (Mirriam-Webster, 1993). The three-component 
conceptualization was described by Hewitt & Flett (1991) as being self-oriented, 
being self-critical and holding very high personal standards; socially-oriented, 
believing that others have incredibly high standards for them; or other-oriented, 
having extremely high standards of other people. Frost et al. (1990) developed a 
dimensional model of perfectionism with six parts: (1) excessive concern over 
mistakes; (2) excessive high personal standards; (3) high parental expectations; 
(4) parental criticism; (5) exaggerated emphasis on precision, order, and 
organization; and (6) doubts about actions. The concern over mistakes (CM) 
dimension is characterized by perceiving errors, even if they are minor, as failure. 
This can lead to problems like excessive checking, procrastination, reassurance 
seeking, and distress (Shafran & Mansell, 2001).  
 
The construct of perfectionism can be conceptualized as transdiagnostic with a 
presence in many disorders, such as obsessive-compulsive disorder, social anxiety 
disorder, eating disorders, personality disorders, and depression (Egan et al., 
2011; Dimaggio et al., 2015). Several studies have reported poorer treatment 
outcome due to perfectionism (E.g., Elkin et al., 1989; Blatt et al., 1995; Blatt et 
al., 1998; Zuroff et al., 2000, Shahar et al., 2004; Bizuel et al., 2001). 
Perfectionism is an important target for treatment as it spans many different 
disorders and has a negative impact on treatment outcome. 
 
Few treatments have been studied for perfectionism; however, more recently it 
has gained attention. A mindfulness-based cognitive approach was compared to 
behavioral self-help for perfectionism by James & Rimes (2017). Participants 

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were university students high in perfectionism who were randomized to receive 
either the mindfulness-based cognitive therapy or the CBT self-help therapy. 
Those in the mindfulness-based cognitive therapy group had significantly lower 
levels of perfectionism and stress than those in the CBT self-help therapy group. 
Handley et al. (2015) investigated the effects of group CBT for perfectionism 
versus wait-list control. Participants who partook in the group CBT had decreased 
perfectionism as well as reductions in symptoms of anxiety and depression. They 
also reported increased self-esteem and quality of life. Shafran and colleagues 
(2017) completed a replication study of a randomized controlled trial of guided 
internet-based CBT for the treatment of perfectionism, first performed in Sweden. 
Both studies found significant effects of the treatment on perfectionism, including 
on the concern over mistakes subscale of the Frost Multidimensional 
Perfectionism Scale. Another web-based CBT study found significant changes 
from pre to post-test for perfectionistic concern over mistakes (Radhu et al., 
2012). 
 
Exposure therapy is when one is repeatedly exposed to anxiety-provoking stimuli 
or a feared situation in order to habituate to it so that it no longer leads to 
significant distress. Though behavioral experiments are described as part of the 
treatment presented in When Perfect Isn’t Good Enough, no formal evaluations of 
pure exposure-based therapy have been conducted to date. This study will expand 
on the treatment literature in an area that is lacking information. The aim of this 
study is to develop a novel treatment for perfectionism. 
 
Therapies for many disorders that are associated with those high in perfectionism 
include an exposure component. An exposure target of perfectionism specifically, 
however, has not been evaluated.  
 
3.2 
The knowledge gained from this study would add to the existing 
literature by obtaining information about a potential new computerized 
treatment for perfectionism. We would like to use an exposure-based 
intervention because exposure-based treatments have proved beneficial for 
several disorders, including social anxiety disorder, obsessive-compulsive 
disorder, and eating disorders (E.g., Bulik et al., 1998; Foa et al, 2005; 
Rodebaugh et al., 2004), all of which are disorders that overlap with 
perfectionism (Egan et al., 2011).  
4.0 
Study Endpoints* 
4.1 The primary endpoint will be scores from the Frost Multi-
Dimensional Perfectionism Scale (FMPS)- Concern Over Mistakes 
Subscale. We will evaluate pre vs post differences. The secondary 
endpoint will include scores from the Center for Epidemiological 
Studies Depression Scale (CES-DS), the State-Trait Inventory for 
Cognitive and Somatic Anxiety (STICSA), the Social Phobia 
Inventory (SPIN), Eating Attitudes Test (EAT-26), Error Sensitivity 
Index (ESI), and the Obsessive-Compulsive Inventory- Revised 

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(OCI-R) to see if there were any decreases from pre to post 
assessment. An additional secondary endpoint will be group 
differences on the behavioral tasks. 
5.0 
Study Intervention 
1.1 Description: Exposure-Based Perfectionism Treatment (EPT) 
involves repeated engagement in computerized tasks that instruct 
participants to purposefully make mistakes. There are three main 
tasks: 
Misspelling Task: Participants will be presented with a phrase or a short 
sentence and be asked to copy that in the text box below. They will also be 
instructed to spell at least three words wrong in the sentence and then 
review the text as a whole after making the spelling errors. After they 
finish, they will click the next button and be given feedback stating that 
they copied the phrase or sentence incorrectly. This sequence will be 
repeated using different phrases or sentences, lasting approximately ten 
minutes total. 
 
Simple Math Task: Subjects are presented with a simple math problem 
(e.g., 5+5) and told to select the answer from the choices below within a 
20 second time limit. The response options only include incorrect answers. 
After selecting a response, a feedback screen will appear stating that their 
response was incorrect. This sequence will be repeated with different 
simple math problems (addition, subtraction, multiplication, and division) 
for a total of approximately 10 minutes.  
 
Shape Ordering Task: Subjects will be presented with a series of eight 
shapes, each shape lasting 1 second on screen, and be instructed to recall 
the order in which they were presented after viewing. Participants will be 
given 20 seconds to decide the order in which they think the shapes are 
presented before being automatically advanced to the next trial. After each 
trial they will be given feedback stating that their response was incorrect. 
 
Distress Ratings: Before subjects begin the tasks and after the tasks end, 
participants will be asked to rate their current and peak levels of distress 
and frustration. Additionally, participants will rate characteristics of their 
perfectionism (using questions from the FMPS-CM) before and after the 
tasks. 
 
6.0 
Procedures Involved* 
6.1 The study will be a randomized wait-list control design, with 50% of 
subjects receiving the intervention and 50% of subjects being on the 
wait-list. 
6.2 Participants will be identified using the mass screening survey 
distributed to the pool of psychology students maintained by the 

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psychology department (SONA) or using a brief, 3 question screener 
that includes three questions from the FMPS-CM. Participants who 
score a 8 or higher on the screener will be invited to participate in 
the current study and provided with the study passcode to sign up if 
they are interested. Additionally, an optional pre-screener not 
associated with research credit on SONA that includes the same 
three question screener that is used in the mass screener (3 items 
from the FMPS-CM) will be available for individuals who would 
like to participate in the study. 
Once they sign up, all participants will be emailed a link to the 
informed consent form, which will be administered using a Qualtrics 
survey. All participants must first complete the informed consent 
before beginning other study procedures. After consenting, the 
participant will be directed to complete the FMPS. If the participant 
scores a 29 or lower on the FMPS-CM, they will be given credit for 
their time (.5 credits) and the experiment will end.  
If they score a 29 or above on the FMPS, they will be emailed a link 
to a HIPAA-Compliant Zoom session scheduled for the appointment 
time for which they signed up on SONA. The HIPAA-Compliant 
Zoom meeting with have a waiting room and will be password 
protected. Participants will be directed to click on the HIPAA-
Compliant Zoom link at the time in which their appointment starts. 
A member of the study team will administer the MINI International 
Neuropsychiatric Interview (MINI) and the Structured Clinical 
Interview for the DSM-IV (SCID) Cluster C Personality Disorders 
Modules via HIPAA-Compliant Zoom. Participants who do not meet 
inclusion criteria based on this clinical interview will be given .5 
credits for their time and the experiment will end. 
If participants meet inclusion criteria, they will be randomized to 
either the intervention group or the wait-list control group. 50% of 
subjects will be randomized to the treatment group and 50% of 
subjects will be randomized to the wait list group. Based on that 
randomization, they will be sent one to two Qualtrics links: 
1. Wait List Qualtrics Link: This link will include questionnaires 
asking about their perfectionism, mood, and behaviors. A detailed 
list of questionnaires is provided below. After completing 
questionnaires, participants will be informed that they have been 
assigned to the wait list control group. They will be asked to 
complete the post-assessment questionnaires via a link that will be 
sent to them via email at the start of their post-assessment 
appointment time, which they signed up for on SONA. Additionally, 
they will be asked to refrain from seeking treatment for 
perfectionism for the duration of the study. 

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2. Intervention Qualtrics Link: This link will include questionnaires 
asking about their perfectionism, mood, and behaviors. A detailed 
list of questionnaires is provided below. After completing 
questionnaires, participants will be directed to watch a pre-recorded 
video with study personnel providing information about 
perfectionism and the rationale of the intervention. They will also be 
informed that they will be asked to click on a link to complete the 
first intervention session immediately following this video and 
complete the intervention at home 4 times: 3, 6, 9, and 12 days after 
the baseline visit. A Qualtrics link to the first treatment session will 
be provided on the page after the video. 
Those in the intervention group will then complete the first treatment 
session using the provided link. This will include three tasks, each 
targeting specific symptoms of perfectionism. Detailed information 
about the tasks is provided above. At the end of the treatment 
session, they will be directed to watch a video reminding them that 
they will receive Qualtrics links 4 times over the next two weeks: 3, 
6, 9, and 12 days after the treatment. They will be instructed to 
complete each treatment session within 24 hours of receiving the 
link. 
 
The first session will last approximately 45 minutes for those assigned to 
the wait list and 1 hour and 15 minutes for those assigned to the 
intervention. 
Two weeks later, subjects will receive a Qualtrics link for the post-test 
assessment, in which the following will occur:  
• The participants will be asked to complete questionnaires 
about their perfectionism, mood, and behaviors. 
• Subjects will be debriefed. 
Questionnaires: 
Frost Multidimensional Perfectionism Scale (FMPS) 
MINI International Neuropsychiatric Interview (MINI) 
Structured Clinical Interview for the DSM-IV (SCID) Cluster C 
Personality Disorder Modules 
Eating Attitudes Test (EAT-26) 
Center for Epidemiological Studies Depression Scale (CES-DS) 
Social Phobia Index (SPIN) 
State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) 
Obsessive-Compulsive Inventory- Revised (OCI-R) 
Error Sensitivity Index (ESI) 
6.3  

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• 
To lessen the risks, participants will be explained what the 
treatment will look like and what the rationale behind it is 
before engaging in the intervention. 
• 
All data collection materials can be found in the appendix of 
the IRB submission. 
6.4 Data collected during the study will be obtained via self-report from 
subjects. Data will include demographics, information from a 
clinical interview, and self-report questionnaire responses. 
7.0 
Data and Specimen Banking* 
7.1 Data will be kept in password protected files on encrypted computers 
that only study staff will have access to. 
7.2 The data stored will include demographics, information from the 
clinical interview, and all responses to self-report questionnaires. 
Subjects will be assigned an ID number. Data will not be linked to 
participants’ names. 
8.0 
Sharing of Results with Subjects* 
8.1 Individual or study results will not be shared with subjects directly.  
9.0 
Study Timelines* 
9.1 Subjects will be in the study for 2 weeks total, with two visits online. 
We anticipate 1.5 years to enroll all study subjects. 
10.0 Subject Population* 
10.1 Students (ages 18-65) from the psychology subject pool will be 
recruited for the study. Additionally, participants from the 
community will be recruited for the study. 
10.2 The subject population will consist of individuals with high levels of 
perfectionism (based on scores on the Frost Multidimensional 
Perfectionism Scale). Subjects must be between the ages of 18 and 
65 and score at least a 29 on the FMPS. The FMPS cutoff score of 
29 was chosen based on Shafran et al., 2017. Exclusion criteria 
include currently being in psychotherapy, had any changes to 
psychotropic medications in the past 4 weeks, current or past 
psychotic disorder or bipolar disorder, or current moderate or severe 
substance use disorder. 
10.3 We will exclude the following populations: 
• 
Adults unable to consent 
• 
Individuals who are not yet adults (infants, children, teenagers) 
• 
Pregnant women 
• 
Prisoners 
11.0 Vulnerable Populations* 

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N/A 
12.0 Local Number of Subjects 
12.1 80 subjects will be recruited, with 40 in the intervention group and 
40 in the wait-list control group. 
13.0 Recruitment Methods 
13.1 Subjects will be recruited at Florida State University using the 
psychology subject pool and members of the community will be 
recruited using referrals from care providers and/or flyers.  
13.2 Subjects will be identified using the mass screening survey. They 
may also respond to the posting on SONA. Community participants 
will be identified if they respond to care provider referrals or flyers. 
13.3 Questions from the FMPS will be used on the mass screening survey 
in order to recruit subjects. Study slots will be posted on SONA, 
which potential subjects can see if they are eligible to sign up for. If 
people from the community reach out based on a referral or a flyer, 
they will be eligible to sign up for a screening in which they 
complete the FMPS.  
14.0 Withdrawal of Subjects* 
14.1 Subjects may be withdrawn from the study without their consent if a 
risk arises that could harm the participant or others. For example, if a 
subject discloses intent to harm themselves or others, they may be 
withdrawn from the study. 
14.2 When subjects withdraw from the research before the completion of 
the study, we will ask if they are willing to complete the post-test 
assessment. 
15.0 Risks to Subjects* 
15.1 The risks to human subjects in the proposed study are minimal. 
Nevertheless, precautions will be taken to minimize participants’ risk 
in the study. All individuals will be informed of the nature of the 
investigation and the types of assessments and procedures. 
Participants will be given an opportunity to have any questions 
answered to their satisfaction and then will be asked to sign an 
informed consent statement prior to participating in the project. The 
specific potential risks involved in the proposed investigation are 
enumerated below.  
Self-report measures:  
There are no foreseeable risks associated with these assessment 
procedures. While some participants may be hesitant to answer the 
assessment forms, others may derive benefit from the self-
assessment as it could increase their awareness of the relationship 

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between their symptoms and environmental, cognitive, and 
interpersonal factors. In addition, referrals to appropriate clinical 
services (e.g., ABHC, FSU Psychology Clinic) will be provided for 
any participants seeking treatment after the study.  
Intervention risks: 
The perfectionism treatment is exposure-based, which means that it 
is expected to involve some discomfort for the subject. The treatment 
may lead to distress for subjects. They are told that they may feel 
psychologically uncomfortable, but that it is expected during this 
treatment. Participants will be able to stop treatment at any time. The 
benefits of exposure-based treatments have shown that though 
anxiety-provoking, the distress is temporary and there is often 
symptom-relief both in the short and long-term.   
General Protection Against Risks:  
At their request, participants will be referred to clinicians with whom 
they may speak about their discomfort or distress.  
Safeguards for maintaining confidentiality:  
The confidentiality of all participants in this study will be 
maintained. Upon arrival at the experimental session, each 
participant will be assigned an Identification Code with which all 
questionnaires will be labeled. This Identification Code will be used 
as the participant’s username for the study website. The information 
from the website will be secure and only accessible to study 
personnel. All the answers to the participants’ questions will be 
identified by the code number. Names will not appear on any of the 
results. No individual responses will be reported in any publications. 
All project staff and participants will be well informed about 
regulations pertaining to confidentiality. Furthermore, all responses 
will be kept in a filing cabinet in the Cougle Laboratory. The data 
will be coded and kept in a file behind the locked doors of the 
laboratory. The link between subject and identification number will 
be destroyed following completion of the study. No records or 
assessment information will be released to any other person. No 
audio or videotapes will be used. 
Safeguards for maintaining patient safety: Persons who express high 
risk symptomatology (e.g., suicidal ideation or other forms of serious 
threat to themselves or others) at any time they are in contact with 
the study personnel will receive ethically and legally appropriate 
courses of action. This would include assessment of seriousness of 
danger or disablement and referral for immediate crisis management 
(e.g., hotlines, crisis centers, hospitals, or contacting emergency 
psychiatric teams or police if necessary). Study personnel who have 
direct contact with study participants (e.g., laboratory assessors, 

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scheduling staff) will be trained in methods of crisis management. A 
detailed step-by-step protocol will be available for dealing with such 
crises (see uploaded suicide risk procedures form).  
In view of the safeguards detailed above, the possibility of a medical 
or psychological incident arising is remote. In the highly unlikely 
event that accidental injury occurs in the laboratory, the participant 
will be aided in contacting a physician for emergent care (to be paid 
for by the participant). 
15.2 This is a new treatment and thus may have unforeseeable risks. 
16.0 Potential Benefits to Subjects* 
16.1 Potential individual benefits to subjects include decreasing their 
levels of perfectionism and/or decreasing levels of depression or 
anxiety symptomatology. 
17.0 Data Management* and Confidentiality 
17.1 The data analysis plan begins with conducting one-way ANOVAs to 
assess for baseline group differences. To measure main effects of 
condition we will use intent-to-treat multiple regression models.  
17.2 The data will be password protected on an encrypted computer only 
accessible by the research team. All identifying information will be 
removed and subjects will be referred to by ID numbers. Consent 
forms that include subjects’ names will be stored separately in a 
locked filing cabinet in a locked room only accessible to the research 
staff.  
17.3 How data will be handled: 
• 
Information in the data will include an ID number, 
demographics, information from the clinical interview, and all 
self-report assessment responses. 
• 
Data will be stored in password-protected files on an encrypted 
computer that only the study team has access to. 
• 
Data will be stored for a minimum of 4 years after study 
completion. 
• 
Only members of the study team (i.e., those listed on the IRB 
submission) will have access to the data. 
• 
The investigator is responsible for receipt or transmission of 
the data. 
• 
If data needs to be transported, it will be done via password 
protected files on encrypted computers. 
18.0 Provisions to Monitor the Data to Ensure the Safety of Subjects* 
N/A 
19.0 Provisions to Protect the Privacy Interests of Subjects 

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19.1 To protect subjects’ privacy interests, all study information will only 
be available for members of the research team. All data will be 
identified by using an ID number and not subjects’ names. 
19.2 To make sure that subjects feel at ease with the research situation we 
will encourage them to ask questions both during the consent process 
and afterward. We will tell subjects that they are free to refuse to 
answer any question without penalty. We will explain the risks of the 
study and inform them in advance that the intervention may be 
uncomfortable, but that they are able to stop it at any time. 
20.0 Compensation for Research-Related Injury 
N/A 
21.0 Economic Burden to Subjects 
21.1 Subjects will not be responsible for any research-related costs. 
22.0 Consent Process 
22.1 We will be obtaining written informed consent: 
• 
The consent process will be online via Qualtrics. 
• 
Subjects will be given contact information for study personnel 
in order to ask questions about the study before clicking that 
they consent to participating. Participants will be reassured that 
they are able to discontinue the study at any time without 
penalty. 
• 
We will be following SOP: Informed Consent Process for 
Research (HRP-090). 
Non-English-Speaking Subjects 
      N/A 
Waiver or Alteration of Consent Process (consent will not be obtained, 
required information will not be disclosed, or the research involves 
deception) 
      N/A 
Subjects who are not yet adults (infants, children, teenagers) 
      N/A 
Impaired Adults 
N/A 
          Adults Unable to Consent 
      N/A 

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         Adults Unable to Consent 
      N/A 
23.0 Process to Document Consent in Writing 
23.1 We will be following SOP: Written Documentation of Consent 
(HRP-091). 
24.0 Setting 
24.1 The research team will be based in Dr. Jesse Cougle’s research suite 
in the psychology building (Room A419). All baseline and post-test 
research procedures will be conducted in the lab. The computerized 
intervention will be conducted by subjects outside of the lab, with 
the exception of the first treatment session. 
25.0 Resources Available 
25.1  
• 
A power analysis based on a repeated measures ANOVA was 
conducted. The results of this power analysis gave a total 
sample size of 68 subjects (34 subjects per group). In order to 
account for attrition, the sample size will be increased to 80 (40 
subjects per group). 
• 
The time devoted to this study will last about 1.5 years. 
• 
Baseline and Post-Test assessments will take place in Dr. Jesse 
Cougle’s research suite. 
• 
The study team will be thoroughly trained by the investigator 
before the study begins. We will meet with them individually 
and review the protocol and consent form. We will provide 
them with a checklist detailing the steps involved in the study. 
They will observe a session before conducting one by 
themselves. 
26.0 References 
 
Antony, M. M., & Swinson, R. P. (2009). When perfect isn’t good enough: 
Strategies for coping with perfectionism. Oakland, CA: New Harbinger 
Publications. 
 
Bizuel, C., Sadowsky, N., & Riguad, D. (2001). The prognostic value of EDI 
scores in anorexia nervosa patients: A prospective follow-up study of 5–10 years. 
European Psychiatry, 16, 232−238. 
 
Blatt, S. J., Quinlan, D. M., Pilkonis, P. A., & Shea, M. T. (1995). Impact of 
perfectionism and need for approval on the brief treatment of depression: the 
National Institute of Mental Health Treatment of Depression Collaborative 

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Research Program revisited. Journal of Consulting and Clinical Psychology, 63, 
125 – 132. 
 
Blatt, S. J., Zuroff, D. C., Bondi, C. M., Sanislow, C. A. III, & Pilkonis, P. A. 
(1998). When and how perfectionism impedes the brief treatment of depression: 
further analyses of the National Institute of Mental Health Treatment of 
Depression Collaborative Research Program. Journal of Consulting and Clinical 
Psychology, 66, 423–428. 
 
Bouchard, C., Rhéaume, J., Ladouceur, R. (1999). Responsibility and 
perfectionism in OCD: An experimental study. Behaviour Research and Therapy, 
37(3), 239-248. 
 
Bulik, C., Sullivan, P., Carter, F., McIntosh, V., & Joyce, P. (1998). The role of 
exposure with response prevention in the cognitive-behavioural therapy for 
bulimia nervosa. Psychological Medicine, 28(3), 611-623. 
 
Dimaggio, G., Lysaker, P. H., Calarco, T., Pedone, R., Marsigli, N., Riccardi, I., 
et al. (2015). Perfectionism and personality disorders as predictors of symptoms 
and interpersonal problems. American Journal of Psychotherapy, 69(3), 317-330. 
 
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