Clinical trial NCT05385289: A Cognitive-behavioral Intervention of Rumination for Perfectionists
Official title: A Cognitive-behavioral Approach of Rumination as Intervention for Overgeneral Mode of Processing in Perfectionism: a Single-case Experimental Design
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Perfectionism
Rumination - Thoughts
Anxiety
Depression
Keywords: Perfectionism
Rumination
Autobiographical Memory
Overgeneral processing
SCED
Lead sponsor: Université Catholique de Louvain
Sponsor class: OTHER
First posted: 2022-05-23
Enrollment: 13
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: The final sample will comprise 12 participants.

The initial sample size was based on Shadish \& Sullivan's (2011) study reporting that the median and modal number of participants in single-case designs is three. Therefore, recruiting 6 participants allowed for a direct intrasubject replication (i.e., a "replication of the experimental effect within the design") while ensuring that three participants were retained despite possible dropout. Moreover, using two waves of six participants (resulting in a total sample of 12 participants) allowed for a direct inter-subject replication (i.e., "repeating the same study but with additional individuals"). Those two replications were used to demonstrate that changes on target behaviors systematically arrives after the intervention introduction, hence controlling for external variables.
Primary purpose: TREATMENT

Brief summary: This study aims to investigate the mediating role of rumination in the relationship between perfectionism and psychological distress, by proposing a cognitive-behavioral intervention targeting rumination. This intervention aims at decreasing - or even neutralizing - the effect of the mediator and then examining how this decrease impacts the relationship between perfectionism and psychological distress.

A randomized, concurrent, multiple-baseline single-case design will be applied.

Detailed description: Perfectionism is defined as "exceedingly high standards of performance accompanied by critical evaluations of oneself and others and a fear of negative social evaluation if not perfect". Factorial analyses of the two main perfectionism scales have identified two overarching dimensions: Perfectionistic Strivings and Perfectionistic Concerns. The perfectionistic concerns dimension is generally associated with negative outcomes and psychopathology, while perfectionistic strivings have been found to yield both positive outcomes and negative outcomes.

Perfectionism is a central transdiagnostic phenomenon involved in the maintenance of multiple psychological disorders (e.g., anorexia nervosa, obsessive compulsive disorder, chronic fatigue, and depression). After decades of research focusing on scales development or relying exclusively on correlational studies, the experimental investigation of the processes underlying perfectionism is just emerging. On a theoretical basis, two processes related to emotional information processing seem particularly relevant: rumination and autobiographical memory. The objective of this study is to investigate with a randomized, concurrent, multiple-baseline single-case design the contribution of these processes to perfectionists' psychological vulnerability.

Rumination is defined as a mental process characterized by repetitive, prolonged, and recurrent thinking about one's concerns and one's experience. The control theory suggests that individuals engage in rumination when perceiving a discrepancy between their goals and their current condition, and stay in this mode of thinking until the goal is either attained or abandoned. Based on this theoretical background, recent research suggests that rumination could be one of the processes explaining the perfectionistic vulnerability to psychological distress, by perseveringly focusing on the discrepancy between high and demanding standards and the actual performance. However, only few study has experimentally manipulated this process, thus precluding from any causal inference.

Autobiographical memories are "memories about personal experiences that go beyond the mere factual description of the event to include personal beliefs, emotions, and thoughts". One feature of those memories is the specificity level defined as "the extent to which retrieved autobiographical memories are specific or not (i.e., memory of a particular event that happened at a particular time and place that lasted no more than one day). Difficulty with retrieving such specific memories is called overgeneral autobiographical memory".

The perfectionism cognition theory aims to clarify how autobiographical memory and working memory might be affected by perfectionist tendencies. It especially postulates retroactive loops between (a) repetitive thinking, (b) an overdeveloped memory for mistakes, failures, and stressful experiences, and (c) a hypervigilance and cognitive bias toward related cues that signal the possibility of failure, mistakes, and negative social evaluation. These authors suggested that perfectionists are characterized by deficits in attentional capacity and working memory during times of stress. This promising cognitive approach has partially been supported. For example, a recent meta-analysis states that perseverative cognitions (i.e., worry and rumination) mediate the relationship between perfectionism and distress in non-clinical samples. However, empirical evidence of an experimental nature is still needed, in particular for the postulated autobiographical memory and working memory biases.

To overcome those limitations, the present study will manipulate rumination with a clinical intervention, to block its mediational role on the relationship between perfectionism and psychological distress (here operationalized by mood state and anxio-depressive symptoms). Moreover, this study aims to go further than identifying a true mediator: its aims to explain the mechanism "through which change come about", namely through a concreteness training to overcome overgeneral mode of processing. Indeed, even if the main focus of the study is to identify mediators that may statistically account for the relationship between perfectionism and psychological distress, a ideal purpose is to propose a therapeutic intervention that may target mechanisms of change underlying hypothesized mediator.

Eligibility criteria: Inclusion Criteria:

* Being native French speakers
* Reporting significant levels of (1) perfectionism, (2) abstract and evaluative repetitive thinking, and (3) anxio-depressive symptoms.

Exclusion Criteria:

* Being involved in a therapeutic treatment.
* Being under 18 years old.

Primary outcomes:
measure: Perfectionism - Hewitt and Flett's Multidimensional Perfectionism Scale (HMPS; Hewitt & Flett,1991)
timeFrame: For the recruitment, i.e. until the number of 6 participants is reached for the second wave of the study (approximately two months after the beginning of the study)
measure: Perfectionism - Hewitt and Flett's Multidimensional Perfectionism Scale (HMPS; Hewitt & Flett,1991)
timeFrame: The day before the beginning of the intervention
measure: Perfectionism - Hewitt and Flett's Multidimensional Perfectionism Scale (HMPS; Hewitt & Flett,1991)
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Perfectionism - Hewitt and Flett's Multidimensional Perfectionism Scale (HMPS; Hewitt & Flett,1991)
timeFrame: Two weeks after the end of the intervention
measure: Perfectionism - Hewitt and Flett's Multidimensional Perfectionism Scale (HMPS; Hewitt & Flett,1991)
timeFrame: Three months after the end of the intervention
measure: Perfectionism - Frost, Marten, Lahart, and Rosenblate's Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, and Rosenblate, 1990)
timeFrame: For the recruitment, i.e. until the number of 6 participants is reached for the second wave of the study (approximately two months after the beginning of the study)
measure: Perfectionism - Frost, Marten, Lahart, and Rosenblate's Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, and Rosenblate, 1990)
timeFrame: The day before the beginning of the intervention
measure: Perfectionism - Frost, Marten, Lahart, and Rosenblate's Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, and Rosenblate, 1990)
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Perfectionism - Frost, Marten, Lahart, and Rosenblate's Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, and Rosenblate, 1990)
timeFrame: Two weeks after the end of the intervention
measure: Perfectionism - Frost, Marten, Lahart, and Rosenblate's Multidimensional Perfectionism Scale (FMPS; Frost, Marten, Lahart, and Rosenblate, 1990)
timeFrame: Three months after the end of the intervention
measure: Depression - Center for Epidemiologic Studies - Depression (CES-D; Radloff, 1997)
timeFrame: For the recruitment, i.e. until the number of 6 participants is reached for the second wave of the study (approximately two months after the beginning of the study)
measure: Depression - Center for Epidemiologic Studies - Depression (CES-D; Radloff, 1997)
timeFrame: The day before the beginning of the intervention
measure: Depression - Center for Epidemiologic Studies - Depression (CES-D; Radloff, 1997)
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Depression - Center for Epidemiologic Studies - Depression (CES-D; Radloff, 1997)
timeFrame: Two weeks after the end of the intervention
measure: Depression - Center for Epidemiologic Studies - Depression (CES-D; Radloff, 1997)
timeFrame: Three months after the end of the intervention
measure: Anxiety - Generalized Anxiety Disorder Screener (GAD-7; Spitzer, Kroenke, Williams, Löwe, 2008)
timeFrame: For the recruitment, i.e. until the number of 6 participants is reached for the second wave of the study (approximately two months after the beginning of the study)
measure: Anxiety - Generalized Anxiety Disorder Screener (GAD-7; Spitzer, Kroenke, Williams, Löwe, 2008)
timeFrame: The day before the beginning of the intervention
measure: Anxiety - Generalized Anxiety Disorder Screener (GAD-7; Spitzer, Kroenke, Williams, Löwe, 2008)
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Anxiety - Generalized Anxiety Disorder Screener (GAD-7; Spitzer, Kroenke, Williams, Löwe, 2008)
timeFrame: Two weeks after the end of the intervention
measure: Anxiety - Generalized Anxiety Disorder Screener (GAD-7; Spitzer, Kroenke, Williams, Löwe, 2008)
timeFrame: Three months after the end of the intervention
measure: Rumination trait - Repetitive Thinking Mode Questionnaire (RTMQ; Philippot, Verschuren, & Douilliez, in press).
timeFrame: For the recruitment, i.e. until the number of 6 participants is reached for the second wave of the study (approximately two months after the beginning of the study)
measure: Rumination trait - Repetitive Thinking Mode Questionnaire (RTMQ; Philippot, Verschuren, & Douilliez, in press).
timeFrame: The day before the beginning of the intervention
measure: Rumination trait - Repetitive Thinking Mode Questionnaire (RTMQ; Philippot, Verschuren, & Douilliez, in press).
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Rumination trait - Repetitive Thinking Mode Questionnaire (RTMQ; Philippot, Verschuren, & Douilliez, in press).
timeFrame: Two weeks after the end of the intervention
measure: Rumination trait - Repetitive Thinking Mode Questionnaire (RTMQ; Philippot, Verschuren, & Douilliez, in press).
timeFrame: Three months after the end of the intervention
measure: Autobiographical Memory - The computerized version of the Autobiographical Memory Test (AMT; Williams et Broadbent, 1986).
timeFrame: The day before the beginning of the intervention
measure: Autobiographical Memory - The computerized version of the Autobiographical Memory Test (AMT; Williams et Broadbent, 1986).
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Autobiographical Memory - The computerized version of the Autobiographical Memory Test (AMT; Williams et Broadbent, 1986).
timeFrame: Two weeks after the end of the intervention
measure: Autobiographical Memory - The computerized version of the Autobiographical Memory Test (AMT; Williams et Broadbent, 1986).
timeFrame: Three months after the end of the intervention
measure: Multiple measures of Rumination state - State Repetitive Thoughts Questionnaire (SRTQ; Philippot et al., n.d.).
timeFrame: before the beginning of the intervention
measure: Measure of change - Multiple measures of Rumination state - State Repetitive Thoughts Questionnaire (SRTQ; Philippot et al., n.d.).
timeFrame: Each day during the intervention, as well as between each week of the intervention
measure: Measure of change - Multiple measures of Rumination state - State Repetitive Thoughts Questionnaire (SRTQ; Philippot et al., n.d.).
timeFrame: During two weeks after the end of the intervention, to assess the change from the 3-week intervention
measure: Daily positive and negative emotions - Visual Analog Mood Scale (VAMS; McNally, Litz, Prassas, Shin, & Weathers, 1994).
timeFrame: before the beginning of the intervention.
measure: Measure of change - Daily positive and negative emotions - Visual Analog Mood Scale (VAMS; McNally, Litz, Prassas, Shin, & Weathers, 1994).
timeFrame: Each day of the three-week intervention, to assess changes between the 10-day A-baseline phase and the intervention phase, as well as between each week of the intervention
measure: Measure of change - Daily positive and negative emotions - Visual Analog Mood Scale (VAMS; McNally, Litz, Prassas, Shin, & Weathers, 1994).
timeFrame: During two weeks after the end of the intervention, to assess the change from the 3-week intervention
Secondary outcomes:
measure: Experiential avoidance - Multidimensional Experiential Avoidance Questionnaire (MEAQ ; Gamez, Chmielewski, Ruggero, Kotov, & Watson, 2011).
timeFrame: For the recruitment, i.e. until the number of 6 participants is reached for the second wave of the study (approximately two months after the beginning of the study)
measure: Experiential avoidance - Multidimensional Experiential Avoidance Questionnaire (MEAQ ; Gamez, Chmielewski, Ruggero, Kotov, & Watson, 2011).
timeFrame: The day before the beginning of the intervention
measure: Experiential avoidance - Multidimensional Experiential Avoidance Questionnaire (MEAQ ; Gamez, Chmielewski, Ruggero, Kotov, & Watson, 2011).
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Experiential avoidance - Multidimensional Experiential Avoidance Questionnaire (MEAQ ; Gamez, Chmielewski, Ruggero, Kotov, & Watson, 2011).
timeFrame: Two weeks after the end of the intervention
measure: Experiential avoidance - Multidimensional Experiential Avoidance Questionnaire (MEAQ ; Gamez, Chmielewski, Ruggero, Kotov, & Watson, 2011).
timeFrame: Three months after the end of the intervention
measure: Self-Discrepancy - Self-Discrepancies Scale (S-DS; Philippot, Dethier, Baeyens, & Bouvard, 2017).
timeFrame: For the recruitment, i.e. until the number of 6 participants is reached for the second wave of the study (approximately two months after the beginning of the study)
measure: Self-Discrepancy - Self-Discrepancies Scale (S-DS; Philippot, Dethier, Baeyens, & Bouvard, 2017).
timeFrame: The day before the beginning of the intervention
measure: Self-Discrepancy - Self-Discrepancies Scale (S-DS; Philippot, Dethier, Baeyens, & Bouvard, 2017).
timeFrame: Once participants have completed 4 sessions of the intervention, about a week and a half after the beginning of the intervention
measure: Self-Discrepancy - Self-Discrepancies Scale (S-DS; Philippot, Dethier, Baeyens, & Bouvard, 2017).
timeFrame: Two weeks after the end of the intervention
measure: Self-Discrepancy - Self-Discrepancies Scale (S-DS; Philippot, Dethier, Baeyens, & Bouvard, 2017).
timeFrame: Three months after the end of the intervention
Other outcomes:
measure: Intervention satisfaction - Consumer Satisfaction Questionnaire (QSC-8; Sabourin, Pérusse, & Gendreau, 1989).
timeFrame: Before each debriefing session with the experimenter
measure: Alcohol consumption - Alcohol Use Disorders Identification Test (AUDIT; Saunders, Aasland, Babor, DeLaFuente, & Grant, 1993)
timeFrame: The day before the beginning of the intervention
measure: Drug consumption - Drug Use Disorders Identification Test (DUDIT; Berman, Bergman, Palmstierna, and Schlyter, 2005).
timeFrame: The day before the beginning of the intervention
measure: Daily drinking, cigarette use, and drug consumption - Timeline Followback (TLFB; Sobell & Sobell, 1992).
timeFrame: before the beginning of the intervention
measure: Measure of change - Daily drinking, cigarette use, and drug consumption - Timeline Followback (TLFB; Sobell & Sobell, 1992).
timeFrame: Each day of the three-week intervention, to assess changes between the 10-day A-baseline phase and the intervention phase, as well as between each week of the intervention
measure: Measure of change - Daily drinking, cigarette use, and drug consumption - Timeline Followback (TLFB; Sobell & Sobell, 1992).
timeFrame: During two weeks after the end of the intervention, to assess the change from the 3-week intervention
Locations:
city: Louvain-la-Neuve
country: Belgium
facility: Université catholique de Louvain
state: Brabant Wallon
Study officials:
affiliation: pierre.philippot@uclouvain.be
name: Pierre Philippot
role: PRINCIPAL_INVESTIGATOR
References: