Cognitive bias modification for perfectionism and intolerance of uncertainty: A randomized controlled trial

Abstract

This study investigated the efficacy of combined cognitive bias modification (CBM) on perfectionism and intolerance of uncertainty. Fifty-four university students scoring over 70.5 on the Brief Symptom Measure were randomly assigned to experimental and placebo control groups. The CBM intervention was administered online for 4 weeks. Assessments were given at baseline, after the 4-week intervention, and 1 month post-intervention. Results showed a statistically significant decrease in two dimensions of perfectionism, concern over mistakes and parental criticism, and intolerance of uncertainty of those in the experimental group, compared to those in the control group. The findings related to the interpretation of perfectionism revealed a significant interaction effect of time and direction of sentences for the experimental group. Lastly, the experimental group’s interpretation bias scores for intolerance of uncertainty showed a statistically significant increase after the intervention compared to those in the control group. The study’s findings provide preliminary support for the effectiveness of CBM on perfectionism and intolerance of uncertainty.

Keywords

cognitive bias modification / experimental design / intolerance of uncertainty / perfectionism

References

[1] American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing, Inc.

[2] Beadel, J. R., Smyth, F. L., & Teachman, B. A. (2014). Change processes during cognitive bias modification for obsessive compulsive beliefs. Cognitive Therapy and Research, 38(2), 103–119.

[3] Beard, C., & Amir, N. (2008). A multi-session interpretation modification program: Changes in interpretation and social anxiety symptoms. Behaviour Research and Therapy, 46(10), 1135–1141.

[4] Beard, C., & Peckham, A. D. (2020). Interpretation bias modification. In J. S. Abramowitz & S. M. Blakey (Eds.), Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms (pp. 359–377). American Psychological Association.

[5] Bieling, P. J., Israeli, A. L., & Antony, M. M. (2004). Is perfectionism good, bad, or both? Examining models of the perfectionism construct. Personality and Individual Differences, 36(6), 1373–1385.

[6] Blais, M., Blagys, M. D., Rivas-Vazquez, R., Bello, I., & Sinclair, S. J. (2015). Development and initial validation of a brief symptom measure. Clinical Psychology & Psychotherapy, 22(3), 267–277.

[7] 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 research program revisited. Journal of Consulting and Clinical Psychology, 63(1), 125–132.

[8] Boswell, J. F., Thompson-Hollands, J., Farchione, T. J., & Barlow, D. H. (2013). Intolerance of uncertainty: A common factor in the treatment of emotional disorders. Journal of Clinical Psychology, 69(6), 630–645.

[9] Budner, N. Y. (1962). Intolerance of ambiguity as a personality variable. Journal of Personality, 30(1), 29–50.

[10] Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40(8), 931–945.

[11] Carleton, R. N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Review of Neurotherapeutics, 12(8), 937–947.

[12] Chik, H. M., Whittal, M. L., & O’Neill, M. L. (2008). Perfectionism and treatment outcome in obsessive-compulsive disorder. Cognitive Therapy and Research, 32(5), 676–688.

[13] Dodd, D. R., Parsons, E. M., Clerkin, E. M., Forrest, L. N., Velkoff, E. A., Kunstman, J. W., & Smith, A. R. (2019). Perfectly imperfect: The use of cognitive bias modification to reduce perfectionism. Journal of Behavior Therapy and Experimental Psychiatry, 64, 167–174.

[14] Dugas, M. J., Buhr, K., & Ladouceur, R. (2004). The role of intolerance of uncertainty in etiology and maintenance. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 143–163). The Guilford Press. https://psycnet.apa.org/record/2004-16375-006

[15] Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy, 36(2), 215–226.

[16] Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005). Intolerance of uncertainty and information processing: Evidence of biased recall and interpretations. Cognitive Therapy and Research, 29(1), 57–70.

[17] Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203–212.

[18] Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cognitive and Behavioral Practice, 17(1), 88–101.

[19] Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528.

[20] Faul, F., Erdfelder, E., Lang, A., & Buchner, A. (2009). G* power. 3.1. Institute for Experimental Psychology: Herinrich Heine University of Dusseldorf.

[21] Flett, G. L., & Hewitt, P. L. (2008). Treatment interventions for perfectionism–A cognitive perspective: Introduction to the special issue. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26(3), 127–133.

[22] Fodor, L. A., Georgescu, R., Cuijpers, P., Szamoskozi, Ş., David, D., Furukawa, T. A., & Cristea, I. A. (2020). Efficacy of cognitive bias modification interventions in anxiety and depressive disorders: A systematic review and network meta-analysis. The Lancet Psychiatry, 7(6), 506–514.

[23] Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791–802.

[24] Frenkel-Brunswik, E. (1949). Intolerance of ambiguity as an emotional and perceptual personality variable. Journal of Personality, 18, 108–143.

[25] Frost, R. O., Lahart, C. M., & Rosenblate, R. (1991). The development of perfectionism: A study of daughters and their parents. Cognitive Therapy and Research, 15, 469–489.

[26] Frost, R. O., & Marten, P. A. (1990). Perfectionism and evaluative threat. Cognitive Therapy and Research, 14(6), 559–572.

[27] George, D., & Mallery, P. (2016). Frequencies. In IBM SPSS statistics 23 step by step (pp. 115–125). Routledge.

[28] Gonsalves, M., Whittles, R. L., Weisberg, R. B., & Beard, C. (2019). A systematic review of the word sentence association paradigm (WSAP). Journal of Behavior Therapy and Experimental Psychiatry, 64, 133–148.

[29] Gülüm, İ. V., & Soygüt, G. (2019). Psychometric properties of the Turkish Brief Symptom Measure-25. Current Psychology, 38(6), 1558–1563.

[30] Hallion, L. S., & Ruscio, A. M. (2011). A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin, 137(6), 940–958.

[31] Howell, J. A., McEvoy, P. M., Grafton, B., Macleod, C., Kane, R. T., Anderson, R. A., & Egan, S. J. (2019). Biased interpretation in perfectionistic concerns: an experimental investigation. Anxiety, Stress, & Coping, 32(3), 259–269.

[32] Howell, J. A. (2017). An examination of cognitive biases and imagery in perfectionism [Doctoral dissertation, Curtin University].

[33] Jacoby, R. J. (2020). Intolerance of uncertainty. In J. S. Abramowitz & S. M. Blakey (Eds.), Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms (pp. 45–63). American Psychological Association.

[34] Jones, E. B., & Sharpe, L. (2017). Cognitive bias modification: A review of meta-analyses. Journal of Affective Disorders, 223, 175–183.

[35] Kağan, M. (2011). Frost Çok Boyutlu Mükemmelliyetçilik Ölçeginin Türkçe formunun psikometrik özellikleri [Psychometric properties of the Turkish version of the Frost Multidimensional Perfectionism Scale]. Anadolu Psikiyatri Dergisi, 12(3), 192.

[36] Khakpoor, S., Bytamar, J. M., & Saed, O. (2019). Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the unified protocol: A randomized clinical trial. Research in Psychotherapy: Psychopathology, Process, and Outcome, 22(3), 402–412.

[37] Koç V., & Işıklı S. (2021). Sosyal kaygı belirtilerini azaltmaya yönelik birleştirilmiş bilişsel yanlılık değişimleme çalışması: Deneysel bir araştırma [Combined Cognitive Bias Modification for Social Anxiety Symptoms: A Randomized Controlled Trial]. Türk Psikoloji Dergisi, 36(87), 84–105.

[38] Koster, E. H., Fox, E., & MacLeod, C. (2009). Introduction to the special section on cognitive bias modification in emotional disorders. Journal of Abnormal Psychology, 118(1), 1–4.

[39] Ladouceur, R., Gosselin, P., & Dugas, M. J. (2000). Experimental manipulation of intolerance of uncertainty: A study of a theoretical model of worry. Behaviour Research and Therapy, 38(9), 933–941.

[40] Li, J., Gao, J., Zhang, Q., Li, C., & Cui, L. (2021). The efficacy of intolerance of uncertainty intervention on anxiety and its mediating role by multilayer linear model analysis. Journal of Psychopathology and Behavioral Assessment, 43(1), 142–151.

[41] Mathews, A., & Mackintosh, B. (2000). Induced emotional interpretation bias and anxiety. Journal of Abnormal Psychology, 109(4), 602–615.

[42] Mathews, A., & MacLeod, C. (2002). Induced processing biases have causal effects on anxiety. Cognition & Emotion, 16(3), 331–354.

[43] McEvoy, P. M., & Mahoney, A. E. (2012). To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behavior Therapy, 43(3), 533–545.

[44] Meidlinger, P. C., & Hope, D. A. (2017). The new transdiagnostic cognitive behavioral treatments: Commentary for clinicians and clinical researchers. Journal of Anxiety Disorders, 46, 101–109.

[45] Mineka, S. (2004). The positive and negative consequences of worry in the aetiology of generalized anxiety. In J. Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (p. 29). Cambridge University Press.

[46] Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35(7), 667–681.

[47] Oglesby, M. E., Allan, N. P., & Schmidt, N. B. (2017). Randomized control trial investigating the efficacy of a computer-based intolerance of uncertainty intervention. Behaviour Research and Therapy, 95, 50–57.

[48] Peirce, J. W. (2007). PsychoPy—Psychophysics software in Python. Journal of Neuroscience Methods, 162(1–2), 8–13.

[49] Pictet, A., Jermann, F., & Ceschi, G. (2016). When less could be more: Investigating the effects of a brief internet-based imagery cognitive bias modification intervention in depression. Behaviour Research and Therapy, 84, 45–51.

[50] RStudio Team. (2020). RStudio: Integrated development for R. RStudio, PBC.

[51] Sari, S., & Dağ İ. (2009). Belirsizliğe Tahammülsüzlük Ölçeği, Endişe ile İlgili Olumlu İnançlar Ölçeği ve Endişenin Sonuçları Ölçeği’nin Türkçeye uyarlanması geçerliliği ve güvenilirliği [Problem solving style, hopelessness, helplessness and haplessness as the predictors of psychopathology asssessed by MMPI-2]. Anadolu Psikiyatri Dergisi, 10(4), 261–270.

[52] Shafran, R., Egan, S., & Wade, T. (2018). Overcoming perfectionism: A self-help guide using scientifically supported cognitive behavioural techniques (2nd ed.). Robinson.

[53] Sutandar-Pinnock, K., Woodside, D. B., Carter, J. C., Olmsted, M. P., & Kaplan, A. S. (2003). Perfectionism in anorexia nervosa: a 6-24-month follow-up study. International Journal of Eating Disorders, 33(2), 225–229.

[54] World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). World Health Organization. https://icd.who.int/

[55] Yiend, J., & Mackintosh, B. (2004). The experimental modification of processing biases. In J. Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (pp. 190–210). Cambridge University Press.

[56] Yiend, J., Parnes, C., Shepherd, K., Roche, M. K., & Cooper, M. J. (2014). Negative self-beliefs in eating disorders: A cognitive-bias-modification study. Clinical Psychological Science, 2(6), 756–766.

[57] Yiend, J., Savulich, G., Coughtrey, A., & Shafran, R. (2011). Biased interpretation in perfectionism and its modification. Behaviour Research and Therapy, 49(12), 892–900.

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