Prediction, understanding, and treatment of perfectionism using acceptance and commitment therapy

Used for OCD and other mental health disorders, acceptance and commitment therapy (ACT) is a form of cognitive behavioral therapy (CBT) that aims for acceptance of one’s symptoms and improvement of functioning in spite of them.

This study by Dr. Twohig and his team used a randomized controlled trial to test whether ACT was effective in treating problematic perfectionism. While some participants were put into a wait-list control group, ten ACT sessions were conducted on other participants—all of whom had perfectionism symptoms, some of whom had OCD, and some of whom had other mental health conditions. Participants were assessed before, immediately after, and one month following this treatment course, using both clinical and neurological measures. The study showed that treatment with ACT had beneficial effects for participants in quality of life, self-compassion, and psychological flexibility. ACT targets psychological inflexibility, making the measured improvements in this area especially notable. At one month follow up, participants continued to experience less concern over making mistakes, and reported overall improvements in their symptoms. However, while participants had less doubt about their abilities immediately following treatment, this improvement was not maintained after one month. These results show the promise of using ACT to treat perfectionism in a wide range of patients—not only those with OCD but also those who have various underlying mental health disorders as well.

Promotion and understanding of tolerance/acceptance of obsessions

Although exposure and response prevention (ERP) is recognized as an effective OCD treatment, previous studies have not examined tolerance and acceptance of distress during exposure, or whether improving tolerance skills can lead to better outcomes for OCD patients. To understand whether teaching tolerance of distress can enhance ERP’s effectiveness, Dr. Twohig and his team tested whether this with a sample of 64 individuals with OCD divided into three groups. Each group was given standardized exposures, but received slightly different variations of exposure therapy and asked to respond to the exposures in different ways. The “tolerance/acceptance” group was trained to use skills to help them tolerate and open up to distressing internal experiences associated with the exposure tasks. The “regulation” group was taught to maintain their emotional distress during the tasks with the knowledge that their distress would eventually decrease. The third and final group was the control group, which was instructed to respond to the distress “as they typically would.”

After two treatment sessions, there were no significant differences between the “tolerance/acceptance” and “regulation” groups in reducing OCD symptoms. However, the “tolerance/acceptance” group experienced less distress during the exposure tasks, and was more willing to engage in them than members of the “regulation” group. This finding could have important implications for treating OCD patients in the future, particularly those who struggle most intensely with the distress ERP evokes and are at risk of dropping out from treatment. Additionally, research that advances the use of standardized exposures, such as this study, could ultimately help improve the quality of future research related to behavioral therapies for OCD.

Resulting Publications:

*Ong, C.W., Barney, J. L., Barrett, T. S., Lee, E. B., Levin, M. E., & Twohig, M. P. (2019). The role of psychological inflexibility and self-compassion in acceptance and commitment therapy for clinical perfectionism. Journal of Contextual Behavioral Science, 13, 7-16.

*Ong, C. W., Lee, E. B., Krafft, J., Terry, C. L., Barrett, T. S., Levin, M. E., & Twohig, M. P. (2019). A randomized controlled trial of acceptance and commitment therapy for clinical perfectionism. Journal of Obsessive-Compulsive and Related Disorders, 22, 100444.

*Ong, C. W., Hancock, A. S., Barrett, T. S., Lee, E. B., Wan, N., Gillam, R., Levin, M. E., & Twohig, M. P. (2020). A preliminary investigation of the effect of acceptance and commitment therapy on neural activation in clinical perfectionism. Journal of Contextual Behavioral Science, 18, 152-161.

Ong, C. W., Lee, E. B., Petersen, J. M., Levin, M. E., & Twohig, M. P. (2021). Is perfectionism always unhealthy? Examining the moderating effects of psychological flexibility and self-compassion. Journal of Clinical Psychology, 77, 2576-2591.

*Petersen, J. M., Ong, C. W., Hancock, A., Gillam, R., Levin, M. E., & Twohig, M. P. (2021). An examination of the relationship between perfectionism and neurological functioning. Journal of Cognitive Psychotherapy, 35, 195-211.