Towards high standards of evidence for cognitive behaviour therapy for perfectionism: A critique of Smith et al. (2023).

Abstract

Perfectionism is associated with symptoms of multiple psychological disorders. In this commentary, we outline our numerous concerns regarding a recent meta-analysis by Smith et al. (2023) that examined the efficacy of cognitive behaviour therapy for perfectionism (CBT-P). To ensure health care and policy decisions are based on high-quality evidence, evidence summaries need to be held to high standards of accountability. The study did not systematically search the literature, and omitted previous studies included in the meta-analyses they sought to reanalyze. Additionally, there was insufficient statistical power to detect intervention effects with small numbers of studies and multiple outcomes, other statistical concerns (e.g., numbers-needed-to-treat analysis), and conflation of the issue of dropout and treatment tolerance. To ensure appropriate guidance for the health care sector, evidence summaries of intervention effects must uphold high standards of quality. CBT-P has demonstrated efficacy in addressing the risk factor of perfectionism and preventing and decreasing symptoms of anxiety, depression, and eating disorders. Further systematic reviews and meta-analyses with rigorous methodology are encouraged.

Towards higher standards and improved treatments for perfectionism: A reply to Egan et al. (2023).

“…It is vital to be transparent and clear about empirically valid findings in treatment research to safeguard patients, provide guidance for policymakers, and facilitate the expansion of empirical knowledge. In the current article, we address the criticisms and allegations in Egan et al’s (2023) critique of our meta-analytic replication (Smith et al, 2023) that assessed the efficacy of cognitive behavioural therapy for perfectionism (CBT-P). By reanalyzing data from 16 randomized controlled trials included in three meta-analytic reviews, we confirmed some limited support for CBT-P while highlighting that many participants do not experience reliable or sustained posttreatment improvements.…”

“…Further, we found a lack of evidence of change in several pernicious elements of perfectionism and that the dropout rate was higher in treatment conditions than in control conditions, suggesting poor acceptability. In this rejoinder, we respond to Egan et al (2023) and discuss what is needed to improve the quality of research and advance treatments for perfectionism. We underscore the ongoing necessity for continuous improvements and new developments that transcend existing paradigms and pave the way for more effective treatment strategies for people struggling with perfectionism.…”

“…Our results also indicated a higher dropout rate in treatment than in control conditions, pointing to challenges with the acceptability of CBT-P to participants. In this rejoinder, we address the critique presented by Egan et al (2023), aiming to catalyze the development and refinement of more effective treatments for perfectionism.…”

“…It is crucial for us to be clear about what we did because elements of Egan et al’s (2023) critique leaves readers with the false impression that we conducted our own new meta-analysis with new studies and did so in a haphazard and shoddy manner. Although they state that, “We encourage good scientific debate and collaboration” (p. 379), nothing can be gained by misrepresenting our article and the work of others.…”

“…Although they state that, “We encourage good scientific debate and collaboration” (p. 379), nothing can be gained by misrepresenting our article and the work of others. Indeed, Egan et al (2023) alleged that we failed to preregister our study. But, as noted, our focus was to revisit the data in three published meta-analyses.…”