Evaluating a Web-based cognitive-behavioral therapy for maladaptive perfectionism in university students.

OBJECTIVE: This study assessed a Web-based cognitive-behavioral therapy (CBT) for maladaptive perfectionism, investigating perfectionism, anxiety, depression, negative automatic thoughts, and perceived stress. PARTICIPANTS: Participants were undergraduate students defined as maladaptive perfectionists through a screening questionnaire at an urban university. The data were collected from July 2009 to August 2010. METHODS: Forty-seven maladaptive perfectionists were randomly assigned to a 12-week CBT or a wait-list control group and assessed via questionnaires at pre- and postintervention. Statistical procedures included t tests, Pearson correlations, and analysis of covariance. RESULTS: At the postintervention measure, the CBT group demonstrated significant decreases in anxiety sensitivity and negative automatic thoughts compared to the control group. Within the CBT group, changes in perfectionism scores were significantly correlated with positive changes in depression, anxiety, stress, and automatic thoughts. CONCLUSIONS: The treatment group improved on psychological outcomes, demonstrating the effectiveness of a Web-based CBT for perfectionism in a university setting.

Cognitive behavioral therapy-related increases in cortical inhibition in problematic perfectionists.

BACKGROUND: Several lines of evidence suggest that cognitive behavioral therapy (CBT) is an effective treatment for depression and anxiety disorders. Evidence suggests that the therapeutic effects of CBT are related to neurophysiologic changes in the cortex, particularly γ-aminobutyric acid (GABA) potentiation. Transcranial magnetic stimulation (TMS) represents a noninvasive method of measuring cortical inhibition, which is a neurophysiologic mechanism associated with the pathophysiology of several psychiatric disorders. OBJECTIVE/HYPOTHESIS: To demonstrate the effectiveness of a 12-week CBT intervention compared with a wait list control group measuring cortical inhibition in participants with pathologic perfectionism. Participants within the CBT group would demonstrate increases in cortical inhibition and improvements on clinical outcomes relative to the wait list control group. METHODS: Twenty-four right-handed perfectionists were randomly assigned to a 12-week CBT intervention or a wait list control group. Cortical inhibition was measured at pre- and postintervention with TMS paradigms specifically short-interval cortical inhibition and the cortical silent period, which index GABAA and GABAB receptor-mediated inhibitory neurotransmission, respectively. RESULTS: The CBT group demonstrated a significant potentiation of the cortical silent period when compared with the wait list control group. The CBT group demonstrated a decrease in anxiety sensitivity and automatic thoughts relative to the control group. CONCLUSIONS: These findings demonstrate that CBT tailored for perfectionism is accompanied by an increase in cortical inhibition of the motor cortex and positive changes on clinical outcomes. These findings provide compelling evidence for an association between positive CBT effects and a potentiation of GABAergic inhibitory neurotransmission.

Equivalence-based measures of clinical significance: assessing treatments for depression.

Treatment efficacy is largely determined by statistical significance testing, and clinical significance testing is often used to quantify or qualify the efficacy of a treatment at the individual or group level. This study applies the equivalence-based clinical significance model proposed by Kendall, Marrs-Garcia, Nath, and Sheldrick (1999) and a revised model proposed by Cribbie and Arpin-Cribbie (2009) to the assessment of treatments for depression. Using several studies that investigated treatments for depression, the authors tested whether the posttreatment means were equivalent to those for a similar normal comparison group. All of the studies had significant improvement from pretest to posttest, although for many of the studies the treated group was not equivalent to a normal comparison group at posttest. Further, there are important differences between the conclusions drawn from the Kendall et al. and Cribbie and Arpin-Cribbie methods for assessing equivalence-based clinical significance.

Psychological well-being in obese inpatients with ischemic heart disease at entry and at discharge from a four-week cardiac rehabilitation program.

The purposes of this observational pre-post study were twofold: 1- to evaluate psychological health in obese patients with ischemic heart disease at admission to cardiac rehabilitation (CR) and 2 - to examine the effectiveness of a 4-week CR residential program in improving obese patients' psychological well-being at discharge from CR. A sample of 177 obese patients completed the Psychological General Well-Being Inventory (PGWBI) at admission to the CR program and at discharge. The equivalence testing method with normative comparisons was used to determine the clinical significance of improvements after having established that baseline mean scores on the PGWBI scales were significantly lower than normal means. Results show that patients scored equally or better than norms on many PGWBI dimensions at admission to CR but scored significantly worse on Global Score, Vitality and Self-control. At discharge, mean scores that were impaired at baseline returned to normal levels at the more conservative equivalence interval. A 4-week CR program was thus effective in improving obese patients' psychological well-being. The equivalence testing method allowed to establish the clinical significance of such improvement.

Evaluating clinical significance through equivalence testing: extending the normative comparisons approach.

The field of psychology, as with many other disciplines, has been increasingly interested in being able to measure the effectiveness of behavioral interventions. This trend has led to a number of different approaches for measuring clinical significance, each addressing a slightly different aspect of the clinical outcome. Recently, clinical psychologists (and clients) have supported the contention that one of the most important therapeutic questions is whether clients are functioning equivalently to normal controls following an intervention. To address this question, Kendall, Marrs-Garcia, Nath, and Sheldrick (1999) presented an approach to measuring clinical significance that utilizes tests of equivalence. The present study clarifies the nature of the hypotheses being conducted in measuring clinical significance with tests of equivalence and extends the approach by incorporating recent advances in equivalence testing. A revised approach for evaluating clinical significance via equivalence testing is proposed, and an empirical example demonstrating this approach is provided.

Recommendations for applying tests of equivalence.

Researchers in psychology reliably select traditional null hypothesis significance tests (e.g., Student's t test), regardless of whether the research hypothesis relates to whether the group means are equivalent or whether the group means are different. Tests of equivalence, which have been popular in biopharmaceutical studies for years, have recently been introduced and recommended to researchers in psychology for demonstrating the equivalence of two group means. However, very few recommendations exist for applying tests of equivalence. A Monte Carlo study was used to compare the test of equivalence proposed by Schuirmann with the traditional Student t test for deciding if two group means are equivalent. It was found that Schuirmann's test of equivalence is more effective than Student's t test at detecting population mean equivalence with large sample sizes; however, Schuirmann's test of equivalence performs poorly relative to Student's t test with small sample sizes and/or inflated variances.