Mobile CBT App Rivals Traditional Treatment for Perfectionism

Abramovitch, A., Uwadiale, A., & Robinson, A. (2023). A randomized clinical trial of a gamified app for the treatment of perfectionism. British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12444

Key Points

1. The study found that a brief, daily mobile app intervention targeting maladaptive perfectionistic beliefs significantly reduced perfectionism symptoms and related impairments in college students.
2. The mobile app intervention yielded similar reductions in perfectionism as traditional cognitive behavioral therapy (CBT) and guided internet-based CBT interventions.
3. Improvements were maintained at a one-month follow-up.
4. The mobile app also reduced obsessive-compulsive symptoms, subjective emotional burdens related to perfectionism, and functional impairment in domains like home, chores, money management, and health maintenance.
5. The research addresses an important gap regarding accessible and effective interventions for perfectionism among college students. However, further research with more diverse samples is needed.

Rationale

Perfectionism is increasingly prevalent among college students and is associated with substantial distress and impairment (Curran & Hill, 2019).

However, barriers like stigma limit the utilization of needed mental health services (Duffy et al., 2019).

Low-intensity mobile app interventions may increase access to effective support.

Prior app-based CBT has shown efficacy for problems related to perfectionism, but apps targeting perfectionism specifically have been lacking (Linardon et al., 2019).

This study evaluated a new mobile app intervention for perfectionism.

Method

Using rigorous randomized controlled trial methodology, the study compared the mobile app to a waitlist control condition among 70 college students with elevated perfectionism.

Participants were assessed at pre-treatment, post-treatment (2 weeks later), and at a 1-month follow-up using validated scales.

Sample

The sample was predominantly female (85.7%) college students with elevated scores (1 SD above the normative mean) on a perfectionism screening measure.

Statistical Analysis

Analyses included repeated-measures ANOVAs and effect sizes. Missing data were addressed using stochastic regression single imputation.

Results

The mobile app group showed significant pre-post reductions in perfectionism symptoms (d= -1.19) that persisted at follow-up. The waitlist control group showed virtually no change (d=.01).

Insight and Depth

The large effect size rivals face-to-face CBT despite the app’s brevity and lack of traditional CBT content.

This demonstrates the efficacy of targeting maladaptive cognitions alone. It also shows that gamification could boost engagement and outcomes.

Strengths

1. Randomized controlled trial methodology
2. Validated measures of perfectionism, related symptoms, and functioning
3. Conservative statistical approach
4. The first study of a mobile app intervention specifically targeting perfectionism

Limitations

1. Small, predominantly female sample from one university -> limited generalizability
2. Modified waitlist condition rather than traditional waitlist informed of study participation -> less expectancy effect
3. One item was missing from the functioning scale due to an error.

Implications

This study establishes mobile app interventions as a promising approach to alleviate perfectionism and related suffering among college students.

The app has the advantages of being accessible, low-cost, and requires very little time investment from users.

Wider implementation could expand service capacity to address college mental health needs.

Conclusions

Mobile app interventions merit further attention as an accessible option for problems prevalent among college students like perfectionism.

Although more research is needed, findings suggest the GG OCD app yields genuine benefits by targeting dysfunctional cognitions underlying perfectionism.

Brief daily use seems sufficient to reduce symptoms and functional impairment. Making such easily accessible tools available could promote college mental health.

References

Abramovitch, A., Abramowitz, J. S., & McKay, D. (2021). The OCI-12: A syndromally valid modification of the obsessive-compulsive inventory-revised. Psychiatry Research, 298, 113808. https://doi.org/10.1016/j.psychres.2021.113808

Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychological Bulletin, 145(4), 410–429. https://doi.org/10.1037/bul0000138

Duffy, A., Saunders, K. E. A., Malhi, G. S., Patten, S., Cipriani, A., McNevin, S. H., MacDonald, E., & Geddes, J. (2019). Mental health care for university students: A way forward? The Lancet Psychiatry, 6(11), 885–887. https://doi.org/10.1016/S2215-0366(19)30275-5

Linardon, J., Cuijpers, P., Carlbring, P., Messer, M., & Fuller-Tyszkiewicz, M. (2019). The efficacy of app-supported smartphone interventions for mental health problems: A meta-analysis of randomized controlled trials. World Psychiatry, 18(3), 325–336. https://doi.org/10.1002/wps.20673

Learning check

1. What are some reasons that perfectionism may be increasing substantially among college students in recent decades? What sociocultural factors could be driving this trend?
2. In what ways might mobile mental health apps help address barriers that prevent college students from accessing needed psychological services? What limitations might these apps still have?
3. Could targeting maladaptive cognitions alone, without traditional CBT psychoeducation and skills training, undermine long-term outcomes or generalizability to other symptoms? Why or why not?
4. What do the study limitations suggest about directions for future research on app-based interventions for perfectionism and other college mental health issues?
5. If this app was made freely available on college campuses, what engagement strategies and supports could optimize utilization and outcomes among students?