تفسیر مغرضانه در کمال گرایی و اصلاح آن

Perfectionism is a transdiagnostic construct associated with a range of diagnoses, including depression, eating disorders and obsessive compulsive disorder. Treatments that directly target perfectionist cognitions have been shown to successfully reduce associated pathologies. However, the way in which they do this is not clear. We set out to assess the role of one candidate mechanism of action, namely the cognitive process of interpretation of ambiguity. In one experiment we looked for associations between biased interpretation and perfectionism. In a second, we manipulated interpretations, thereby providing a strong test of their aetiological significance. Results from the first experiment confirmed the presence of biased interpretation in perfectionism and demonstrated that these are highly specific to perfection relevant information, rather than reflecting general negativity. The second experiment succeeded in manipulating these perfection relevant interpretations and demonstrated that one consequence of doing so is a change in perfectionist behaviour. Together, these data experimentally demonstrate that biased interpretation of perfection relevant ambiguity contributes to the maintenance of perfectionism, but that it is also possible to reverse this. Clinical implications include the identification of one likely mechanism of therapeutic change within existing treatments, as well as identification of an appropriate evidence-based focus for future treatment development. Targeting underlying functional mechanisms, such as biased interpretation, has the potential to offer transdiagnostic benefits.

Recent interest in transdiagnostic processes (Allen et al., 2008, Fairburn et al., 2003, Fairburn et al., 2009 and Norton, 2008) encourages an approach which bypasses traditional diagnostic categories. The transdiagnostic view points to common cognitive mechanisms which maintain a range of different expressions of an underlying psychopathology. Perfectionism is one such transdiagnostic construct. It can be a significant problem in its own right and is associated with psychopathologies including eating disorders (Fairburn et al., 1998 and Fairburn et al., 1997), depression (Blatt et al., 1998 and Shahar et al., 2003), and obsessive compulsive disorder (Coles et al., 2003 and Halmi et al., 2005). High levels of perfectionism are predictive of poor treatment outcomes and lower satisfaction with treatment (Blatt et al., 1998 and Shahar et al., 2003). Converging clinical evidence increasingly suggests that perfectionism is an underlying risk factor for Axis 1 psychopathology. Perfectionism has been previously viewed as a self-oriented unidimensional construct (Burns, 1980 and Pacht, 1984) but researchers now favour a multidimensional approach (e.g. Ashby and Rice, 2002, DiBartolo et al., 2008, Dunkley et al., 2003, Hewitt and Flett, 1990, Hewitt and Flett, 1991, Frost et al., 1990, Hill et al., 2004, Pearson and Gleaves, 2006, Rice and Preusser, 2002, Slaney et al., 2001 and Terry-Short et al., 1995). Multidimensional factors include parental expectations, personal standards and concerns over mistakes (Frost et al., 1990). Perfectionism is thought to have a complex relationship with well being. Both adaptive and maladaptive features have been identified (Grzegorek et al., 2004 and Hamachek, 1978) and positive aspects of perfectionism are thought to be related to those features which reflect high standards and achievement striving (Blankstein and Dunkley, 2002, Dunkley et al., 2006 and Dunkley et al., 2006). Some authors argue that perfectionism becomes clinically relevant when the setting of excessively high standards (see Kobori, Hayakawa, & Tanno, 2009 for evidence of this) interacts with overly critical self-evaluation (Boone et al., 2010 and Shafran et al., 2002). These authors argue that clinical perfectionists set unrealistic goals which they have difficulty meeting, perceive their failures personally and suffer more overtly negative consequences. Although it is clear that there is no single consensus on the best definition of perfectionism, most researchers now adopt a multidimensional conceptualization and are united in their acknowledgement of the clinical utility and importance of the construct. The importance of negatively biased interpretations for diagnostic psychopathologies is widely recognised, both empirically (Blanchette & Richards, 2010) and theoretically (Mathews & Mackintosh, 2000) and recent work underlines their aetiological significance (Salemink, van den Hout, & Kindt, 2007). Most research to date has focussed on anxious (Mathews and MacLeod, 1994, Williams et al., 1997 and Yiend, 2004) or depressed (Lawson and MacLeod, 1999 and Mogg et al., 1994) populations as well as other diagnostic categories (Eating Disorders: Cooper, 1997; Social Phobia: Beard & Amir, 2009). Experimental evidence for interpretative biases associated with perfectionism is however, absent. Our first study was therefore designed to seek experimental evidence for the interpretative biases thought to be associated with perfectionism and to identify their level of specificity. Specificity is an important question to address since interpretative biases could be mere epiphenomena of co-occurring variations in anxiety and depression. Interpretation biases were therefore measured both for content specifically tailored for its relevance to perfectionism, as well as more generally positive or negative emotional material, known to be sensitive to biased interpretation in anxiety and depression. In addition we assessed performance on measures of behaviour designed to reflect perfectionism, as well as differences in general task performance. Experiment 1 The aim of Experiment 1 was to identify and characterise naturally occurring interpretation biases associated with perfectionism. The degree of content specificity was assessed by comparing generally positive or negative interpretations of emotionally ambiguous information with perfection-specific interpretations of perfection relevant material (material which permitted interpretation in either a perfectionist or non-perfectionist direction). We hypothesized that high and low perfectionists would interpret perfection relevant material in a perfectionist and non-perfectionist direction respectively, but would not differ in their interpretations of general emotionally ambiguous information. We further hypothesized that high perfectionists would exhibit a greater degree of perfectionist behaviours than low perfectionists on three perfection relevant behavioural tasks, above and beyond any generic differences in performance on a control task.