<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04459260</url>
  </required_header>
  <id_info>
    <org_study_id>UU2020-0001</org_study_id>
    <nct_id>NCT04459260</nct_id>
  </id_info>
  <brief_title>Treating Perfectionism Using Internet-Based Cognitive Behavior Therapy</brief_title>
  <official_title>Treating Perfectionism Using Internet-Based Cognitive Behavior Therapy: A Randomized Controlled Trial Comparing Cognitive Behavior Therapy to Unified Protocol</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Karolinska Institutet</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Uppsala University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Linkoeping University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>Stockholm University</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>University College, London</agency>
      <agency_class>Other</agency_class>
    </collaborator>
  </sponsors>
  <source>Karolinska Institutet</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Perfectionism is characterized by setting high standards and striving for achievement,&#xD;
      sometimes at the expense of social relationships and wellbeing. Despite sometimes being&#xD;
      viewed as a positive feature by others, people with perfectionism tend to be overly concerned&#xD;
      about their performance and how they are being perceived by people around them. This tends to&#xD;
      create inflexible standards, cognitive biases, and performance-related behaviors that&#xD;
      maintain a belief that self-worth is linked to accomplishments. Cognitive behavior therapy&#xD;
      has been shown to be a viable treatment for perfectionism, both in terms of reducing levels&#xD;
      of perfectionism and improving psychiatric symptoms. Furthermore, a number of recent studies&#xD;
      indicate that it can be successfully delivered via the Internet, both with regular support&#xD;
      and guidance on demand from a therapist. In the present study protocol, a clinical trial for&#xD;
      perfectionism is described and outlined. In total, 128 participants will be recruited and&#xD;
      randomized to either a treatment that has already been demonstrated to have many benefits,&#xD;
      Internet-based Cognitive Behavior Therapy for perfectionism (iCBT-P), or an active comparison&#xD;
      condition, Internet-based Unified Protocol (iUP), targeting the emotions underlying&#xD;
      depression and anxiety disorders. The results will be investigated with regard to&#xD;
      self-reported outcomes of perfectionism, psychiatric symptoms, self-compassion, and quality&#xD;
      of life, at post-treatment and at six- and 12-month follow-up. Both iCBT-P and iUP are&#xD;
      expected to have positive effects, but the difference between conditions and adherence to&#xD;
      respective treatment are currently unknown and will be explored. The clinical trial is&#xD;
      believed to lead to a better understanding of how perfectionism can be treated, with the aim&#xD;
      of providing efficacious treatments in an accessible format via the Internet.&#xD;
    </textblock>
  </brief_summary>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">August 24, 2020</start_date>
  <completion_date type="Actual">November 1, 2021</completion_date>
  <primary_completion_date type="Actual">November 1, 2020</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Clinical Perfectionism Questionnaire (CPQ)</measure>
    <time_frame>One month</time_frame>
    <description>The CPQ is a self-report measure determining the level of perfectionism and consists of 12 items that are scored on a four-point Likert-scale 1-4 (&quot;Not at all&quot; to &quot;All of the time&quot;), with two items that are in reverse (items 2 and 8), and employing a time-frame of one month to increase its clinical usefulness. The CPQ was translated to Swedish in a previous clinical trial, demonstrating good convergent and discriminant validity when compared to self-report measures of perfectionism and psychiatric symptoms, as well as adequate internal consistency and test-retest reliability (McMahan et al., submitted).</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Frost Multidimensional Perfectionism Scale (FMPS)</measure>
    <time_frame>One month</time_frame>
    <description>The FMPS is self-report measure determining the level of perfectionism and is scored on a five-point Likert-scale 1-5 (&quot;Strongly disagree&quot; to &quot;Strongly agree&quot;), with a total of 35 items that cover the six separate subscales Concern over Mistakes, Personal Standards, Doubts about Action, Parental Expectations, Parental Criticism, and Organization. However, only the two first are usually of interest in clinical trials as the other subscales are considered less related to the two higher-order dimensions of perfectionism (Limburg et al., 2017). The subscales of the FMPS has adequate to excellent internal consistencies and exhibits convergent and discriminant validity when compared to self-report measures of perfectionism and psychiatric symptoms (Purdon, Antony, &amp; Swinson, 1999). The FMPS was originally translated to Swedish by Lundh, Broman, Hetta, and Saboonchi (1994).</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Patient Health Questionnaire - 9 Items (PHQ-9)</measure>
    <time_frame>Two weeks</time_frame>
    <description>The nine-item PHQ-9 assesses the degree of depression and is scored on a four-point Likert-scale 0-3 (&quot;Not at all&quot; to &quot;Nearly every day&quot;). The PHQ-9 is often used as a screening tool for depressive symptoms, has been validated against other self-report measures and clinical interviews of depression, and has an excellent internal consistency (Kroenke et al., 2001).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Generalized Anxiety Disorder - 7 Items (GAD-7)</measure>
    <time_frame>Two weeks</time_frame>
    <description>The seven-item Generalized Anxiety Disorder (GAD-7) determines the level of anxiety and is scored on a four-point Likert-scale 0-3 (&quot;Not at all&quot; to &quot;Nearly every day&quot;). The GAD-7 is often used for screening for symptoms of anxiety and worry, corresponds well with other similar self-report measures, and has exhibited excellent internal consistency (Spitzer, Kroenke, Williams, &amp; Lowe, 2006).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Brunnsviken Brief Quality of Life (BBQ)</measure>
    <time_frame>One month</time_frame>
    <description>The 12-item Brunnsviken Brief Quality of Life (BBQ) explores the quality of life in six areas, e.g., leisure and learning, and level of importance, e.g., &quot;my leisure time is important to me&quot;, which are then multiplied with each other. The BBQ is scored on a four-point scale 1-4 (&quot;Strongly disagree&quot; to &quot;Strongly agree&quot;), with a range in scores of 0-96. The BBQ demonstrates good convergent and discriminant validity, good classification ability, and has an adequate internal consistency (Lindner et al., 2016).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Self-Compassion Scale - Short Form (SCS-SF)</measure>
    <time_frame>One month</time_frame>
    <description>The 12-item Self-Compassion Scale - Short Form (SCS-SF) tests the degree of self-compassion and is scored on a five-point scale 1-5 (&quot;Almost never&quot; to &quot;Almost all of the time&quot;). The SCS-SF has been shown to correlate with self-report measures of psychiatric symptoms, and has a good internal consistency (Raes, Pommier, Neff, &amp; Van Gucht, 2011).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Pure Procrastination Scale (PPS)</measure>
    <time_frame>One month</time_frame>
    <description>The 12-item Pure Procrastination Scale (PPS) determines the level of procrastination and is scored on a five-point Likert-scale 1-5 (&quot;Seldom, or do not agree&quot; to &quot;Very often, or totally agree). The PPS has been shown to have good convergent and discriminant validity, and internal consistency (Rozental, Forsell, et al., 2014; Steel, 2010).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Perceived Stress Scale (PSS)</measure>
    <time_frame>One month</time_frame>
    <description>The 14-item Perceived Stress Scale (PSS) evaluates the subjective experience of general stress in various situations and is scored on a five-point Likert-scale 0-4 (&quot;Never&quot; to &quot;Very often&quot;), with seven items being scored in reverse (items 4-7, 9-10, and 13). The PSS has been shown to have adequate internal consistency as well as good convergent and discriminant validity (Cohen, Kamarck, &amp; Mermelstein, 1983).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Negative Effects Questionnaire (NEQ)</measure>
    <time_frame>One month</time_frame>
    <description>Negative Effects Questionnaire (NEQ) will be used to probe for unwanted and adverse events that might arise during treatment, which is scored on a five-point Likert-scale 0-4 (&quot;Not at all&quot; to &quot;Extreme&quot;), and classifies the incidents as caused by the treatment or other circumstances. The NEQ has demonstrated excellent internal consistency and is mainly used to descriptively determine the occurrence and nature of possible negative effects (Rozental, Kottorp, Boettcher, Andersson, &amp; Carlbring, 2016).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Credibility/Expectancy Questionnaire</measure>
    <time_frame>Two weeks</time_frame>
    <description>The perceived integrity of treatment will be explored using the five-item Credibility/Expectancy Questionnaire (Borkovec &amp; Nau, 1972), which is scored on a 10-point Likert-scale 0-10 (e.g., &quot;Not at all logical&quot; to &quot; Very logical&quot;). It has exhibited good internal consistency and test-retest reliability, with the factor expectancy being correlated with outcomes of treatment (Devilly &amp; Borkovec, 2000).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Domains</measure>
    <time_frame>One month</time_frame>
    <description>The effects of treatment will be explored using subjective ratings of its impact on different domains. This will entail eight aspects of life that each participant rates on a 10-point Likert-scale 0-10 with regard to how perfectionism is affecting them negatively (&quot;Not at all&quot; to &quot;Very much&quot;): interests/leisure, work/studies, friendships/social life, community engagement/spirituality, family life/parenting, rest/sleep, love/intimate relationships, and physical activity/diet.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Goal attainment</measure>
    <time_frame>One month</time_frame>
    <description>The effects of treatment will be explored using participants own statements and definitions of their goals of treatment, and to what extent they have lived up to them, rated on a 10-point Likert-scale 0-10.</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">138</enrollment>
  <condition>Perfectionism</condition>
  <condition>Anxiety</condition>
  <condition>Depression</condition>
  <condition>Stress</condition>
  <arm_group>
    <arm_group_label>Cognitive Behavior Therapy</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>An eight-week Internet-based self-guided treatment, delivered with guidance on demand from therapists in training. The treatment is based on cognitive behavior therapy and includes both cognitive interventions, e.g., cognitive restructuring and behavioral experiments, and behavioral interventions, behavioral activation. The treatment was manualized by Egan et al. (2016) and has been tested in several clinical trials, both via the Internet and face-to-face.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Unified Protocol</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>An eight-week Internet-based self-guided treatment, delivered with guidance on demand from therapists in training. The treatment is based on a transdiagnostic approach derived from cognitive behavior therapy called Unified Protocol, focusing on the shared emotional aspects underlying depression and anxiety disorders. The treatment was manualized by Ellard et al. (2010) and has been tested in several clinical trials, but so far not over the Internet.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Cognitive Behavior Therapy</intervention_name>
    <description>A standardized evidence-based treatment manual based on cognitive behavior therapy, developed specifically for targeting perfectionism (Egan et al., 2016). Includes the following components: 1) providing psychoeducation about perfectionism and creating an individualized conceptualization 2) broadening the domains for self-evaluation 3) testing out beliefs and predictions, and 4) addressing personal standards and self-criticism.&#xD;
Week 1: Understanding your perfectionism.&#xD;
Week 2: Your own model, values, and motivation.&#xD;
Week 3: Surveys and experiments.&#xD;
Week 4: Dealing with perfectionistic behaviors.&#xD;
Week 5: New ways of thinking.&#xD;
Week 6: Self-criticism and self-compassion.&#xD;
Week 7: Self-worth.&#xD;
Week 8: Maintain and continue positive change.</description>
    <arm_group_label>Cognitive Behavior Therapy</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Unified Protocol</intervention_name>
    <description>A standardized evidence-based treatment manual based on cognitive behavior therapy, developed to target the shared emotional factors in depression and anxiety disorders (Ellard et al., 2010). Fundamental to this approach is to register and become more aware of the emotions, cognitions, and physical sensations that occur in difficult situation, and to try out more adaptive ways of coping in these instances.&#xD;
Week 1: Emotional symptoms.&#xD;
Week 2: Understanding your emotions.&#xD;
Week 3: Emotional awareness.&#xD;
Week 4: Thoughts.&#xD;
Week 5: Behaviors.&#xD;
Week 6: Emotional exposure.&#xD;
Week 7: Continued emotional exposure.&#xD;
Week 8: Planning ahead.</description>
    <arm_group_label>Unified Protocol</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  At least 18 years&#xD;
&#xD;
          -  Adequate reading and writing levels in Swedish&#xD;
&#xD;
          -  A computer, smartphone, or tablet with Internet access&#xD;
&#xD;
          -  Elevated levels of perfectionism, as determined by a score of &gt;29 on the subscale&#xD;
             Concerns over Mistakes on the Frost Multidimensional Perfectionism Scale&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Diagnoses warranting immediate care, e.g., anorexia nervosa, substance abuse, bipolar&#xD;
             disorder, psychosis, and schizophrenia&#xD;
&#xD;
          -  Severe depression, as determined by a score of &gt;15 points on the Patient Health&#xD;
             Questionnaire - 9 Items&#xD;
&#xD;
          -  Suicidality, as determined by &gt;2 points on the item on suicidal ideation on the&#xD;
             Patient Health Questionnaire - 9 Items&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Monica Buhrman, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Monica.Buhrman@psyk.uu.se</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Uppsala University</name>
      <address>
        <city>Uppsala</city>
        <country>Sweden</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Sweden</country>
  </location_countries>
  <link>
    <url>https://www.iterapi.se/sites/lizzie/</url>
    <description>Study website</description>
  </link>
  <verification_date>March 2022</verification_date>
  <study_first_submitted>July 1, 2020</study_first_submitted>
  <study_first_submitted_qc>July 1, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">July 7, 2020</study_first_posted>
  <last_update_submitted>March 28, 2022</last_update_submitted>
  <last_update_submitted_qc>March 28, 2022</last_update_submitted_qc>
  <last_update_posted type="Actual">March 29, 2022</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Karolinska Institutet</investigator_affiliation>
    <investigator_full_name>Alexander Rozental</investigator_full_name>
    <investigator_title>Principal Investigator</investigator_title>
  </responsible_party>
  <keyword>Perfectionism</keyword>
  <keyword>Cognitive Behavior Therapy</keyword>
  <keyword>Unified Protocol</keyword>
  <keyword>Internet-based</keyword>
  <keyword>Randomized controlled trial</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Depression</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
    <ipd_description>Masked and anonymised data will be able to retrieve upon request.</ipd_description>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04459260
org study id: UU2020-0001
nct id: NCT04459260
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Perfectionism is characterized by setting high standards and striving for achievement,
      sometimes at the expense of social relationships and wellbeing. Despite sometimes being
      viewed as a positive feature by others, people with perfectionism tend to be overly concerned
      about their performance and how they are being perceived by people around them. This tends to
      create inflexible standards, cognitive biases, and performance-related behaviors that
      maintain a belief that self-worth is linked to accomplishments. Cognitive behavior therapy
      has been shown to be a viable treatment for perfectionism, both in terms of reducing levels
      of perfectionism and improving psychiatric symptoms. Furthermore, a number of recent studies
      indicate that it can be successfully delivered via the Internet, both with regular support
      and guidance on demand from a therapist. In the present study protocol, a clinical trial for
      perfectionism is described and outlined. In total, 128 participants will be recruited and
      randomized to either a treatment that has already been demonstrated to have many benefits,
      Internet-based Cognitive Behavior Therapy for perfectionism (iCBT-P), or an active comparison
      condition, Internet-based Unified Protocol (iUP), targeting the emotions underlying
      depression and anxiety disorders. The results will be investigated with regard to
      self-reported outcomes of perfectionism, psychiatric symptoms, self-compassion, and quality
      of life, at post-treatment and at six- and 12-month follow-up. Both iCBT-P and iUP are
      expected to have positive effects, but the difference between conditions and adherence to
      respective treatment are currently unknown and will be explored. The clinical trial is
      believed to lead to a better understanding of how perfectionism can be treated, with the aim
      of providing efficacious treatments in an accessible format via the Internet.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: Clinical Perfectionism Questionnaire (CPQ)
time frame: One month
description: The CPQ is a self-report measure determining the level of perfectionism and consists of 12 items that are scored on a four-point Likert-scale 1-4 ("Not at all" to "All of the time"), with two items that are in reverse (items 2 and 8), and employing a time-frame of one month to increase its clinical usefulness. The CPQ was translated to Swedish in a previous clinical trial, demonstrating good convergent and discriminant validity when compared to self-report measures of perfectionism and psychiatric symptoms, as well as adequate internal consistency and test-retest reliability (McMahan et al., submitted).
measure: Frost Multidimensional Perfectionism Scale (FMPS)
time frame: One month
description: The FMPS is self-report measure determining the level of perfectionism and is scored on a five-point Likert-scale 1-5 ("Strongly disagree" to "Strongly agree"), with a total of 35 items that cover the six separate subscales Concern over Mistakes, Personal Standards, Doubts about Action, Parental Expectations, Parental Criticism, and Organization. However, only the two first are usually of interest in clinical trials as the other subscales are considered less related to the two higher-order dimensions of perfectionism (Limburg et al., 2017). The subscales of the FMPS has adequate to excellent internal consistencies and exhibits convergent and discriminant validity when compared to self-report measures of perfectionism and psychiatric symptoms (Purdon, Antony, & Swinson, 1999). The FMPS was originally translated to Swedish by Lundh, Broman, Hetta, and Saboonchi (1994).
measure: Patient Health Questionnaire - 9 Items (PHQ-9)
time frame: Two weeks
description: The nine-item PHQ-9 assesses the degree of depression and is scored on a four-point Likert-scale 0-3 ("Not at all" to "Nearly every day"). The PHQ-9 is often used as a screening tool for depressive symptoms, has been validated against other self-report measures and clinical interviews of depression, and has an excellent internal consistency (Kroenke et al., 2001).
measure: Generalized Anxiety Disorder - 7 Items (GAD-7)
time frame: Two weeks
description: The seven-item Generalized Anxiety Disorder (GAD-7) determines the level of anxiety and is scored on a four-point Likert-scale 0-3 ("Not at all" to "Nearly every day"). The GAD-7 is often used for screening for symptoms of anxiety and worry, corresponds well with other similar self-report measures, and has exhibited excellent internal consistency (Spitzer, Kroenke, Williams, & Lowe, 2006).
measure: Brunnsviken Brief Quality of Life (BBQ)
time frame: One month
description: The 12-item Brunnsviken Brief Quality of Life (BBQ) explores the quality of life in six areas, e.g., leisure and learning, and level of importance, e.g., "my leisure time is important to me", which are then multiplied with each other. The BBQ is scored on a four-point scale 1-4 ("Strongly disagree" to "Strongly agree"), with a range in scores of 0-96. The BBQ demonstrates good convergent and discriminant validity, good classification ability, and has an adequate internal consistency (Lindner et al., 2016).
measure: Self-Compassion Scale - Short Form (SCS-SF)
time frame: One month
description: The 12-item Self-Compassion Scale - Short Form (SCS-SF) tests the degree of self-compassion and is scored on a five-point scale 1-5 ("Almost never" to "Almost all of the time"). The SCS-SF has been shown to correlate with self-report measures of psychiatric symptoms, and has a good internal consistency (Raes, Pommier, Neff, & Van Gucht, 2011).
measure: Pure Procrastination Scale (PPS)
time frame: One month
description: The 12-item Pure Procrastination Scale (PPS) determines the level of procrastination and is scored on a five-point Likert-scale 1-5 ("Seldom, or do not agree" to "Very often, or totally agree). The PPS has been shown to have good convergent and discriminant validity, and internal consistency (Rozental, Forsell, et al., 2014; Steel, 2010).
measure: Perceived Stress Scale (PSS)
time frame: One month
description: The 14-item Perceived Stress Scale (PSS) evaluates the subjective experience of general stress in various situations and is scored on a five-point Likert-scale 0-4 ("Never" to "Very often"), with seven items being scored in reverse (items 4-7, 9-10, and 13). The PSS has been shown to have adequate internal consistency as well as good convergent and discriminant validity (Cohen, Kamarck, & Mermelstein, 1983).
measure: Negative Effects Questionnaire (NEQ)
time frame: One month
description: Negative Effects Questionnaire (NEQ) will be used to probe for unwanted and adverse events that might arise during treatment, which is scored on a five-point Likert-scale 0-4 ("Not at all" to "Extreme"), and classifies the incidents as caused by the treatment or other circumstances. The NEQ has demonstrated excellent internal consistency and is mainly used to descriptively determine the occurrence and nature of possible negative effects (Rozental, Kottorp, Boettcher, Andersson, & Carlbring, 2016).
measure: Credibility/Expectancy Questionnaire
time frame: Two weeks
description: The perceived integrity of treatment will be explored using the five-item Credibility/Expectancy Questionnaire (Borkovec & Nau, 1972), which is scored on a 10-point Likert-scale 0-10 (e.g., "Not at all logical" to " Very logical"). It has exhibited good internal consistency and test-retest reliability, with the factor expectancy being correlated with outcomes of treatment (Devilly & Borkovec, 2000).
measure: Domains
time frame: One month
description: The effects of treatment will be explored using subjective ratings of its impact on different domains. This will entail eight aspects of life that each participant rates on a 10-point Likert-scale 0-10 with regard to how perfectionism is affecting them negatively ("Not at all" to "Very much"): interests/leisure, work/studies, friendships/social life, community engagement/spirituality, family life/parenting, rest/sleep, love/intimate relationships, and physical activity/diet.
measure: Goal attainment
time frame: One month
description: The effects of treatment will be explored using participants own statements and definitions of their goals of treatment, and to what extent they have lived up to them, rated on a 10-point Likert-scale 0-10.
arm group label: Cognitive Behavior Therapy
arm group type: Experimental
description: An eight-week Internet-based self-guided treatment, delivered with guidance on demand from therapists in training. The treatment is based on cognitive behavior therapy and includes both cognitive interventions, e.g., cognitive restructuring and behavioral experiments, and behavioral interventions, behavioral activation. The treatment was manualized by Egan et al. (2016) and has been tested in several clinical trials, both via the Internet and face-to-face.
arm group label: Unified Protocol
arm group type: Active Comparator
description: An eight-week Internet-based self-guided treatment, delivered with guidance on demand from therapists in training. The treatment is based on a transdiagnostic approach derived from cognitive behavior therapy called Unified Protocol, focusing on the shared emotional aspects underlying depression and anxiety disorders. The treatment was manualized by Ellard et al. (2010) and has been tested in several clinical trials, but so far not over the Internet.
intervention type: Behavioral
intervention name: Cognitive Behavior Therapy
description: A standardized evidence-based treatment manual based on cognitive behavior therapy, developed specifically for targeting perfectionism (Egan et al., 2016). Includes the following components: 1) providing psychoeducation about perfectionism and creating an individualized conceptualization 2) broadening the domains for self-evaluation 3) testing out beliefs and predictions, and 4) addressing personal standards and self-criticism.
Week 1: Understanding your perfectionism.
Week 2: Your own model, values, and motivation.
Week 3: Surveys and experiments.
Week 4: Dealing with perfectionistic behaviors.
Week 5: New ways of thinking.
Week 6: Self-criticism and self-compassion.
Week 7: Self-worth.
Week 8: Maintain and continue positive change.
arm group label: Cognitive Behavior Therapy
intervention type: Behavioral
intervention name: Unified Protocol
description: A standardized evidence-based treatment manual based on cognitive behavior therapy, developed to target the shared emotional factors in depression and anxiety disorders (Ellard et al., 2010). Fundamental to this approach is to register and become more aware of the emotions, cognitions, and physical sensations that occur in difficult situation, and to try out more adaptive ways of coping in these instances.
Week 1: Emotional symptoms.
Week 2: Understanding your emotions.
Week 3: Emotional awareness.
Week 4: Thoughts.
Week 5: Behaviors.
Week 6: Emotional exposure.
Week 7: Continued emotional exposure.
Week 8: Planning ahead.
arm group label: Unified Protocol
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
last name: Monica Buhrman, PhD
role: Principal Investigator
affiliation: Monica.Buhrman@psyk.uu.se
facility: 
country: Sweden
url: https://www.iterapi.se/sites/lizzie/
description: Study website
responsible party type: Principal Investigator
investigator affiliation: Karolinska Institutet
investigator full name: Alexander Rozental
investigator title: Principal Investigator
mesh term: Depression
sharing ipd: No
ipd description: Masked and anonymised data will be able to retrieve upon request.