Perfectionism and Daily Coping and Emotion Regulation Processes: A Trial of Two Explanatory Feedback Interventions

1\. Rationale for Study. Over the past three decades, perfectionism has received increasing theoretical and empirical attention as a cognitive-personality factor that increases vulnerability to several psychological problems, including depression and anxiety. In Canada, the United States, and the United Kingdom, young adults are experiencing higher levels of depression, anxiety, and suicide ideation as well as significantly higher levels of self-critical perfectionism than a decade ago. Although the self-criticism (SC) dimension of perfectionism has been consistently associated with lower well-being, little longitudinal research has examined the mechanisms through which SC is related to well-being over time.

1.a. Perfectionism Dimensions and Daily Stress Reactivity and Coping (In)effectiveness.

Previous longitudinal studies of university students, community adults, and depressed patients have used 7-day and 14-day daily diary designs to obtain several assessments of appraisals, coping, and affect for each individual in the individual's natural everyday environments. Based on the Perfectionism Coping Processes Model (PCPM), multilevel structural equation modeling (MSEM)/SEM between-persons results have demonstrated that SC perfectionists maintain lower well-being (e.g., negative affect, lower positive affect) over time because these individuals have a tendency to: (a) generate daily stress for themselves by magnifying the negative aspects of events such that mundane difficulties can be interpreted as threatening stressors; (b) engage in avoidant coping, which stems from helplessness thinking that the individual is unable to cope with stressors to the individual's own and others' satisfaction; and (c) perceive that others are unwilling or unavailable to help the individual in times of stress, and thereby lack an important resource (i.e., perceived social support) to make stressors seem less overwhelming. On the other hand, the adaptive potential of PS has been exhibited by an indirect relation with positive affect through maintenance of higher daily problem-focused coping when individuals with higher PS are not depressed. MSEM within-person results have shown that several distinct appraisals (e.g., event stress) and coping strategies (e.g., avoidant coping) commonly operate together across many different stressors when the typical individual experiences daily increases in negative affect and drops in positive affect. In parallel, constructive social (e.g., perceived social support) and self (e.g., perceived control) appraisals and engagement coping strategies (e.g., positive reinterpretation, problem-focused coping) commonly facilitate one another, which is linked to within-person increases in daily positive affect for the typical individual.

1.b. Perfectionism Dimensions and Daily Emotion (Dys)regulation. Given the pervasive and enduring stress management problems that generate persistent distress for perfectionistic individuals, it is important to better understand how certain emotion regulation strategies might make emotional reactions worse or serve a protective role. A recent SSHRC-funded study extends this previous research by using 14-day daily diaries and MSEM/multilevel modeling to examine the impact of SC and PS dimensions of perfectionism on emotion regulation (e.g., mindfulness, self-compassion, experiential avoidance, rumination) and well-being in a sample of 154 community adults over two years. Based on the Perfectionism and Emotion Regulation Processes Model (PERPM), MSEM between-persons results demonstrated that SC perfectionism maintains higher negative affect and lower positive affect over 14 days because these individuals have a tendency to generate daily stress for themselves and engage in experiential avoidance and rumination, and tend less to engage in mindfulness, self-compassion, and reappraisal. Within-person mediation results showed that, when the typical individual perceives more stress than usual, the individual responds with less mindfulness, self-compassion, and reappraisal than usual, and engages in more experiential avoidance and rumination than usual, and this was connected to decreases in daily well-being. Further, multilevel modeling results demonstrated that individuals with higher SC perfectionism, relative to those with lower SC, experience stronger within-person decreases in well-being (e.g., higher negative affect, lower positive affect) when the individual reports more stress than usual, and less self-compassion and mindfulness than usual.

1. c. Feedback Interventions for Perfectionists. Although mediators and moderators of the link between perfectionism and well-being have been identified, the direct clinical utility of these findings has not been a focus. Few studies have involved participants in a role beyond the completion of study questionnaires/diaries. An exception was a study in which a total of 60 young adults assessed to be maladaptive perfectionists were randomized to a control group or a single-session feedback intervention in which the participant's perfectionism results were discussed. Findings revealed that providing feedback to maladaptive perfectionists about the individual's perfectionism reduced self-reported global symptomatic distress as well as emotional reactivity. Although the findings suggest that a brief, individualized feedback intervention is effective, one important limitation of extant studies employing feedback interventions is that the feedback did not describe the actions to be taken to make change. According to feedback intervention theory and the model of actionable feedback, feedback will have an optimal effect on performance when information is focused on helping the recipient see how his/her behaviour should change to improve functioning. This entails customizability of feedback that engages the individual with his/her own data, making him/her an active participant in the sense-making process, rather than a passive recipient of information.

The Perfectionism and Coping Processes Model - Explanatory Feedback Intervention (PCPM-EFI) draws on previous findings and analyzes participant responses to perfectionism measures and online daily questionnaires of stress, coping, and mood over 7 days. The PCPM-EFI provides an individualized slideshow presentation that is delivered in a single 45-60 minute session by a student research assistant to answer five questions about the participant's perfectionism and daily stress, coping, and affect patterns. Question 1 ("What increases the participant's negative mood?") is addressed by contrasting scores from two days with a path diagram to demonstrate to the individual that, when the individual perceives more criticism, engages in more self-blame, and/or perceives less control than usual, the individual uses more avoidant coping and/or experiences higher event stress than usual, and this is connected to daily increases in negative affect. Question 2 ("What increases the participant's positive mood?") is addressed by contrasting scores from two days with a path diagram to show to the individual that, when the individual perceives more support from others, uses more positive reinterpretation, and/or perceives more control than usual, the individual engages in more problem-focused coping than usual, and this is connected to daily increases in positive affect. Question 3 ("What's keeping the participant stuck?") is addressed by showing the individual how higher levels of SC maintained higher negative affect and lower positive affect averaged over seven days because of selected higher disengagement tendencies (e.g., stress, avoidant coping, perceived criticism, self-blame) and selected lower engagement tendencies (e.g., perceived social support, positive reinterpretation, perceived control, problem-focused coping). Question 4 ("What are the participant's strengths?") is addressed by highlighting strengths to the individual, including healthy striving (i.e., PS without SC), selected lower disengagement tendencies, and selected higher engagement tendencies averaged over seven days. Most important, Question 5 ("What can the participant do to improve the participant's mood?") is addressed with a summary slide to show what the person needs to do to manage and improve the individual's mood. A given mechanism is designated as a "best target" when it is keeping the individual stuck and daily changes are connected to improvements in at least one other mechanism and mood.

The investigators recently completed a waitlist controlled feasibility trial comparing the PCPM-EFI condition with a waitlist control condition over 4 weeks in 176 university students with higher SC perfectionism, with individualized feedback delivered one-on-one by student trainees in-person or remotely through videoconferencing. The feasibility of the individualized analyses of each participant's daily data was supported by identifying daily trigger patterns, maintenance tendencies, strengths, common triggers, and best targets for reducing negative mood and increasing positive mood across several stressors for each participant. Participant ratings indicated that the comprehensive feedback was coherent and functional. Participants in the EFI condition, compared to those in the control condition, reported increases in empowerment, coping self-efficacy, and problem-focused coping, as well as decreases in depressive and anxious symptoms. Between-group effect sizes were moderate-to-large. There were reliable improvements in empowerment and depressive symptoms for 56% and 36%, respectively, of participants in the EFI condition. These findings demonstrate the broad applicability, conceptual utility, and effectiveness of the PCPM-EFI for self-critical perfectionistic individuals. Given these promising findings, research is needed to examine the utility of customizing daily emotion regulation findings, and the complementary effects of providing meaningful feedback on well-being. 2. The Present Study. The present SSHRC-funded study will build on the promising findings of the PCPM-EFI by using a 7-day daily diary methodology to test a complementary EFI on perfectionism and emotion regulation processes (e.g., self-compassion, mindfulness, experiential avoidance, rumination, reappraisal) delivered online through videoconferencing in a sample of university students with higher self-critical perfectionism. Based on the Perfectionism and Emotion Regulation Processes Model (PERPM), the PERPM-EFI follows the same structure as the PCPM-EFI to provide individualized analyses drawn from previous findings as well as findings from a current SSHRC-funded study. The results of a pilot study of 12 university students with higher SC perfectionism suggest that the PERPM-EFI is broadly applicable, conceptually useful, and effective. Specifically, despite the small sample size, participants reported increases in empowerment, mindfulness, self-compassion, and emotional self-awareness, as well as decreases in depressive and anxious symptoms. The present study will use a randomized control design to examine whether the PCPM-EFI plus PERPM-EFI can better improve well-being, relative to providing no feedback, the PERPM-EFI alone, or PCPM-EFI alone in the context of a 4-week longitudinal study with three time points in a sample of 180 university students. The four conditions will be: (a) waitlist control condition, (b) PCPM-EFI, (c) PERPM-EFI, and (d) PCPM-EFI plus PERPM-EFI.

Based on theory and previous findings, it is expected that the EFIs will demonstrate three central features of the PCPM and PERPM as viable models of change (Hayes, Hofmann, and Ciarrochi, 2020). Hypothesis 1 will examine the feasibility of the individualized analyses of each participant's daily questionnaire data to show that the PCPM-EFI and PERPM-EFI are broadly applicable across a wide array of stressors for most participants in predictable, empirical

• Beck Depression Inventory (BDI; Beck and Steer, 1987) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Depression, Anxiety, and Stress Scale-Short Form (DASS-21; Lovibond and Lovibond, 1995) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Positive and Negative Affect Scale (PANAS; Watson et al., 1988) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2). Will also be administered immediately before and after feedback.]
• Coping Self-Efficacy Scale (CSES; Chesney et al., 2006) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2). Will also be administered immediately after feedback.]
• COPE Inventory (Carver et al., 1989) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Self-Compassion Scale (Neff, 2003) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Five Facet Mindfulness Questionnaire (Baer et al., 2006) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Ruminative Responses Scale (RRS; Treynor et al., 2003) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Brief Experiential Avoidance Questionnaire (BEAQ; Gámez et al., 2014) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Emotional Self-Awareness Scale (ESAS; Kauer et al., 2012) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• General, Academic, Social Hassles Scale for Students - Abbreviated version (GASHSS; Blankstein and Flett, 1993; Dunkley et al., 2003) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]
• Brief Frost et al. (1990) Multidimensional Perfectionism Scale (FMPS) [Time frame: Measure completed at baseline, at Time 2 (two weeks after baseline), and at Time 3 (two weeks after Time 2).]