David M. Dunkley

Self-Critical Perfectionism and Daily Affect: Dispositional and Situational Influences on Stress and Coping

This study of university students (64 men and 99 women) examined both dispositional and situational influences of self-critical (SC) perfectionism on stress and coping, which explain its association with high negative affect and low positive affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Structural equation modeling indicated that the relation between SC perfectionism and daily affect could be explained by several maladaptive tendencies associated with SC perfectionism (e.g., hassles, avoidant coping, low perceived social support). Multilevel modeling indicated that SC perfectionists were emotionally reactive to stressors that imply possible failure, loss of control, and criticism from others. As well, certain coping strategies (e.g., problem-focused coping) were ineffective for high-SC perfectionists relative to low-SC perfectionists.

Childhood maltreatment, depressive symptoms, and body dissatisfaction in patients with binge eating disorder: the mediating role of self-criticism.

OBJECTIVE We examined the mediating role of self-criticism in the relation between childhood maltreatment and both depressive symptoms and body dissatisfaction in patients with binge eating disorder (BED). METHOD Participants were 170 BED patients who completed measures of childhood maltreatment, self-criticism, self-esteem, depressive symptoms, and body dissatisfaction. RESULTS Specific forms of childhood maltreatment (emotional abuse, sexual abuse) were significantly associated with body dissatisfaction. Path analyses demonstrated that self-criticism fully mediated the relation between emotional abuse and both depressive symptoms and body dissatisfaction. Specificity for the mediating role of self-criticism was demonstrated in comparison to other potential mediators (low self-esteem) and alternative competing mediation models. DISCUSSION These results highlight self-criticism as a potential mechanism through which certain forms of childhood maltreatment may be associated with depressive symptoms and body dissatisfaction in BED patients.

Self-criticism versus neuroticism in predicting depression and psychosocial impairment for 4 years in a clinical sample

The present study extended previous findings demonstrating self-criticism, assessed by the Dysfunctional Attitude Scale (DAS) (Weissman AN, Beck AT. Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. Paper presented at the 86th Annual Convention of the American Psychological Association, Toronto, Ontario, Canada, 1978), as a potentially important prospective predictor of depressive symptoms and psychosocial functional impairment over time. Using data from a prospective, 4-year study of a clinical sample, DAS self-criticism and neuroticism were associated with self-report depressive symptoms, interviewer-rated major depression, and global domains of psychosocial functional impairment 4 years later. Hierarchical multiple regression results indicated that self-criticism uniquely predicted depressive symptoms, major depression, and global psychosocial impairment 4 years later over and above the Time 1 assessments of these outcomes and neuroticism. In contrast, neuroticism was a unique predictor of self-report depressive symptoms only 4 years later. Path analyses were used to test a preliminary 3-wave mediational model and demonstrated that negative perceptions of social support at 3 years mediated the relation between self-criticism and depression/global psychosocial impairment for 4 years.

Perfectionism Dimensions and the Five‐factor Model of Personality

This study of university students (n = 357) and community adults (n = 223) examined personal standards (PS) and evaluative concerns (EC) higher–order dimensions of perfectionism that underlie several measures from three different theoretical frameworks. In both students and community adults, confirmatory factor analyses supported PS perfectionism and EC perfectionism higher–order latent factors. In relation to the revised NEO Personality Inventory, PS perfectionism was primarily related to conscientiousness and achievement striving. In contrast, EC perfectionism was primarily related to neuroticism, and lower positive emotions, trust and competence. EC perfectionism accounted for unique variance in current depressive and anxious symptoms over and above the five–factor domain scores. Copyright

The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants

BackgroundVery low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues) in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mothers ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants.Methods and designMothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals, and are randomly assigned to the experimental (Cues) intervention or to an attention control (Care) condition. The Cues intervention teaches mothers to attend to their own physiological, cognitive, and emotional cues that signal anxiety and worry, and to use cognitive-behavioural strategies to reduce distress. Mothers are also taught to understand infant cues and to respond sensitively to those cues. Mothers in the Care group receive general information about infant care. Both groups have 6 contacts with a trained intervener; 5 of the 6 sessions take place during the infants hospitalization, and the sixth contact occurs after discharge, in the participant mothers home. The primary outcome is maternal symptoms of anxiety, assessed via self-report questionnaire immediately post-intervention. Secondary outcomes include maternal sensitive behaviour, maternal symptoms of posttraumatic stress, and infant development at 6 months corrected age.DiscussionThe Cues and Care trial will provide important information on the efficacy of a brief, skills-based intervention to reduce anxiety and increase sensitivity in mothers of very low birthweight infants. A brief intervention of this nature may be more readily implemented as part of standard neonatal intensive care than broad-based, multi-component interventions. By intervening early, we aim to optimize developmental outcomes in these high risk infants.Trial RegistrationCurrent Controlled Trials ISRCTN00918472The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants

The cues and care randomized controlled trial of a neonatal intensive care unit intervention: effects on maternal psychological distress and mother-infant interaction.

Objective: This study tested the efficacy of a brief intervention (Cues program) with mothers of very low birth weight (VLBW <1500 g) infants. The primary hypothesis was that mothers in the Cues program would report lower levels of anxiety compared with mothers in the control group. Secondary hypotheses examined whether Cues mothers would report less stress, depression, and role restriction, and exhibit more sensitive interactive behavior, than control group mothers. Methods: A total of 121 mothers of VLBW infants were randomly assigned to either the experimental (Cues) intervention or an attention control (Care) condition. The Cues program combined training to reduce anxiety and enhance sensitivity. The control group received general information about infant care. Both programs were initiated during the neonatal intensive care unit stay. Maternal anxiety, stress, depression, and demographic variables were evaluated at baseline, prior to randomization. Postintervention outcomes were assessed during a home visit when the infant was ∼6 to 8 weeks of corrected age. Results: Although mothers in the Cues group demonstrated greater knowledge of the content of the experimental intervention than mothers in the Care group, the groups did not differ in levels of anxiety, depression, and symptoms of posttraumatic stress. They were similar in their reports of parental role restrictions and stress related to the infants appearance and behavior. Cues and Care group mothers were equally sensitive in interaction with their infants. Conclusion: Nonspecific attention was as effective as an early skill-based intervention in reducing maternal anxiety and enhancing sensitive behavior in mothers of VLBW infants.

The evidence base for the cues program for mothers of very low birth weight infants: an innovative approach to reduce anxiety and support sensitive interaction.

Very low birth weight (VLBW) infants, born weighing less than 1,500 g, are at risk for several developmental problems. Consequently, there has been interest in developing intervention programs to prevent such problems. This article describes the empirical evidence that guided the development of an innovative, multicomponent intervention program for mothers of VLBW infants, as well as the program content and features. Based on the evidence, the program was designed to include six sessions and commence shortly after birth to reduce maternal psychological distress during the infant’s hospitalization in the neonatal intensive care unit and to promote sensitive mother–infant interaction. The program incorporates various learning activities, including written materials, observational exercises, discussion, and video feedback.

Perfectionism dimensions and dependency in relation to personality vulnerability and psychosocial adjustment in patients with coronary artery disease.

The present study sought to illuminate self-criticism and personal standards dimensions of perfectionism and dependency as specific cognitive-personality vulnerability factors that might contribute to a better understanding of numerous psychosocial problem areas that are relevant to coronary artery disease (CAD). One hundred and twenty-three patients diagnosed with clinically significant CAD completed self-report questionnaires. Zero-order correlations and factor analysis results revealed that self-criticism was primarily related to personality vulnerability (aggression/anger/hostility, Type D negative affectivity) and psychosocial maladjustment (depressive symptoms, worry, avoidant coping, support dissatisfaction), whereas personal standards was primarily related to adaptive coping (problem-focused coping, positive reinterpretation) and dependency was primarily related to worry. Hierarchical regression results demonstrated the incremental utility of self-criticism, personal standards, and dependency in relation to (mal)adjustment over and above aggression/anger/hostility, negative affectivity, and social inhibition. Continued efforts to understand the role of perfectionism dimensions and dependency in CAD appear warranted.

Follow-Up of the Cues and Care Trial Mother and Infant Outcomes at 6 Months

The long-term effects of the Cues intervention to reduce anxiety and enhance the interactive behavior of mothers of very low birth weight (VLBW) infants were investigated. A randomized trial comparing the Cues intervention to an attention control condition was conducted. A total of 122 mothers of newborns weighing < 1,500 g were randomized, and 96 participated in a follow-up assessment when the infants were 6 months corrected age. Maternal outcomes included anxiety, posttraumatic stress and depression, and mother–infant interaction. The Bayley Scales were used to assess infant development. Mother’s anxiety was not significantly lower in the Cues group (27.8 [SD = 7.9]) compared with the control group (30.5 [SD = 10.0]; p = 0.14). Mothers in the Cues group were not more sensitive in interactions with their infants. There were no differences between groups with respect to infant development. Thus, there was no evidence of any differential beneficial effects of the Cues program.

Personal Standards and Self-Critical Perfectionism and Distress: Stress, Coping, and Perceived Social Support as Mediators and Moderators

This chapter examines the mediating and moderating roles of daily stress, coping, and perceived social support in the relation between self-critical (SC) and personal standards (PS) perfectionism dimensions and distress symptoms (i.e., depression, anxiety) in hopes of addressing what might constitute more effective prevention and intervention efforts for highly perfectionistic individuals. First, we review several mediation studies that have tested theoretical models with stress, coping, and perceived social support as trait-like correlates of perfectionism that can explain how or why SC and PS dimensions are differentially associated with well-being outcomes. Second, we review several moderation studies that have examined certain types of stressors, appraisals, and coping strategies that determine when the relation between perfectionism dimensions and (mal)adjustment is maximized or minimized. Third, as stress has predominantly been assessed in previous studies using self-report measures, we examine emerging evidence that demonstrates the impact of perfectionism on physiological measures of stress (e.g., cortisol). Clinical implications of the extant findings are discussed.