Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism

Behav Res Ther. 2023 Feb:161:104258. doi: 10.1016/j.brat.2023.104258. Epub 2023 Jan 19.


It has been 21 years since the publication of the cognitive behavioural model of clinical perfectionism that underpins cognitive behaviour therapy (CBT) for perfectionism. The notion of clinical perfectionism and CBT for perfectionism has been controversial. Despite 15 randomised controlled trials which have demonstrated the efficacy of CBT for perfectionism in reducing perfectionism and symptoms of anxiety, depression and eating disorders, strong responses to this work continue to appear in the literature. In this article, we examine the evolution and controversy surrounding clinical perfectionism, the efficacy of CBT for perfectionism, and future directions for the concept of perfectionism and its treatment. Future research should aim to provide independent evaluations of treatment efficacy, compare CBT for perfectionism to active treatments, conduct dismantling trials to examine the effective components of treatment, and examine the causal processes involved in perfectionism. We provide recommendations for future pathways to support innovation in theory, understanding, and treatment of perfectionism with a view towards improving clinical outcomes.

Keywords: Anxiety; Cognitive behaviour therapy; Depression; Eating disorders; Perfectionism.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cognitive Behavioral Therapy*
  • Humans
  • Perfectionism*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome