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The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: a systematic review and meta-analysis
Open accessAbstract
Perfectionism is a transdiagnostic process across anxiety, depression, and eating disorders. The aim of this systematic review was to examine the efficacy of self-help and face to face CBT for perfectionism in reducing perfectionism and anxiety, depression, and eating disorders. A total of 15 randomised controlled trials of CBT for perfectionism were identified (N = 912 participants; mean pooled age = 23 years) which met inclusion criteria. There were medium or large effect sizes found on perfectionism measures; personal standards (g = 0.57, 95% CI = 0.43–0.72), concern over mistakes (g = 0.89, 95% CI = 0.71–1.08) and clinical perfectionism (g = 0.87, 95% CI = 0.70–1.04). There were medium effects for symptoms of eating disorders (g = 0.61, 95% CI = 0.36–0.87) and depression (g = 0.60, 95% CI = 0.28–0.91), and a small-medium effect on anxiety (g = 0.42, 95% CI = 0.21–0.62). There was no publication bias found. Limitations included the small number of trials included and lack of active treatment comparisons. Results suggested that CBT for perfectionism is efficacious in reducing perfectionism and symptoms of depression, anxiety and eating disorders. Future research should examine comparisons of CBT for perfectionism with other psychological treatments.
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“Over the last two decades, a cognitive behavioural therapy for perfectionism (CBT-P) has been successfully used to modify the standards, concerns, and behaviours of perfectionists (e.g. Egan and Shafran, 2018; Egan et al ., 2016) with the goal of alleviating their symptoms of depression, anxiety, and eating disorders”
From The impact of internet-based cognitive behavior therapy for perfectionism: a reinterpretation through the lens of the Model of Excellencism and Perfectionism (2024) · cites this paper as Galloway et al., 2022
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“CBT for perfectionism is undoubtedly the leading treatment for perfectionism and has been examined in 15 randomised controlled trials (RCTs), across a variety of groups (see Galloway et al., 2022).”
From Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism (2023) · cites this paper as Galloway et al., 2022
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“The efficacy of treatment has been demon strated via statistical significance (all 15 RCTs included in the Galloway et al., 2022 meta-analysis), in addition to reliable and clinically signif icant change (e.g., Handley et al., 2015; Hoiles et al., 2022; Riley et al., 2007; Shu et al., 2019).”
From Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism (2023) · cites this paper as Galloway et al., 2022
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“Significant improvement in psychological adjustment after CBT-P was found in a recent meta-analytical review (Galloway et al ., 2022) and discussed in a reflection of the first 21 years of the intervention (Shafran et al ., 2023).”
From The impact of internet-based cognitive behavior therapy for perfectionism: a reinterpretation through the lens of the Model of Excellencism and Perfectionism (2024) · cites this paper as Galloway et al., 2022
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“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.”
From Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism (2023) · cites this paper as Galloway et al., 2022
The cited source says what the claim attributes to it.
In the citing paper
“CBT for perfectionism is undoubtedly the leading treatment for perfectionism and has been examined in 15 randomised controlled trials (RCTs), across a variety of groups (see Galloway et al., 2022).”
From Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism (2023) · cites this paper as Galloway et al., 2022
The cited source says what the claim attributes to it.
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“A strength of the literature to date is that across the 15 randomised controlled trials of CBT for perfectionism, the treatment has been delivered in a variety of different modalities, age ranges and populations.”
From Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism (2023) · cites this paper as Galloway et al., 2022
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Hill, A. P., Madigan, D. J., Chintapatla, S., & Chitsabesan, P. (2026) · Journal of Health Psychology · doi:10.1177/13591053261449051
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Bissett, R., Clough, B. A., Hood, M., Sluis, R. A., & Waters, A. M. (2026) · Child Psychiatry & Human Development · doi:10.1007/s10578-026-02044-0
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Sivertsen, B., Woodfin, V. I., Sand, L., Reneflot, A., Knudsen, A. K., Skogen, J. C., & Hysing, M. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122189
Nowacka, M. (2025) · Przegląd Psychologiczny · doi:10.31648/przegldpsychologiczny.12959
“Meta-analyses confirm the high effectiveness of CBT both in reducing perfectionism and in alleviating symptoms associated with various mental disorders (Galloway et al., 2021; Lloyd et al., 2015; Robinson & Wade, 2021; Shu et al., 2019).”
Clinical Perfectionism as a Transdiagnostic Process: A Cognitive-Behavioural Conceptualisation
Ussorowska-Krokosz, A. (2026) · Przegląd Psychologiczny · doi:10.31648/przegldpsychologiczny.13027
“Meta-analyses indicate that perfectionism-focused interventions are effective in both individual and group therapy formats, and that their effects extend to symptoms that were not the direct targets of treatment (Galloway et al., 2021; Robinson & Wade, 2021).”
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Self-citationWas She Perfect? Maladaptive Perfectionism in Black Swan Across REBT, CBT, ACT, IFS, and the EEMM
Tsarev, A. (2026) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-026-00683-9
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Effectiveness of Emotion‐Focused Therapy for Self‐Criticism: A Systematic Review and Meta‐Analysis
Wang, Y., Douris, C., & Timulák, L. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70346
Triguero-López, M. J., Moreno-García, M. I., & Ortíz, M. M. (2026) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe16100163
“In line with this perspective, systematic reviews and intervention studies suggest that addressing maladaptive perfectionism may have beneficial effects across multiple symptomatic domains, including social anxiety (Abdollahi et al., 2021; Galloway et al., 2022; Suh et al., 2019).”
Hu, P., Hao, X., Ding, X., Wu, J., & Fu, Z. (2026) · Behavioral Sciences · doi:10.3390/bs16111994
Gao, H., & Zhang, M. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1961617
Metadata
- Authors
- Galloway, R., Watson, H., Greene, D., Shafran, R., & Egan, S. J.
- Affiliations
- Curtin University (AU)
- University of North Carolina at Chapel Hill (US)
- University College London (GB)
- Corresponding author
- Egan, Sarah J.
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2021-08-04
- Volume
- 51
- Issue
- 2
- Pages
- 170-184
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- OpenAlex
- W4229072348
- Cited by
- 115
- References
- 45
- Citations by year
- 2026: 24 · 2025: 28 · 2024: 24 · 2023: 24 · 2022: 14 · 2021: 1
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- Cognitive Behaviour Therapy (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- not funded
- Topics
- Social Sciences › Psychology › Clinical Psychology › Perfectionism, Procrastination, Anxiety Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- perfectionism, self-help intervention, anxiety, depression, eating disorders, transdiagnostic mechanisms, concern over mistakes, personal standards, clinical perfectionism, treatment efficacy
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