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    An internet-delivered Cognitive Behaviour Therapy for clinical perfectionism : a thesis presented in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology at Massey University, Albany, New Zealand
    (Massey University, 2019) Miller, Emma
    Clinical perfectionism has been associated with a number of cognitive and behavioural difficulties including work strain, procrastination, burnout, sleep disturbance, and problems with rumination, intimacy, emotional expressiveness, and assertiveness. In addition, it has been recognised as a vulnerability factor for the development and maintenance of several psychological disorders, such as eating disorders, obsessive–compulsive disorder, social anxiety, and depression. Cognitive behaviour therapy (CBT) is a well-established treatment modality that has been demonstrated to be an effective intervention for clinical perfectionism. Recently, advances have been made in terms of the online delivery of effective CBT-based interventions. This study explored whether an eight-week online, guided self-help treatment for elevated clinical perfectionism produced clinically significant reductions in perfectionism, self-criticism, stress, low mood and anxiety, and increases in self-esteem within an adult New Zealand sample. The study included mixed methods, using a case series methodology with an AB plus follow-up design. It included both a reliable and clinically significant change (RCSC) analysis of repeated measures and a thematic analysis of module reflections and interviews completed at follow-up. Twelve participants completed weekly measures of perfectionism, mood, self-criticism and self-esteem over a four-week baseline phase andeight-week intervention, and then completed follow-up measures and an interview two months post-treatment. The intervention included eight weekly online self-help modules of CBT for clinical perfectionism (CBT-P) guided by the lead researcher. Interviews were completed individually with each participant to better understand how they experienced the treatment under investigation and changes to their clinical perfectionism and related difficulties. This study explored the hypotheses that: 1) the treatment would produce clinically significant reductions in clinical perfectionism, and 2) the treatment would also produce clinically significant reductions in low mood, anxiety, stress and self-criticism, and increases in self-esteem. The study also sought to answer the question regarding how the participants experience the guided ICBT-P. RCSC was achieved in clinical perfectionism for 90% of the participants. For selfcriticism and stress RCSC rates were 73% and 57%, respectively. Lower success rates were observed in the final three phenomena, with RCSC occurring in 27% of participants for self-esteem and 11% of participants for both depression and anxiety. The analysis of qualitative data resulted in two major clusters of themes. The first cluster described the participants’ experiences of the website and included four themes: 1) engagement with the treatment, 2) treatment delivery, 3) the website content, and 4) the guiding therapy. The second cluster of themes, which covered the participants’ perceived outcomes of treatment, included six themes: 1) a change in thinking, 2) developing insight, 3) an increase in self-love, 4) interpersonal improvements, 5) improved productivity and 6) a work in progress. This study provides initial evidence for the effectiveness of an eight-week online, guided self-help treatment for clinical perfectionism within a New Zealand sample. Participants perceived the treatment to be useful and reported experiencing a number of promising outcomes.
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    The acceptability and effectiveness of computerised cognitive-behavioural self-help for depression in primary care : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University
    (Massey University, 2010) Scheibmair, Rebecca
    Cognitive Behavioural Therapy (CBT) is an effective treatment for depression; however lack of available practitioners and lack of resources in secondary mental health settings, mean patients often don’t receive this treatment. Self-help approaches including computer-based self-help are one option to meet this unmet need. However there is little research examining the effectiveness of computer-based self-help in primary care, and no current research conducted in a New Zealand sample. ‘Overcoming Depression’, a six session computer-based Cognitive Behavioural Therapy (CBT) programme for depression has demonstrated effectiveness in significantly reducing symptoms of depression in a pilot study in a clinical psychology clinic (Whitfield, Hinshelwood, Pashely, Campsie & Williams, 2006). The current study investigated the acceptability and effectiveness of ‘Overcoming Depression’ in General Practice in New Zealand. The current study is divided into two parts. The first part of this research was a survey of patients in general practice which showed that computer-based self-help is acceptable and most patients would be willing to try this as a treatment for depression. The second part of the research involved a randomized controlled trial of ‘Overcoming Depression’ in general practice. In this study ‘Overcoming Depression’ was found to significantly reduce depression as measured by the Hospital Anxiety Depression Scale (HADS) and the Primary Health Questionnaire-9 (PHQ-9). However due to low statistical power no significant differences were found between the ‘Overcoming Depression’ and a waiting list control group. While all completers evaluated the programme positively, low up-take and high drop out rates suggest that there needs to be careful consideration of how best to integrate this type of treatment in to primary care settings.