Author: Katherine Robinson
Robinson, Katherine, 2024 Investigating the use of an online perfectionism intervention for disordered eating, Flinders University, College of Education, Psychology and Social Work
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Perfectionism is a multifaceted construct which is characterised by inflexible high standards, self-criticism, and concern over mistakes. Perfectionism has been suggested to contribute to the development and maintenance of eating disorders through perfectionistic tendencies being applied to dieting behaviours as well as to control over weight, shape and eating. Interventions tackling perfectionism have shown an impact on symptoms of eating disorders, depression, and anxiety. Online interventions provide a means to increase access to mental health care and offers a low intensity option for individuals considered at-risk of developing an eating disorder. This thesis examined the use of an eight-module online intervention targeting perfectionism, evaluating efficacy in people with disordered eating before conducting effectiveness research in an uncontrolled real-world setting.
The first study reviewed previous perfectionism interventions which have examined disordered eating as an outcome through a systematic search and meta-analysis. Robust effects were observed for the reduction of perfectionism and disordered eating, and moderate effects were described for the reduction of depression and anxiety. The second study was a preliminary uncontrolled feasibility trial of the perfectionism intervention in an online and a university cohort. Qualitative feedback from the university cohort and unsuccessful recruitment attempts in the online cohort led to the revision of intervention content and recruitment strategies ahead of further evaluation. The third study included a fully powered randomised control trial comparing the interactive online intervention format against a static cognitive behavioural therapy intervention for perfectionism. Both active interventions were successful at reducing eating disorder symptom severity compared to control, though a greater number of significant effects were observed for the online interactive format. An implementation feasibility trial was then conducted at a university in the United Kingdom reported against the RE-AIM framework. Due to the limited success of the recruitment efforts and unsustained adoption of the program, a final scoping review was conducted to investigate methods to improve reach and uptake of online mental health interventions across all disorders. The scoping review mapped current efforts to improve initial online engagement and provide suggestions for future initiatives in this area. Despite the proven efficacy of the online perfectionism intervention for reducing perfectionism and related symptomology, further work is needed to optimise the use of digital mental health platforms such that the effectiveness of such programs is capitalised on. Across these studies new information is provided about the feasibility, effectiveness, and current limitations of using online perfectionism interventions to treat disordered eating as an indicative intervention approach.
Keywords: Perfectionism, eating disorders, online interventions, young adults, self-guided intervention
Subject: Psychology thesis
Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Education, Psychology and Social Work
Supervisor: Tracey Wade