Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: A randomized controlled trial

Depression affects at least 10% of women in pregnancy, and the negative impact of post-natal depression and anxiety on mothers and babies is well documented. Women are often very short of time in this demanding period of their life, and examining if a very brief, self-help approach to treatment is effective makes sense, to increase access to treatment which does not involve a lot of time or visiting a specialists office. One approach that might hold promise for depression and anxiety during pregnancy and after the birth of a baby is cognitive behavioural treatment (CBT) for perfectionism (for further details about the treatment see Egan, Wade, Shafran, & Antony, 2014 and Shafran, Egan, & Wade, 2018).

Perfectionism can be thought of as a characteristic where people set demanding goals and react with distress when they do not feel they have achieved their goals, and the tendency to base self-worth on achievement of goals. This can be problematic in women around the birth of a baby as if they hold high standards, for example, in how good they are at being a mother and then when a baby cries a lot or has difficulty sleeping, they may conclude they are ‘not good enough’ as a mother, and this can lead to anxiety and depression. Perfectionism has been shown in many scientific studies to be linked to numerous psychological problems (Egan, Shafran, & Wade, 2011). In our previous research where we followed women from the third trimester of pregnancy to post birth, we found that perfectionism predicted the onset of postnatal depression (Egan, Kane, Winton, Eliot, & McEvoy, 2017).

In the current study 60 women who had high levels of perfectionism and were in the third trimester of pregnancy were involved, 30 received treatment immediately and the remaining women waited for 4 weeks to receive treatment (the ‘control’ group). In the treatment group, women were asked to read the booklet ‘Changing Perfectionism’ (Egan, Shafran, & Wade 2012) which is a brief (44 A4 pages), summarized version of a self-help CBT for perfectionism book (Shafran, Egan, & Wade, 2010). The women were asked to read the booklet over a 4 week period, and each week one of the researchers gave them a quick, 5 minute phone call to check in how they were going with the reading and suggested homework tasks to change their perfectionism (hence the treatment was ‘guided’ self-help). We found that the women who received the guided self-help CBT for perfectionism had reductions in perfectionism at the end of treatment, and when we followed them up three months later their perfectionism was still reduced, so the effect of treatment had been maintained. The control group that had waited for treatment, however, showed no changes in their perfectionism as compared to the women who had received treatment. When we looked at the effects of treatment regarding symptoms of anxiety and depression, we found that changes in perfectionism were associated with decreases in these symptoms. The study was a first look at the effect of brief, self-help CBT for perfectionism in women during pregnancy and post-birth, and more research is needed with larger numbers of women to really establish whether it is an effective treatment. Nevertheless, at this stage the study gives some promising results that a very brief, self-help treatment can reduce perfectionism, which is linked to the onset of post-natal depression. CBT for perfectionism might potentially be a good approach for women who have high perfectionism and are pregnant in order to reduce the impact of anxiety and depression after their birth of their baby.

Read the full paper: Lowndes, T. A., Egan, S. J., & McEvoy, P. M. (in press). Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial. Cognitive Behaviour Therapy. doi:10.1080/16506073.2018.1490810

Talitha Lowndes
Sarah Egan
Peter McEvoy







  • Egan, S.J., Kane, R.T., Winton, K., Eliot, C., & McEvoy, P.M. (2017).  A longitudinal investigation of perfectionism and repetitive negative thinking in perinatal depression. Behaviour Research and Therapy, 97, 26-32.
  • Egan, S.J, Shafran, R., & Wade, T.D. (2012).  Changing perfectionism.  Oxford, UK: Oxford Cognitive Therapy Centre.
  • Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review31, 203-212.
  • Egan, S.J., Wade, T.D., Shafran, R., & Antony, M.M. (2014).  Cognitive-behavioral treatment of perfectionism.  NY: Guilford.
  • Shafran, R., Egan, S., & Wade, T. (2010). Overcoming perfectionism: A self-help guide using cognitive behavioral techniques. London, UK: Robinson.
  • Shafran, R., Egan, S., & Wade, T. (2018). Overcoming perfectionism: A self-help guide using cognitive behavioral techniques, second edition. London, UK: Robinson.


Photo by: Štefan Uram

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