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Electronic Theses, Treatises and Dissertations
The Graduate School
2007
Maladaptive Cognitive Schemas as
Mediators Between Perfectionism and
Psychological Distress
Donghyuck Lee
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THE FLORIDA STATE UNIVERSITY
COLLEGE OF EDUCATION
MALADAPTIVE COGNITIVE SCHEMAS AS MEDIATORS BETWEEN PERFECTIONISM
AND PSYCHOLOGICAL DISTRESS
By
DONGHYUCK LEE
A Dissertation submitted to the
Department of Educational Psychology and Learning Systems
in partial fulfillment of the
requirements for the degree of
Doctor of Philosophy
Degree Awarded:
Summer Semester, 2007
Copyright © 2007
Donghyuck Lee
All Rights Reserved
The members of the Committee approve the dissertation of Donghyuck Lee defended on April
14, 2006.
_______________________(signed)
F. Donald. Kelly
Professor Directing Dissertation
_______________________(signed)
Thomas A. Cornille
Outside Committee Member
_______________________(signed)
Gary W. Peterson
Committee Member
_______________________(signed)
James P. Sampson
Committee Member
Approved:
__________________________________________________
Frances F. Prevatt, Chairperson
Department of Educational Psychology and Learning Systems
The Office of Graduate Studies has verified and approved the above named committee members.
ii
ACKNOWLEDGMENTS
I am blessed to have received abundant support from many wonderful people throughout
this endeavor. First, I would like to thank God for His being my shelter and power to complete
this project. I am deeply grateful to my parents whose sincere belief in my abilities and
unconditional support of love helped me travel this long path. Also, I would like to express my
gratitude to my wife. She has always been an unwavering source of strength and support for me
as a spouse, and had empathized with the difficult process of dissertation assisting me as a
colleague. Without her, I could not have accomplished this project.
I would also like to thank my mentor and advisor, Dr. Donald Kelly. He has always been
willing to listen to my concerns, which helped me to grow as a person and a profession. In
addition, he has been a wonderful role model to me as a researcher, teacher, and counselor. I am
also grateful to Dr. Gary Peterson, Dr. James Sampson, and Dr. Tomas Cornille for their advice
and insight for my career and dissertation. They have openly shared their knowledge of research
and guided me for my future. Moreover, Dr. Richard Tate and Dr. Akihito Kamata have
provided me with a valuable advice of statistics and methodology. I also appreciate their
willingness to share their knowledge with me.
To my friends and colleagues, I am thankful for their being with me as helpers and
supporters on this journey. Their honest friendship, constant prayer, and unfettered faith in me
allowed me to enjoy this long path.
Finally, I would like to thank my two sons, Daniel and Joshua for their unconditional
love for me. They has always been my joy and happiness, and provided me with reason to
accomplish all this journey and endeavors.
iii
TABLE OF CONTENTS
List of tables................................................................................................................................... vi
List of figures............................................................................................................................... vii
Abstract ........................................................................................................................................ viii
INTRODUCTION .......................................................................................................................... 1
Statement of the Problem.................................................................................................. 1
Purpose of study................................................................................................................ 4
Hypothesized Model ......................................................................................................... 4
Research Questions and Hypotheses ................................................................................ 6
Definition of Terms........................................................................................................... 9
REVIEW OF THE LITERATURE .............................................................................................. 11
The nature of perfectionism ............................................................................................ 11
Perfectionism and Cognitive Schemas............................................................................ 16
Perfectionism and psychological distress ....................................................................... 21
Perfectionism and Depression.............................................................................. 21
Perfectionism and Anxiety................................................................................... 24
Cognitive Schemas and Psychological Distress ............................................................. 27
Perfectionism, Cognitive Schema, and Psychological Distress...................................... 30
Summary ......................................................................................................................... 33
METHODOLOGY ....................................................................................................................... 34
Participants...................................................................................................................... 34
Procedure ........................................................................................................................ 35
Instruments...................................................................................................................... 36
Perfectionism ....................................................................................................... 36
Maladaptive Cognitive Schema ........................................................................... 39
Depression............................................................................................................ 42
Anxiety................................................................................................................. 45
Data Analysis .................................................................................................................. 48
iv
RESULTS ..................................................................................................................................... 50
Introduction..................................................................................................................... 50
Preliminary Analysis....................................................................................................... 50
Primary Analyses ............................................................................................................ 54
Depression Model ................................................................................................ 55
Anxiety Model ..................................................................................................... 58
DISCUSSION ............................................................................................................................... 63
Introduction..................................................................................................................... 63
Summary of the study ..................................................................................................... 63
Interpretation of the results ............................................................................................. 64
Depression Model ................................................................................................ 64
Anxiety Model ..................................................................................................... 67
Clinical implications for counseling ............................................................................... 70
Implications for perfectionistic individuals .................................................................... 71
Limitations and recommendation for future study.......................................................... 73
Conclusions..................................................................................................................... 75
APPENDIX A: Informed Consent Forms..................................................................................... 76
APPENDIX B: Demographic Questionnarie................................................................................ 80
REFERENCES ............................................................................................................................. 82
BIOGRAPHICAL SKETCH ........................................................................................................ 97
v
LIST OF TABLES
Table 1.
Bivariate correlations, means, standard deviations for latent variables in
depression model
53
Table 2.
Bivariate correlations, means, standard deviations for latent variables in anxiety
model
53
Table 3.
Chi-squares, degrees of freedom, and fit indices for the hypothesized and
revised depression model
56
Table 4.
Chi-squares, degrees of freedom, and fit indices for the hypothesized, initial
revised, and second revised anxiety model
61
Table 5.
Standardized path coefficients and standard error for the second revised model
61
vi
LIST OF FIGURES
Figure 1.
A hypothesized depression model that depicts the association between socially
prescribed perfectionism, maladaptive cognitive schemas, and depression
8
Figure 2.
A hypothesized anxiety model that delineate the relationship between socially
prescribed perfectionism, maladaptive cognitive schemas, and anxiety
8
Figure 3.
A revised model and standardized path coefficients of the relationships between
socially prescribed perfectionism, maladaptive cognitive schemas, and
depression
57
Figure 4.
An initial revised model and standardized path coefficients of the associations
between socially prescribed perfectionism, maladaptive cognitive schemas, and
anxiety
59
Figure 5.
A second revised model and standardized path coefficients of the relationship
between socially prescribed perfectionism, maladaptive cognitive schemas, and
anxiety
62
vii
ABSTRACT
This study examines the relationship between perfectionism, maladaptive cognitive
schemas, and psychological distress. Particularly, the mediating effects of maladaptive cognitive
schemas between socially prescribed perfectionism and psychological distress such as depression
and anxiety are explored using structural equation modeling. For the study, the data were
collected from 281 college students who attend in a large southeastern public university. A final
sample of 233 students was used for the data analysis after deleting and replacing missing data.
In order to analyze the data, the hypothesized models to be tested were constructed based on
theoretical models and previous empirical studies. The models depict that the maladaptive
cognitive schemas—fear of abandonment, defectiveness/shame, functional
dependence/incompetence, and insufficient self-control—mediate the relationship between
socially prescribed perfectionism and depression. On the other hand, the association of socially
prescribed perfectionism and anxiety is mediated by the maladaptive cognitive schemas—fear of
abandonment, vulnerability to harm, and failure to achieve. To test these hypothesized models,
the following four instruments were administered to subjects: the Multidimensional
Perfectionism Scale (Hewitt & Flett, 1991c), the Schema Questionnaire-Short Form (Young,
1990), the Center for Epidemiologic Studies Depression Scale (Radloff, 1977), and the StateTrait Anxiety Inventory (Spielberger, 1983). The results reveal that both hypothesized
depression and anxiety models do not fit the observed data. However, the anxiety model provides
an adequate fit to the data following a model revision. Furthermore, the model meets all the
requirements for mediating effects to exist. These findings suggest that 1) the association
between socially prescribed perfectionism and anxiety is not linear, but that an underlying
mechanism exist in the relationship, and 2) specific maladaptive cognitive schemas, such as Fear
of Abandonment and Failure to Achieve, mediate the relationship between socially prescribed
perfectionism and anxiety. In addition, the Vulnerability to Harm schema indirectly influences
the association through Fear of Abandonment. These results focus attention on the specific
cognitive components involved in precipitating socially prescribed perfectionists’ psychological
distress. However, the current study is not without limitations in spite of the significant outcomes.
Based on these limitations, the study recommended several future research directions.
viii
CHAPTER ONE
INTRODUCTION
Statement of the Problem
Perfectionism is one of the most prevalent social values existing in most industrialized
societies. D. D. Burns (1980) held that perfectionistic attitudes are remarkably widespread
among people, as well as a cultural phenomenon reinforced by language, the media, and
religious beliefs. Individuals in current society are willing to pay a painful price of perfectionism
because they believe it leads them to high level of excellence and productivity. However, the
outcomes of perfectionism are not always positive. Along with the positive aspects of
perfectionism, such as high achievement and successful performance, many researchers
emphasized the negative outcomes of perfectionism (Blatt, 1995; D. D. Burns, 1980; Hamachek,
1978; Pacht, 1984). Blatt (1995) pointed out the destructive results of seeking perfection. He
illustrated two talented and accomplished individuals who committed suicide. Even though both
gifted individuals were very successful lawyers, they were never satisfied with their success.
Consequently, their intense striving resulted in a pattern of self criticism, judgment toward others,
despondency, depression, and ultimately suicide.
This dysfunctional aspect of perfectionism has been claimed by various theories and
empirical studies. Beck (1967) theorized that the individuals who have excessively high personal
goals would experience emotional disturbances. Similarly, other theorists pointed out that
perfectionists suffer from psychological distress because of their stringent evaluation of
themselves and high standards (Ansbacher & Ansbacher, 1956; D. D. Burns, 1980; Hamachek,
1978). Various empirical studies have explored the relationship between perfectionism and
psychological distress and have found perfectionism to be one of the factors that may promote
the development of depression (Blatt, 1995; Blatt, D'Afflitti, & Quinlan, 1976; Hewitt & Dyck,
1986; Hewitt & Flett, 1990, 1991b) and anxiety (Blankstein, Flett, Hewitt, & Eng, 1993; Flett,
Hewitt, Endler, & Tassone, 1994-1995; Saboonchi & Lundh, 1997). In addition, perfectionism
has been associated with many other psychological problems, such as eating disorder (Bastiani,
Rao, Weltzin, & Kaye, 1995; Hewitt, Flett, & Ediger, 1995; Minarik & Ahrens, 1996; Owens &
1
Slade, 1987), obsessive-compulsive symptoms (Frost & Steketee, 1997; Frost, Steketee, Cohn, &
Griess, 1994), and social phobia (Bieling & Alden, 1997; Juster et al., 1996).
Furthermore, perfectionism has been a difficult problem to treat and change (Blatt, 1995).
Blatt, Quinlan, Pilkonis, and Shea (1995; 2002) have indicated that perfectionism, as assessed by
the Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978), is associated with poor
treatment response and problems with establishing a good working alliance between the therapist
and client. The findings hold across several different types of treatment. Such is the case because
perfectionists tend to hold on to their standards due to the perceived benefits and rewards (Flett
& Hewitt, 2002). As well, they become perfectionistic in the treatment process and
underestimate treatment outcomes with their dichotomous thinking (Sorotzkin, 1998).
In spite of these negative outcomes of perfectionism and its resistance to change, much
research continues to focus on the fundamental association between perfectionism and
psychological distress without exploring the underlying mechanisms. Only recent studies have
attempted to explore the underlying mechanisms that explain the relationship between
perfectionism and psychological distress. For instance, ego defense style (Flett, Besser, & Hewitt,
2005), stress (Chang, Watkins, & Banks, 2004), unconditional self-acceptance (Flett, Besser,
Davis, & Hewitt, 2003), self-concealment (Kawamura & Frost, 2004), and self-esteem (Rice,
Ashby, & Slaney, 1998) were identified as mediating mechanisms that influenced the
relationship between perfectionism and psychological distress. Frazier, Tix, and Baron (2004)
suggested that understanding the underlying change mechanisms in the relationship between
predictor and outcome variables is critical for counseling interventions because the mechanisms
provide information relevant to understanding effective components of treatments. Furthermore,
these efforts may enables researchers to build and test theory regarding the causal mechanisms
responsible for change (Judd & Kenny, 1981; MacKinnon, 2000; MacKinnon & Dwyer, 1993).
Therefore, diverse potential mechanisms in the relationship between perfectionism and
psychological distress are to be more focused on in order to decrease the perfectionists’
resistance to change and improve treatment effectiveness.
Current theories of perfectionism have suggested a variety of intervening cognitive and
affective variable that may mediate the relationship between perfectionism and psychological
distress. For example, perfectionists tend to have such dysfunctional cognitive emotional
processes such as “should” statements (Ellis, 2002), dichotomous thinking (Beck, 1976;
2
Mahoney & Arnkoff, 1979), overgeneralization (Beck, 1976; D. D. Burns, 1980), feelings of
inferiority (Ansbacher & Ansbacher, 1956), and shame or guilt (Hamachek, 1978). These
maladaptive cognitive affective variables are believed to determine perfectionists’ mood and
behavior because those are the ways in which perfectionists structure the world (Brown & Beck,
2002). However, to date, very few studies have confirmed these mediating mechanisms.
Although some empirical studies have explored components which may have an influence on
psychological distress, more studies should be done to expand these knowledge of the
mechanisms (Flett et al., 2003; Flett, Hewitt, Blankstein, & Gray, 1998; Sherry, Hewitt, Flett, &
Harvey, 2003).
Consequently, the present study attempted to clarify the mechanisms that would mediate
the relationship between perfectionism and psychological distress. In particular, socially
prescribed perfectionism, among three types of perfectionism suggested by Hewitt and Flett
(1991c), was employed in this study. This variant of perfectionism has been significantly and
consistently associated with psychological distress across previous studies. This contrasts with
self-oriented and other oriented perfectionism which have demonstrated a less stable relationship
with psychological distress. It was anticipated that the results of the proposed study would clarify
why socially prescribed perfectionists suffered from psychological distress and how socially
prescribed perfectionism was related to emotional disturbances. Particularly, the study focused
on the mediating effects of maladaptive cognitive schemas as suggested by the theories of
perfectionism. Also, among the various psychological problems that socially prescribed
perfectionism might produce, depression and anxiety were examined because they were the two
most prevalent psychological problems among university students. Miller and Rice (1993)
discovered that 53% of the students, who have attended a university counseling center, reported
that they were experiencing depression and 30% presented problems with concentration, fears,
and nervousness. In a survey of student needs at a large urban university, more than one third of
the students reported a need for assistance with depression and anxiety (Bishop, Bauer, & Becker,
1998).
3
Purpose of Study
The purpose of this study is to examine the potential mediating effects of maladaptive
cognitive schemas on the relation between socially prescribed perfectionism and psychological
distress—depression and anxiety respectively—in a sample of college students using a structural
equation modeling approach. Mediators serve to explain “how” or “why” certain variables
predict or cause an outcome variable. In other words, mediators are the mechanism through
which a predictor influences an outcome variable (Baron & Kenny, 1986; Frazier et al., 2004;
Holmbeck, 1997). More specifically, in the context of current study, maladaptive cognitive
schemas may explain why socially prescribed perfectionists experience more psychological
distress than do non-perfectionists. Such findings reveal a key mechanism in socially prescribed
perfectionists’ vulnerability to psychological distress.
In order to examine this relationship, hypothesized models were created based on
theoretical foundations and previous empirical studies. Existing theories of perfectionism hold
that perfectionists experience psychological distress such as depression and anxiety because they
possess maladaptive cognitive schemas (Beck, 1976; D. D. Burns, 1980; Ellis, 2002; Hamachek,
1978). As well, some preliminary empirical studies have supported this connection (Flett, Hewitt,
Blankstein, & Koledin, 1991; Flett, Russo, & Hewitt, 1994). This study tested hypothesized
models to determine whether the model provided a good fit to the data collected. A good model
fit would shed light on the specific cognitive mechanisms that mediate the association between
socially prescribed perfectionism and psychological distress. The model to be tested in this study
includes socially prescribed perfectionism as a predictor, maladaptive cognitive schemas as
mediators, and depression and anxiety as outcome variables, as shown in Figure 1 and Figure 2.
Hypothesized Model
Based on current theories of perfectionism and recent empirical studies, two hypothesized
models were constructed: the depression model and the anxiety model. First, Fear of
Abandonment, Defectiveness/Shame, Functional Dependence/Incompetence, and Insufficient
Self-Control were hypothesized to mediate the relationship between socially prescribed
perfectionism and depression (Beck, 1967; Flett et al., 1991; Flett et al., 1994; Guidano & Liotti,
1983; Hamachek, 1978; Hewitt & Flett, 1991c). Socially prescribed perfectionists, who would
4
believe that 1) significant others may reject them when they do not reach the standards set by
others (Fear of Abandonment), 2) they are not capable of achieving goals because the standards
are too high (Dependence/Incompetence), 3) they are worthless because they always fail to
accomplish the goals established by significant others (Defectiveness/Shame), and 4) they will
lose self-control before they achieve their personal goals (Insufficient Self-Control), are
vulnerable to depression. Such is the case because socially prescribed perfectionists are likely to
be concerned with meeting other’s standards, exhibit a greater fear of negative evaluation, and
place greater importance on obtaining the attention but avoiding the disapproval of others
(Hewitt & Flett, 1991c). Moreover, socially prescribed perfectionism has been found to be
correlated with a variety of irrational beliefs including demand for social approval, dependency,
blame proneness, and anxious overconcern (Flett et al., 1991; Flett et al., 1994; Hamachek, 1978).
Depression also has been associated with these schemas. According to cognitive theories and
empirical studies, the depressed individual believes that others would abandon them because
they are worthless (Fear of Abandonment and Defectiveness/Shame), and that they are too weak
to deal with rejection, hopelessness, and helplessness (Dependency/Incompetence and
Insufficient Self-Control) (Beck, 1967; Beck, Rush, Shaw, & Emery, 1979; D. A. Clark & Beck,
1989; Glaser, Campbell, Calhoun, Bates, & Petrocelli, 2002; Guidano & Liotti, 1983; Joiner &
Schmidt, 1995; Petrocelli, Glaser, Calhoun, & Campbell, 2001; Welburn, Coristine, Dagg,
Pontefract, & Jordan, 2002).
The second outcome variable of interest in this study is anxiety. Existing literature
suggests that Fear of Abandonment, Vulnerability to Harm, and Failure to Achieve may mediate
the association between perfectionism and anxiety (Breger, 1974; Flett et al., 1991; Guidano &
Liotti, 1983; Hamachek, 1978; Hewitt & Flett, 1991c). In other words, socially prescribed
perfectionists, who would believe that 1) significant others may reject them when they do not
reach the standards set by others (Fear of Abandonment), 2) they will have psychological setbacks and physical problems because they are too weak to deal with life stresses (Vulnerability
to Harm), 3) they fail to accomplish their goals because they are untalented, stupid, and less
successful than others (Failure to Achieve), are vulnerable to anxiety. These effects are assumed
due to the fact that socially prescribed perfectionists are inclined to anticipate others’ negative or
harsh judgment, and blame themselves for failure to reach the standards, and expect rejection
from significant others due to their worthlessness (Flett et al., 1991; Hamachek, 1978; Hewitt &
5
Flett, 1991c). Furthermore, it has been suggested by cognitive constructivist theorists that
anxious individuals view themselves as weak within a threatening and hostile world and possess
fear of abandonment from significant others (Breger, 1974; Guidano & Liotti, 1983). Empirical
studies have supported that contention that anxiety is related to cognitions of harm, danger, threat
and fear of abandonment in college students (Beck & Emery, 1985; S. Epstein, 1972; Glaser et
al., 2002; Goldfried & Sobocinski, 1975; Joiner & Schmidt, 1995; Spielberger, 1972; Welburn et
al., 2002).
Consequently, the above hypothesized models were constructed based on both current
theories of perfectionism and existing empirical studies. In summary, the depression model
proposes the cognitive schemas of Fear of Abandonment, Defectiveness/Shame, Functional
Dependence/Incompetence, and Insufficient Self-Control as mediators of the relationship
between socially prescribed perfectionism and depression. Similarly, the anxiety model suggests
that the connection between socially prescribed perfectionism and anxiety will be mediated by
Fear of Abandonment, Vulnerability to Harm, and Failure to Achieve.
Research Questions and Hypotheses
The primary research question asks: What is the relationship between socially prescribed
perfectionism, maladaptive cognitive schemas, and psychological distress among university
students? In particular, the current study examines 1) whether maladaptive cognitive schemas
(Fear of Abandonment, Defectiveness/Shame, Functional Dependence/Incompetence, and
Insufficient self-control) mediate the relationship between socially prescribed perfectionism and
depression, and 2) whether maladaptive cognitive schemas (Fear of Abandonment, Failure to
achieve, and Vulnerability to harm) mediate the relationship between socially prescribed
perfectionism and anxiety. In addressing these questions, this study expects to confirm the
theoretically derived model of the relationship between socially prescribed perfectionism,
maladaptive cognitive schemas, and psychological distress. Particularly, the mediating effects of
maladaptive cognitive schemas on the relationship between perfectionism and psychological
distress are verified.
Based on the research questions, the study advances the following specific hypotheses.
These hypotheses are proposed based on the testing process of mediating effects using a
6
structural equation modeling analysis, which is suggested by Baron and Kenny (1986), Frazier et
al. (2004), and Hoyle and Smith (1994).
1. The coefficient of the direct path from socially prescribed perfectionism to depression
and anxiety will be statistically significant (path a in Figure 1 and path x in Figure 2). As
well, socially prescribed perfectionism will have positive relationship with depression
and anxiety respectively. As subjects’ reported socially prescribed perfectionism
increases, so too will their reported depression and anxiety. A significant relationship
establishes that there is an effect to be mediated.
2. The overall model involving direct paths from socially prescribed perfectionism to
maladaptive cognitive schemas, from maladaptive cognitive schemas to psychological
distress, and socially prescribed perfectionism to psychological distress will fit the
observed data (see paths a, b, and c in Figure 1, and paths x, y, and z in Figure 2). As well,
socially prescribed perfectionism, maladaptive cognitive schemas, and psychological
distress will be associated with each other statistically significantly and positively.
3. The path coefficients from socially prescribed perfectionism and psychological distress
will be significantly reduced when the model with the direct path was compared with the
overall model including mediating variables. Both fitness of the overall model and
significant declination in path coefficients indicate that maladaptive cognitive schemas
mediate the relationship between socially prescribed perfectionism and depression, and
anxiety respectively. The outcome variables, depression and anxiety, will be tested
separately.
7
Fear of Abandonment
Defectiveness/Shame
Functional
Dependence/Incompetence
b
c
Insufficient self-control
Socially
Prescribed
Perfectionism
Depression
a
Figure 1. A hypothesized depression model that depicts the association between socially
prescribed perfectionism, maladaptive cognitive schemas, and depression
Fear of Abandonment
Vulnerability to harm
y
z
Failure to achieve
Socially
Prescribed
Perfectionism
Anxiety
x
Figure 2. A hypothesized anxiety model that delineate the relationship between socially
prescribed perfectionism, maladaptive cognitive schemas, and anxiety
8
Definition of Terms
Socially prescribed perfectionism: the individual’s beliefs that others expect them to
achieve unrealistically high standards, judge them based on the high standards, and
require them to be perfect. Due to these beliefs, socially prescribed perfectionists are over
concerned with meeting other’s standards, exhibit a greater fear of negative evaluation,
and blame themselves for failure to reach the standards (Hewitt & Flett, 1991c).
Furthermore, they expect abandonment from significant others; they place greater
importance on obtaining the attention but avoiding the disapproval of others (Hamachek,
1978).
Depression: depressed mood or the loss of interest, including symptoms such as changes
in appetite or weight, sleep, and psychomotor activity; reduced energy; feelings of shame
or guilt; difficulty thinking, paying attention, or making decisions; and persistent
thoughts of death or suicidal ideation, plans, or attempts (American Psychiatric
Association, 2000).
Trait Anxiety: an individual’s predisposition to identify threats across a wide range of
stimuli. Trait anxiety remains relatively invariable and is more like potential energy that
will be triggered by a specific situation (Spielberger, 1972).
The following definitions clarify the meaning of maladaptive cognitive schemas
in the context of this study. These definitions are excerpted from Cognitive Therapy for
Personality Disorders: A Schema-Focused Approach (Young, 1999).
Fear of Abandonment: Unstable and unreliable perception of those available for support
and association. It engages the view that significant others will not consistently offer
emotional support, connection, strength, or practical security.
Defectiveness/Shame: The feeling that one is imperfect, awful, useless, inferior, or
worthless; or that one will be unacceptable to significant others.
Functional Dependence/Incompetence: The belief that one is not capable to deal with
one’s everyday responsibilities in a proficient way, without significant assistance from
others. Often it reveals as helplessness.
9
Vulnerability to harm or illness: Overstated fear that impending tragedy will strike at any
time and that one will be unable to avoid it. Fears are related to one or more of the
following: a) medical catastrophes, b) emotional upheavals, and c) external disasters.
Failure to achieve: The belief that one has failed, will certainly fail, or is essentially
insufficient comparative to one’s peers, in areas of accomplishment. Often involves
views that one is unintelligent, incompetent, maladroit, ignorant, lower in status, and less
successful than others.
Insufficient self-control: Persistent difficulty in exercising adequate self-control and
frustration forbearance to attain one’s personal goals, or to restrain the excessive
expression of one’s emotions and desires.
10
CHAPTER TWO
REVIEW OF THE LITERATURE
Introduction
This chapter reviews the literature that has examined the relationship between
perfectionism, maladaptive cognitive schemas, and psychological distress. First, the nature of
perfectionism will be discussed in order to provide a fundamental understanding of this construct.
Second, the relationships between each variable, such as perfectionism and maladaptive schemas,
perfectionism and psychological distress, and maladaptive cognitive schemas and psychological
distress, will be examined based on prior studies. Third, the prior literature will be introduced,
which explored the overall relationship between perfectionism, maladaptive cognitive schemas,
and psychological distress. For each section, a discussion of future research topics will follow.
The Nature of Perfectionism
There has been intense debate and controversy about the conceptualization of
perfectionism since Hollander (1978) pointed out that perfectionism is an ignored personality
trait in spite of its significance. Some theorists describe perfectionism as a unidimensional trait
emphasizing on its cognitive aspects such as irrational beliefs (Ellis, 1962) and dysfunctional
attitudes (D. D. Burns, 1980). However, others viewed perfectionism as a multidimensional
personality trait emphasizing its positive and negative aspects. Ellis (1958) defined perfectionism
as an inflexible belief that one should be thoroughly capable, satisfactory, intelligent, and
successful in all respects. Beck (1976) also identified perfectionism in terms of a dysfunctional
cognitive style characterized by dichotomous thinking and overgeneralization. The dichotomous
thinking style is one of the major problems found among perfectionists. D. D. Burns (1980)
identified it as “all or nothing” thinking and Barrow and Moore (1983) described it as “saint or
sinner polarity.” For perfectionists, there is no middle ground in the continuum; only the
extremes of the continuum exist. Due to this pattern of thinking, perfectionists perceive the
achievement of 95% or even 99% of the goal as a failure because it is not perfect (Pacht, 1984).
Therefore, perfectionists are “those whose standards are high beyond reach or reason, people
11
who strain compulsively and unremittingly toward impossible goals and who measure their own
worth entirely in terms of productivity and accomplishment” (D. D. Burns, 1980, p. 34).
However, a problem with this unidimensional definition of perfectionism is that it does
not distinguish dysfunctional perfectionistic people from those who are highly competent,
successful, and well-functioning. The setting of and striving for high standards is certainly not, in
and of itself, pathological (Frost, Marten, Lahart, & Rosenblate, 1990). For example, Owens and
Slade (1987) compared perfectionism and dissatisfaction in marathon runners and eating
disorders. They found that marathon runners’ perfectionism level was comparable to the level
seen in individuals with eating disorders. However, marathon runners’ level of dissatisfaction
was significantly higher than those of eating disorder group, and even similar to those of normal
subjects. This research suggests that conceptualizing perfectionism as a unidimensional trait fails
to take full account of both positive and negative aspects of perfectionism.
According to Hamachek (1978), there are both healthy and unhealthy characteristics
associated with perfectionism. Hamachek (1978) and Missildine (1963) have both noted that one
of the most important differences between healthy and unhealthy perfectionists is their level of
satisfaction when striving for their high standards. The healthy perfectionists report a deep sense
of satisfaction, but unhealthy perfectionists do not. Also, healthy perfectionists are inclined to
improve their self-esteem, be satisfied with their skills, and value a well-performed job. However,
this is not true for unhealthy perfectionists. The unhealthy perfectionists are not able to feel
satisfaction because they perceive that their works are never good enough to obtain that feeling
(Hamachek, 1978). The unhealthy perfectionists demand an unattainable level of performance,
which significantly diminishes any positive feeling about themselves. Meanwhile, healthy
perfectionists establish appropriate level of goals for performance, acknowledging both their
limitations and strengths. Therefore, they are more likely to succeed and have both more
reasonable and realistic self-expectations. Finally, the unhealthy perfectionist worries about their
defectiveness and over-emphasizes how to avoid making mistakes. The healthy perfectionist
focuses on strengths and how to do things right (Hamachek, 1978).
This distinction between positive and negative aspects of perfectionism can be explained
by a behavioral perspective in terms of the function of reinforcement. According to Terry-Short,
Owens, Slade, and Dewey (1995), positive perfectionists’ behaviors are a function of positive
reinforcement (i.e., motivation to move toward rewarding stimuli). For example, the positive
12
perfectionist tends to seek support from others, desires to approximate their ideal self, and
secures satisfaction and pleasure when they succeed. In contrast, negative perfectionism is
represented as a result of negative reinforcement (i.e., aspiration to avoid aversive results). In
other words, positive perfectionism is a function of positive reinforcers or outcomes, and
negative perfectionism is associated with the avoidance of aversive stimuli or outcomes. For
example, the negative perfectionist avoids possible disapproval from others, ignores their feared
self as much as possible, and is dissatisfied with goal-directed behavior because they expect
potential failure. In other words, positive perfectionism is a function of positive reinforcers or
outcomes, and negative perfectionism is associated with the avoidance of aversive stimuli or
outcomes. The explicit behavior of the positive and negative perfectionist seems to identical, but
the implicit goals of behaviors are different. Two kinds of perfectionists may experience very
different consequences after failing to achieve goals. Skinner (1968) held that identical behavior
might be associated with quite different emotional states according to whether it is performed in
a function of positive or negative reinforcement. If a person does something to obtain positive
reinforcement, the behavior is considered to be a ‘free choice’. On the other hand, performing the
same behavior to avoid a negative effect is perceived to be ‘coerced.’ This distinction is
consistent with Hamachek’s notion that “normal perfectionists focus on their strengths and how
to do things right” (p.28) while neurotic perfectionists are motivated by fear of failure
(Hamachek, 1978).
Adler also distinguished normal perfectionism from neurotic perfectionism in terms of
the striving for social interest and the management of inferiority feelings (Ansbacher &
Ansbacher, 1956). Normal perfectionists strive for an adequate level of perfection and
experience controllable levels of inferiority feelings, resulting in constructive management of
these feelings. They reveal high levels of social interest and seek to conquer their feelings of
inferiority through behaviors that benefit themselves and others. In contrast, neurotic
perfectionists struggle with more numerous feelings of inferiority and seek unrealistic perfection.
They exhibit lower levels of social interest and try to obtain personal power and personal
superiority, without regard or concern for others. Similarly, Ashby and Kottman (1996) found
that one of the major differences between normal and neurotic perfectionism was the level of
inferiority perceived by individuals. In their study, the score of neurotic perfectionists on feelings
of inferiority, as measured by the Comparative Feeling of Inferiority Index (Strano & Dixon,
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1990), was significantly higher than that of normal perfectionists. Neurotic perfectionists also
scored significantly higher than normal perfectionists on perfectionism as measured by the
Almost Perfect Scale—Revised (Slaney, Rice, Mobley, & Trippi, 2001). These results suggested
that the individuals who exhibited relatively higher levels of inferiority feelings might experience
psychological distress and negative perfectionism. In contrast, the individuals who were rated
with comparatively lower levels of inferiority feelings were unlikely to experience psychological
distress and might strive for perfection positively.
Recent research has supported the distinction between adaptive and maladaptive
perfectionism. For instance, Frost, Heimberg, Holt, Mattia, and Neubauer (1993) found that
adaptive perfectionism was positively associated with positive affect but was unrelated to
depressive symptoms and negative affect. On the other hand, they found that maladaptive
perfectionism was positively related with depressive symptoms and negative affect. These results
were also corroborated by the findings produced from a factor analysis of the subscale scores of
two perfectionism measurements, the Frost Multidimensional Perfectionism Scale (FMPS; Frost
et al., 1990) and the Hewitt and Flett’s Multidimensional Perfectionism Scale (HFMPS; Hewitt
& Flett, 1991c). The analysis generated a two-factor solution, which were labeled as Maladaptive
Evaluation Concerns and Positive Striving. The first factor included the sub-factors of Concern
over Mistakes, Parental Expectations, Parental Criticism, and Doubt about Actions subscales of
the FMPS, and Socially Prescribed Perfectionism subscale of the HFMPS. These subscales were
positively correlated with psychological distress or negative affect. The second factor included
the sub-factors of Personal Standards, and Organization subscales of the FMPS, and Selforiented Perfectionism and Other-oriented Perfectionism scales of the HFMPS. These subscales
were positively associated with positive affect and negatively related to psychological distress.
Consistent with these findings, Slaney, Ashby, and Trippi (1995) also supported the
distinction between adaptive and maladaptive perfectionism. Their study investigated the
relationship between the subscales of several measures of perfectionism utilizing a principal
component factor analysis. The analysis produced a two-factor solution; one factor was labeled
adaptive perfectionism and the second was labeled maladaptive perfectionism. They also
reported a factor analysis of perfectionism subscales scores that included the subscales of the two
Multidimensional Perfectionism Scales (MPS) and the subscales of the Almost Perfect Scale
(APS; Slaney & Johnson, 1992). Again, a two-factor solution including adaptive perfectionism
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and maladaptive perfectionism was suggested. The MPS subscales were then grouped into two
factors as in the results from the research of Frost et al. (1993). The APS dimensions of
Standards and Order loaded on adaptive perfectionism and the dimensions of Relationships,
Anxiety, and Procrastination loaded on maladaptive perfectionism.
Furthermore, Terry-Short et al. (1995) identified two discrete types of perfectionism by
conducting a factor analysis of a perfectionism instrument they developed. The study intended to
measure perfectionism explicitly defined in terms of positive versus negative perfectionism.
After scrutinizing several developed assessments of perfectionism, the authors formulated a new,
40-item questionnaire with a deliberate balance of items measuring positive and negative
perfectionism and personal versus socially prescribed perfectionism. A factor analysis produced
a three-factor solution: (1) negative perfectionism including both personal and social items; (2)
positive personal perfectionism; and (3) positive social perfectionism. Limiting the number of
factors to two yielded a clear distinction between positive and negative perfectionism. The twofactor solution effectively discrimintated between groups; a sample of successful athletes showed
high positive perfectionism associated with a low negative perfectionism score while a sample of
people with eating disorders showed a high positive perfectionism score to be associated with a
high negative perfectionism score. When analyzed in terms of personal and social items with
both the negative and positive components, the athlete obtained comparatively high positive
personal perfectionism score. However, the clinical group showed comparatively higher negative
perfectionism scores than did the athletes.
Further, studies exploring the relationship between perfectionism dimensions and
personality factors have consistently found that adaptive perfectionism is strongly correlated
with conscientiousness while maladaptive perfectionism is strongly associated with neuroticism
(Hill, McIntire, & Bacharach, 1997; Stumpf & Parker, 2000). Other researchers who have made
a conceptual distinction between adaptive and maladaptive perfectionism also reported similar
findings (Dunkley, Zuroff, & Blankstein, 2003; Slaney et al., 2001; Terry-Short et al., 1995).
Consequently, despite arguments about the definition of this construct, theories of
perfectionism and associated empirical studies have confirmed that perfectionism is not
unidimensional, but multidimensional. There is both positive and negative perfectionism.
Positive perfectionism is associated with satisfaction and positive affect, and negative
perfectionism is related to negative affect and a variety of psychological distress. Additional
15
studies need to examine potential variables that may clarify the differences between positive and
negative perfectionism.
Perfectionism and Cognitive Schemas
According to cognitive theory, cognitive structures called schemas screen, code, and
evaluate incoming stimuli. On the basis of schemas, individuals orient themselves and interpret
experiences in a meaningful way. Schemas are gradually elaborated during the long course of
development (Beck, 1976; Guidano & Liotti, 1983). During the course of development, if
individuals experience highly negative environmental events (e.g., abandonment, abuse, or
neglect), they may develop a distorted view of oneself, world, and the future, thus contributing to
the development of maladaptive schemas (Beck, Freeman, & Associates, 1990). Maladaptive
schemas result in the production of negative feelings, such as depression and anxiety (Young,
1999). Based on this theoretical conceptualization, perfectionism can also be explained. Beck
(1976) and Ellis (2002) held that perfectionists demonstrate dysfunctional cognitive structures or
irrational beliefs of perfection, which contributes to the development of emotional disturbances.
In other words, maladaptive schemas may lead to dysfunctional emotions, behaviors, and
physiological responses (Beck et al., 1990). Thus, it is critical to review the cognitive
representations of perfectionism and their relationship to psychological distresses.
One of the most often identified cognitive manifestations of perfectionism is “the
should.” According to Hamachek (1978), perfectionists express the nagging “I should” feeling
the most frequently. D. D. Burns (1980) also contended that perfectionism involves “should”
statements. Such statements create feelings of frustration and guilt that cause individuals to
perseverate on the error. Individuals manifesting this tendency become trapped by nonproductive, self-critical ruminations that lead to psychological distress and an unrealistically
negative self-image. This concept is similar to Horney’s “tyranny of the should” (Horney, 1950),
as well as Ellis’s work on irrational beliefs (Ellis, 1962). Horney’s “tyranny of the should”
exemplifies the exaggerated self-commands in which perfectionists or neurotic people engage.
For example, a perfectionist may internally assert, “I should be perfect,” “I should have been
better,” and “I should be the best.” These stubborn inner dialogues are developed unconsciously,
and therefore perfectionists never consciously understand the true meaning of “the shoulds.”
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Explaining perfectionists’ impractical desire for achievement and their lack of consciousness of
“the shoulds,” Horeny stated that perfectionists were plainly fantastic and tended to strive for
standards that no human being could achieve. However, they were not aware of this process.
With a similar point of view, Ellis (1958) describes that the chief irrational belief of the
perfectionist as follows: “one should be thoroughly competent, adequate, intelligent, and
achieving in all possible respects if one is to consider oneself worthwhile.” (p. 41) As a result of
this imperative, perfectionistic individuals would conclude that it is awful and catastrophic when
things do not turn out successfully. They believe that there is consistently a correct, exact, and
ideal answer to human problems and that it is disastrous if this perfect solution is not found.
Finally, the main goal and purpose of life for the perfectionist is achievement and success.
Defectiveness in anything is an indication that a person is insufficient or worthless (Ellis, 1957,
1962).
Furthermore, Ellis (2002) contends that perfectionists’ strong over-ambitious desires
make them more likely to think that those desires are valid, and that they must be perfectly
accomplished. However, strong preferences limit the possibility of alternative choices. Ellis
suggests that because perfectionists do not realize alternative options, they feel that their strong
preferences must be fulfilled. Because of its strength, the perfectionist’s preference secludes him
or her from alternative choices and makes the particular choice seem compulsory instead of
favored. This is a fairly grandiose idea itself. In stressful conditions, perfectionists may insist
that stress be absent and claim that they achieve perfect resolutions to everyday difficulties.
Therefore, under conditions that are equally stressful to others, perfectionists find more stress,
less satisfaction, and more prolonged difficulties than non-perfectionists.
Beck (1976) and D. D. Burns (1980) described dichotomous or polarized thinking as
another cognitive manifestation of perfectionism. Perfectionists view their inner and external
worlds with two extreme perspectives. In other words, they usually evaluate their ideas and
achievements in terms of “black or white,” “good or bad,” and “wonderful or horrible,” while
ignoring more moderate views. The example given by Beck revealed how a young perfectionistic
college student can think dichotomously. In his example, the student typically brought strong
perfectionistic demands to the way that he played basketball. For instance, the student rated his
basketball performance in the base of his rigid criteria. This resulted in defining himself as a
“failure” if he did not score eight or more points in a game. In fact, he said to himself, “I’m a
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failure” when he scored less than eight points a game. In contrast, this student thought, “I’m a
really great player” if he scored eight or more points in a game.
Similar to Beck’s notion of dichotomous thinking, Mahoney and Arnkoff (1979) also
suggested a saint-or-sinner syndrome as one of cognitive representation of perfectionism. These
authors held that individuals with an excessively stringent cognitive schema considered
themselves as either all good or all bad, either saint or sinner. For example, if individuals with
strict cognitive styles resumed smoking after several months of abstinence, then they might
consider themselves to be failures. As a result, they condemn themselves as “sinners.” This not
only continues self-hatred, but also promotes the maintenance of self-defeating behaviors. This
happens because individuals view their minor mistakes as entirely devastating, making it
extremely difficult for such individuals to regain their self-esteem. This system of thinking can
be understood as a form of punishment. By reprimanding themselves, individuals maintain their
value of perfection and obtain emotional relief. However, self-punishment cause negative affect
and interfere with adaptive behavior for perfectionists (Mahoney & Arnkoff, 1979).
Another cognitive distortion that is easily observed among perfectionists is
overgeneralization (Beck, 1976; D. D. Burns, 1980). This refers to unreasonably generalizing the
outcomes of one aversive experience to future performance. The individual who possesses this
distorted idea tends to jump to the conclusion that a negative event will be repeated endlessly.
Because of such overgeneralized thinking, perfectionists perceive themselves as having a very
limited margin of security (D. D. Burns, 1980). For example, students with this pattern of
cognition, who received a critical review of their performance from a teacher, would then
determine that their overall academic skills are not completely acceptable and that future success
is not possible. These students generalize the consequences of a single incident and concludes
that future acceptable performance is unachievable, which is highly irrational thinking. Because
of this ruthless evaluation, perfectionists are inclined to procrastinate chronically and afraid of
the negative feelings related to a less-than-perfect outcome. Even perfectionists perceive
constructive criticism from others to be negative evaluation for them and overgeneralize it to
their future performance, which make them to avoid beginning a new task (Beck, 1976).
Alfred Adler discussed that the individuals who strive to approach inaccessible targets are
like those who seek to achieve “godlikeness” (Ansbacher & Ansbacher, 1956). He described that
people who overly pursue perfection are neurotic, which happens because they try to compensate
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for implicit feelings of inferiority. Adler held that feelings of inferiority are associated with early
childhood experiences. If individuals receive constant criticism from parents and other authority
figures in early childhood, they develop such feelings. Thus, the individuals try to over achieve
in order to compensate for feelings of inferiority. Adler distinguished between healthy and
unhealthy feelings of inferiority. A healthy feeling of inferiority is fundamental base to
developing into a well-adjusted individual. The healthy form of inferiority feelings stimulates
individuals to perform better, to achieve more, and to put forth the best effort. However, the
unhealthy form of inferiority feelings may completely devastate certain individuals, resulting in
excessively low self-esteem. Thus, the individuals become obsessive in their every performance,
striving for “perfect” behavior. Ironically, feelings of inferiority sometimes result in the
superiority complex because individuals overcompensate for their inferiority feelings in
unhealthy ways, in order to demonstrate that they are competent and perfect in their performance.
Hamachek (1978) suggested shame, guilt, and self deprecation as additional affective and
cognitive manifestations of perfectionism. Shame develops when perfectionists perceive
themselves as not living up to the expectations of others. Further, perfectionists may develop
guilt feelings if they feel that an inner standard has been violated or broken. This notion was
supported by Fedewa, L. R. Burns, and Gomez (2005). They found that negative perfectionism
was positively correlated with shame and guilt in a sample of 220 college students. Perfectionism
was measured by the Positive and Negative Perfectionism Scale (PNPS; Terry-Short et al., 1995),
and shame and guilt were assessed by the Test of Self-Conscious Affect-3 (TOSCA-3; Tangney,
Dearing, Wagner, & Gramzow, 2000) and the State Shame and Guilt Scale (SSGS; Marschall,
Saftner, & Tangney, 1994). Self-deprecation is also commonly observed among perfectionists.
Hamachek stated that self-deprecation serves four primary functions: 1) to confirm a perception
of “I’m not good enough,” 2) to fulfill a need for punishment as a result of not being good
enough, 3) to help them feel as though they have potential worth, and 4) to help them feel an
actual sense of self-worth.
Empirical evidence for the relationship between perfectionists and their distorted
cognitive styles has been provided by Flett et al. (1991). They conducted two different studies to
examine the relationship between perfectionism and irrational thinking. In study 1, 102 subjects
completed the HFMPS and the Irrational Belief Test (IBT; Jones, 1969). Analyses revealed that
self-oriented perfectionism was correlated positively with the IBT high self-expectations and
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perfect solutions subscales. Socially prescribed perfectionism was correlated significantly with a
variety of irrational beliefs including high self-expectations, demand for social approval,
dependency, blame proneness, and anxious overconcern. Other-oriented perfectionism was
correlated with high self-expectations. In this study 2, 139 subjects completed the HFMPS and
the Survey of Personal Beliefs (SPB; Demaria, Kassinove, & Dill, 1989). The data analysis
confirmed that self-oriented perfectionism was associated with self-directed “shoulds” and otherdirected “shoulds.” Other-oriented and socially prescribed perfectionism were correlated with all
of the irrational beliefs, including self-directed “shoulds,” other-directed “shoulds,” awfulizing
beliefs, low frustration tolerance, and low self-worth. The findings clearly showed that all three
perfectionism dimensions are associated with several indices of irrational thinking, which are
essentially consistent with the theoretical formulations of perfectionism. The specific automatic
thoughts they found are high self-expectations, demand for social approval, dependency, blame
proneness, anxious concern, and perfect solutions. Particularly, high self-expectation appeared as
the core cognition of perfectionists. This cognition may lead to emotional distress as well as a
tendency to engage in excessive self-criticism.
Flett et al. (1994) also confirmed the relationship between perfectionism and its cognitive
representations. They administered the HFMPS and the Constructive Thinking Inventory (CTI; C.
Epstein, 1992) to 77 college students. The findings revealed that socially prescribed
perfectionism was negatively associated with constructive thinking and these associations
remained significant after accounting for variance due to levels of depression symptoms. In the
other hand, there was no significant relationship between self-oriented perfectionism and
constructive thinking. The data show that self-oriented perfectionism had a significant negative
relationship with self-acceptance. Similarly, L. R. Burns and Fedewa (2005) revealed that
negative perfectionism, measured by the Positive and Negative Perfectionism Scale (PNPS;
Terry-Short et al., 1995), was strongly and negatively correlated with constructive thinking in a
sample of 221 college students. In addition, negative perfectionism was positively associated
with rumination.
In sum, cognitive theories suggest that perfectionists may demonstrate distorted cognitive
styles, such as “the shoulds” thinking, polarized thinking, overgeneralization, and ideation of
inferiority. These cognitions lead to the development of psychological distress or maladjustment.
As well, the empirical studies supported some aspects of the theories. In particular, they showed
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that perfectionism was associated with negative or irrational thoughts in general. However,
existing empirical research has not uncovered a relationship between perfectionism and specific
patterns or contents of thought. Although some theoretical positions have proposed that
perfectionists will interpret their internal and external worlds in particular ways, and even
suggest what types of irrational views they may have, few empirical studies have supported these
speculations. Thus, the relationship between perfectionism and specific cognitive contents
remains unclear and is, thus, open for further investigation.
Perfectionism and Psychological Distress
Perfectionism and Depression
Perfectionism has been thought to be related to the development and maintenance of
depression. Beck (1967) suggested that individuals experience depression when they have
negative self-evaluations that result from holding excessively high personal standards. Rehm
(1977) also held that depressed individuals set especially rigorous personal goals. In both cases,
it is hypothesized that setting excessively high goals leaves the individual more vulnerable to
experiences of failure, disappointment, and depression. These hypotheses of the relationship
between perfectionism and depression have also been empirically supported.
Hewitt and Flett (1991b) revealed a positive relationship between some subscales of
perfectionism and depression in a sample of depressed patients. They tested the hypothesis that
self-oriented perfectionism and socially prescribed perfectionism are associated with depression.
A sample of 22 depressed patients, 22 matched normal control subjects, and 13 anxiety patients
completed the Multidimensional Perfectionism Scale (MPS), Beck Depression Inventory (BDI),
and Endler Multidimensional Anxiety Scales-State (EMAS-S; Endler, Edwards, & Vitelli, 1991).
It was found that the depressed patients showed a higher mean score on self-oriented
perfectionism than did either the patients with anxiety or the normal control group. In addition,
depressed patients and anxious patients had higher scores on socially prescribed perfectionism
than did the normal control group. However, other-oriented perfectionism was not associated
with depression.
Similarly, Hewitt and Flett (1993) assessed the association of perfectionism with
depression as well as the role of specific stress in depression with a sample of 51 depressed
21
patients and 94 general psychiatric patients. Subjects completed the HFMPS, BDI, and Hassles
Scale (Delongis, Folkman, & Lazarus, 1988). As a result, Self-Oriented Perfectionism and
Socially Prescribed Perfectionism were associated with depression in both samples. A follow-up
analysis with achievement stressors and then interpersonal hassles separately revealed that SelfOriented Perfectionism interacted only with achievement stressors to predict depression. Socially
Prescribed Perfectionism interacted with both interpersonal stress and achievement stress to
predict depression. These results suggest that perfectionism dimensions (Self-Oriented and
Socially Prescribed Perfectionism) are associated with depression and may play a role as a
vulnerability factor in the development of depressive symptoms.
Enns and Cox (1999) examined the relationship between various dimensions of
perfectionism as well as self and observer rated depressive symptoms in a group of 145 patients
with major depressive disorder. Perfectionism was measured by the FMPS and HFMPS and the
Self-Criticism subscale of Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976).
Depression was measured by the Beck Depression Inventory (BDI; Beck, Ward, Mendelson,
Mock, & Erbaugh, 1961), and the Hamilton Depression Ratings (HamD-17; M. Hamilton, 1960),
which is rated by an observer. The results revealed that only three of the ten perfectionism
dimensions (Socially Prescribed Perfectionism, Concern over Mistakes, and Self-Criticism)
displayed medium to large correlations with depressive symptoms. However, medium-sized
correlations remained when the effects of neuroticism and extraversion were controlled for.
These positive relationships between perfectionism and depression were also supported in
a longitudinal study. Hewitt, Flett, and Ediger, (1996) explored the relationship between
perfectionism and depression longitudinally, over 4-month period, in a sample of 103 current and
former unipolar and bipolar depressive patients. For the study, the authors administered measures
of perfectionism (HFMPS) and depression (BDI) to the subjects initially and measures of stress
and depression four months later. The results displayed that both Self-Oriented Perfectionism
and Socially Prescribed Perfectionism were significantly correlated with depression at both time
points.
The relationship between perfectionism and depression was revealed differently between
ethnic groups. Castro and Rice (2003) explored ethnic differences in perfectionism among Asian
American, African American, and Caucasian college students. A sample of 59 Asian American
students, 65 African American students, and 65 Caucasian students completed the FMPS and the
22
Center for Epidemiologic Studies Depression Scale (CES-D Scale; Radloff, 1977). Significant
relationships were found between some of the characteristics of perfectionism and depressive
symptoms for all three groups of college students. Specifically, the three subscales (Concern
over Mistakes, Parental Criticism, and Doubts about Actions) were significantly correlated with
depression for each ethnic group. In other words, the students with depressive symptoms,
regardless of ethnic group, may possess more perfectionistic tendencies than other students. In a
regression analysis, the combined effects of the FMPS subscales accounted for significant
variation in depressive symptoms for the Asian American and Caucasian Students but not for the
African American Students. Especially, for the Asian American Students, the combined effect of
the perfectionism explained approximately 50% of the variance in depressive symptoms.
Particularly, Doubts about Action was a significant predictor of depressive symptoms when other
subscales were partialled out for these two groups. These findings suggest that the association
between perfectionism and depression is more prominent for some ethnic groups than others.
Studies using other general measures of depression also support an association between
perfectionism and depression. However, many investigations have detected a relationship
between perfectionism and a variety of measures of non-depression psychopathology as well.
Frost et al. (1990) explored the relationship between the FMPS subscales and different kinds of
pathology in the sample of female college students. The Brief Symptom Inventory (BSI;
Derogatis & Mesilaratos, 1983) was used as a measure of psychopathology. Their findings
indicated that scores on total perfectionism and the subscales of Concern over Mistakes and
Doubts about Actions were positively associated with depressive symptoms. Using the same
sample, they also examined the relationship between perfectionism and two different kinds of
depression: dependency depression and self-critical depression. Given the nature of
perfectionism, the authors hypothesized that perfectionism would be more closely associated
with self-critical depression than dependency depression. Depression was measured by the
Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976). The results indicated that
Concern over Mistakes and Doubts about Actions were significantly related to self-critical
depression, when controlled for dependency depression. However, the relationship with
dependency depression was not significant when controlling for self-critical depression.
Therefore, the findings were consistent with the hypothesis that perfectionism was more closely
related to self-critical depression than to dependency or sociotropic depression.
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Hewitt and Flett (1991a) examined the relationships of self-oriented, socially prescribed
and other-oriented perfectionism types to psychopathology in a sample of 104 Canadian college
students. The study used the Symptom Checklist 90-Revised (SCL-90; Derogatis, 1975) as a
measure of general maladjustment. Both Socially Prescribed and Self-Oriented Perfectionism
were found to be significantly correlated with depression. Socially Prescribed Perfectionism,
however, was the stronger predictor of depression, accounting for over 23% of the variance in
depression. A similar relationship pattern was found in a study conducted by Arthur and
Hayward (1997) with a sample of 178 first year postsecondary students. The researchers sought
to explore relationships among perfectionism, standards for academic achievement, and
emotional distress in postsecondary students. The study focused on depression and anxiety as the
two most common types of psychopathology in the target population. The Beck Depression
Inventory (BDI) was used to measure depressive symptoms. Self-Oriented and Socially
Prescribed Perfectionism subscales were significantly correlated with depression.
Consequently, the studies of perfectionism and depression suggest that dimensions of
perfectionism, particularly Concern over Mistakes, Doubts about Actions, Self-Oriented and
Socially Prescribed Perfectionism, are correlated with Depression. Personal Standards and OtherOriented perfectionism do not appear to be strongly related to depression. However, these
relationships were not stable and consistent across the studies. Thus, further studies should be
conducted to clarify nature and magnitude of these relationships. Such clarification would assist
practicing clinicians who are struggling to develop effective interventions for this client group.
Perfectionism and Anxiety
Numerous studies have found the relationship between perfectionism and anxiety.
Hankin, Roberts, and Gotlib (1997) examined the relationship between perfectionism measured
by the HFMPS (Hewitt & Flett, 1991c) and anxiety measured by State-Trait Anxiety Inventory
(STAI; Spielberger, Gorsuch, & Lushene, 1970) among high school students. The results
indicated that socially prescribed perfectionism was positively correlated with Anxiety, but not
self-oriented perfectionism. Similarly, Flett et al. (1994-1995) found that two trait-anxiety
subscales of the Endler Multidimensional Anxiety Scales (EMAS; Endler et al., 1991) were
positively correlated with socially prescribed perfectionism with 1,135 undergraduate students.
24
However, self-oriented perfectionism was not significantly correlated with any of the EMAS
trait-anxiety subscales.
Furthermore, Juster et al. (1996), and Minarik and Ahrens (1996) showed a positive
relationship between subscales of the FMPS and anxiety. Juster et al. examined the association
between trait anxiety and the FMPS (Frost et al., 1990) scores among 61 participants with social
phobia. The results indicated that trait anxiety, as measured by the STAI, was significantly
correlated with two FMPS subscales: Concerns over Mistakes and Doubt about Actions. The
correlations remained significant even when the effects of depression scores were controlled.
Minarik and Ahrens also reported significant relationships between both Concern over Mistakes
and Doubts about Actions and anxiety assessed by the Beck Anxiety Inventory (BAI; Beck,
Epstein, Brown, & Steer, 1988). These findings revealed that the relationship between anxiety
and perfectionism is a result of the maladaptive evaluation concerns associated with
perfectionism, particularly its socially prescribed aspects.
Some studies have found that perfectionism is significantly associated with more specific
types of anxiety. Frost and Roberts (1997) explored the relationship between worry measured by
the Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990) and
perfectionism dimensions among college students. The results showed that the subscales of the
FMPS, such as Concern over Mistakes, Personal Standards, Doubts about Actions, and Parental
Criticism, were significantly and positively correlated with scores on the PSWQ. Particularly,
Concern over Mistakes and Doubts about Actions are the most significantly related to worry
scores. Correlation coefficients ranged from .53 to .64. Similarly, Stober and Joormann (2001)
found that worry is closely related to the dimensions of perfectionism. The study with a sample
of 185 German college students revealed that worry, measured by Worry Domains Questionnaire
(WDQ; Tallis, Eysenck, & Mathews, 1992), was significantly associated with the dimensions of
perfectionism (Concern over Mistakes and Doubts, and Parental Expectation and Criticism). In
addition, worry was significantly correlated with those dimensions of perfectionism after
controlling for pathological worry, anxiety, and depression.
Blankstein et al. (1993) investigated the relationship between perfectionism and specific
fears. Researchers administered the HFMPS and the Fear Survey Schedule-III (FSS-III; Wolpe
& Lang, 1964) to a sample of 189 college students. It was found that Self-Oriented Perfectionism
was correlated significantly in a positive direction with fears involving the loss of control,
25
feeling angry, failure, and making mistakes. Socially Prescribed Perfectionism was significantly
related with fears of failure, making mistakes, losing control, being criticized, looking foolish,
people in authority, feeling angry, and adapting to college life. However, there was no positive
relationship between Other-Oriented Perfectionism and specific fears. Saboonchi and Lundh
(1997) investigated the relationship between the dimensions of perfectionism and anxiety in a 70
Swedish college students. Perfectionism was measured by both the FMPS and HFMPS, and
anxiety was assessed by the Stroop task (Hope, 1990). They found that the perfectionism
dimensions of Concern over Mistakes, Doubts about Action, and Socially Prescribed
Perfectionism were significantly correlated with social anxiety, agoraphobic fears, and fears of
bodily injury, death, and illness. Finally, Flett, Greene, and Hewitt (2004) found that there are
significant relationships between one of the dimensions of perfectionism and anxiety sensitivity,
measured by Anxiety Sensitivity Index-Revised (ASI-R; S. Taylor & Cox, 1998). More
specifically, Socially Prescribed Perfectionism was positively correlated with ASI-R total score
and specific subscales of ASI-R (Fear of Cognitive Dyscontrol, Fear of Observable Symptoms,
and Fear of Respiratory Symptoms).
Studies using other general measures of anxiety also support an association between
perfectionism and anxiety. Frost et al. (1990) found that some subscales of the FMPS, such as
Concern over Mistakes and Doubts about Actions, are significantly associated with anxiety scale
in the Brief Symptom Inventory (BSI; Derogatis & Mesilaratos, 1983) among college students.
Moreover, Hewitt and Flett (1991c) reported a significant relationship between both SelfOriented Perfectionism and Socially Prescribed Perfectionism and Anxiety subscale of the SCL90 in a sample of college students.
In sum, the studies on perfectionism and general anxiety suggest that dimensions of
perfectionism, particularly Concern over Mistakes, Doubts about Actions, and Socially
Prescribed Perfectionism, are correlated with Anxiety. Personal Standards and Self-Oriented
Perfectionism do not appear to be strongly related to anxiety. However, this confirmed linear
relationship between perfectionism and anxiety has been minimally useful to the practicing
clinician. Further studies that clarify the mediating mechanisms between these variables would,
hopefully, help practitioners develop more effective and efficient treatment strategies.
26
Cognitive Schemas and Psychological Distress
Beck et al. (1979) postulated that the idiosyncratic beliefs such as negative views of the
self (low self-esteem), ongoing experiences (cognitive distortions), and the future (hopelessness)
make individuals vulnerable to future depressive episodes activated by loss, failure, or other
stressors. These dysfunctional beliefs are preserved by typical errors in thinking, such as
arbitrary inference, selective abstraction, overgeneralization, magnification and minimization,
personalization, and dichotomous thinking. Similarly, Beck (1976), and Beck and Emery (1985)
posited that individuals who constantly think about danger and worry about possible physical or
mental harm are susceptible to any events indicating imminent disaster or harm. Such is the case
because they are not able to think rationally and evaluate objectively about such situations. These
dysfunctional beliefs related to danger are maintained by maladaptive thinking styles, such as
catastrophizing, selective abstraction, and dichotomous thinking.
Abundant empirical studies have confirmed this relationship between cognitive schemas
and psychological distress. It has been found that negative schemas, such as an irrational beliefs
(Nelson, 1977), negative self-statements (Harrell & Ryon, 1983; Hollon & Kendall, 1980),
negative self-focused attention (Ingram, Lumry, Cruet, & Sieber, 1987; Ingram & Smith, 1984;
Smith & Greenberg, 1981), and self-debasing attributional patterns (E. W. Hamilton &
Abramson, 1983; Selignman, Abramson, Semmel, & von Baeyer, 1979), were associated with
depression. Similarly, other researchers have reported relationships between anxiety and deficits
in rational beliefs (Gormally, Sipps, Raphael, Edwin, & Varvil-Weld, 1981; Himle, Thyer, &
Papsdorf, 1982), patterns of anxious self-statements (Glass, Merluzzi, Biever, & Larsen, 1982;
Smith, Houston, & Zurawski, 1984), increased self-focused attention (Carver, Peterson,
Follansbee, & Scheier, 1983; Wine, 1971), and dysfunctional attributions (Girodo, Dotzenroth,
& Stein, 1981).
However, these studies did not examine the specific content of schemas associated with
depression and anxiety. Furthermore, although negative thoughts have been observed in both
clinical and empirical studies as contributing to the development of depression and anxiety,
differences in cognitive contents of depressed and anxious individuals have not been explored.
According to Beck (1967, 1976), anxiety and depression are different in terms of the form and
content of the maladaptive cognitive schemas related to these disorders. As well, a content-
27
specificity hypothesis proposed by Derry and Kuiper (1981), and Kuiper and Derry (1982)
postulated that the schemas of depressed individuals consist of negative depression-relevant
information. Cognitive theory posits that depressed individuals possess automatic thoughts
involving personal worthlessness, incompetence, and pessimism, and expectations of loss and
failure (D. A. Clark & Beck, 1989). Meanwhile, anxiety is significantly correlated with the
cognitions containing anticipated harm or danger, threat, unpredictability, and uncertainty as
applied to the individual (Beck & Emery, 1985; S. Epstein, 1972; Spielberger, 1972). Also,
anxious schemas include more situational, future-oriented, and probabilistic themes (Beck &
Clark, 1988). The tripartite model, suggested by Clark and Watson (1991), also distinguishes
depression from anxiety in terms of the content of the respective cognitive schemas. Empirical
studies based on the model have confirmed that Negative Affect correlates with both anxiety and
depression. However, Positive Affect showed a significant inverse relationship with only
depression (Watson, Clark, & Carey, 1988; Watson & Kendall, 1989).
Cognitive theorists have described how specific cognitive schemas differentially
contribute to the development of depression and anxiety. According to Guidano and Liotti (1983),
individuals can be vulnerable to depression when they have schemas such as the fear of
abandonment, low self-esteem, and self-reliance. Individuals, who have experienced the relative
isolation and lack of affective contact in the childhood, develop the view of self as unlovable,
worthless, and impotent. This negative view of self coerces the individual to have either fear of
abandonment or a “compulsive self-reliance (Bowlby, 1977).” In other words, these individuals
expect rejection from others because they are inclined to view themselves as unworthy.
Therefore, they rely only on themselves in order to avoid interpersonal disappointment. The
interaction between these personal cognitive vulnerabilities and current life stressors often results
in the experience of depression. On the other hand, anxious individuals are inclined to hold such
schemas as the vulnerability to harm and the fear of abandonment. Guidano and Liotti concluded
that continuous warnings of danger from overprotective parents or threats of abandonment may
result in personal insecurity. Individuals who are overly protected by parents may develop a view
of self as weak or fragile within a threatening and hostile world. As a result, these individuals
exert extreme efforts to control their personal weakness in order to alleviate their insecurity. As
well, Breger (1974) asserted that the main schema of anxious individuals is a fear of
abandonment. The individual who has received continuous threats of separation from parents
28
may feel helpless and experience insecurity in relationships. Goldfried and Sobocinski (1975)
found that college students who endorsed more irrational beliefs reported significantly more
anxiety and hostility when they are imagined situations of social rejection than those who
possessed fewer irrational beliefs.
Differences in schemas between depressed and anxious subjects have been supported
through studies using the Schema Questionnaire (Young, 1999). The Schema Questionnaire is an
assessment that measures 15 early maladaptive schemas. It evaluates core beliefs that have
formed during early childhood. These maladaptive schemas are presumed to be rigid, stable
across ages, and reinforced by schema related experiences, contributing to the development of
emotional disorders (Young, 1999). Schmidt, Joiner, Young and Telch (1995) showed that
‘Dependence/Incompetence’ and ‘Defectiveness/Shame’ schemas accounted for the most
variance in depression as measured by the Beck Depression Inventory (BDI; Beck et al., 1961).
Anxiety as measured by a subscale of the Symptom Checklist-90-R (Derogatis, 1975) was most
strongly associated with the ‘Vulnerability to harm’ schema. Welburn et al. (2002) found that
‘Fear of Abandonment’ and ‘Insufficient self-control’ schemas accounted for about 20.0% of the
variance in depression, and ‘Fear of Abandonment’, ‘Vulnerability to harm,’ and ‘Failure to
achieve’ schemas were the most significant predictors in anxiety. Both depression and anxiety
were assessed by the subscales of Brief Symptoms Inventory (Derogatis & Mesilaratos, 1983).
Glaser et al. (2002) measured depression and anxiety using three different inventories. These
were the SCL-90-R, the Millon Clinical Multiaxial Inventory-II (Millon, 1983), and the BDI.
They evaluated 188 outpatients who received psychotherapy treatment in a university-based
counseling center. According to their results, ‘Fear of Abandonment’ was significantly
associated with depression across all inventories, and ‘Social Isolation’ was correlated with
depression when measured by the subscale of SCL-90-R. The ‘Fear of Abandonment’ and
‘Vulnerability to harm’ schemas were significant predictors of anxiety when measured by the
subscale of SCL-90-R. However, anxiety assessed by the MCMI-II was not related to any
schema. Finally, Petrocelli et al. (2001) found that the greatest proportion of variance in
depression was accounted for by ‘The Fear of Abandonment’ and ‘Defectiveness/Shame’
schemas.
Consequently, despite inconsistent results across studies, the data revealed that specific
maladaptive schemas appear to be associated with depression and anxiety. For example, ‘Fear of
29
Abandonment’ was a core belief related to both depression and anxiety, and ‘Vulnerability to
harm’ and ‘Defectiveness/Shame’ were significantly correlated with anxiety and depression
respectively in most studies. In addition, ‘Dependence/Incompetence,’ Insufficient self-control,’
and ‘Social isolation’ were the significant predictors of depression. Finally ‘Failure to achieve’
was an anxiety relevant maladaptive schema. These results are compatible with the theoretical
predictions of cognitive theory that specific maladaptive schemas are associated with depression
and anxiety. However, further studies should be performed to secure more consistency in this
relationship across studies. In addition, measurement should be employed more carefully and
systematically according to the purpose of study. In the past, a wide variety of different
measurements assessing the same construct have produced varied results (Glaser et al., 2002).
Perfectionism, Cognitive Schema, and Psychological Distress
Perfectionism has been identified as one of the core factors contributing to such
psychological disorders as depression, anxiety, and eating disorders. Several theories have
suggested that perfectionists display such dysfunctional thinking patterns as “shoulds”,
dichotomous thinking, and overgeneralizations. However, few research studies have examined
on how these maladaptive belief systems contribute to the development of perfectionists’
maladjustment. Followings are some studies that have explored the relationship between
perfectionism, its cognitive aspects, and psychological distress.
Flett et al. (1998) examined the relationship between the frequency of perfectionistic
cognition and psychological distress with the sample of college students. First, the authors
developed the Perfectionism Cognitions Inventory (PCI) with a sample of college students. The
items for the PCI were created based on available literature, the authors’ experience with
perfectionists, and a general understanding of perfectionism. Items reflected direct indications of
perfectionism (e.g., I should be perfect), to upward striving defined in absolute terms (e.g., I can
always be better, even if things are almost perfect), and in relative terms involving social
comparison (e.g., I have to be the best). Additional PCI items assessed an individual’s awareness
of being imperfect (e.g., Why can’t I be perfect?). The psychometric analysis of the PCI showed
that this measure is unidimensional and has a high level of internal consistency when
administered to student samples. Second, the study explored the relationship between
30
perfectionism, relevant cognitions which is measured by the PCI, and psychological distress. The
data analysis confirmed that individuals who experience perfectionistic beliefs report greater
levels of both anxiety and depression and a greater frequency of thoughts or images involving
content related to themes of anxiety and depression. In addition, scores on the PCI were
correlated with all of the depressive thoughts measures and anxious thoughts measures.
The relationship between perfectionism, cognition, and psychological distress was also
confirmed by Flett, Madorsky, Hewitt, and Heisel (2002). Their correlational analyses with 65
college students showed that high levels of perfectionistic beliefs, and rumination were
associated with measures of depression and anxiety. The results support the view that there are
salient cognitive aspects of perfectionism which contribute to levels of psychological distress.
Similarly, Sherry et al. (2003) showed that perfectionists’ Perfectionistic Attitudes (PA)
and Dependent Attitudes (DA) accounts for the significant amount of variance in the measure of
depression in both psychiatric patients and university students. According to Beck and
associates’ model (Imber et al., 1990), perfectionists would have dysfunctional attitudes such as
perfectionistic attitudes (PA) and dependent attitudes (DA), and these attitudes contribute to the
development of depression. PA and DA involve beliefs, attitudes, and assumptions where selfworth is contingent upon obtaining or satisfying unrealistic needs or improbable goals. Persons,
Miranda, and Perloff (1991) found that PA is characterized by harsh self-criticism, stringent selfevaluation, unrealistic standard-setting, intense interpersonal sensitivity, extreme fear of
evaluation, and basing self-worth on achievement. Pleasing others, craving nurturance, needing
admiration, requiring acceptance, and deriving self-worth from others’ approval typify DA. The
data analysis confirmed that perfectionism is associated with these dysfunctional attitudes and
revealed that Socially Prescribed Perfectionism in particular had a significantly positive
relationship with both PA and DA in a clinical sample and a college student sample. In addition,
perfectionistic attitudes accounted for a significant amount of variance in depression in the
university student sample.
These studies, while valuable, are of limited value because they did not examine the
mediating effects of cognitive style or any other variables on the relationship between
perfectionism and psychological distress. The following studies, on the other hand, advanced the
envelope of knowledge regarding this phenomenon by examining cognitive variables that might
mediate the relationship between perfectionism and psychological distress.
31
Flett et al. (2003) confirmed that cognitive aspects of perfectionism can mediate the
relationship between perfectionism and depression. The authors developed a model to examine
the mediating role of unconditional self-acceptance in the relationship between perfectionism
and depression. Unconditional self-acceptance is a condition that fosters personal adjustment and
well-being. However, conditional self-worth is associated with psychological distress (Ellis,
1962; Rogers, 1951). Flett and Hewitt (2002) described a perfectionist as the one who finds it
difficult to unconditionally accept self, and parenthetically, this individual is greatly concerned
and preoccupied with obtaining the approval and avoiding the disapproval of other people. The
data analysis showed that all three dimensions (i.e., self-oriented, other-oriented, and socially
prescribed perfectionism) were related negatively to unconditional self acceptance. Also,
depression was associated with low unconditional self-acceptance. A path analysis showed that
unconditional self-acceptance mediated the association between socially prescribed
perfectionism and depression. According to these findings, perfectionists, who have an irrational
belief that their self-worth is contingent on others’ evaluation, are vulnerable to psychological
distress. Similarly, Beevers and Miller (2004) showed that cognitive bias mediated the
relationship between perfectionism and suicidal ideation using in a sample of 121 depressive
inpatients. The path analysis indicated that the depressive inpatients with a negative cognitive
bias experienced hopelessness, which in turn led to higher suicidal ideation.
Rice, Vergara, and Aldea (2006) also corroborated that perfectionists have difficulties in
adjustment because of their dysfunctional thinking, particularly dichotomous thinking, as
suggested by Beck (1976) and D. D. Burn (1980). According to the results of this study,
categorical thinking mediated partially the association between maladaptive perfectionism and
adjustment in a sample of 364 college students. Categorical thinking was measured by the
Categorical Thinking Scale from the Constructive Thinking Inventory (CTI; S. Epstein & Meier,
1989), and perfectionism was assessed by the Almost Perfect Scale-Revised (APS-R; Slaney et
al., 2001).
These empirical studies supported the hypothesis that perfectionists’ dysfunctional
cognitive styles may contribute to the development of psychological distress. As well, Flett et al.
(2003), and Rice et al. (2006) both confirmed a connection between perfectionism, dysfunctional
schemas, and psychological distress by examining cognition as a mediating role. However, there
32
are few previous studies that have examined the relationships among perfectionism, specific
thought content, cognitive patterns, and psychological distress.
Summary
In terms of the above review of theoretical models and empirical studies, perfectionism is
associated with maladaptive cognitive schemas and psychological distress. Even though the
previous findings of the relationship between perfectionism, maladaptive cognitive schemas, and
psychological distress are not consistent across the studies, the results generally revealed a
positive relationship between them. Particularly, it was demonstrated that perfectionists have
dysfunctional beliefs about themselves, the world, and the future, as well as suffer from various
psychological symptoms. Furthermore, perfectionists, who have maladaptive schemas, are found
to be vulnerable to depression and anxiety. More specifically, the schemas, such as fear of
abandonment, defectiveness, shame, functional dependence/incompetence, and insufficient selfcontrol, were significant factors that affect the relationship between perfectionism and depression.
Meanwhile, the schemas, such as fear of abandonment, vulnerability to harm, and failure to
achieve, were the cognitive aspects of perfectionism that related to anxiety.
Most empirical studies have confirmed the linear relationship between perfectionism and
psychological distress. On the other hand, variables that may influence this relationship, such as
cognitive and affective aspects of perfectionism, have not received much attention, relatively.
Only a few recent studies have shown that perfectionists are vulnerable to psychological distress
because of their dysfunctional thinking, low self-esteem, and conditional self-acceptance. The
linear relationship between perfectionism and psychological distress suggests negative outcomes.
However, it does not offer much in the way of clinical implications. An understanding of the
underlying mechanisms may provide an explanation for the reason why perfectionists experience
psychological distress. Thus, further empirical research on this topic is warranted.
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CHAPTER THREE
METHODOLOGY
Introduction
This chapter presents a description of the participants and the procedures employed in
conducting the present study. First, the characteristics of study participants will be described in
terms of gender, ethic background, grade, age, and GPA. Participant recruitment procedures will
be described in detail. Second, the data collection process will be presented. Third, the measures
employed in this study will be presented and discuss in terms of validity and reliability. Finally,
the method used to analyze the data will be explained.
Participants
The data for this study were collected during the implementation of two prior studies,
which were conducted by the author during the 2003-2004 academic year. The first study
examined the relationship between perfectionism and maladaptive cognitive schemas, while the
second study explored the relationship between coping styles and psychological distress. The
data for these two studies were collected from same participants at the same time although the
studies were reviewed and approved separately by the University’s Institutional Review Board
(IRB). In other words, the participants completed all instruments that were used for the two prior
studies at the same time.
The participants for the present study were recruited from college students who
matriculated in education, business, and political science courses from a large southeastern
public university in the U.S. Political science courses were introductory level undergraduate
classes, and education and business courses were both upper level undergraduate classes. Out of
a total of 285 recruited students, 281 volunteered to participate in the studies. Among them, 48
students did not complete all four of the measures that were used for this study
(Multidimensional Perfectionism Scale, the Schema Questionnaire-Short Form, the Center for
Epidemiologic Studies Depression Scale, and the State-Trait Anxiety Inventory). Thus, these 48
missing cases were deleted from the sample and, as a result, a total 233 subjects were included
34
for the data analysis. The demographical characteristics of 48 missing cases, such as gender, age,
ethnic background, and college grade, were not different from the subjects used for final data
analysis except in GPA. Although there was statistically significant difference in GPA between
48 missing cases and the remaining subjects used for data analysis (t = -2.703, p < .01), the
difference was not practically significant. The mean difference in GPA was 0.205. As a result,
233 subjects were used for the data analysis. Finally, missing data were replaced by mean scores
of the participant group. The missing data are the item values that were not answered by
participants. A large amount of missing data in a data set may produce bias in study results. A
loss in sample size may affect the representativeness of the sample to the population of interest.
Thus, it is recommended that the missing observations be replaced with mean values instead of
deleting the entire subject (Tate, 1998).
The demographic characteristics of the participants were as follows. The sample
consisted of 46.4% male and 53.6% female, and the ethnic composition of the participants
included African American (8.2%), Asian American (2.6%), Caucasian (78.5%), Hispanic
American (9.4%), and Other (1.3%) students. The mean age in this sample was 20.6 years (SD =
2.03) and the mean GPA was 3.17 (SD = 0.47). Furthermore, the academic level of participants
was distributed as follows: 11.2% freshmen, 26.6% sophomores, 28.3% juniors, and 33.9%
seniors.
Procedure
The researcher informed the class instructors of the general purpose of the study and
secured their cooperation, arranging an extra credit incentive for students’ participation. At the
beginning of collecting data, the researcher explained the general purpose of the study to the
participants. The participants consented to participate in the study by keeping one copy of two
consent forms and putting another copy of them back into the envelope in which the surveys
were included. In order to assure participants’ confidentiality, the researcher did not receive
participants’ signatures on the consent form. The consent form included the purpose of the study,
the utilization of the study outcomes, and participant’s right of confidentiality. However, detailed
information of the study was not distributed to the participants in order to minimize experiential
bias. The researcher administered the questionnaires in class. The questionnaires consisted of
35
demographic questions, the Multidimensional Perfectionism Scale, the Schema QuestionnaireShort Form, the Center for Epidemiologic Studies Depression Scale, the State-Trait Anxiety
Inventory, and the Ways of Coping Questionnaire-Revised. The data collected from the Ways of
Coping Questionnaire-Revised were not used for the current study. The demographic questions
presented first and the remaining questionnaires were counterbalanced to control for order effects.
After completing measurement, a researcher offered participants the option of requesting the
study’s results. The subjects were awarded extra credit for their participation by instructors.
Instruments
Perfectionism
The Multidimensional Perfectionism Scale (MPS; Hewitt & Flett, 1991c) was used to
assess perfectionism. Perfectionism refers to a personality that possessed by individuals whose
standards are extreme, who compulsively attempt to achieve impossible goals, and who evaluate
themselves in the basis of accomplishment (Burns, 1980). Because of this personality trait,
perfectionists typically experience psychological distress (Beck, 1967). However, not all aspects
of perfectionism are negative or maladaptive. There are healthy characteristics associated with
perfectionism. Hamachek (1978) held that adaptive perfectionists are satisfied with their
performance and improve self-esteem because they realize their performance boundaries.
Meanwhile, perfectionism also has been defined in terms of social components along with
personal characteristics.
Hewitt and Flett (1991c) categorized perfectionism into three different types in terms of
social aspects: Self-oriented, other-oriented, and socially prescribed perfectionism. Self-oriented
perfectionism refers to setting high standards for oneself and evaluating one’s own behavior
based on those standards. Thus, self-oriented perfectionists are inclined to overly blame
themselves when the standards are not met. Other-oriented perfectionists have unrealistic
standards for others and insist others to be perfect. This results in blaming others and being
hostile toward others. Socially prescribed perfectionists believe that others have impractical high
standards and that they evaluate the individual based on these unrealistically high standards. The
MPS measures these three dimensions of perfectionism.
36
The MPS includes 45 items, which are answered based on a 7-point Likert scale. The
scale ranges from 1 of ‘disagree’ to 7 of ‘agree’. Thus, higher scores show greater chance of
perfectionism. Each of three dimensions consists of 15 items: self-oriented perfectionism (SOP),
socially prescribed perfectionism (SPP), and other-oriented perfectionism (OOP). Mean scores in
college student sample for self-oriented perfectionism, other-oriented perfectionism, and socially
prescribed perfectionism were 68.0, 57.9, and 53.6, respectively (Hewitt & Flett, 1991c).
The reliability and validity of the MPS has been supported by empirical studies. Hewitt
and Flett (1991c) reported coefficient alphas for subscales in samples of college students and
psychiatric subjects who were diagnosed with an mood disorder. The coefficient alphas were
reported as follows: .89 for the SOP, .79 for the OOP, and .86 for the SPP in college students,
and .88 for the SOP, .74 for the OOP, and .81 for the SPP in patients. These coefficient alphas
indicate that the MPS has very good internal consistency in both populations. Furthermore, the
stability of the MPS subscales was strong in student sample. The result revealed that three month
test-retest reliabilities were .88 for SOP, .85 for OOP, and .75 for SPP. However, the stability in
psychiatric patients sample was somewhat lower than those in the student sample. Hewitt, Flett,
Turnbull-Donovan, and Mikail (1991) reported that three month test-retest reliabilities for this
group were .69, .66, and .60 for SOP, OOP, and SPP, respectively. It is assumed that internal
consistency and test-retest reliabilities are higher in college student sample than psychiatric
patient sample because the MPS was originally developed using college student subjects (Hewitt
& Flett, 1991c).
Hewitt and Flett (1991c) conducted a factor analysis using the principal components
method in order to confirm construct related validity of the MPS. The analysis yielded a threefactor model as hypothesized. The obtained three factors accounted for 36 % of the total variance
in student sample and 34% of the variance in patient sample. As well, Hewitt and Flett (1991c)
reported the convergent and discriminant validity of the MPS using a student sample. According
to the individual subscales, self-oriented perfectionism is expected to be correlated with such
related measures as high standards, self-criticism, and self-blame; Other-oriented perfectionism
should be associated with other blame; Socially prescribed perfectionism is hypothesized to be
related to demand for approval of others, fear of negative evaluation, and locus of control. The
results corroborated these hypotheses indicating that each subscale was significantly correlated
in positive direction with the measures assessing the same constructs. Moreover, the results
37
revealed low or negative correlations between the subscales and instruments measuring different
constructs. These results were supported in psychiatric outpatient sample (Hewitt et al., 1991).
According to the study results (Hewitt et al., 1991), self-oriented perfectionism was related
significantly to high self-standards, self-criticism, overgeneralization, and perseveration. Otheroriented perfectionism was significantly correlated with Personal Standards. Socially prescribed
perfectionism was associated with parental expectations and parental criticism.
Finally, the MPS subscales were related to various forms of psychopathology. According
to Hewitt and Flett (1991c), self-oriented perfectionism and socially prescribed perfectionism
were significantly correlated with all of the symptom scales in the Symptom Cheklist-90 (SCL90; Derogatis, 1975). Other oriented perfectionism was also significantly associated with
maladjustment like phobias and paranoia. The results were supported by Hewitt et al. (1991) in a
psychiatric patient sample. The study showed that higher levels of socially prescribed
perfectionism were correlated with more severe forms of psychopathology. Moreover, several
studies have demonstrated the positive relationship between the MPS scores and a wide range of
psychopathology indicating the strong predictive validity of the MPS subscales: depression
(Blatt, 1995; Blatt et al., 1976; Hewitt & Dyck, 1986; Hewitt & Flett, 1990, 1991b), anxiety
(Blankstein et al., 1993; Flett et al., 1994-1995; Saboonchi & Lundh, 1997), eating disorder
(Bastiani et al., 1995; Hewitt et al., 1995; Minarik & Ahrens, 1996; Owens & Slade, 1987),
obsessive-compulsive symptoms (Frost & Steketee, 1997; Frost et al., 1994), and social phobia
(Bieling & Alden, 1997; Juster et al., 1996).
Consequently, the MPS is a reliable and valid instrument assessing a multidimensional
perfectionism construct. The reliability and validity of the subscales have been clearly
demonstrated by empirical studies, and several studies have confirmed its validity in various
populations. Thus, the MPS is a useful instrument to assess perfectionism in diverse populations
and situations. In this study, the socially prescribed perfectionism scale was used because only
socially prescribed perfectionism has been correlated with psychological distress consistently
across various studies. Self-oriented perfectionism also has been associated with psychological
distress significantly, but the results are not consistent across the studies (Flett et al., 2004;
Hankin et al., 1997; Saboonchi & Lundh, 1997). The reliability coefficient for socially
prescribed perfectionism in current sample was .81.
38
Maladaptive Cognitive Schema
The mediating variables which may influence the relationship between perfectionism and
psychological distress are maladaptive cognitive schemas. According to Young (1999),
maladaptive cognitive schemas are stable and lasting cognitive themes that develop during early
childhood, are maintained throughout an individual’s lifetime, and are dysfunctional to a
significant degree. These schemas serve as a framework to process later experience. The
characteristics of maladaptive schemas are (1) unconditional, implicit beliefs and feelings about
one self in relation to the environment, (2) resistant to change because of their self-perpetuating
nature, (3) the core of an individual’s self-concept and conception of the environment, (4)
dysfunctional in significant manner, (5) activated by events in the environment relevant to the
particular schema, and finally (6) the result of the child’s innate temperament, interacting with
dysfunctional experiences with parents, siblings, and peers during the first few years of life. Thus,
maladaptive schemas can lead to psychological distress like depression or anxiety. Specific
maladaptive schemas identified in prior research were Fear of Abandonment,
Defectiveness/Shame, Dependence/Incompetence, Vulnerability to harm, Insufficient to selfcontrol, and Failure to Achieve (Glaser et al., 2002; Petrocelli et al., 2001; Schmidt et al., 1995;
Welburn et al., 2002). Out of these maladaptive schemas, Fear of Abandonment was associated
with both depression and anxiety, Defectiveness/Shame, Dependence/Incompetence, and
Insufficient self-control were correlated with depression, and Vulnerability to harm and Failure
to Achieve were linked to anxiety. The definitions of maladaptive schemas used in this study
were described in Chapter One, Introduction.
These maladaptive cognitive schemas were measured by using the Schema
Questionnaire-Short Form (SQ-SF; Young, 1990). The SQ-SF assesses 15 maladaptive schemas:
Emotional Deprivation (e.g., “For much of my life, I haven’t felt that I am special to someone”),
Fear of Abandonment (e.g., “I need other people so much that I worry about losing them”),
Mistrust/Abuse (e.g., “I feel that people will take advantage of me”), Social Isolation (e.g., “I
don’t fit in”), Defectiveness/Shame (e.g., “I feel that I’m not lovable”), Functional
Dependence/Incompetence (e.g., “I lack common sense”), Failure to Achieve (e.g., I’m
incompetent when it comes to achievement”), Vulnerability to Harm (e.g., “I can’t seem to
escape the feeling that something bad is about to happen”), Enmeshment (e.g., “I often feel that I
do not have a separate identity from my parents or partner”), Subjugation (e.g., “In relationships,
39
I let the other person have the upper hand”), Self Sacrifice (e.g., “I’ve always been the one who
listens to everyone else’s problems”), Emotional Inhibition (e.g., “I control myself so much that
people think I am unemotional”), Unrelenting Standards (e.g., “I must meet all my
responsibilities”), Entitlement (e.g., “I hate to be constrained or kept from doing what I want”),
and Insufficient Self-Control (e.g., “If I can’t reach a goal, I become easily frustrated and give
up”). The Schema Questionnaire was originally developed assessing 16 maladaptive schemas
with 205 items. Each item is rated on a 6-point Likert scale (1 = not true at all to 6 = this
describes me perfectly). Thus, higher scores show that subjects are likely to have maladaptive
cognitive schemas. Mean scores for all subscales in non-clinical group ranged from 1.57 to 3.00
(Waller, Shah, Ohanian, & Elliott, 2001).
Schmidt et al. (1995) investigated psychometric properties of the Schema Questionnaire
using 1,125 undergraduate students and 187 outpatients. The results revealed that the internal
consistencies of the Schema Questionnaire’s subscales were adequate in both samples ranging
from 0.83 to 0.96. Test-retest reliabilities were also adequate in both samples ranging from 0.50
to 0.82. Factor analysis of the items in both subject groups produced similar factor structures,
which significantly matched Young’s proposed hierarchical schema relationships. Furthermore,
the Schema Questionnaire was revealed to have convergent and discriminant validity by
measuring conceptually relevant constructs such as self-esteem, psychological distress,
personality disorder traits, and dysfunctional attitudes related to depression. Results showed that
the Schema Questionnaire was significantly correlated with Axis I and Axis II symptomatology
and negatively related to self-esteem and positive affect.
Lee, Taylor, and Dunn (1999) also corroborated the Schema Questionnaire’s structure
validity in a clinical population composed of private-practice outpatients and inpatients of an
acute psychiatric unit (N = 433). Of the total sample, 221 received an Axis II diagnosis and 135
received Axis I diagnosis only. The information of 77 subjects was not identified. Structure
analysis of the instrument produced 14 factors, which are consistent with 14 factors of the 16
factors hypothesized by Young (1990). Schmidt et al. (1995) also obtained the same 14 factors in
their patient sample.
Young and Brown (1999) developed a 75-item short form by revising the 205-item
Schema Questionnaire. They selected the five items which had the highest pattern/structure
coefficients for each schema based on the factor analysis performed by Schmidt et al. (1995).
40
The 75 items are grouped into 15 subscales, assessing specific maladaptive schemas. Glaser et al.
(2002) examined construct validity using the Schema Questionnaire-Short Form (SQ-SF) in 141
outpatients. The subjects received psychotherapy treatment through a university counseling
center. The results revealed that all subscales of the SQ-SF have reasonable reliability. Alpha
coefficients for subscales ranged from .71 to .93. The average alpha coefficient was .83. Also,
SQ-SF subscales scores were significantly related to measures of general symptomatology, such
as depression and anxiety. Particularly, significant amount of variance in depression and anxiety
were accounted for by Fear of Abandonment, Social Isolation, and Vulnerability to Harm. As
well, the same subscales significantly contributed to explain the variance of general
symptomatology. These results generally coincide with the Schmidt et al’s models (1995)
although the total variance of depression and anxiety were accounted for by some different SQSF subscales. According to these results, the SQ-SF can be a valuable measurement to assess
psychological distress.
Similarly, Welburn et al. (2002) examined the psychometric properties of the SQ-SF
using a sample of 135 patients in a psychiatric day treatment program. The subjects were referred
by hospital psychiatrists due to depression, suicidal ideation, anxiety, PTSD, and personality
disorders. According to the results, all 15 subscales possessed moderate to very good internal
consistencies; Coefficient alphas ranged from .76 to .93. Furthermore, the factor analytic results
supported the hypothesized structure of the questionnaire, revealing 15 factors. Seventy of the 75
items precisely loaded on the same factor as the theoretically suggested one. Four items showed
significant cross loading with other subscales, and one item failed to load on the same structure.
The study also explored the relationship between the SQ-SF subscales and psychological distress
such as anxiety, depression, and paranoia in order to examine construct validity. According to
the results, vulnerability to harm, fear of abandonment, failure to achieve, self-sacrifice, and
emotional inhibition, were significantly related to anxiety; Fear of abandonment and insufficient
self-control were significantly correlated to depression; Paranoia was mostly predicted by
mistrust, vulnerability to harm, self-sacrifice, and insufficient self-control.
Waller, Meyer, and Ohanian (2001) compared the psychometric properties of the Schema
Questionnaire-Long Form and Short Form with a sample of 60 bulimic women and 60 women
with no known clinical disorder. The bulimic women suffered from bulimia nervosa, anorexia of
the bulimic subtype, or binge eating disorder. Meanwhile, the comparison women were
41
volunteers. The results supported the reliabilities of both instruments. The coefficient alphas for
the overall scale were .99 for the Long form and .96 for the Short form in a sample of bulimic
women. For the comparison women, the coefficient alphas for the overall scale were .97 for the
Long form and .92 for the short form. Internal consistencies of subscales were greater than .80
for each group on each version. The scores on the two versions for two groups also showed no
differences in the pattern of direction, and none of the differences were large. The two versions
were highly correlated. Furthermore, the two versions discriminated the bulimic women from
the comparison women, suggesting discriminant validity of both instruments. According to the
results, the bulimic women are likely to see themselves as flawed, unable to control their
impulses, and less deserving than the comparison women.
As a result, both the Schema Questionnaire Long Form and the Short Form are reliable
and valid psychometric instruments assessing maladaptive cognitive schemas. The reliability and
validity of the subscales have been verified by empirical studies. Thus, the Schema
Questionnaire is a useful measurement to assess maladaptive cognitive schemas in diverse
populations and situations. Particularly, the Short Form has practical and clinical advantages
because of its similar psychometric properties with the Long Form while having fewer items. In
this study, out of 15 subscales, five subscales (Fear of abandonment, Defectiveness/Shame,
Functional dependence/Incompetence, Failure to Achieve, Vulnerability to Harm, and
Insufficient self-control) were included in the model because these maladaptive cognitive
schemas has been considered by various theories and empirical studies to be mediators between
perfectionism and psychological distress (Beck, 1976; D. D. Burns, 1980; Guidano & Liotti,
1983; Hamachek, 1978; Hewitt & Flett, 1991c). The coefficient alphas for these five subscales in
the current sample ranged from .64 to .90.
Depression
According to DSM-IV-TR (American Psychiatric Association, 2000), depression refers
to depressed mood or the loss of interest in nearly all activities. The depressive individuals
experience symptoms, such as changes in appetite or weight, sleep, and psychomotor activity;
decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or
making decisions; and recurrent thoughts of death or suicidal ideation, plans, or attempts.
Similarly, the components of depression suggested by clinical literature include depressed mood,
42
feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor
retardation, loss of appetite, and sleep disturbance (Radloff, 1977).
Depression was measured by the Center for Epidemiologic Studies Depression Scale
(CES-D Scale; Radloff, 1977). The CES-D was developed to assess current levels of depressive
symptomatology. It focuses on the affective element and depressed mood. It is a short and
structured self-report instrument. The CES-D consists of 20 items, questioning a wide range of
depressive symptoms (e.g., “I felt depressed,” “I felt lonely”). Respondents rate each item based
on the frequency of occurrence of each symptom in the past week on a 4-point Likert scale. The
4-point Likert scale ranges from rarely or none of the time (less than 1 day) to most or all of the
time (5-7 days). The possible score range is from 0 to 60. Higher scores show a higher
probability of depression. The commonly used cutting point for the discrimination of depression
is 16; and the more conservative score of 23 is used for the best discrimination of probable
depression. Mean scores in both non-clinical and clinical groups ranging in age from 18 to 25
were 9.12 and 25.70, respectively (Husaini, Neff, Harrington, Hughes, and Stone, 1980).
The CES-D has been supported by a majority of studies across diverse populations as a
valid and reliable measurement. The internal consistency, reported by the author, was high for
both the general population as well as a patient sample (Radloff, 1977). According to the results,
coefficient alphas were about .85 for general population and .90 for patient sample. As well, the
reliability produced by Split-Halves and Spearman-Brown method were high in both populations,
ranging from .77 to .92. The high internal consistency of the CES-D was corroborated by other
studies with various populations such as a non-psychiatric community sample (Reis & Herz,
1986), an illness population (Devins, Orme, Costello, & Binik, 1988), an older population
(Hertzog, Van Alstine, Usala, & Hultsch, 1990), people with physical disabilities (Coyle &
Roberge, 1992), minority groups (Prescott et al., 1998), and adolescents (Mojarrad & Lennings,
2002).
Radloff (1977) reported that the CES-D was significantly correlated with other
depression scales such as the Hamilton Clinican’s Rating Scale (Hamilton, 1967), the Raskin
Rating Scale (Raskin, 1965), and the Symptom Checklist-90 (SCL-90; Derogatis, 1975).
Furthermore, the CES-D score was significantly correlated with the severity of depression rated
by a nurse-clinician. These results were supported by other studies. Feightner and Worrall (1990)
examined the psychometric properties of the CES-D in community and clinical sample,
43
indicating that the CES-D score was highly correlated with other depression instruments.
Moreover, Santor, Zuroff, Ramsay, Cervantes, and Palacios (1995) revealed that the Beck
Depression Inventory (BDI; Beck et al., 1961) was significantly associated with the CES-D.
Radloff (1977) also reported that the CES-D discriminated patients from individuals in the
general population. The results revealed that the scores of patients were significantly higher than
those of non-clinical samples. Seventy percent of the patients scored above a cutoff score of 16,
but only 21% of the general population scored beyond that point. The same results were found in
the outcomes from Husaini et al. (1980). They reported that the CES-D scores of patients were
significantly higher than non-patients’ scores. As well, the CES-D produced low or negative
correlation with scales that were different from depression. For example, the Marlowe-Crowne
scale of “social desirability” and the Bradburn Positive Affect scale were negatively correlated
with the CES-D.
Finally, Radloff (1977) discovered a four-factor structure model using principlecomponents factor analysis. The interpreted factors were as follows: Depressed affect (blues,
depressed, lonely, cry sad), Positive affect (good, hopeful, happy, enjoy), Somatic and retarded
activity (bothered, appetite, effort, sleep, get going), and Interpersonal (unfriendly, dislike). The
four-factor model was also confirmed by other confirmatory factor analytic studies. For example,
studies using samples of younger and older population (Hertzog et al., 1990), urban subjects (V.
A. Clark, Aneshensel, Frerichs, & Morgan, 1981), African Americans (Jones-Webb & Snowden,
1993), illness population (Devins et al., 1988) obtained the same four factor model as the Radloff
(1977). However, some research has reported that three or five-factor model better fit the data
(Guarnaccia, Angel, & Worobey, 1989; Thorson & Powell, 1993). Particularly, Thorson and
Powell found a five-factor structure that included Depressed affect, Somatic, Interpersonal,
Positive affect, and Self-worth.
In sum, the CES-D is a user friendly depression instrument. It includes short and
structured items, and has demonstrated to have strong reliability and validity across a range of
population. Thus, the CES-D is a useful measurement to assess depression in diverse populations
and situations. The coefficient alpha in the current sample was .84.
44
Anxiety
Freud (1936) defined anxiety as “the fundamental phenomenon and the central problem
of neurosis (p.85).” In terms of this definition, anxiety can refer to a persistent personality trait.
This trait leads to a specific unpleasant state or condition. Anxiety also can be conceptualized in
two different ways. Cattell (1966) and Spielberger (1972) held that there are state and trait
anxiety. State anxiety refers to an individual’s emotional reaction to the external or internal
threat that an individual perceives. Trait anxiety is an individual’s tendency to perceive threats
across a wide range of stimuli. Therefore, state anxiety tends to be temporary and situational, but
trait anxiety remains relatively constant and is more like potential energy that will be triggered
by a specific situation. In this study, trait anxiety was used as one of outcome variables because
the study aims to measures anxiety proneness of subjects rather than situational anxiety.
The State-Trait Anxiety Inventory (STAI; Spielberger, 1983) was used to measure
anxiety. The STAI assess two different types of anxiety: State Anxiety and Trait Anxiety. State
anxiety (S-anxiety) is transitory feelings of tension, apprehension, nervousness, and worry,
which are stimulated by certain stimuli. Meanwhile, trait anxiety (T-anxiety) is relatively stable
individual tendency to consider stressful events to be dangerous or harmful, and react to such
situations with frequent and intense anxious feelings (Spielberger, 1983). Therefore, S-anxiety
scale tends to be sensitive to changes in situations or stimulus, but T-anxiety scale is useful in
identifying neurotic anxiety and relatively long-term anxiety problems. The STAI consists of
total 40 items and each subscale includes 20 items (e.g., “I feel calm,” “I feel rested”).
Respondents rate their feelings on 4-likert scale ranged from 1 (not at all) to 4 (very much so) for
the S-anxiety scale, and from 1 (almost never) to 4 (almost always) for the T-anxiety scale. The
S-anxiety scale assesses how respondents “feel right now at this moment.” The T-anxiety scale
evaluates how subjects “generally feel.” Thus, higher scores show a greater probability of
anxiety. Mean scores in samples of male and female college students were 36.47 and 38.76,
respectively (Spielberger, 1983).
Spielberger (1983) reported the internal consistency of the STAI in a range of
populations, calculated by KR-20 Formula. Coefficient alphas for S-anxiety were above .90 in
working adults, students, and military recruits. The coefficient alpha was somewhat lower in a
high school student sample (.86). Likewise, the alpha coefficients for the T-anxiety scale were all
above .90 in working adults, students, and high school students. Military recruits demonstrated
45
coefficient alpha of .89. The median alphas were .93 and .90 for the S-anxiety and T-anxiety,
respectively, indicating that the STAI scales possess strong internal consistency. These results
were substantially confirmed by the following empirical studies (Barnes, Harp, & Jung, 2002;
Martuza & Kallstrom, 1974; Nixon & Steffeck, 1977; Novy, Nelson, Goodwin, & Rowzee, 1993;
Sherwood & Westerback, 1983). Particularly, Barnes et al. (2002) reviewed 816 research articles
using the STAI between 1990 and 2000 in order to obtain the internal consistency of the STAI.
The results exhibited that mean coefficient alphas were .91 and .89 for the S-anxiety and Tanxiety scales, respectively. The ranges of coefficient alphas were from .65 to .96 and .72 to .96
for the S-anxiety and T-anxiety scales, respectively. The internal consistency was found to be
higher for the S-anxiety scale when respondents were under stressful situations. Coefficient
alpha, computed after a difficult task was given to subjects, was .94. However, the alpha that
obtained after relaxation training was given to students was .89 (Spielberger, 1983). The results
indicate that the S-anxiety scale measures the property of trait anxiety.
The temporal stability of the STAI scales also was strong. According to Spielberger
(1983), test-retest correlations for the T-anxiety scale ranged from .65 to .86 in both college and
high school student samples, with median coefficients of .77 and .70 for college and high school
students, respectively. Meanwhile, test-retest correlations for the S-anxiety were relatively low,
ranging from .16 to .62, with a median coefficient of .33. The low test-retest reliability in the Sanxiety scale confirms the nature of the S-anxiety. The similar results were reproduced by
Joesting (1977), and Nixon and Steffeck (1977). Joesting (1977) found that test-retest reliability,
obtained by administering the STAI before and after a class examination, was lower in the Sanxiety (.66) than the T-anxiety scale (.83). Also, Nixon and Steffeck (1977) confirmed lower
test-retest reliability of the S-anxiety scale over 3, 8, and 11-month period in college student
sample. Barnes et al. (2002) reported mean and standard deviation of test-retest coefficients after
reviewing 816 research articles that used the STAI. According to the results, the mean test-retest
coefficient of the S-anxiety scale was lower than the one of the T-anxiety scale, as well as the
standard deviation of test-retest anxiety was greater than the one of the T-anxiety scale.
Spielberger (1983) also presented support for the construct, convergent, discriminant, and
concurrent validity of the STAI subscales. For the T-anxiety, it was revealed that
neuropsychiatric patients had significantly higher T-anxiety scores than normal subjects. As well,
general medical and surgical patients with psychiatric complications scored higher in the T-
46
anxiety scale than the patients without complications. The results indicated that the T-anxiety
scale screened patients with anxiety symptoms from a normal group of people. The S-anxiety
scale score tend to increase when it is assessed after stressful situations. According to the report
by Spielberger (1983), the S-anxiety scale mean score of college students obtained under
examination conditions (male: 54.99, female: 60.51) was substantially higher than the one
attained after relaxation training (male: 40.02, female: 39.36). This supports the contention that
the S-anxiety scale identifies anxiety evoked by certain stimuli.
The T-anxiety scale had high correlations with other anxiety instruments, indicating
strong concurrent validity of the STAI. Spielberger (1983) reported that the correlations between
the T-anxiety scale, and the IPAT Anxiety Scale (Cattell & Scheier, 1963) and the Taylor
Manifest Anxiety Scale (J. A. Taylor, 1953) ranged from .73 to .85 in both college student and
neuropsychiatric patient samples. Kabacoff, Segal, Hersen, and Van Hasselt, (1997) also
confirmed concurrent validity of the STAI by comparing the former with the Beck Anxiety
Inventory (Beck et al., 1988). The results showed that both scales of the STAI were significantly
associated with the BAI. Moreover, the STAI scales acquire high correlations with the MMPI
scales and Cornell Medical Index score. These data support the convergent validity of the STAI
(Novy et al., 1993; Spielberger, 1983). However, the STAI was not significantly associated with
Edwards Personal Preference Schedule (Edwards, 1954) subscales, except for Abasement scale.
This shows that the STAI are generally independent of the personality traits measured by the
EPPS. Finally, the correlations between the S-anxiety and T-anxiety scale were high, ranging
from .59 to .75 in non psychiatric patients. It suggests that the T-anxiety and S-anxiety scales
basically measure similar constructs in normal situations (Spielberger, 1983). Ramanaiah,
Franzen, and Schill (1983), and Martuza and Kallstrom (1974) also confirmed the high
correlations between the T-anxiety and S-anxiety scales. However, the degree of correlations
changes according to the severity or type of stressful situations in which subjects are involved
(Spielberger, 1972). The T-anxiety scale is highly correlated with the S-anxiety when the STAI
was administered after examination; the trait-anxiety correlation was significantly lower when
the respondents are exposed to physical danger or threats (Hodges & Spielberger, 1966).
Consequently, the STAI is a reliable and valid psychometric instrument assessing state
and trait anxiety. The reliability and validity of the subscales have been clearly corroborated by
empirical studies, and several studies verified validity in various populations. Thus, the STAI is a
47
useful measurement to assess anxiety in diverse populations and situations. In this study, only the
trait anxiety scale was utilized because the current study is interested in individual’s stable
tendencies rather than transitory feelings. While the state anxiety scale assesses the level of
anxiety that is stimulated by environmental stressors, the trait anxiety scale measures the extent
of chronic anxiety that is independent of that produced by external stressful circumstances. The
coefficient alpha in the current sample for trait anxiety was .91.
Data Analysis
A Structural Equation Modeling (SEM) approach was used to test if a hypothesized
model of the relationship between socially prescribed perfectionism, maladaptive cognitive
schemas and psychological distress fit the observed data. It was expected that maladaptive
cognitive schemas mediated the association of perfectionism with depression and anxiety
respectively. Two different approaches have been suggested for testing the mediating effects of
variables: multiple regression and structural equation modeling (Baron & Kenny, 1986; Frazier
et al., 2004; Holmbeck, 1997; Hoyle & Smith, 1994). Both methods provide meaningful tests of
a hypothesized model. However, SEM is often the preferred method because it presents the
degree of fit for the model after controlling for measurement error and reveals causal
relationships between variables (Peyrot, 1996). As well, the SEM strategy is more useful when
the model includes more than one mediating variable (Holmbeck, 1997).
The process of testing mediating effects using the structural equation modeling method is
as follows (Frazier et al., 2004; Hoyle & Smith, 1994): First, the direct effect from a predictor to
outcome variable in the absence of mediators is assessed to examine if there is a relationship to
be mediated. The path coefficients from socially prescribed perfectionism to depression and
anxiety must be statistically significant for mediation to exist. Second, the fit of the overall
model including all direct and indirect effects is tested. Then, assuming that the overall model
provides an adequate fit, all path coefficients are examined. These path coefficients should be
statistically significant in the direction predicted. Third, two estimated path coefficients are
compared. The first coefficient is associated with the direct path from a predictor to an outcome
in the model that does not include mediating variables. The second coefficient is for the direct
path from a predictor to an outcome in the model including mediators. If the first path coefficient
48
is greater than the second coefficient, there are mediating effects on an outcome. In other words,
a mediating model is consistent with the observed data. Finally, the significance of mediating
effects is tested. Sobel (1982) offered an approximate significance test for the mediating effect of
the predictor variable on the outcome variable: the mediated effect is divided by its standard
error. Specifically, the path coefficient from socially prescribed perfectionism to maladaptive
cognitive schema is denoted as x and its standard error is sx. The path coefficient from
maladaptive cognitive schema to psychological distress is denoted y and its standard error is sy.
The mediated effect (the product of path x and y) divided by its standard error produce a z score
of the mediated effect. If the z score is greater than 1.96, the effect is significant at the .05 level.
The error term is calculated using the following formula; the square root of y2sx2 + x2sy2 + sx2sy2.
49
CHAPTER FOUR
RESULTS
Introduction
This chapter is organized into two separate sections. The first section covers the
preliminary data analyses including an examination of the raw data for outliers and violations of
requisite statistical assumptions. This section also provides a presentation and examination of the
means, standard deviations and bivariate correlations among the variables of interest. The second
section presents the primary analyses and results, which address the three hypotheses that
prompted this project. In order to study the mediating effects of maladaptive cognitive schemas
between socially prescribed perfectionism and psychological distress (depression and anxiety) a
Structural Equation Modeling procedure with LISREL (version 8.51) was employed. Two
separate Structural Equation Modeling analyses were conducted, the first for the dependent
variable of depression, and the second for the dependent variable of anxiety.
Preliminary Analysis
Tate (1998) proposed that the researcher conduct a preliminary analysis of the raw data to
(1) determine whether there are any outliers or influential observations that excessively influence
any important analysis results, and (2) check any violations of assumptions that might invalidate
the primary anaylses. In the present study, the characteristics of each participant, the distribution
of data, and the data collecting process were reviewed. Furthermore, the author provided the
descriptive statistics such as mean, standard deviations, and bivariate correlations among all
measured variables.
First, an analysis of missing cases and missing data was conducted. As mentioned in
chapter three, it was found that 48 students out of total 281 participants did not complete all of
the measures used for the study. Thus, these participants were deleted from the sample.
Therefore, a total of 233 subjects were used for the data analysis. Then, missing data, the item
values that were not answered by study participants, were replaced by mean scores of the subject
group as suggested by Tate (1998). Following the deletion of missing cases, the demographic
50
characteristics of the missing cases were reviewed to ensure that the removal did not affect to the
nature of sample used in the study. The demographic characteristics of 48 missing cases, such as
gender, age, ethnic background, and college classification were not different from the subjects
used the final data analysis except in GPA. Although there was statistically significant difference
in GPA between the 48 missing cases and the remaining subjects used for data analysis (t = 2.703, p < .01), the difference was not practically significant. The mean difference in GPA was
0.205.
Second, a case analysis was performed to examine individual observations that may
excessively influence on the results. Two outliers, which fit the model very poorly, were
recognized. Both outliers revealed studentized residuals of approximately 3.1. An individual case
with an absolute studentized residual value of greater than 3.0 indicates that it is a possible
outlier observation (Tate, 1998). However, the two observations did not exert excessive impact
on the model coefficients. The index ( ∆β ), the change in the model coefficient when the
individual observation is deleted from the sample, was not significant. Also, sensitivity analysis
in which the two outliers were deleted from the sample to compare the models with and without
the outliers reflected that the outliers did not have significant influence on the result.
Third, an examination of the data was executed to confirm whether the data fit the
assumptions for the Structural Equation Modeling. Inspection of a residual scatter plots,
histograms, and skewness and kurtosis statistics for all measured variables revealed that the
variables of maladaptive cognitive schemas had a non-normal distribution. The distribution of
raw scores was generally grouped at the low end for all maladaptive cognitive schema variables.
Given that the Schema Questionnaire-Short Form (SQ-SF: Young 1990) was developed to assess
maladaptive cognitive schemas, and the subjects used in this study were not recruited from
clinical populations, this might be expected theoretically. However, since the normality
assumption is critical for the maximum-likelihood procedure used in this study, a logtransformation was conducted for the variables of maladaptive cognitive schemas to shape a
distribution closer to normality. Although log-transformation is not applied universally, it is
recommended unless there is feasible reason not to endorse it (Tabachnick & Fidell, 1996).
Furthermore, interpretation will not be affected by this transformation because this study is
interested in relative differences in maladaptive cognitive schemas.
51
Following the log-transformation, distributions of the variables were inspected again to
examine for a violation of the normality assumption. The residual scatter plots, histogram, and
Q-Q plots of the variables revealed that the distributions of interest more closely approximated
normality. In addition, skewness and kurtosis statistics were reduced under absolute value of 2,
indicating that the distributions are viable (Tate, 1998). The correlations between all the
variables of maladaptive cognitive schemas and the transformed variables were high, ranging
from .966 to .981. Therefore, log-transformed data for the variables of maladaptive cognitive
schemas were employed in subsequent analyses.
The examination of residual scatter plots did not indicate any violation of constant
variance and correct fit assumption. In addition, the measures of all variables were sufficiently
reliable to assume that all independent variables were accurately assessed. The independence
assumption was also assumed because there were no conditions during data collection that held
potential to violate this assumption.
Finally, the bivariate correlations between variables were examined for depression and
anxiety models separately (see Table 1 and Table 2). The results indicated that there were no
problems with multicolinearity because all correlation coefficients were less than .90 (Tate,
1998). Correlation coefficients ranged from .03 to .54 and most coefficients were statistically
significant. More specifically, in the depression model, the highest correlation was between Fear
of Abandonment and Defectiveness/Shame, and the lowest correlation was between Socially
Prescribed Perfectionism and Insufficient Self-control. In the anxiety model, the correlation in
the relationship between Vulnerability to Harm and Anxiety was the highest, and the relationship
between Failure to Achieve and Vulnerability to Harm was the lowest. Means and standard
deviations for all measured variables are also shown in the Table 1 and Table 2. Mean scores for
all scales were similar with previous study results that used the same instruments with a college
population or non-clinical group. The mean score (M = 13.23) for depression was higher than
that (M = 9.12) found in the previous study (Husaini et al., 1980); however, the mean score in the
current study was still less than the cutting point of 16 (Husaini et al., 1980).
52
Table 1.
Bivariate Correlations, Means, Standard Deviations for latent variables in Depression Model
1
1. Socially Prescribed Perfectionism
2
3
4
5
6
1.00
2. Fear of Abandonment
.25**
3. Defectiveness/Shame
.26**
.50**
4. Functional Dependence/Incompetence
.27**
.47**
.46**
5. Insufficient Self-control/Self-discipline
.09
.36**
.28**
.30**
6. Depression
.21*
.37**
.30**
.32**
.41**
1.00
M
54.48
2.17
1.84
1.95
2.33
13.23
SD
11.64
0.48
0.34
0.36
0.45
8.00
1.00
1.00
1.00
1.00
Note. ** p < .001, * p < .01
Table 2.
Bivariate Correlations, Means, Standard Deviations for Latent Variables in Anxiety Model
1
1. Socially Prescribed Perfectionism
2
3
4
5
1.00
2. Fear of Abandonment
.25**
1.00
3. Failure to Achieve
.27**
.07
4. Vulnerability to Harm
.19*
.43**
.03
5. Anxiety
.32**
.49**
.21**
.54**
M
54.48
2.17
2.55
1.99
38.04
SD
11.64
0.48
0.53
0.39
10.17
Note. ** p < .001, * p < .01
53
1.00
1.00
1.00
Primary Analyses
The primary analyses in this study tested whether the maladaptive cognitive schemas
mediate the relationship between socially prescribed perfectionism and psychological distress
(depression and anxiety). Three specific hypotheses were advanced and tested: (1) there will be
significant relationships between a predictor variable (socially prescribed perfectionism) and
criterion variables (depression and anxiety) in the absence of mediating variables, (2) the
proposed models, including mediating effects of maladaptive cognitive schemas, will fit the
observed data, (3) the path coefficient, evaluating the direct path from a predictor to a criterion,
will be significantly reduced after the mediating effects are added to the model. In order to
examine these hypotheses, the statistical procedures suggested by Frazier et al. (2004), and
Hoyle and Smith (1994) were followed.
First, the direct effect model including the paths from Socially Prescribed Perfectionism
to Depression and Anxiety were tested to examine if there is an effect to be mediated. The path
coefficients are required to be statistically significant and in the hypothesized direction in order
for the researcher to continue to assess the mediating effect. If the path coefficients from Socially
Prescribed Perfectionism to Depression and Anxiety were not significant, then there would be no
effects to mediate. The results revealed that the path coefficients from the predictor (socially
prescribed perfectionism) to the criterions (depression and anxiety) were both statistically
significant (ps < .001). The path coefficient values were.141 and .277, respectively. Also, as
hypothesized, they both showed a positive relationship. This outcome satisfied the first step for
examining a mediating effect.
Second, according to the procedures suggested by Frazier el al. (2004), and Hoyle and
Smith (1994), the overall models, including the mediating effects, were assessed to confirm
whether or not the proposed models fit the observed data. Once the models were confirmed to
provide an adequate fit, all path coefficients associated with the direct and indirect effects were
estimated to examine the significance and direction of the path coefficients. Then, it was
determined whether mediators mediate the relationship between a predictor and an outcome
variable by comparing two path coefficients. The first path coefficient represents the relationship
between socially prescribed perfectionism and psychological distress when maladaptive
cognitive schemas were not in the model. The second coefficient represents the relationship
54
between predictor and criterion when maladaptive schemas are in the model. If the first path
coefficient is larger than the second path coefficient, it is determined the maladaptive cognitive
schemas mediate the relationship between socially prescribed perfectionism and psychological
distress. These steps are followed in analyzing both the depression model and the anxiety model.
Depression Model
The hypothesized model (Model A) was analyzed to examine whether the maladaptive
cognitive schemas mediate the relationship between Socially Prescribed Perfectionism and
Depression. The outcome indicated that the hypothesized model did not fit the observed data
( χ 2 [6] = 158.98, p < .001 ). The hypothesis that the hypothesized model fit the observed data was
rejected. The ratio of the chi-square statistic to the degrees of freedom was approximately 26.5,
which was larger than two required for an acceptable fit (Tate, 1998). Global fit indices also
indicated that the hypothesized model was discrepant from the data. First, the Root Mean Square
Error of Approximation (RMSEA) was 0.371. It should be less than 0.08 for an acceptable fit
(Tate, 1998). Second, the Adjusted Goodness of Fit Index (AGFI) was 0.229, which is smaller
than the 0.9 required for an acceptable fit (Tate, 1998). Furthermore, the Normed Fit Index (NFI)
and the Comparative Fit Index (CFI) were 0.425 and 0.415 respectively, which were both less
than the 0.9 required for an acceptable fit (Tate, 1998). Finally, all standardized differences
between observed and logically implied covariances were larger than 3.0. The large value of
standardized difference indicates that the discrepancy between the hypothesized model and the
observed data is larger than what may be explained only by chance (Tate, 1998). The results
associated with the Model A are shown in Table 3.
Since the study indicated that the hypothesized model was inconsistent with the observed
data, the author conducted a model revision based on empirical data and theoretical principles
(Allen, 2001; Armogida, 2001; Finzi, Cohen, Sapir, & Weizman, 2000; Finzi, Ram, Har-Even,
Shnit, & Weizman, 2001; Gross & Hansen, 2000; Guidano & Liotti, 1983). They suggested
several alternative paths to include in the model A, which might decrease the discrepancy
between the revised model and the observed data. Among the suggested paths, those from 1)
Fear of Abandonment to Defectiveness/Shame, 2) from Fear of Abandonment to Functional
Dependence/Incompetence, and 3) from Fear of Abandonment to Insufficient Self-Control were
included because they were supported by existing theory and empirical studies, and possessed
55
large modification indices of 49.0, 42.3, and 27.8, respectively. The modification index indicates
the approximate improvement in overall model fit following the inclusion of the paths (Tate,
1998). According to those modification indices, the overall chi-square statistic of 158.98 for the
hypothesized model (Model A) will decrease by approximately 119.1 when these paths are
included in the hypothesized model (Model A). Then, the estimated coefficients associated with
the paths will be approximately 0.32, 0.32, and 0.33, respectively.
Table 3.
Chi-Square, Degree of Freedom, and Fit Indices For The Hypothesized and Revised Depression
Model
Model
χ2
df
RMSEA
AGFI
NFI
CFI
Model A
158.982*
6
.371
.229
.425
.415
Model B
27.045*
3
.191
.727
.902
.908
Note. RMSEA = root-mean-square error of approximation; AGFI = adjusted goodness of fit index; NFI =
normed fit index; CFI = comparative fit index; Model A = hypothesized model; Model B = revised model
based on theories and empirical findings. * p < .001
The revised model (Model B), including the paths from (1) Fear of Abandonment to
Vulnerability to Harm, (2) Fear of Abandonment to Functional Dependence/Incompetence, and
(3) Fear of abandonment to Insufficient self-control were tested. The outcomes are summarized
in Table 3. The results indicated that the fitness of the revised model was on the borderline
between adequate fitness and poor fitness. According to the outcomes, the improvement of the
model fit was statistically significant after adding these new paths to the hypothesized model
( G 2 [3] = 131.94, p. < 001 ). However, the indices for model evaluation did not reveal consistent
results. The hypothesis that the revised model fit the data was rejected
( χ 2 [4] = 27.045, p < .001 ). The ratio of the chi-square statistic to degrees of freedom was 6.76,
which is larger than two required for acceptable fit. Two of the global fit indices indicated that
the revised model was not consistent with the observed data. First, the RMSEA was 0.191, which
was larger than the required 0.08 for acceptable fit. Second, the AGFI was 0.727, which was
56
smaller than 0.9. Furthermore, several standardized differences between observed and implied
covariances were larger than 3.0. In contrast to the above results, the NFI and CFI showed
adequacy of the model, resulting in 0.902 and 0.908. Because of these inconsistent results, one
more model evaluation index was applied to provide a conservative conclusion about the model
fitness. The index is the Akaike Information Criterion (AIC), which is a goodness-of-fit measure
which adjusts the model chi-square to penalize for model complexity. It reflects the discrepancy
between implied and observed covariance matrices. It does not have a cutoff value and the lower
value represents the better fit. The AIC of the revised model was 64.283, which is larger than 0,
indicating that the revised model does not fit the observed data (Burnham & Anderson, 1998).
Defectiveness/
Shame
.142**
.459**
.165**
Socially
Prescribed
Perfectionism
.245
**
.425**
Fear of
Abandonment
.071
Functional
Dependence/
Incompetence
.098
.161
.301**
.356**
.004
Depression
**
Insufficient
self-control
.096
Figure 3. A revised model and standardized path coefficients of the relationships between socially
prescribed perfectionism, maladaptive cognitive schemas, and depression. Dashed lines indicate
insignificant path coefficients. ** p < .01
The significance of estimated path coefficients was not consistent with the hypothesis. As
shown in Figure 3, several path coefficients, such as those from Socially Prescribed
Perfectionism to Insufficient Self-control, from Defectiveness/Shame to Depression, and from
57
Functional Dependence/Incompetence to Depression, were not statistically significant. This
result did not support a mediation effect, which requires that all path coefficients are to be
statistically significant. In addition to the borderline fitness of the model, insignificant path
coefficients suggested that the revised model reflect the observed data inappropriately. Thus,
further analysis or revision of the model was not conducted.
In sum, the results did not support the hypothesis that the maladaptive cognitive schemas,
such as Fear of Abandonment, Defectiveness/Shame, Functional Dependence/Incompetence, and
Insufficient Self-control, mediate the relationship between Socially Prescribed Perfectionism and
Depression. The revised model also was not consistent with the data, and thus did not support the
hypothesis. In other words, the model represented the data inadequately.
Anxiety Model
The hypothesized model for Anxiety (Model A) was tested to examine the mediating
effects of maladaptive cognitive schemas in the relationship between Socially Prescribed
Perfectionism and Anxiety. The results indicated that the hypothesized model did not fit the
observed data ( χ 2 [3] = 42.095, p < .001 ). Therefore, the hypothesis that the initial model fit the
data was rejected. The ratio of the chi-square statistic to the degrees of freedom was large at
14.03. Global fit indices also suggested that the hypothesized model was not correct. First, the
Root Mean Square Error of Approximation (RMSEA) was 0.226, which is larger than the upper
limit of 0.08 required for an acceptable fit. Second, the Adjusted Goodness of Fit Index (AGFI)
was 0.689, which is smaller than 0.9 required for an acceptable fit. Third, the Normed Fit Index
(NFI) and the Comparative Fit Index (CFI) were 0.799 and 0.804 respectively, which were both
less than the 0.9 required for an acceptable fit. Finally, the results showed that there were several
larger standardized differences between observed and logically implied covariances than 3.0.
The large value of standardized difference indicated that the hypothesized model demonstrated
discrepancies larger than what might be explained only by chance. The results associated with
the Model A are shown in Table 4.
Since the hypothesized model did not fit the observed data, a model revision was
considered on the basis of theoretical principles and empirical studies. The results obtained from
the initial analysis suggested several alternative paths to add to the model, which might decrease
the discrepancy between a revised model and the observed data. Among the suggested paths, the
58
path from Fear of Abandonment to Vulnerability to Harm possessed the largest modification
index of 38.2, indicating that the inclusion of the path would improve the model fit significantly.
In other words, the overall chi-square statistic of 42.095 for the hypothesized model will
decrease by approximately 38.2 when the path is included in the hypothesized model (Model A).
Then, the estimated coefficient associated with the path will be approximately 0.34. The
insertion of this path to the hypothesized model (Model A) is also supported by previous
theoretical and empirical studies (Guidano & Liotti, 1983; Shah & Waller, 2000).
The revised model (Model B), including the path from Fear of Abandonment to
Vulnerability to Harm, did fit the observed data (See Table 4). According to the outcomes, the
improvement of the model fit was statistically significant after adding the path to the
hypothesized model ( G 2 [1] = 41.97, p < .001 ). The hypothesis that the revised model is correct
was accepted ( χ 2 [2] = 0.125, p = .939 ). The ratio of the chi-square statistic to degrees of
freedom was less than one. Furthermore, the global fit indices revealed that the revised model
was consistent with the observed data: First, the RMSEA was smaller than 0.001, with a p-value
of 0.965. Second, the AGFI, NFI, and CFI indices were 0.998, 0.999, and 1.000, respectively.
Finally, all standardized difference of observed and implied covariances were smaller than 0.3.
Fear of Abandonment
0.245**
0.084
Socially
Prescribed
Perfectionism
0.412**
Vulnerability to Harm
0.275**
0.392**
Anxiety
0.138**
0.273**
0.144**
Failure to achieve
Figure 4. An initial revised model and standardized path coefficients of the associations between socially
prescribed perfectionism, maladaptive cognitive schemas, and anxiety. Dashed line is insignificant path
coefficient. * p < .05, ** p < .01.
59
However, the revised model still did not meet one of the criteria suggested by Frazier et
al. (2004), and Hoyle and Smith (1994) for the mediation to exist. This criterion required that all
path coefficients in a model be statistically significant. The results revealed that one of the
estimated path coefficients associated with the direct path from Socially Prescribed
Perfectionism to Vulnerability to Harm was not statistically significant. The insignificant path is
shown in Figure 4 as a dashed line. This indicates that the revised model does not sufficiently
support mediating effects of maladaptive cognitive schemas on the relationship between Socially
Prescribed Perfectionism and Anxiety. Meanwhile, other path coefficients were statistically
significant and in the direction hypothesized, which is shown in Figure 4. Since the initial
revised model did not satisfy all requirements for mediation to exist, another model revision was
conducted again by deleting the non-significant path from the initial revised model.
The second revised model (Model C), deleting the path from Socially Prescribed
Perfectionism to Vulnerability to Harm did fit the observed data. The results revealed that the
model chi-square value was small and was not significant ( χ 2 [3] = 2.042, p = .564 ), indicating
that the hypothesized mediating effects of maladaptive cognitive schemas between socially
prescribed perfectionism and anxiety could be accepted. The ratio of the chi-square statistic to
degrees of freedom was less than one. Furthermore, the global fit indices showed that the second
revised model was consistent with the observed data: First, the RMSEA was smaller than 0.001,
with a p-value of 0.754. Second, the AGFI, NFI, and CFI indices were 0.983, 0.990, and 1.000,
respectively. Finally, all standardized differences of observed and implied covariances were
smaller than 0.3. The improvement of the model fit was not statistically significant after
removing the path from the initial revised model ( G 2 [1] = 1.917, p < .001 ), implying that the two
models provide comparable fits to the data. The results for Model C are shown in Table 4.
The standardized direct, indirect, and total causal effects depicted by the model are
summarized in Table 5 and Figure 5. The estimated path coefficients and all effects were
statistically significant. Also, the directions of all of these effects were congruent with the
direction hypothesized. This meets the standard requirement to confirm whether of not mediating
effects exist. In addition, the associated standard errors were relatively small. This indicates that
the second revised model reflects the population effects precisely. Socially prescribed
perfectionism and maladaptive cognitive schemas accounted for approximately 41.6% of the
variance of anxiety.
60
Table 4.
Chi-Square, Degree of Freedom, and Fit Indices For The Hypothesized, Initial Revised, and
Second Revised Anxiety Model
Model
χ2
df
RMSEA
AGFI
NFI
CFI
Model A
42.095*
3
0.226
.689
.799
.804
Model B
0.125
2
< .01
.998
.999
1.000
Model C
2.042
3
< .01
.983
.990
1.000
Note. RMSEA = root-mean-square error of approximation; AGFI = adjusted goodness of fit index; NFI =
normed fit index; CFI = comparative fit index; Model A = hypothesized model; Model B = initial revised
model (the model with the path from ‘Fear of Abandonment’ to ‘Vulnerability to Harm’); Model C =
second revised model (the model without the insignificant path from socially prescribed perfectionism to
‘Vulnerability to Harm’). * p < .001
Table 5.
Standardized Path Coefficients and Standard Error For The Second Revised Anxiety Model
Outcome
Causal Effects
Determinant
Direct
Indirect
Total
Socially Prescribed
Perfectionism
.138** (.054)
.149** (.036)
.317** (.065)
Fear of Abandonment
.276** (.057)
.171** (.033)
.447** (.057)
Failure to Achievement
.145** (.052)
.145** (.052)
Vulnerability to Harm
.394** (.056)
.394** (.056)
Fear of Abandonment
(R2 = .060)
Socially Prescribed
Perfectionism
.245** (.064)
.245** (.064)
Failure to Achieve
(R2 = .074)
Socially Prescribed
Perfectionism
.273** (.063)
.273** (.063)
Vulnerability to Harm
(R2 = .188)
Socially Prescribed
Perfectionism
Anxiety
(R2 = .416)
.106** (.031)
.433** (.059)
Fear of Abandonment
Note. The values are in parentheses are standard errors. ** p < .01, * p < .05
61
.106** (.031)
.433** (.059)
0.245**
Fear of
Abandonment
0.433**
Vulnerability
to Harm
0.394**
0.276**
Socially
Prescribed
Perfectionism
Anxiety
0.138**
0.273**
0.145**
Failure to achieve
Figure 5. A second revised model and standardized path coefficients of the relationship between socially
prescribed perfectionism, maladaptive cognitive schemas, and anxiety. * p < .05, ** p < .01.
Finally, the path coefficient from socially prescribed perfectionism to anxiety was
reduced from .277 to .138 when the direct effect model (the model without mediating variables)
was compared with the second revised model (Model C). Moreover, the significance of the
mediating effects was tested. The results revealed that all mediating effects were statistically
significant: The mediating effect of Fear of Abandonment on anxiety (Z = 2.979, p < .05) and the
mediating effect of Failure to Achieve on anxiety (Z = 2.317, p < .05).
Consequently, the results indicated that maladaptive cognitive schemas mediated the
relationship between socially prescribed perfectionism and anxiety. More specifically, the
maladaptive cognitive schemas, such as Fear of Abandonment and Failure to Achieve were
identified as the principal mediators. Meanwhile, the Vulnerability to Harm schema did not
mediate, but indirectly influenced on the relationship between Socially Prescribed Perfectionism
and Anxiety through the Fear of Abandonment schema.
62
CHAPTER FIVE
DISCUSSION
Introduction
The following discussion summarizes the major findings and reviews the implications of
the study outcomes in clinical and theoretical areas. First, the results of this study will be
examined through the lens of current theoretical models and empirical findings. Second, the
usefulness of these data for the perfectionistic individuals and the practicing clinician who is
working with perfectionistic clients will be discussed. Finally, the implications and the major
limitations of the study will be provided, as well as suggestions for possible future research.
Summary of the Study
The purpose of the current study is to uncover the underlying mechanism through which
socially prescribed perfectionism influences psychological distress in a sample of college
students using a structural equation modeling approach. More specifically, the present study aims
to determine whether there are mediating effects of maladaptive cognitive schemas on the
relationship between socially prescribed perfectionism and the symptoms of depression and
anxiety.
In order to examine this relationship, two hypothetical models were developed for
depression and anxiety separately. These models were based on prior theoretical formulations
regarding perfectionism and previous empirical research studies. The depression model
suggested that maladaptive cognitive schemas, specifically Fear of Abandonment,
Defectiveness/Shame, Functional Dependence/Incompetence, and Insufficient Self-Control
mediate the relationship between socially prescribed perfectionism and depression (see Figure 1).
The anxiety model proposed that maladaptive cognitive schemas, specifically Fear of
Abandonment, Failure to Achieve, and Vulnerability to Harm, mediate the association between
socially prescribed perfectionism and anxiety (see Figure 2).
Both models were tested to determine whether either or both of the models provided an
adequate fit to the observed data. First, the direct relationships between socially prescribed
63
perfectionism and psychological distress were tested. In order to advance to subsequent steps, the
direct path should be statistically significant. Second, in order for mediating effects to exist, the
models should fit the obtained data and the associated path coefficients should be statistically
significant. Third, if the models satisfy these requirements, then the direct path coefficients from
socially prescribed perfectionism to psychological distress are compared both before and after
the addition of the mediating variables. A significant contraction of the direct path coefficient
after the inclusion of the mediators provides a preliminarily indication that there are mediating
effects on psychological distress. Finally, the significance of the mediating effects of cognitive
schemas is tested using the method that suggested by Sobel (1982). This provides a final
confirmation of the models.
Interpretation of the Results
The results indicate that socially prescribed perfectionism influences anxiety through
maladaptive cognitive schemas. However, the data do not support the mediating effects of
maladaptive cognitive schemas on the relationship between socially prescribed perfectionism and
depression. Although both models were developed on the basis of previous research studies and
established theoretical formulations, only the anxiety model was corroborated by the data.
Possible reasons for these findings will be discussed later. These findings suggest that the
relationship between socially prescribed perfectionism and anxiety is not simply a direct linear
relationship. Specific maladaptive cognitive schemas play important mediating roles in the
association between socially prescribed perfectionism and anxiety.
Depression Model
The direct relationship between socially prescribed perfectionism and depression was
statistically significant, which indicates that there is a relationship to be mediated. However, the
hypothesized depression model (see Figure 1) did not fit the observed data. Due to this poor fit,
the hypothesized depression model was revised. These revisions were based the initial statistical
analyses, as well as some previous research, as well as some alternative theoretical positions.
The revised model included paths from Fear of Abandonment to Defectiveness/Shame, from
64
Fear of Abandonment to Functional Dependence/Incompetence, and from Fear of Abandonment
to Insufficient Self-Control.
This model revision was supported by several theoretical positions and empirical studies.
Guidano and Liotti (1983) suggested that the people who had an insecure attachment with
significant others in early childhood were likely to develop a fear of rejection. This fear
supposedly contributes to the development of an incompetent self-image and feelings of selfshame. This theory has been supported by several empirical studies. Finzi, Cohen, Sapir, and
Weizman (2000), and Finzi, Ram, Har-Even, Shnit, and Weizman (2001) found that neglected
children were at risk of possessing feelings of incompetence and a fear of social rejection. Allen
(2001) and Armogida (2001) found that young adults and adolescents who experienced insecure
attachment in early childhood tended to have difficulties regulating their emotion and behaviors.
Also, the relationship between fear of abandonment and shame was supported by a study
conducted by Gross and Hansen (2000). In addition, Lopez et al. (1997) found that fear of
attachment and a sense of shame are positively associated in a sample of college students.
The revised model (see Figure 3), however, was also inconsistent with the data collected.
As shown in Table 3, the model fit indices did not suggest an adequate fit for the revised model.
In addition, insignificant path coefficients between latent variables indicate that the model does
not meet the requirements for mediating effects to exist. In other words, mediating effects exist
when mediators are significantly associated with a predictor variable and an outcome variable
(Baron & Kenny, 1986; Frazier et al., 2004). Thus, the hypothesis for the both the initial and the
revised depression models was not supported because the models satisfied neither the adequate
fit criterion, nor the significant path coefficient criterion.
These outcomes are incongruent with recent theories of perfectionism (Beck, 1976; Burns,
1980; Ellis, 2002; Hamacheck, 1978). These theories hold that perfectionists are vulnerable to
psychological distress such as depression and anxiety because they possess maladaptive
cognitive schemas. This suggests that the maladaptive cognitive schemas mediate the
relationship between perfectionism and psychological distress, but the current study findings do
not support this notion. Some previous empirical studies also suggest mediating role of cognitive
schemas in the relationship between perfectionism and psychological distress. Flett et al. (1998)
and Flett et al. (2002) found that perfectionistic beliefs contributed to the development of
depression. Flett et al. (2003) confirmed that cognitive aspects of perfectionism could mediate
65
the relationship between perfectionism and depression. More particularly, Beever and Miller
(2004) and Rice et al. (2006) found that negative cognitive bias and categorical thinking
mediated the association.
One possible reason for the finding is that the relationships between specific cognitive
schemas and depression are inconsistent across studies. The positive direction of the association
between cognitive schemas, in general, and depression is consistent across studies. However, the
particular schemas which are significantly correlated with depression are varied. Schmidt et al.
(1995) showed that Functional Dependence/Incompetence and Defectiveness/Shame schemas
accounted for the most variance in depression. In contrast, Welburn et al. (2002) found that Fear
of Abandonment and Insufficient self-control schemas accounted for the most variance in
depression. Meanwhile, Glaser et al. (2002) examined the relationship between specific cognitive
schemas and depression using three different depression measures (SCL-90-R, Millon Clinical
Multiaxial Inventory-II, and BDI). According to the results, Fear of Abandonment was
significantly associated with depression across all measurements, and Social Isolation was
correlated with depression when measured by the subscale of the SCL-90-R. Finally, Petrocelli
et al. (2001) revealed that the greatest proportion of variance in depression was accounted for by
Fear of Abandonment and Defectiveness/Shame schemas. As shown in these studies, Fear of
Abandonment was the only schema that consistently predicted depression. However, other
schemas, such as Defectiveness/Shame, Functional Dependence/Incompetence, and Social
Isolation, have not been supported by empirical studies as consistent predictors of depression.
This trend is also shown in the current study. As displayed in Figure 3, only Fear of
Abandonment is significantly associated with both socially prescribed perfectionism and
depression. The relationship is also strong. The path coefficients are .245 and .161, respectively.
However, Defectiveness/Shame and Functional Dependence/Incompetence are not related to
depression, and Insufficient Self-Control is not correlated with socially prescribed perfectionism
when other variables are controlled for.
Furthermore, diverse factors contribute to the development of depressive symptoms. Riso
and Klein (2004) posited that several other ecological variables, such as family history,
childhood adversity, maladaptive interpersonal relationship, and stress, in addition to cognitive
factors contribute to depression. Also, one’s genetic endowment or chemical imbalance has been
found to be related to the development of depression (Zuckerman, 1999). Thus, it may not be
66
possible to explain depression only with cognitive factors and individual personality traits. For
future study, other influential variables should also included into the prediction model.
Thus, further studies should be conducted to obtain a clearer understanding of which
specific cognitive schemas contribute to the development of depression. Also, caution should be
employed when choosing the depression measures because different depression inventories can,
and do, assess different aspects of depression (Glaser et al., 2002). In contrast to depression,
anxiety has been consistently associated with specific cognitive schemas, such as Fear of
Abandonment, Vulnerability to Harm, and Failure to Achieve, across previous empirical studies
(Glaser et al., 2002; Schmidt et al., 1995; Welburn et al., 2002).
Anxiety Model
First, the direct relationship between socially prescribed perfectionism and anxiety was
statistically significant. This indicates that there is a relationship to be mediated. However, as
with the depression model, the initial anxiety model did not provide a solid fit for the data. The
results did not support the anxiety model as originally designed (see Table 4). Thus, the
researcher modified the model based on the initial analyses and alternative ideas drawn from
existing theory and prior research. The modified model included a path is from Fear of
Abandonment to Vulnerability to Harm. According to Guidano and Liotti (1983), individuals
who experienced an insecure attachment in their early childhood would likely develop a fear of
abandonment. This supposedly contributes to a fearful vigilance of potential harm and the
generalized perception of a hostile world. Shah and Waller (2000) confirmed empirically that
insecure attachment contribute to the development of a Vulnerability to Harm schema.
The results for this modified model (see Figure 4) demonstrate that the model does fit the
observed data. However, the path from Socially Prescribed Perfectionism to Vulnerability to
Harm was not statistically significant. This does not satisfy the criteria (significant path
coefficient) for a mediating effect to exist for this particular schema. Thus, the model with the
insignificant path deleted was tested again. This analysis of the revised model (see Figure 5) was
congruent with the observed data and all path coefficients associated with the model were
statistically significant. These results are depicted in Table 4 and Table 5. Furthermore, the
coefficient associated with the direct path from socially prescribed perfectionism to anxiety was
67
significantly reduced after the mediators were added to the model. The mediating effects of Fear
of Abandonment and Failure to Achieve were significant.
These results demonstrate that the schemas, Fear of Abandonment and Failure to Achieve,
mediate the association between socially prescribed perfectionism and anxiety. On the other
hand, the schema, Vulnerability to Harm, does not mediate the relationship, but influence the
relationship indirectly through Fear of Abandonment. This indicates that socially prescribed
perfectionists, who perceive that significant others have unrealistic expectations for them, are
vulnerable to anxiety when they possess maladaptive schemas, such as Fear of Abandonment,
Failure to Achieve, and Vulnerability to Harm. In other words, if socially prescribed
perfectionists hold the beliefs 1) that others are not reliably available to provide support or
protection (Fear of Abandonment), 2) that one will inevitably fail, or is basically inadequate
relative to one’s peers, in areas of achievement (Failure to Achieve), and 3) that something bad
could happen at any moment (Vulnerability to harm), they are likely to experience anxiety.
These findings suggest that the relationship between socially prescribed perfectionism
and anxiety is not simply a direct linear relationship. Rather, maladaptive cognitive schemas play
important mediating roles in the relationship between these two phenomena. This outcome is
consistent with a variety of theoretical positions regarding perfectionism. Beck (1976) and Ellis
(2002) posit that perfectionists demonstrate dysfunctional cognitive structures or irrational
beliefs of perfection, which contribute to the development of emotional disturbances. Hamachek
(1978) and Burns (1980) hold that cognitive manifestations of perfectionism, such as “should”
statements, polarized thinking, and overgeneralization lead to psychological distress. More
particularly, Frost and DiBartolo (2002) suggest that socially prescribed perfectionists are
vulnerable to anxiety because they perceive the environment as holding the potential for harm. In
addition, they fear abandonment by loved ones and friends. Finally, they lack confidence in their
ability to achieve and perform. These cognitions are nurtured by their inclination to be
oversensitive to negative evaluation, and over concerned with making mistakes.
In contrast to the theories of perfectionism, empirical studies have focused on the linear
relationship between perfectionism and psychological distress. For instance, Hankin et al. (1997)
found that socially prescribed perfectionism is significantly associated with anxiety. Also,
Blankstein et al. (1993) found that socially prescribed perfectionism is significantly related with
specific anxiety, such as fears of failure, making mistakes, and losing control. However, these
68
studies have not shed light on the underlying mechanisms in the relationship between
perfectionism and anxiety, nor have they examined other variables that may influence the
relationship indirectly (Flett et al., 1994-1995; Hankin et al., 1997; Juster et al., 1996; Minarik &
Ahrens, 1996). Only a few recent studies have found mediating mechanisms in the relationship
between perfectionism and anxiety (E. C. Chang & Sanna, 2001; Flett et al., 2003). Regarding
the cognitive aspects of perfectionism, Flett et al. (2002) and Flett et al. (1998) showed that
perfectionists’ irrational beliefs are significantly associated with anxiety. Also, Sherry et al.
(2003) confirmed that socially prescribed perfectionism is significantly and positively related to
such dysfunctional attitudes as unrealistic standard-setting, fear of evaluation, requiring
acceptance, and deriving self-worth from others’ approval. Moreover, they found that these
dysfunctional attitudes also resulted in psychological distress.
The findings of the current study indicate that specific maladaptive cognitive schemas
explain the relationship between socially prescribed perfectionism and anxiety. Specifically, Fear
of Abandonment and Failure to Achieve directly mediate the relationship between socially
prescribed perfectionism and anxiety, and Vulnerability to Harm indirectly influences the
association through Fear of Abandonment. These outcomes are consistent with the theories of
perfectionism and previous empirical studies. Guidano and Liotti (1983) and Breger (1974)
posited that socially prescribed perfectionists cling to worries about possible abandonment, entail
a constant fear of failure, and ruminate about possible physical danger and emotional harm.
Similarly, Frost and DiBartolo (2002) held that socially prescribed perfectionists experience
anxiety due to specific maladaptive beliefs, such as fear of potential harm, fear of abandonment,
and concern about failing to achieve. These apprehensions are nurtured by their over-sensitivity
to other’s evaluation and excessive concern about making mistakes. Empirically, Martin and
Ashby (2004) confirmed that maladaptive perfectionism interferes with intimate relationship.
The results revealed that maladaptive perfectionists reported significantly greater fear of
intimacy than non-perfectionists. Blankstein et al. (1993) found that socially prescribed
perfectionists have fears of failure, fears of bodily injury, death, and illness, and fears of negative
evaluation. All of these variables are associated with the development of anxiety. Similarly,
Sherry et al. (2003) showed that socially prescribed perfectionists’ dysfunctional attitudes are
significantly associated with anxiety.
69
However, these findings need to be corroborated by further empirical studies. Historically,
most studies which examined the cognitive aspects of perfectionism have not focused on the
specific content of cognitive schemas that may influence psychological distress. Such knowledge
of the cognitive contents associated with psychological distress may provide clinicians with
information useful for the development of effective interventions.
Clinical Implications for Counseling
Based on the above results, the current study suggests possible therapeutic interventions.
The mediating effects of maladaptive cognitive schemas found in the current study imply that
socially prescribed perfectionistic clients with anxiety could be helped to restructure their
maladaptive cognitive schemas. In other words, practitioners might help socially prescribed
perfectionists who suffer from anxiety to understand the relationship between perfectionism,
cognitive schemas, and anxiety, and modify their maladaptive cognitive schemas, such as Fear of
Abandonment, Failure to Achieve, and Vulnerability to Harm. Thus, perfectionists need to build
strong beliefs that their self-worth is not contingent on others’ approval, that it is legitimate to
make mistakes, and that they can deal with possible dangers successfully through the a stable and
trusting relationship with a therapist and significant others. The effectiveness of cognitive
treatment with perfectionistic clients has been supported by several studies. Ferguson and
Rodway (1994) reported that cognitive therapy is effective in treating perfectionism and
associated problems. Particularly, DiBartolo, Frost, Dixon, and Almodovar (2001) found that the
students who scored high in Concern Over Mistakes scale of the FMPS benefited more from
cognitive therapy than the students who scored low in the scale. They also found that cognitive
restructuring reduced students’ level of negative expectations that feared outcomes would occur,
and lowered the degree of anxiety symptoms.
However, Young (1999) acknowledged that maladaptive schemas are difficult to change
because they are made up of implicit beliefs and are slowly constructed as a result of the
interaction between the child’s innate temperament and dysfunctional experiences with
significant others. Similarly, Flett and Hewitt (2002) suggested that perfectionists resist change
because they tend to hold on to their standards due to the perceived benefits of these standards.
These authors observed that such clients tend to strive for perfectionistic goals in the treatment
70
process. Therefore, they do not easily give up their efforts toward perfection and are not typically
satisfied with the effects of treatment. Similarly, Blatt (1995) and Blatt and Zuroff (2002) found
that perfectionism is not only associated with poor treatment response, but also problems with
building a good working alliance in therapeutic relationship.
Due to the rigidity of schemas and perfectionism, Young (1999) and Blatt and Zuroff
(2002) suggest that practitioners encourage clients to battle their maladaptive cognitive schemas
persistently. According to Young (1999), the maladaptive schemas can be modified by
integrating cognitive, experiential, behavioral, and interpersonal techniques. First, clients learn
how to fight schemas each time they are triggered. Second, they make schemas more flexible
using experiential techniques. Third, the therapist and client focus on changing self-defeating
behaviors that are associated with the schemas. Finally, the therapist may challenge the clients’
Fear of Abandonment schema through a here and now examination of the therapist-client
relationship. Rice et al. (2006) also suggest that cognitive components of intervention (e.g.,
hypothesis testing, examining the evidence, and preparation for tolerating uncertainty and
ambiguity) may help maladaptive perfectionists to experience less distress by reducing cognitive
rigidity and providing alternative beliefs.
Implications for Perfectionistic Individuals
The current study outcomes suggest that perfectionistic individuals need to be alert to the
significant role that their maladaptive cognitive schemas (Fear of Abandonment, Failure to
Achieve, and Vulnerability to Harm) are playing when they suffer from anxiety. It is likely that
individuals who are ultra sensitive to other’s evaluation are likely to experience anxiety precisely
because their maladaptive cognitive schemas direct them to be vigilant for such reactions of
others.
Based on these findings, it may be suggested that socially prescribed perfectionists be
helped to reexamine and reframe their maladaptive beliefs. First, according to the current study
results, socially prescribed perfectionists tend to believe that others would likely abandon them if
they make mistakes. Also, perfectionists think that others will always have exaggerated
expectations, as well as be easily disappointed with their imperfections, thus resulting in
rejection and abandonment (Fear of Abandonment). These thoughts are not based on concrete
71
evidence. Thus, positively reframed alternative beliefs might be stated as follows: “Others would
not abandon me in spite of my imperfection. They care for me not because I am perfect, but
because I am valuable. Others’ negative evaluation is not rejection.” Second, socially prescribed
perfectionists are likely to conclude that they are going to fail to achieve their goals in the
absence of concrete evidence. In addition, they may consider themselves to be untalented and
therefore unable to pursue high standards (Failure to Achieve). Associated restructured beliefs
are as follows: “Failure to achieve a goal is not permanent. Nor is it the end of world. I can
reevaluate my goals and I can examine the methods I’ve been using to attain my goals.” Finally,
socially prescribed perfectionists are vigilant to external dangers that may be caused by their
imperfection. Thus, they expect that something negative will happen when they make mistakes
(Vulnerability to Harm). Thus, they can change this maladaptive thinking as follows: “Outcomes
of imperfection may be uncomfortable, but rarely are they harmful. I am strong enough to deal
with negative results of imperfection.”
Furthermore, perfectionism, itself, is not always negative. As discussed in the literature
review, theories of perfectionism have suggested that there are two different types of
perfectionism; positive and negative. Positive perfectionists strive for perfection and obtain high
goals as do negative perfectionists. However, positive perfectionists are satisfied with the results
of their efforts and negative perfectionists are not (Hamachek, 1978). Also, positive
perfectionists seek perfection to secure positive reinforcement such as approval from others,
satisfaction, and euphoria, and negative perfectionists strive for high standards to avoid aversive
outcomes, such as negative evaluation, failure, possible harm, and abandonment (Terry-Short, et
al. 1995). Based on these notions and current study findings, negative perfectionists must work
to moderate their perfectionistic standards (accept less than perfect), focus on the process of
living and achieving more than the outcome, and appreciate the small successes and victories in
life. Also, they may need to loosen their rigid dichotomous thinking to increase their satisfaction
level (Beck, 1976; D. D. Burns, 1980; Mahoney & Arnkoff, 1979). This will be accompanied by
their contentment with process of reaching their goals.
However, it is not easy for perfectionists to give up their perfectionistic tendencies
because perfection has been reinforced by high achievement and successful performance in spite
of its painful price (Burns, 1980; Flett & Hewitt, 2002). In addition, established cognitive
schemas are stable and resist changing (Young, 1999). Therefore, previous studies have
72
suggested that considerable effort and commitment must be exerted by perfectionists to change
maladaptive cognitive schemas and to maintain these changes (Blatt and Zuroff, 2002).
Limitations and Recommendations for Future Study
The present study was aimed at discovering the mediating effects of maladaptive
cognitive schemas on the relationship between socially prescribed perfectionism and
psychological distress. However, the study is not without its limitations. First, due to the nature
of the sample, it is difficult to generalize the study results to all college students who reside in
the U.S. As noted in Chapter Three, the participants in the present study were predominantly
Caucasian American college students enrolled in undergraduate classes. Thus, the results should
not be generalized to all other populations such as clinical or minority ethnic populations. Future
studies may want to replicate the current study in other populations or employ a sample that
closely approximates the population in terms of important demographic and social characteristics
such as age, gender, ethnic background, economic status, and regional representation.
Second, a measurement model was not employed in the study although the study used the
Structural Equation Modeling (SEM) as a data analysis method. The SEM controls for
measurement error by using a measurement model before analyzing a structural model with
latent variables (Tate, 1999). Future researchers might use multiple measures to create latent
variables so that they may have a structural model with reduced measurement error.
Third, caution is advised in drawing any firm conclusions regarding the causal
relationships among the variables even though the model was designed based on previous theory
and empirical research. The SEM procedure, itself, assumes that the model includes causal
relationships and hypotheses are developed based on this assumption (Peyrot, 1996). However,
the results of SEM are based on correlational data. In addition, in order to confirm the causal
relationship between these latent variables, researchers need to conduct psychotherapy outcome
studies by examining whether the interventions of modifying one’s maladaptive cognitive
schemas can decrease the psychological distress of perfectionistic clients.
Fourth, maladaptive cognitive schemas explain only part of the relationship between
socially prescribed perfectionism and psychological distress. As previous studies suggested,
there are other possible variables that may influence the association between perfectionism and
73
psychological distress. For instance, ego defense style (Flett, Besser, & Hewitt, 2005), stress
(Chang, Watkins, & Banks, 2004), unconditional self-acceptance (Flett, Besser, Davis, & Hewitt,
2003), self-concealment (Kawamura & Frost, 2004), and self-esteem (Rice, Ashby, & Slaney,
1998) were suggested as potential mediating mechanisms in the association between
perfectionism and psychological distress. These additional variables need to receive greater
research focus in future studies in order to improve treatment effectiveness and expand the
knowledge of perfectionism (Judd & Kenny, 1981; MacKinnon, 2000).
Fifth, the current study failed to reveal the underlying mechanisms that might
differentially explain depression versus anxiety in perfectionistic individuals. Beck (1976) and
Derry and Kuiper (1981) posited that different content in maladaptive cognitive schemas relate
to anxiety and depression respectively. Kuiper and Derry (1982) postulated that the schemas
including personal worthlessness, incompetence, and pessimism, are associated with depression.
Conversely, anxiety is correlated with the cognitions containing anticipated harm, uncertainty,
and unpredictability. Therefore, the current study was expected to shed light on the discrepancy
between underlying mechanisms associated with depression and anxiety. However, the results do
not support the depression model in the study. It is recommended that future research into
perfectionism carefully reexamine the cognitive differences between depression and anxiety.
Finally, order effects in collecting data were not completely controlled although the
surveys were counterbalanced to reduce order effects. Some of the items that were included in
the questionnaires asked about subjects’ past negative experiences. Rumination of negative past
experience may have affected individuals’ subjective feelings while they were completing the
instruments. These emotional reactions may have had an impact on the results of assessment.
Therefore, the future studies are recommended to consider possible order effects on study results
and to design study processes more carefully.
In spite of these limitations, however, the present findings provide preliminary support
for the mediating effects of maladaptive cognitive schemas on psychological distress and expand
the knowledge of the relationship between perfectionism and anxiety. Also, the results offer
important implications for counseling with socially prescribed perfectionists. Of course, more
research is needed to confirm the relationships found in the present study.
74
Conclusions
In conclusion, the present study examined the mediating effects of maladaptive cognitive
schemas in the relation between socially prescribed perfectionism and psychological distress by
using structural equation modeling. Neither of the two hypothesized depression and the anxiety
models were consistent with the observed data. However, the anxiety model fit the collected data
following a model revision. This indicated that maladaptive cognitive schemas have a mediating
effect on anxiety when socially prescribed perfectionism is associated with that anxiety.
The findings expanded the knowledge of perfectionism, suggesting that the relationship
between socially prescribed perfectionism and anxiety is not a direct linear relationship as was
previously thought. Maladaptive cognitive schemas serve as an underlying mechanism through
which socially prescribed perfectionism affects anxiety. Furthermore, the results revealed that
the specific content of schemas, such as Fear of Abandonment, Failure to Achieve, and
Vulnerability to Harm, explain the relationship between socially prescribed perfectionism and
anxiety. More particularly, Fear of Abandonment and Failure to Achieve mediate the association
between socially prescribed perfectionism and anxiety, and Vulnerability to Harm indirectly
influence the relationship through Fear of Abandonment.
These encouraging findings strongly imply that therapists need to consider perfectionistic
clients’ maladaptive cognitive schemas when they suffer from psychological distress. In other
words, socially prescribed perfectionists, who perceive that significant others have unrealistic
expectations for them, may decrease their anxiety levels by revising their maladaptive cognitive
schemas, such as Fear of Abandonment, Failure to Achieve, and Vulnerability to Harm.
However, the current study is not without limitations in spite of the significant outcomes. Based
on these limitations, the study recommended several future research directions.
75
APPENDIX A:
Informed Consent Form
76
77
78
79
APPENDIX B:
Demographic Questionnaire
80
Demographic Questionnaire
Date: _____________
Directions: Please complete every question.
1. Gender:
Male
Female
2. Age: _______
3. Ethnicity:
African American
Hispanic
Native American
Asian/Pacific Islander
Caucasian
Other
4. Current College Level:
Fresh.
Soph.
Junior
Senior
5. GPA: _______
81
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96
BIOGRAPHICAL SKETCH
Education
Ph.D. Candidate, Combined Doctoral Program in Counseling Psychology & School
Psychology (APA accredited program), 2007
Department of Educational Psychology and Learning Systems, College of Education
The Florida State University; Tallahassee, FL; GPA: 3.87/4.00
Dissertation Topic: Madaptive Cognitive Schemas as Mediators between Perfectionism and
Psychological Distress
Pre-doctoral Psychology Internship (APA accredited program) August 2006 – August 2007
Center for Counseling and Psychological Services
Pennsylvania State University, State College, PA
Graduate Certificate in Measurement and Statistics, 2006
Department of Educational Psychology and Learning Systems, College of Education
The Florida State University, Tallahassee, FL
M.Ed. Educational Counseling, 1999
Seoul National University; Seoul, Korea; GPA: 3.83/4.00
Thesis: School counseling systems and student’s quality of life
B.A. Public Administration, 1995
Kon-Kuk University; Seoul, Korea; GPA : 3.86/4.00
Professional Experience
Counseling, Assessment, and Supervision
Intern, June 2005 – present
Forensic Unit
The Florida State Hospital, Chattahoochee, FL
Intern, May 2004 – December 2005
Psychology Department
Tallahassee Memorial Hospital Behavioral Health Center, Tallahassee, FL
Career Advisor, August 2003 – May 2004
Curricular Career Information Service, The Career Center
The Florida State University; Tallahassee, FL
Supervisor, January 2003 – May 2004
College of Education
The Florida State University; Tallahassee, FL
Practicum, January 2002 – August 2002
Counseling Department
Tallahassee Community College, Tallahassee, FL
97
Counselor, July 1999 – February 2000
Korean Youth Counseling Institute, Seoul, Korea
Counseling Essay Writer, April 1999 – June 1999
Korean Youth Counseling Institute, Seoul, Korea
Full-time Intern, March 1997 – February 1999
Center for counseling and student service
Seoul National University, Seoul, Korea
Practicum, March 1995 – February 1997
Center for counseling and student service
Seoul National University, Seoul, Korea
Intern, September 1995 – February 1996
Hot-line department
Love Welfare Foundations, Seoul, Korea
Consulting and Program Management
Project KICK (Kids In Cooperation with Kids) May 2001 – Current
College of Education, Florida State University, Tallahassee, FL
Boys and Girls Club Parent Program, November 2002 – August 2003
Tallahassee, FL
Workshop
Assistant leader, September 2005
The Dankook University; Seoul, Korea
Topic: Effective counseling skills for mental health problems
Instruction
Instructor, August 2003 – Present
The Florida State University; Tallahassee, FL
•
•
SDS 4481 – Communication and Human Relations; Fall 2004, Spring and Fall 2005,
Spring 2006
SDS 3340 – Introduction to Career Development; Fall 2003, Spring 2004, Fall 2005
Instructor, August 1999 – June 2001
Graduate School of Education, Deajin University, Pocheon, Korea
•
•
•
•
•
Introduction to Group Counseling; Fall 1999
Counseling Theories; Spring 2000
Stress Management; Spring 2000
Family Therapy; Fall 2000
Introduction to Career Counseling; Spring 2001
Instructor, August 1999 – August 2000
Continuing Education Institute, Daejin University, Pocheon, Korea
• Counseling and Psychology; Fall 1999, Spring and Summer 2000
98
Instructor, July 1999 – August 2000
Continuing Education for School Counselor, Deajin University, Pocheon, Korea
•
Counseling Theories; Summer 1999
•
Family Therapy; Summer 2000
Research and Development
Co-Researcher, January 2004 – present
College of Education
The Florida State University; Tallahassee, FL
Co-researcher, January 2004 – present
The Career Center
The Florida State University; Tallahassee, FL
Co-Researcher, January, 2003 – present
College of Education
The Florida State University; Tallahassee, FL
Co-Researcher, August 1999 – February, 2000
Korean Youth Counseling Institude, Seoul, Korea
Co-Researcher, August 1999 – November, 2000
Korean Youth Counseling Institude, Seoul, Korea
Co-Researcher, July 1997 – December 1997
Center for counseling and student service
Seoul National University, Seoul, Korea
Graduate Research Assistant, September, 1995 – February, 1997
College of Education
Seoul National University, Seoul, Korea
Publications
Reardon, R. C., Leierer, S. J., & Lee, D. (under review). Using grades to evaluate a career course.
Journal of Career Assessment.
Dao, T. K., Lee, D., & Chang, H. L. (in press). Acculturation level, perceived English fluency,
perceived social support level, and depression among Taiwanese international students,
College Student Journal.
Lee, D. & Pfeiffer, S. I. (in press). The reliability and validity of a Korean translated version of
Gifted Rating Scale, Journal of Psychoeducational Assessment.
Reardon, R. C., Leierer, S. J., & Lee, D. (February 22, 2006). Using Grades to Evaluate a Career
Course (Technical Report No. 43). Tallahassee, FL: Florida State University, Center for
the Study of Technology in Counseling and Career Development [On-line]. Available:
http://www.career.fsu.edu/techcenter/technical_reports.htm
Folsom, B., Reardon, R. C., Lee, D. (June 28, 2005). The effects of college career course on
learner outputs and outcomes (Technical Report No. 37). Tallahassee, FL: Florida State
University, Center for the Study of Technology in Counseling and Career Development
[On-line]. Available: http://www.career.fsu.edu/techcenter/technical_reports.htm
Yoo, S. & Lee, D. (2001). An exploratory study of attitude toward help-seeking in Korean
culture, The Korean Journal of Counseling and Psychotherapy, 12, 55-67.
99
Lee, D. & Yoo, S. (2000). Publication trends in counseling journals and theses, The Korean
Journal of Youth Counseling, 8, 37-58.
Lee, D. (1999). School counseling systems and quality of school life, Student Review, 33, 47-61.
Lee, D., Koo, B., Hwang, S., & Kim, H. (1999). Adolescents’ behaviors in internet. Review of
Youth Counseling, 37. Seoul: Korean Youth Counseling Institute.
Kwon, S. & Lee, D. (1998). Characteristics of clients who visited the center for student
counseling and personnel service at Seoul National University for individual counseling
in 1997, Student Review, 32, 71-90.
Lee, D. (1995). Impact of achievement motivation on performance of the civil service, Journal of
Government, 29, 155-172.
Presentations
Kelly, F. D. & Lee, D. (2006, August). Perfectionism, coping styles, and psychological distress.
Accepted as program presentation at the American Psychological Association Annual
Conference, New Orleans, Louisiana.
Reardon, R. C., Leierer, S. J., & Lee, D. (2006, July). Drilling through 26 years of grades in a
career course: what did we find?. Accepted as program presentation at the National
Career Development Association Annual Conference, Chicago, Illinois.
Dao, T., Lee, D., Chang, H., & Lee, J. (2005, August). The contribution of English fluency,
acculturation and social support to international students’ psychological well-being.
Program presented at the American Psychological Association Annual Conference,
Washington D.C.
Lee, D., & Kelly, F. D. (2005, August). Maladaptive cognitive schemas as mediators between
perfectionism and anxiety. Program presented at the American Psychological Association
Annual Conference, Washington D.C.
Lee, D., & Kelly, F. D. (2005, April). Mediating effects of maladaptive cognitive schemas in the
relationship of perfectionism with depression. Program presented at the Southeastern
Psychological Association Annual Conference, Nashiville, Tennessee.
Pfeiffer, S. I., Li, H., Kumtepe, A., Petscher, Y., Rosado, J., Lee, D., & Williams, K. (2005,
March). The Gifted Rating Scale: what the research says. Symposium presented at the
National Association of School Psychologists Annual Conference, Atlanta, Georgia.
Pfeiffer, S. I., Li, H., Kumtepe, A., Petscher, Y., Rosado, J., Lee, D., & Williams, K. (2004,
November). The validiation of Gifted Rating Scale. Symposium presented at the Florida
Association of School Psychologists Annual Conference, Sarasota, Florida.
Dao, T., Li, H., & Lee, D. (2004, August). Ratial/ethnic research in the journal of counseling
psychology revisited: a content analysis and methodological critique. Program presented
at the Asian American Psychological Association Annual Conference, Honolulu, Hawaii.
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Membership in Professional Organizations
American Psychological Association, January 2003 - present
Graduate Student Affiliate, Division of Counseling Psychology
Asian American Psychological Association, January 2004 - present
Florida Association of School Psychologists, January 2003 – present
Honors and Awards
College Teaching Fellowship, 2001-2002
College of Education, Florida State University
Dean’s Award, 1995
College of Social Science, Kon-Kuk University, Seoul, Korea
Academic Scholarship, 1989-1995
College of Social Science, Kon-Kuk University, Seoul Korea
Additional Training
Advanced Certificate, Summer 1999
Advanced MBTI interpretation and trainer
Korean MBTI Association
Certificate, Summer 1996
Solution Focused Brief Therapy
Korean Brief Family Therapy Association
Certificate, Fall 1995
Psychodrama
Korean Psychodrama Association
Information Communication Technology Skills
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•
creating databases, graphs, and reports using Microsoft Word, Excel, and Powerpoint
analyzing data using SPSS, LISREL, and HLM-5.
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