Towards High Standards of Evidence for Cognitive Behaviour Therapy for Perfectionism: A Critique of Smith et al. (2023)

Perfectionism is associated with symptoms of multiple psychological disorders. In this commentary, we outline our numerous concerns regarding a recent meta-analysis by Smith et al. (2023) that examined the efficacy of cognitive behaviour therapy for perfectionism (CBT-P). To ensure health care and policy decisions are based on high-quality evidence, evidence summaries need to be held to high standards of accountability. The study did not systematically search the literature, and omitted previous studies included in the meta-analyses they sought to reanalyze. Additionally, there was insufficient statistical power to detect intervention effects with small numbers of studies and multiple outcomes, other statistical concerns (e.g., numbers-needed-to-treat analysis), and conflation of the issue of dropout and treatment tolerance. To ensure appropriate guidance for the health care sector, evidence summaries of intervention effects must uphold high standards of quality. CBT-P has demonstrated efficacy in addressing the risk factor of perfectionism and preventing and decreasing symptoms of anxiety, depression, and eating disorders. Further systematic reviews and meta-analyses with rigorous methodology are encouraged.