Recent Models of Psychological Health

Applied in the Workplace

A Research Journey into Perfectionism,

Perseverative Cognition, and Acceptance-Based Therapy

Dr. Paul Flaxman

Here’s the Plan

• Perfectionism (nature, measures, and current debates)

• Brief look at work-related worry and rumination during leisure time

• Results of three recent studies

• Reflection on intervention, and potential of mindfulness/ acceptance-based approaches

Warm-Up Task

While the song and slides are playing, use the ‘perfectionism’ handout to note:

• A few outcomes or effects of perfectionism that might be adaptive, useful, or helpful • A few outcomes or effects of perfectionism that seem maladaptive or unhelpful

Why Wilko is a kicking perfectionist

“Sometimes when I'm kicking I can get obsessive about seeing results. I'll tell myself: I need to hit five in a row from here.... That may sound obsessive, but I like to think that sort of thing gives me the extra one per cent that could get me through in really tough situations.”

Jonny Wilkinson Ex England fly-half

His fear not just of failure but of a lowering of standards, borders on the autistic. More recently, he admitted that the fear still exists. Because of this, he does not really 'enjoy' his rugby enough; never has.

Inside the tortured mind of our hero Jonny Wilkinson

THE INDEPENDENT (May 2013)

Roberto Mancini to exit Manchester City: Rising expectations of perfectionist manager was a recipe for trouble.

Nonetheless, Mancini’s City last year won the club’s first title since 1968 and he delivered an FA Cup in his first season at the club.

His own medical staff copped it, especially over what Mancini saw as mistakes over injuries to Micah Richards and Sergio Aguero.

'Perfectionist' Charlie

Chaplin demanded 342 takes for one movie scene

Charlie Chaplin made Virginia Cherrill perform one scene -- in which she says just two words in a silent film -- an excruciating 342 times. “He knew exactly what he wanted and he would have preferred not to have any other actors in his films"

Estee Lauder

Perfectionist Wrinkle Lifting/Firming Serum

The development of the Macintosh took more than three years, because of Jobs’s obsession with detail. He wanted his engineers to redesign the Mac’s motherboard, just because it looked inelegant.

‘As seemingly everyone on the planet knows, Steve Jobs’s defining quality was perfectionism.’

“Moreover Eddi felt under pressure from [another band member’s] continual

perfectionism in the band.

So when he stormed out of a recording session for a second album one day in November 1989, Fairground Attraction split.....” http://www.eddireader.net/eddibiog.htm Copyright © 1999-2000 Adrian Dover

Eddi Reader Biography

Perfectionism: Conceptualisation and Measurement

Prof. Randy Frost Smith College, Massachusetts.

Frost’s Multidimensional Perfectionism Scale (FMPS; Frost et al., 1990)

Frost MPS scales

Concern over mistakes: Excessive concern over mistakes in performance

If I fail at work/ school, I’m a failure as a person.

If I fail partly, it is as bad as being a complete failure.

Doubts about actions: Doubting the quality of one’s performance

Even when I do something carefully, I often feel it is not quite right.

I tend to get behind in my work because I repeat things over and over.

Personal standards: Excessively high personal standards.

I expect higher performance in my daily tasks than most people.

If I do not set the highest standard for myself, I am likely to end up a second-rate person.

Parental criticism: Belief that failure to meet parental standards can result in loss of acceptance

I never felt like I could meet my parents’ expectations.

As a child, I was punished for doing things less than perfect.

Parental expectations: Perceptions about standards parents have for the individual

My parents set very high standards for me.

Only outstanding performance is good enough in my family.

Organisation: Exaggerated emphasis on precision, order, and organisation

Neatness is very important to me.

Organisation is very important to me.

Frost MPS scales

Gordon Flett, Professor of Psychology, York University, Toronto

Paul Hewitt, professor of psychology (and clinical psychologist), University of British Columbia, Vancouver

Hewitt & Flett’s Multidimensional Perfectionism Scale (MPS; Hewitt & Flett, 1991)

Self-oriented perfectionism: Setting of excessively high standards and perfectionistic motivation for oneself

I must always be successful at school or work.

One of my goals is to be perfect in everything I do.

Socially prescribed perfectionism: The perception that others hold excessively high standards for oneself

Those around me readily accept that I can make mistakes too (reversed).

The people around me expect me to succeed at everything I do.

Other-oriented perfectionism: Holding unrealistic standards of performance or behaviour for significant others

I have high expectations for the people who are important to me.

If I ask someone to do something, I expect it to be done flawlessly.

Hewitt & Flett MPS

Evaluative concerns

perfectionism

Doubts about actions

Socially prescribed perfectionism

Concern over mistakes

Perfectionist Strivings

Personal standards

Self-oriented perfectionism

Neuroticism

Conscientiousness

Avoidant coping

Social support

Hassles

Negative affect

+ -

Active coping

Hassles +

Positive affect

Distress

Achievement

+

+

+

Evaluative concerns

perfectionism

Perfectionist Strivings

+ + +

Clinical Focus

“Our research on perfectionism has an emphasis that is predominantly clinical, and as such we have focused primarily on the negative aspects of perfectionism.” “We remain unconvinced that what is being referred to as ‘positive’ perfectionism is indeed positive and healthy.” Flett & Hewitt, 2006

“Why do many researchers find it difficult to accept that perfectionism can be positive?” Stoeber & Otto, 2006

‘Perfectionist’ surgeon hanged himself after he made minor mistake in operation. Last night, friends described the father-of-two as a 'perfectionist' who had won awards for his pioneering work in hip replacement, but said he could not bear to make mistakes.

Alexander Reading was one of Britain's top orthopaedic and trauma surgeons

Perfectionism: Theoretical Models

Diathesis-Stress Model

Perfectionism (Underlying vulnerability factor)

High distress

Specific vulnerability (congruency) hypothesis

Self-oriented Perfectionism

High distress

High distress

Socially prescribed perfectionism

Approach/ avoidance reinforcement systems

Maladaptive perfectionism

Cognitions and behaviours directed toward the achievement of high-level goals to AVOID OR ESCAPE FROM NEGATIVE CONSEQUENCES

‘Adaptive’ perfectionism

Cognitions and behaviours directed toward the achievement of high-level goals to OBTAIN POSITIVE CONSEQUENCES

Slade & Owens, 1998

(positive reinforcement)

(negative reinforcement)

Rationale for examining employee perfectionism

• Items in perfectionism measures already refer to ‘work’!

• Perfectionism may offer more detailed understanding of stress vulnerability than higher-order traits

• Work is the life domain in which many people report their strongest perfectionistic tendencies • Different patterns of perfectionism found between undergraduate student and older samples

Poor psychological detachment from work during leisure time

WORK

Taxing work-related functional systems

Less likely to fully contact leisure resources (e.g., social support, self-efficacy, mood repair)

I forget about work.

I get a break from the demands of work.

I distance myself from my work.

I don’t think about work at all.

Psychological detachment from work during leisure time

Sonnentag and Fritz (2007) Recovery Experiences Questionnaire

Perseverative cognition (worry and rumination)

“Repeated or chronic activation of the cognitive representation of one or more psychological stressors” (Brosschot et al., 2006)

Prolongs psychosocial (e.g., work) stressors in representational form, leading to sustained activation of stress-related physiological and emotional response systems

Thoughts About Work Scale (Flaxman et al., 2012)

Worry/ Rumination Constructive thinking

I worried about how I would deal with a work task or issue

I had constructive thoughts about a work project

I worried about things I need to do at work

I reflected on things that have gone well for me in my job

My thoughts kept returning to a stressful situation at work

I thought positively about my work performance

Subscale Example item

Affective rumination I was annoyed by thinking about work-related issues

Detachment from work I found it easy to unwind after work

Problem-solving rumination

I found solutions to work-related problems

Work-related rumination questionnaire (Mark Cropley et al., 2012)

Overarching research questions

• Can we demonstrate that worry/ rumination about work during leisure time is highly detrimental to employee recovery?

• Do perfectionists show a particular vulnerability for worrying and ruminating about work? • Do more adaptive perfectionists think about work during leisure time, but in a more constructive way?

Study 1:

Impact of perfectionism on employee well-being during and after the Easter holiday

Flaxman, Ménard, Bond & Kinman (2012). Journal of Applied Psychology, 97, 854-865.

Participants: N = 77 Academic staff from two UK Universities

Length of respite: 32% weekend equivalent 47% extended weekend (3 to 4 days) 21% 1 or 2 week vacation

Design:

Initial questionnaire (demographics, work demands, Frost DA perfectionism)

Week-level surveys before during and after the Easter break

Doubts about actions: Doubting the quality of one’s performance

Example items:

Even when I do something carefully, I often feel it is not quite right.

I tend to get behind in my work because I repeat things over and over.

Week 1 (work week)

Week 2 (Respite from work)

Week 3 (work week)

Week 4 (work week)

3rd or 10th March 25th to 28th March 7th April 21st or 28th April

(Easter 21st to 24th March)

well-being; burnout

well-being; burnout; thoughts about work

well-being; burnout

well-being; burnout

Respite Design (N = 77)

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

week 1 week 2 week 3 week 4

PERF high

PERF low

Academics’ FATIGUE as a function of doubts about action perfectionism

Easter weekend

1

1.5

2

2.5

3

3.5

week 1 week 2 week 3 week 4

PERF high

PERF low

Academics’ BURNOUT as a function of doubts about action perfectionism

Easter weekend

0

0.5

1

1.5

2

2.5

week 1 week 2 week 3 week 4

PERF high

PERF low

Academics’ ANXIETY as a function of doubts about action perfectionism

Easter weekend

Worry and rumination about work during the Easter holiday

Mediation Results

Doubts about action

perfectionism

Increase in fatigue, exhaustion, anxiety when returning to work after Easter

Control variables: age; job role; respite length; hours worked over Easter; and well-being during Easter

Study 2:

Impact of employee perfectionism on evening leisure time, sleep quality, and work day functioning

Flaxman, Carmichael, Stride, & Söderberg (in prep)

Participants:

N = 160 mix of government and NHS employees

Design:

Initial questionnaire (demographics, work demands, Frost perfectionism, negative affectivity, neuroticism)

Daily surveys completed 11 times across a working week

Flaxman, Carmichael, Stride, & Söderberg (in prep)

Mon Tues Wed Thur

Fri

Morning

Sleep

quality

Sleep

quality

Sleep

quality

Sleep

quality

After

work

Burnout &

Work

engagement

Burnout &

Work

engagement

Burnout &

Work

engagement

Evening

Thoughts

about work

Thoughts

about work

Thoughts

about work

Thoughts

about work

Study 2 Daily Surveys

Evaluative concerns

perfectionism

Perfectionist Strivings

Constructive thinking

about work during the

evening

Sleep quality

Burnout

Work engagement

Morning sense of recovery

Collected once per day (EVENING, Mon-Thu)

Collected once per day (MORNING/ WORK DAY, Tue-Fri)

+ -

-

-

+

INITIAL SURVEY

Control variables: Job demands, job control, gender, age, neuroticism, negative affectivity

+

+

Worry and rumination about work during the

evening

Study 3:

Perfectionism, work day coping strategies, and evening rumination about work

Flaxman, Carmichael, Stride, & Söderberg (in prep)

Participants:

N = 130 NHS employees, teachers, local council workers

Design:

Initial questionnaire (demographics, job demands/ control/support, both forms of the MPS, neuroticism, conscientiousness)

Daily surveys completed 10 times across a working week

Mon Tues Wed Thur

Fri

Immediately

after work

Perceived

stress;

affect;

coping

strategies

Perceived

stress;

affect;

coping

strategies

Perceived

stress;

affect;

coping

strategies

Perceived

stress;

affect;

coping

strategies

Perceived

stress;

affect;

coping

strategies

Evening

(before going to

bed)

Perceived

stress;

affect;

work-

related

thoughts

Perceived

stress;

affect;

work-

related

thoughts

Perceived

stress;

affect;

work-

related

thoughts

Perceived

stress;

affect;

work-

related

thoughts

Perceived

stress;

affect;

work-

related

thoughts

Study 3 Daily Surveys

Coping Measure

HOW YOU DEALT WITH PROBLEMS TODAY

We are interested in how people respond when they confront difficult or stressful events in their lives. Please now think about your most bothersome or problematic event or issue of the day so far. [Then asked to rate what they did when they experienced this event – items from COPE and Heppner et al ]

(Adapted from Dunkley et al., 2003; Stoeber & Janssen, 2011)

Avoidant coping

(behavioural disengagement/

suppressive coping)

Evaluative concerns

perfectionism

Negative affect

Perceived stress

Negative affect

Perceived stress

Affective rumination about work

Work part of day

Evening

(controlling for well-being after work)

Evaluative concerns

perfectionism

Perfectionist Strivings

Avoidant coping

(behavioural disengagement/

suppressive coping)

Active coping (planning and active coping)

+

+

- -

Control variables: demos, job demands, control, support, neuroticism and conscientiousness

How employees coped with their most difficult event of the work day

Take home messages

• Worry and rumination during leisure time can be highly detrimental to employee well-being

(over and above: how much time people have off; how many hours they actually worked during leisure time; and degree to which they felt they got a break from work)

• Evaluative concerns perfectionism reliably associated with avoidant forms of coping

• For maladaptive perfectionists, time off work likely to be crucial

Take home messages

Perfectionist strivers:

• able to detach from work during leisure time • less likely to use avoidant coping strategies • think constructively about work during leisure time

Intervention Reflections

Core perfectionist beliefs often considered difficult to change

Interventions can focus on the ‘products’ (or processes) of perfectionism - such as coping skills etc.

Perfectionists known to be reluctant to seek help.

Martin Antony Roz Shafran

Acceptance-based psychological skills training in the workplace

Acceptance and Commitment Therapy

• An acceptance/ mindfulness-based behaviour therapy

• Transdiagnostic intervention model

• Mindfulness used as a means to an end (valued living)

• Focus is on altering function rather than changing content or frequency of unhelpful thoughts and feelings

Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

Open

Psychological Flexibility

Be here now

Open up

Watch your thinking

Pure awareness

Aware Active

Know what matters

Do what works

Hayes et al. (2011)

Psychological Flexibility

The ability to contact the present moment, and all the thoughts and feelings it contains without needless defence, and based on what the situation affords , To persist or change behaviour in the service of chosen values.

Hayes et al., 2011

The essence of ACT/ psychological flexibility

ACT in the Workplace

Several trials showing brief ACT training improves employees’ mental health (Bond & Bunce, 2000; Flaxman & Bunce,

2010; Dahl et al., 2004; Hayes et al., 2004; Brinkborg et al, 2011; Lloyd, Bond & Flaxman, 2013)

69% of initially distressed employees experienced clinically significant improvements (Flaxman & Bond, 2010)

Repeated demonstration that improved psychologcial flexibility (or its facets) is the key mechanism of change

ACT

Psychological

flexibility

Improved

mental health

Improved

mental health

Decreased

perfectionist

attitudes

CBT

Decreased

perfectionist

attitudes

Flaxman & Bond (2010). Behaviour Research and Therapy.

Very Final Reflections

• Perfectionism seems a viable research area for our discipline

• Worry/ rumination a key mechanism in employee well-being and recovery from work demands

• Recent developments in CBT have great potential for improving employees’ mental health