Trends
Original Article
in Psychiatry and Psychotherapy
Perfectionism and negative/positive affect associations:
the role of cognitive emotion regulation and perceived
distress/coping
Associação entre perfecionismo e afeto negativo e positivo: o papel da
regulação emocional cognitiva e do stresse/coping percebidos
Juliana Castro, Maria João Soares, Ana T. Pereira, António Macedo*
Abstract
Resumo
Objective: To explore 1) if perfectionism, perceived distress/
coping, and cognitive emotion regulation (CER) are associated
with and predictive of negative/positive affect (NA/PA); and
2) if CER and perceived distress/coping are associated with
perfectionism and if they mediate the perfectionism-NA/PA
associations. There is a distinction between maladaptive and
adaptive perfectionism in its association with NA/PA. CER and
perceived distress/coping may mediate the maladaptive/adaptive
perfectionism and NA/PA associations.
Methods: 344 students (68.4% girls) completed the Hewitt &
Flett and the Frost Multidimensional Perfectionism Scales, the
Composite Multidimensional Perfectionism Scale, the Profile
of Mood States, the Perceived Stress Scale, and the Cognitive
Emotion Regulation Questionnaire.
Results: NA predictors were maladaptive/adaptive perfectionism,
maladaptive CER and perceived distress (positively), positive
reappraisal and planning, and perceived coping (negatively).
PA predictors were maladaptive/adaptive perfectionism and
perceived distress (negatively), positive reappraisal and
planning, positive refocusing and perceived coping (positively).
The association between maladaptive perfectionism and
NA was mediated by maladaptive CER/low adaptive CER,
perceived distress/low coping. Maladaptive perfectionism and
low PA association was mediated by perceived distress. High
PA was determined by low maladaptive perfectionism and this
association was mediated by adaptive REC and coping. Adaptive
perfectionism and NA association was mediated by maladaptive
CER and perceived distress.
Conclusion: CER and perceived distress/coping are associated
and mediate the perfectionism-NA/PA associations.
Keywords: Perfectionism, cognitive emotion regulation,
perceived stress/coping, negative affect, positive affect.
Objetivo: Explorar 1) se o perfeccionismo, o estresse/coping
percebidos e a regulação emocional cognitiva (REC) estão
associadas e predizem o afeto negativo/positivo (AN/AP); e
2) se a REC e o estresse/coping estão associados e mediam
a relação perfeccionismo-AN/AP. Existe uma distinção entre o
perfeccionismo mal-adaptativo/adaptativo na associação com o
AN/AP. A REC e o estresse/coping poderão mediar as associações
entre o perfeccionismo mal-adaptativo/adaptativo-AN/AP.
Métodos: 344 estudantes (68.4% do sexo feminino) completaram
as Escalas Multidimensionais do Perfeccionismo de Hewitt &
Flett e de Frost, a Escala Multidimensional de Perfeccionismo
Compósita, o Perfil dos Estados de Humor, a Escala de Estresse
Percebido e o Questionário da Regulação Emocional Cognitiva.
Resultados: Os preditores do AN foram o perfeccionismo
adaptativo/mal-adaptativo, a REC mal-adaptativa e o estresse
percebido (positivamente), a reavaliação positiva e planeamento e o
coping (negativamente). Os preditores do AP foram o perfeccionismo
adaptativo/mal-adaptativo e o estresse percebido (negativamente),
a reavaliação positiva e planeamento, a refocalização positiva
e o coping percebido (positivamente). A associação entre o
perfeccionismo mal-adaptativo e o AN foi mediada pela REC maladaptativa/baixa REC adaptativa, pelo estresse/baixo coping
percebidos. A associação entre o perfeccionismo mal-adaptativo/
adaptativo e baixo AP foi mediada pelo estresse percebido. O
elevado AP foi determinado pelo baixo perfeccionismo maladaptativo e esta associação foi mediada pela REC adaptativa e
pelo coping. A associação entre o perfeccionismo adaptativo e o AN
foi mediada pela REC mal-adaptativa e pelo estresse percebido.
Conclusão: A REC e o estresse/coping percebidos estão associados
e medeiam as associações entre o perfeccionismo e AN/AP.
Descritores: Perfecionismo, regulação emocional cognitiva,
estresse/coping percebidos, afeto negativo, afeto positivo.
* Departamento de Psicologia Médica, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.
Submitted Jun 08 2016, accepted for publication Dec 28 2016.
Suggested citation: Castro J, Soares MJ, Pereira AT, Macedo A. Perfectionism and negative/positive affect associations: the role of cognitive emotion regulation
and perceived distress/coping. Trends Psychiatry Psychother. 2017;39(2):77-87. http://dx.doi.org/10.1590/2237-6089-2016-0042
APRS
Trends Psychiatry Psychother. 2017;39(2) – 77-87
Perfectionism and negative/positive affect associations - Castro et al.
Introduction
Frost et al.1 defined perfectionism as “the setting of
excessively high standards for performance accompanied
by overly critical self-evaluation.” Perfectionism has been
a topic of increased interest in recent years, because of
its association with stress generation and maintenance2
and with several psychopathological conditions, being
considered a transdiagnostic process.3 Recent research
has given support to the notion that perfectionism is
multidimensional in nature and has both personal and
interpersonal facets, some of which are adaptive, and
some of which have more detrimental consequences
for the individual. The perfectionism dimensions more
frequently associated with psychopathology are concerns
over mistakes (CM) and doubts about actions (DA)
from the Frost-Multidimensional Perfectionism Scale
(F-MPS),1 and socially prescribed perfectionism (SPP)
from the Hewitt and Flett Multidimensional Perfectionism
Scale (H&F-MPS).4,5 Self-oriented perfectionism (SOP)
and personal standards (PS), from the H&F-MPS and
F-MPS, respectively, are considered the most adaptive
dimensions of perfectionism.5,6
Based on factor analysis of F-MPS and H&F-MPS
items, a model has been proposed that incorporates
two factors. One of these factors is evaluative concerns
(EC), which involves self-critical tendencies and includes
CM, SPP, DA, parental expectations (PE) and parental
criticism (PC). This factor is essentially maladaptive,
being related to negative outcomes, such as higher levels
of depression, anxiety and stress.6,7 The other factor
is positive strivings (PStr), which involves the setting
and striving for high standards and goals, including PS,
SOP, organization and other-oriented perfectionism. It
is associated with positive characteristics, processes
and outcomes and is unrelated or even inversely
related to negative characteristics. However, the
distinction between the positive and negative aspects
of perfectionism is not straightforward.5,6
Negative affect (NA) is a stable and heritable trait
tendency to experience a broad range of negative
feelings such as worry and self-criticism, and to
have a negative self-image.8 NA is described as a
transdiagnostic factor for depression and anxiety.9
Positive affect (PA), in turn, is one aspect of pleasurable
and positive life experiences. The high energy and
engagement, optimism, and social interest that
characterize individuals with higher levels of PA suggest
that they are more likely to be satisfied with their lives.10
According to the diathesis-stress model,11 perfectionism
may interact with stress to predispose individuals to NA.
Therefore, perfectionism (the diathesis) is considered a
relatively stable vulnerability trait. This stability does not
78 – Trends Psychiatry Psychother. 2017;39(2)
exclude that perfectionism trait is also state dependent,
and some of its characteristics may be exacerbated
by affective states, such as depressive symptoms.
As a stable personality trait, perfectionism involves a
temporal and spatial coherent pattern of cognitions,
and it affects behavior and motivation. Cognitive
characteristics and cognitive emotion regulation (CER)
mechanisms associated with perfectionism are prime
candidates for investigation when we intend to explore
the association between perfectionism and negative or
positive outcomes, such as NA, psychological distress/
psychopathology or PA.
As postulated in Beck’s cognitive model of depression,
dysfunctional cognitions are deviations from accurate
thought content that occur automatically regarding one’s
self or the world. Dysfunctional cognitions have been
associated with many psychopathological conditions and
dispositional factors, including perfectionism.12 A negative
perfectionistic cognitive style has been implicated in the
development and maintenance of NA, especially after
individuals experience stressful life events, and both
negative and positive cognitions seem to be important
to understand how perfectionism is related to subjective
well-being.13 The perfectionistic cognitive style is
also implicated in psychiatric disorders, for example,
dichotomous thinking and rumination.14,15 One possible
explanation for this is that these dysfunctional cognitive
processes (e.g. rumination) impact negatively on emotion
regulation. Even though emotions are biologically based,
people are able to influence their emotions as well as the
way they are expressed.16 The regulation of emotions
by cognitions or thoughts (CER) helps people to keep
control over their emotions during or after threatening or
stressful events,17,18 and is a critical process in initiating,
motivating and organizing adaptive behavior.19
Garnefskiet al.17 conceptualized nine cognitive
emotion coping strategies that are typically used in
response to stressful events. Four of them may be
considered “less adaptive” and are related to negative
responses: self-blame, blaming others, rumination
and catastrophizing. The other five dimensions are
related to more positive or adaptive coping responses:
acceptance, refocus on planning, positive refocusing,
positive reappraisal and putting into perspective. Results
from studies revealed that self-blame, rumination and
catastrophizing were positively associated with negative
emotions. In contrast, positive reappraisal and positive
refocusing had negative associations with depression
and anxiety.17,19,20 Positive reappraisal also had a positive
connection with PA.21
Concerning the association between perfectionism
and the Cognitive Emotion Regulation Questionnaire
(CERQ) dimensions, literature findings showed that both
Perfectionism and negative/positive affect associations - Castro et al.
maladaptive and adaptive perfectionism were related
to negative CERQ dimensions. Thus, SOP, PS, CM and
SPP were associated with self-blame,19,22 and PS and
SPP were associated with rumination.19,23 Rudolph et al.
showed that SPP was related to self-blame, rumination
and catastrophizing and to lower levels of positive
reappraisal and planning and putting into perspective,
and that SOP was associated with self-blame as well
as with depression.20 Literature findings also suggested
that coping strategies, daily hassles, event stress,
coping resources, and social resource appraisals have
an important mediation role in the association between
perfectionism and psychological distress, such as
NA/emotions,24-26 or may interact with perfectionism
to predict PA and/or NA.27 To our knowledge, there
are no studies exploring the mediation role of CERQ
dimensions in perfectionism and NA/PA associations.
In addition, the role of CER and of perceived distress/
coping in the association between adaptive/maladaptive
perfectionism and PA has been scarcely explored.
The aims of this paper were: 1) to explore if
perfectionism, perceived distress/coping and CER are
associated with and predictive of NA/PA; and 2) to analyze
if CER and perceived distress/coping are associated
with perfectionism and if they mediate the associations
between perfectionism and NA/PA. Figure 1 represents
the model that was explored in the present study.
Method
This study was approved by the ethics committee of
the local institution where it was developed.
Participants
Data collection was performed at a university in
September 2012, i.e., not including the exam period.
The study aims were explained to the students,
confidentiality was ensured, and they signed an informed
consent form. The participants were recruited by
convenience. The students were 344 medical students
(68.4% female). Their mean age was 20.69±1.586
years, and there was no significant gender difference in
age (females=20.73±1.584 vs. males=20.61±1.595;
t336=-0.619). More than half of the participants (54.2%,
n=182) were 4th-year students; 26.2% (n=88) were
enrolled in the first three years, and 19.6% (n=66)
were 5th-year students.
Instruments
All the questionnaires used in the present study
showed good reliability and/or internal validity in
Portuguese samples.
Perfectionism
The Portuguese version of the H&F-MPS comprises
45 statements that evaluate SOP, SPP and otheroriented perfectionism.28 For this study, only SPP and
SOP statements were used. Items were answered
using a 7-point scale ranging from strongly disagree to
strongly agree.
The Portuguese version of the F-MPS was used to
measure PS, DA, CM, PE, PC and organization.29 The
F-MPS comprises 35 statements; for this study, the
24-item version of the F-MPS was used.30 Items were
answered using a 5-point scale ranging from strongly
disagree to strongly agree.
To measure EC and PStr, the Portuguese version of
the Composite Multidimensional Perfectionism Scale31
was used.
NA and PA
The Portuguese version of the Profile of Mood States
(PoMS) was used to evaluate NA and PA.32 The original
version consists of 65 adjectives assessing seven
dimensions: tension-anxiety, anger-hostility, fatigueinertia, depression-dejection, confusion-bewilderment
and vigor-activity. In some samples, the dimension
friendliness is included. PoMS items were answered using
a 5-point scale ranging from not at all to extremely. In
Figure 1 - Cognitive emotion regulation and perceived distress/coping as possible mediators
of the association between perfectionism and negative/positive affect.
Trends Psychiatry Psychother. 2017;39(2) – 79
Perfectionism and negative/positive affect associations - Castro et al.
the present study, NA was assessed by summing the
scores obtained for tension-anxiety, anger-hostility,
fatigue-inertia and depression-dejection, and PA
corresponded to vigor-activity score.
Results
Perceived distress/coping
To measure perceived distress, the Portuguese
version of the Perceived Stress Scale-10 (PSS-10) was
used.33 Items were answered using a 5-point scale
ranging from never to very often. Factor analysis using
varimax rotation, which was performed in the sample
of the present study, revealed two factors that were
inversely correlated (r=-0.541; p<0.01), namely,
perceived distress (explained variance [EV] 44.11%;
α=0.819) and perceived coping (EV 12.54%; α=0.754)
(data not published).
NA was positively correlated with EC, SPP, CM, DA, PC,
PE (from r=0.162 to r=0.524; all p<0.01), PStr, PS and
SOP (from r=0.157 to r=0.169; p<0.01) and inversely
correlated with organization (r=-0.181; p<0.01).
PA was significantly and negatively correlated with
EC, CM, DA, SPP (from r=-0.267 to r=-0.374; p<0.01),
PC (r=-0.124; p<0.05), PStr and SOP (from r=0.-122
to r=-0.154; p<0.01).
CER
The Portuguese version of the CERQ was used to
evaluate positive reappraisal and planning (EV 22.86%;
α=0.89), positive refocusing (EV 15.59%; α=0.86),
rumination (EV 6.45%; α=0.78), blaming others (EV
4.92%; α=0.79), putting into perspective (EV 4.11%;
α=0.80), self-blame (EV 3.71%; α=0.76), acceptance
(EV 3.51%; α=0.70) and catastrophizing (EV 3.25%;
α=0.74) (total scale EV=59.96%; α=0.89).34 The items
were answered using a 5-point scale ranging from never
to always.
Statistical analysis
All data analyses were performed using the Statistical
Package for the Social Sciences (SPSS), version 19
for Windows. Descriptive statistics were determined.
Parametric or non-parametric tests were used according
to the normality of variable distribution. Pearson’s or
Spearman’s correlation coefficients were used to calculate
the associations between variables. The magnitude of
associations was classified according to Cohen’s criteria:
0.01, low; 0.30, moderate; and 0.50, high.35
Simple and multiple linear regression analyses
were performed. Only variables showing significant
correlations with the dependent variables were entered
in the regression model as independent variables.
Simple mediation analysis with Bootstrapping
methodology36,37 was used to study the explanatory
role of a mediator variable (M) in the causal association
between an independent variable (X) and a dependent
variable (Y). Bootstrap confidence intervals for indirect
effects were calculated with 5,000 bootstrap resample. An
indirect effect of X on Y was considered significant when
the interval for its 5,000 bootstrap estimates, with 95% of
confidence interval (95%CI), did not contain zero.
80 – Trends Psychiatry Psychother. 2017;39(2)
Correlations between NA/PA and
perfectionism
Correlations between NA/PA and CER
NA was positively correlated with rumination, blaming
others, self-blame, and catastrophizing (from r=0.307 to
r=0.421; p<0.01), and inversely correlated with positive
reappraisal and planning, positive refocusing and putting
into perspective (r=-0.237 to r=-0.372; p<0.01).
PA was only positively correlated with adaptive CER
mechanisms, namely positive reappraisal and planning,
positive refocusing, putting into perspective and
acceptance (from r=0.189 to r=0.432; p<0.01).
Correlations between NA/PA and
perceived distress/coping
NA and PA were associated, in opposite ways, with
perceived distress (r=0.727; r=-0.528, respectively)
and with perceived coping (r=-0.581; r=0.529,
respectively) (all p<0.1).
Correlations between
perfectionism and CER
PS, SOP and PStr were not significantly correlated
with adaptive CER. PS was positively associated with
higher levels of blaming others (r=0.175) and selfblame (r=0.210). SOP was positively associated with
self-blame (r=0.201) and catastrophizing (r=0.141)
(all p<0.01). PStr was positively associated with
rumination, blaming others, catastrophizing (from
r=0.112 to r=0.133; all p<0.05) and self-blame
(r=0.225; p<0.01). Organization showed a positive
association with positive reappraisal and planning,
positive refocusing and putting into perspective (from
r=0.162 to r=0.259; all p<0.01), and was negatively
related to self-blame (r=-0.136; p<0.01).
CM, DA, SPP and EC were positively correlated
with all maladaptive CER dimensions (from r=0.147 to
r=0.418; all p<0.01).
Perfectionism and negative/positive affect associations - Castro et al.
PC and PE were positively correlated with selfblame, blaming others, and catastrophizing (from
r=0.148 to r=0.288; all p<0.01). Additionally, CM,
DA, SPP, PC, PE and EC were negatively correlated
with positive reappraisal and planning (from r=0.126 [p<0.05] to r=-0.378 [p<0.01]), and all of
these perfectionism dimensions (excluding PE) were
negatively correlated with positive refocusing and
putting into perspective (r=-0.125 [p<0.05] to r=0.270 [p<0.01]). CM was negatively associated with
acceptance (r=-0.163; p<0.01).
Correlations between perfectionism and
perceived distress/coping
CM, DA, SPP, PC, PE and EC as well as SOP, PS and
PStr were positively associated with high perceived
distress (from r=0.167 to r=0.467; all p<0.01). CM,
DA, PC, PE and SPP were negatively correlated with
perceived coping (from r=-0.166 to r=-0.323; all
p<0.01), and organization (r=0.144; p<0.01) was
positively correlated with it. PStr, SOP and PS were not
significantly associated with perceived coping.
Regression analysis: NA/PA as dependent
variables
Table 1 shows the results of the regression model
considering NA/PA as dependent variables.
Regression analysis: perfectionism as
independent variable
The linear regression analysis revealed that EC and
PStr explained 29.6 and 2.7% of the NA total variance,
respectively, and both were significant predictors of
NA. H&F/F-MPS dimensions globally explained 37.5%
of the NA total variance, and DA, SPP and CM were the
significant predictors of it.
EC and PStr explained 9.4 and 1.5% of the PA
total variance, respectively, and both were negative
significant predictors of it. H&F/F-MPS dimensions
globally explained 14.7% of the PA total variance, and
CM was its unique significant negative predictor.
Regression analysis: CER as independent
variable
The multiple regression analysis revealed that CERQ
dimensions globally explained 34.9% of the NA total
variance, but only blaming others, self-blame and
catastrophizing (positively) and positive reappraisal
and planning (negatively) were significant predictors of
NA (all p<0.01). Also, the multiple regression analysis
revealed that adaptive CERQ dimensions globally
explained 19% of the PA total variance (p<0.01);
significant predictors of PA were positive reappraisal and
planning (p<0.01) and positive refocusing (p<0.05).
Regression analysis: perceived distress/
coping as independent variable
The linear regression analysis showed that perceived
distress and perceived coping explained 52.7 and
33.6% of the total variance of NA, respectively, and
were positive and negative significant predictors of it,
respectively (both p<0.01).
Perceived distress and perceived coping also
explained 27.6 and 27.7% of the PA total variance,
respectively, and were negative and positive predictors
of it, respectively (both p<0.01).
Perfectionism and NA association:
perceived distress/coping and CER as
possible mediators
Only those perfectionism dimensions showing
a significant contribution to the explanation of NA
variance in the previous regression analyses, namely
DA, SPP, CM, EC and PStr, were selected to be explored
as independent variables in mediation analyses.
Perceived distress/coping and maladaptive/adaptive
CER strategies were explored as possible mediators of
the association between perfectionism and NA.
Mediation role of maladaptive CER
The results of mediation analyses showed that
the association between DA and NA was partially
mediated by rumination, blaming others, self-blame
and catastrophizing (indirect effect [IE]=0.371,
95%CI=0.159/0.697; IE=0.401, 95%CI=0.155/0.747;
IE=0.410;
95%CI=0.105/0.744;
IE=0.632,
95%CI=0.332/1.051; respectively). These maladaptive
CER dimensions also partially mediated the association
between SPP and NA (IE=0.130, 95%CI=0.059/0.239;
IE=0.158,
95%CI=0.061/0.274;
IE=0.161,
95%CI=0.062/0.278; IE=0.304, 95%CI=0.167/0.457;
respectively), between CM and NA (IE=0.331,
95%CI=0.077/0.703; IE=0.380, 95%CI=0.115/0.786;
IE=0.581,
95%CI=0.257/1.021;
IE=0.866,
95%CI=0.466/1.457; respectively) and between EC
and NA (IE=0.065, 95%CI=0.027/0.127; IE=0.086,
95%CI=0.031/0.163; IE=0.081, 95%CI=0.025/0.153;
IE=0.175, 95%CI=0.100/0.273; respectively).
PStr and NA association was partially mediated
by rumination, blaming others and catastrophizing
Trends Psychiatry Psychother. 2017;39(2) – 81
Perfectionism and negative/positive affect associations - Castro et al.
(IE=0.046,
95%CI=0.006/0.104;
IE=0.058,
95%CI=0.011/0.125; IE=0.082, 95%CI=0.021/0.155;
respectively) and fully mediated by self-blame
(IE=0.101, 95%CI=0.047/0.177) (Figure 2).
DA, CM, PSP, EC and PStr dimensions were
associated with significantly high levels of rumination,
blaming others, self-blame and catastrophizing, which
in turn were associated with significantly increased
levels of NA. However, while self-blame was a necessary
condition for the association between PStr and NA, the
other CER dimensions strengthened the relationship
between these variables.
Mediation role of adaptive CER mechanisms
Positive reappraisal and planning, positive refocusing
and putting into perspective partially mediated
the association between CM and NA (IE=0.731,
95%CI=0.381/1.20; IE=0.290, IC95%=0.063/0.633;
Table 1 - Regression models with negative/positive affect as dependent variables
Independent variable/predictor
R2
Adjusted R2
F change (df)
0.389
0.375
F8,329=26.24*
Beta
Negative affect (dependent variable)
H&F/F-MPS
Organization
-0.041
Personal standards
0.035
Concerns over mistakes
0.202*
Doubts about actions
0.305*
Parental expectations
-0.110
Parental criticism
0.098
Socially prescribed perfectionism
0.275*
Self-oriented perfectionism
-0.107
Composite MPS
Evaluative concerns
0.296
0.294
F1,337=141.533*
0.544*
Positive striving
0.027
0.024
F1,336=9.354*
0.165*
0.362
0.349
F7,332=26.941*
Cognitive emotion regulation
Positive reappraisal and planning
-0.268*
Positive refocusing
0.014
Rumination
0.090
Blaming others
0.121†
Putting into perspective
-0.094
Self-blame
0.129†
Catastrophizing
0.275*
Perceived stress (PSS-F1)
0.528
0.527
F1,338=378.494*
0.724*
Perceived coping (PSS-F2)
0.338
0.336
F1,338=172.596*
-0.581*
0.159
0.147
F5,333=12.641*
Positive affect (dependent variable)
H&F/F-MPS
Concerns over mistakes
-0.283*
Doubts about actions
-0.088
Parental criticism
0.026
Self-oriented perfectionism
0.019
Socially prescribed perfectionism
-0.112
Composite MPS
Evaluative concerns
0.097
0.094
F1,338=36.309*
-0.311*
Positive striving
0.015
0.012
F1,337=5.117*
-0.122†
0.200
0.190
F4,336=20.954*
Cognitive emotion regulation
Positive reappraisal and planning
0.324*
Positive refocusing
0.131†
Putting into perspective
0.036
Acceptance
0.013
Perceived stress (PSS-F1)
0.279
0.276
F1,139=130.929*
-0.528*
Perceived coping (PSS-F2)
0.279
0.277
F1,338=131.452*
0.529*
CERQ = Cognitive Emotion Regulation Questionnaire; df = degrees of freedom; H&F/F-MPS = dimensions of the Hewitt and Flett Multidimensional Perfectionism
Scale and Frost Multidimensional Perfectionism Scale; PSS = Perceived Stress Scale.
* p<0.01.
†
p<0.05.
82 – Trends Psychiatry Psychother. 2017;39(2)
Perfectionism and negative/positive affect associations - Castro et al.
IE=0.294,
95%CI=0.063/0.645;
respectively),
between DA and NA (IE=0.440, 95%CI=0.199/0.768;
IE=0.173,
95%CI=0.049/0.384;
IE=0.150,
IC95%=0.005/0.388; respectively), between SPP
and NA (IE=0.156, 95%CI=0.073/0.265; IE=0.062,
95%CI=0.016/0.137; IE=0.052, 95%CI=0.005/0.135;
respectively) and between EC and NA (IE=0.097,
95%CI=0.049/0.163; IE=0.037, 95%CI=0.012/0.079;
IE=0.045, 95%CI=0.015/0.096; respectively). CM,
DA, SPP and EC were predictive of low levels of these
adaptive CER strategies, which in turn were associated
with increasing NA (Figure 2).
The previous regression analyses also indicated
that PStr was predictive of NA but not associated with
adaptive CER mechanisms and therefore the mediation
analysis was not performed.
Mediation role of perceived distress
Perceived
distress
partially
mediated
the
association
between
CM
and
NA
(IE=2.22,
95%CI=1.619/2.914), between DA and NA (IE=1.995,
95%CI=1.450/2.665), between SPP and NA (IE=0.637,
95%CI=0.454/0.839), and between EC and NA
(IE=0.409, 95%CI=0.306/0.524), and fully mediated
the association between PStr and NA (IE=0.251,
95%CI=0.119/0.369) (Figure 2). Thus, CM, DA,
SPP, EC and PStr were associated with high levels
of perceived distress, which in turn were associated
with increased levels of NA. However, while perceived
distress strengthened the relationship between CM,
DA, SPP, EC and NA, it was a necessary condition for
the association between positive striving and NA.
Mediation role of perceived coping
Perceived coping was not significantly correlated with
PStr, but partially mediated the association between CM
and NA (IE=1.331, 95%CI=0.868/1.872), between DA and
NA (IE=1.044, 95%CI=0.660/1.492), between SPP and
NA (IE=0.385, 95%CI=0.248/0.550) and between EC and
NA (IE=0.232, 95%CI=0.152/0.330) (Figure 2). Perceived
coping strengthened the link between these perfectionism
dimensions and NA, in the following way: CM, DA, SPP and
EC were associated with low levels of perceived coping,
which in turn were associated with high levels of NA.
Perfectionism and PA association:
perceived distress/coping and CER
strategies as possible mediators
The previous regression analyses showed that
CM, EC and PStr were significant predictors of PA,
and therefore they were selected to be independent
variables in mediation analyses. Perceived distress/
coping and maladaptive/adaptive CER mechanisms
were explored as possible mediators of the association
between perfectionism and PA.
Figure 2 - Cognitive emotion regulation dimensions and perceived distress/coping mediating the association between perfectionism
dimensions and negative affect. ↓ = low levels; ↑ = high levels.
Trends Psychiatry Psychother. 2017;39(2) – 83
Perfectionism and negative/positive affect associations - Castro et al.
Mediation role of maladaptive CER
Maladaptive CER dimensions were not significantly
correlated with PA, and therefore they were not explored
as possible mediators.
Mediation role of adaptive CER mechanisms
Positive reappraisal and planning, positive refocusing,
putting into perspective and acceptance partially
mediated the association between CM and PA (IE=0.243, 95%CI=-0.354/-0.155; IE=-0.139, 95%CI=0.229/-0.074; IE=-0.134, 95%CI=-0.204/-0.052; IE=0.041, 95%CI=-0.100/-0.009; respectively). All of these
adaptive CER dimensions, excluding acceptance (which
was not associated with the EC dimension), partially
mediated the association between EC and PA (IE=-0.032,
95%CI=-0.050/-0.019; IE=-0.018, 95%CI=-0.031/0.008; IE=-0.014, 95%CI=-0.027/-0.005; respectively)
(Figure 3). Low levels of CM and EC were associated with
high levels of positive CER dimensions, which in turn
were associated with high PA.
Mediation role of perceived distress
Perceived distress partially mediated the association
between CM and PA (IE=-0.332, 95%CI=-0.451/-0.231)
and totally mediated the association between EC, PStr
and PA (IE=-0.070, 95%CI=-0.093/-0.051; IE=-0.039,
95%CI=-0.060/-0.022; respectively) (Figure 3). Thus,
CM, EC and PStr led to increasing perceived distress,
which in turn led to low PA. However, while perceived
distress strengthened the link between CM and low PA,
it was a necessary condition for the association between
EC, PStr and low PA.
Mediation role of perceived coping
Perceived coping partially mediated the association
between CM and PA (IE=-0.273, 95%CI=-0.379/-
0.181) and fully mediated the association between EC
and PA (IE=-0.273, 95%CI=-0.379/-0.181) (Figure 3).
Therefore, low levels of CM and of EC led to the increase
of perceived coping; this increase, in turn, led to increase
of PA. However, while perceived coping strengthened
the inverse association between CM and PA, it was a
necessary condition for the inverse association between
EC and PA.
The role of PStr was not explored due to its nonsignificant correlation with perceived coping.
Discussion
One of the main goals of the present study was to
analyze if perfectionism, CER strategies and perceived
distress/coping were associated with NA/PA. The
findings suggest that people who experience NA have
high levels of adaptive and maladaptive perfectionism
(particularly CM, DA, SPP, EC and PStr), tend to
perceive high stress and to perceive themselves as
having low coping while facing stress, and tend to use
all maladaptive CER strategies and fewer adaptive
ones (particularly high blaming others, self-blame,
catastrophizing and low positive reappraisal and
planning). Conversely, people who experience PA show
low levels of adaptive and maladaptive perfectionism
(particularly CM, EC and PStr), tend to perceive low
stress and to perceive themselves as having high
resources of coping while facing stress, and tend
to involve themselves in adaptive CER processes,
particularly positive reappraisal and planning and
positive refocusing (PA was not significantly associated
with maladaptive CER strategies).
Our results are in line with those of other studies,
which showed an association between perfectionism
Figure 3 - Cognitive emotion regulation dimensions and perceived distress/coping mediating the association between perfectionism
dimensions and positive affect. ↓ = low levels; ↑ = high levels.
84 – Trends Psychiatry Psychother. 2017;39(2)
Perfectionism and negative/positive affect associations - Castro et al.
and stress and coping, and between perfectionism and
NA/PA.26,27 The findings from the correlation analysis
showed that maladaptive perfectionism dimensions were
associated with high levels of maladaptive and low levels
of adaptive CER strategies. These results were expected,
since they are negative dimensions of perfectionism
and have been consistently associated with negative
processes and outcomes.6,24 In fact, previous literature
results revealed that CM was associated with high levels
of avoidance, negative expectation and self-blame (as
coping strategies),19 that SPP was related to deficits in
adaptive mechanisms, to a negative problem-solving
orientation, to emotion regulation coping, to lower
levels of constructive thinking38,39 and to high levels of
self-blame, rumination, catastrophizing and low levels
of positive reappraisal and planning and putting into
perspective.20,22,23 Similarly, EC were prospectively
associated with high use of avoidant coping and with low
use of problem-focused and positive reinterpretation.27
In our study, maladaptive perfectionism was also
related to increased perceived distress and decreased
perceived coping. These results confirm the literature
findings, suggesting that perfectionism is implicated
in stress generation, anticipation, enhancement and
maintenance.2,24,26,27
Concerning the adaptive perfectionism dimensions
(PS, SOP and PStr), the significant positive correlation
with perceived distress and with several maladaptive CER
strategies (consistently with self-blame), as well as the
absence of significant association with perceived coping
and with adaptive CER, were somewhat unexpected.
However, these results corroborate previous findings,
showing that PS and SOP are not completely adaptive1,40
and may be involved in both positive and negative
outcomes, processes and mechanisms.6 Our results
also confirm the findings from other studies exploring
the association between perfectionism and CER
strategies, which revealed, for example, an association
between SOP and self-blame,20,22 and between PS and
rumination.19
Additionally, organization is a poor representation
of the perfectionism construct and was not included
in many studies.6 Nevertheless, it is part of several
measures of perfectionism, and we decided to explore
it to compare our results with those from studies which
also included this dimension. Our results showed that
organization was the only perfectionism dimension
revealing a significant and positive relation with all
adaptive CER mechanisms (excluding acceptance) and
an inverse association with self-blame. It also had a
protective effect against distress and was associated
with lower levels of NA.
The other main goal of the present study was to
consider the role of CER and perceived stress/coping
in the association between perfectionism and NA/PA. A
strength of this study is that the results showed how CER
and perceived distress/coping mediate the associations
between perfectionism and NA/PA.
Therefore, maladaptive perfectionists, who have high
levels of self-critical perfectionism (EC, CM, DA and SPP),
may be more vulnerable to NA, because they engage
in maladaptive CER strategies (rumination, self-blame,
blaming others, catastrophizing) as well as in decreased
adaptive CER strategies (positive reappraisal and planning,
positive refocusing and putting into perspective) and also
because they experience high perceived distress, which
is accompanied by low perceived resources of coping
with stress. These findings were expected, since they
are in line with several studies that have used different
measures to assess perfectionism, perceived stress/
coping, emotion regulation and psychological distress.
For instance, the results confirm the findings reported by
Dunkley & Blankstein,24 which revealed that dysfunctional
coping (high emotion-oriented and distraction, low
task-oriented) fully mediated the relation between
maladaptive perfectionism and psychological distress.
They are also in conformity with the study conducted
by Dunkley et al.,26 which revealed that the association
between maladaptive perfectionism and NA was partially
mediated by hassles and avoidant coping. Moreover, our
results are in line with the prospective findings of Dunkley
et al.,27 which suggest that self-critical perfectionists
have higher levels of event stress, avoidant coping and
NA and lower levels of perceived control over stress.
Finally, the finding that maladaptive perfectionists use
low adaptive CER strategies that lead to NA increase
complements the results of Dunkley et al.,26,27 showing
that low task-oriented coping mediated the association
between maladaptive perfectionism and psychological
distress. Then, when maladaptive perfectionists engage
in problem-focused and positive reinterpretation, they
may experience greater decreases in negative emotions,
such as in sadness.27 Therefore, the use of adaptive
coping/CER may be particularly effective in well-being
promotion in self-critical perfectionists.
Our results also indicate that subjects with high
EC and excessive CM are also more vulnerable to
experiencing low PA because they generate high levels
of perceived distress. High self-critical perfectionists
may be more reactive to stressors and feel lower
perceived control26 and may be more vulnerable to
experiencing less PA in the future when daily problems
are more stressful than usual and when they perceive
low control over stress.27
Trends Psychiatry Psychother. 2017;39(2) – 85
Perfectionism and negative/positive affect associations - Castro et al.
There is an increasing recognition that PStr is more
associated with positive characteristics.5,6 Our findings
support the assumption that PStr may sometimes
be associated with NA41 and that this association is
mediated by perceived distress and maladaptive CER
strategies (PStr and adaptive CER were not significantly
associated). Adaptive perfectionists (high in PStr) are
prone to NA because they experience rumination, blaming
others, catastrophizing, and particularly self-blame, and
because they generate high levels of perceived distress.
These results are in line with the findings of Blankstein &
Dunkley,25 which suggested that adaptive perfectionism
interacts with hassles, and that perceived stress may
lead to distress in adaptive perfectionists. They are also
in agreement with the prospective findings of Dunkley et
al.,27 which showed that adaptive perfectionism interacts
with both future event stress and avoidant coping to
predict NA and sadness.
Adaptive perfectionism, which implicates the
setting of high standards and the motivation to attain
perfection, may be accompanied by increased selffocus, involving self-critical tendencies when goals are
not attained or when failures are faced. Therefore,
due to self-discrepancies in face of an inability to
comply with one’s own standards, which is perceived
as a failure, adaptive perfectionists may engage in
maladaptive coping strategies. They may ruminate on
negative life experiences and failures, catastrophize,
blame others, and in particular blame themselves for
negative outcomes,27,38 which in turn may determine
maladjustment, including increased perceived distress
and NA. Maladaptive CER strategies (e.g., rumination),
which are predicted by both maladaptive and adaptive
perfectionism, may also maintain perceived distress
and NA, because they are ineffective in dealing with
NA, intensify negative thinking and contribute to
impairments in problem solving.15
Concerning perfectionism and PA association, our
results revealed that lower levels of CM and EC were
associated with higher levels of adaptive CER dimensions
(particularly positive reappraisal and planning, positive
refocusing and putting into perspective), and with
higher perceived coping, which in turn promoted PA.
These results are in agreement with those of Dunkley
et al.,27 which indicated that individuals with higher selfcritical perfectionism, comparing to those with lower
levels, prospectively showed greater decreases in PA
when experiencing more stressful events, and perceived
less control over stress than usual. However, they may
also experience greater increases in PA when they use
more problem-focused-coping than usual.
Overall, the results from the mediation analyses
support the diathesis-stress and coping model42 of the
86 – Trends Psychiatry Psychother. 2017;39(2)
relationship between perfectionism and NA. Thus, high
perfectionists (diathesis) exposed to life stress are more
vulnerable to psychological distress, because they use
ineffective coping strategies and perceive high stress
levels and low coping resources.
Both our results and those reported by Dunkley et
al.27 suggest that the variability in levels of maladaptive
perfectionism leads to variability in PA, and that the effect
of perfectionism on perceived distress/coping and adaptive
coping/CER may contribute to it. These findings support
the risk-resilience continuum model of the relationship
between maladaptive perfectionism and PA. Therefore, at
the extreme of the high vulnerability end of the spectrum,
high maladaptive perfectionism is associated with high
levels of perceived distress and, as a consequence, with
low PA. At the other end of the spectrum, low maladaptive
perfectionism seems to be a resilience factor, because it
is associated with no significant levels of distress and
with significantly high perceived coping with stress and
adaptive CER, and may promote PA.
The results of the present study may have
applications in the prevention of and intervention for NA.
Perfectionists could benefit from specific psychological
interventions targeting the modification of cognitive
CM, doubts about performance quality, cognitions
related to the importance of being perfect, nonacceptance of imperfection and conditional acceptance,
appraisals of stress/coping with stress and negative
CER mechanisms. These interventions could also
promote positive CER, particularly positive reappraisal
and planning and positive refocusing, which promote
PA and include support or direct education focusing on
orderliness/organization skills.
The participants of the present study were medical
students, which limits the generalization of results. Future
studies should be conducted with other populations,
including clinical samples. The cross-sectional nature of
this study is another limitation, as prospective studies
are the most adequate ones to study causality between
variables. Furthermore, considering the evidence that
there are gender differences in CER and affectivity,43
future studies exploring gender specificities may
contribute to a better understanding of this issue.
Adaptive
perfectionism
predicted
NA,
and
maladaptive perfectionism predicted NA and low PA.
Low maladaptive perfectionism predicted high PA, and
CER strategies and perceived distress/coping with stress
had an important mediation role in these associations.
The results of this study may have clinical implications.
NA prevention and treatment models for use with
university students may focus on maladaptive and
adaptive components of perfectionism and their impact
on CER strategies, stress and coping resource appraisal.
Perfectionism and negative/positive affect associations - Castro et al.
Disclosure
No conflicts of interest
publication of this article.
declared
concerning
the
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Correspondence:
Juliana Castro
Departamento de Psicologia Médica, Faculdade de Medicina, Universidade de Coimbra
Rua Larga, 3004-504
Coimbra, Portugal
E-mail: jsc.fmuc@gmail.com
Trends Psychiatry Psychother. 2017;39(2) – 87