Ariel Ko
Doctor of Philosophy in Psychology (PhD)
Research Topic
Parenting, attachment, and perfectionism: A test of the Perfectionism Social Disconnection Model in Children and Adolescents
Paul Hewitt
Professor
Relevant Thesis-Based Degree Programs
Graduate Student Supervision
Doctoral Student Supervision
Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
Using the dual control model to understand Chinese and Western cultural influences in sexuality for university women and men (2021)
Young Chinese men and women living in Canada frequently report lower levels of sexualresponse and behaviour compared to their Euro-Caucasian peers. These differences are likelyrelated to cultural factors and acculturation, but has not been well-integrated into more generalmodels of sexual response regulation. The current investigation used the dual control model toorganize and better understand these patterns in three studies in university men and women ofChinese and Euro-Caucasian descent. The first study examined whether dual control processes ofsexual excitation and inhibition were applicable to between-group ethnic differences in sexualresponse and behaviour. Lower sexual excitation explained a significant proportion of thedifference in mean sexual response and activity between Chinese and Euro-Caucasian women,and this effect was mediated by sexual attitudes. Sexual attitudes was separately associated withhigher sexual inhibition and lower dyadic sexual response and activity in Chinese compared toEuro-Caucasian men. The second study examined the association of heritage and mainstreamacculturation with sexual excitation, inhibition, attitudes, response, and activity among theChinese individuals. For heterosexual men and women, mainstream acculturation was theprimary predictor of sexuality variables, while heritage acculturation had a moderating role.Exploratory analyses for non-heterosexual Chinese men and women were also conducted; eachsexual orientation group displayed different patterns of associations between acculturationfactors and sexuality variables. The third study examined whether between-group differences insexual excitation and inhibition were associated with sexual dysfunctions, asexuality, or sexualabstinence. The results did not conclusively suggest more dysfunction in Chinese women, butdid suggest more dysfunction in Chinese men. Abstinence versus engagement in partnered sexhad a moderation role on other outcomes. Theoretical implications for understanding the role ofivChinese culture, and culture in general, in regulating sexual response and behaviours werediscussed for all three studies. Clinical implications for treatment of sexual concerns in youngChinese men and women were also discussed.
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Perfectionism and therapy relationship quality in psychodynamic-interpersonal group psychotherapy (2020)
Perfectionism has been identified as a core vulnerability and maintenance factor in myriad psychopathologies and additionally appears to obstruct the course of improvement from the treatment of that psychopathology. The Perfectionism Social Disconnection Model posits that perfectionism is related to various negative outcomes through the mediating effects of social disconnection. When applied to the therapy realm, one would expect that perfectionism impedes the formation and growth of therapy relationships and that this then leads to worse outcomes from psychotherapy (e.g. less symptomatic improvement). Much of what is known about perfectionism in the context of psychotherapy comes from a series of papers stemming from a single study, the Treatment of Depression Collaborative Research Program (TDCRP, Elkin et al., 1989). These papers support the notion that perfectionism impairs both therapeutic alliance and therapeutic outcomes. This dissertation seeks to evaluate the Perfectionism Social Disconnection Model in the context of psychotherapy and to extend what is known about the relationships between perfectionism, therapy relationship quality, and therapy outcomes beyond the context of individual group treatment of depression using contemporary, empirically validated multidimensional measures of perfectionism. Furthermore, previous studies addressing these issues have mostly conceptualized perfectionism as a static measure. It is unknown if treatments that lead to decreases in perfectionism also improve therapy relationship quality and if those changes account for better therapeutic outcomes. The current paper addresses these questions in a group of 71 patients taking part in a group psychodynamic-interpersonal psychotherapy treatment designed to address issues related to perfectionism. Hypotheses were that 1) pre-treatment perfectionism would be negatively related to initial therapy relationship quality, 2) decreases in perfectionism would be accompanied by increases in therapy relationship quality, and 3) that changes in therapy relationship quality would account for the relationship between decreases in perfectionism and better therapy outcomes. In the current study, these hypotheses were not supported. These null results are discussed in the context of a literature that suggests that perfectionism is related to both worse treatment outcomes and to interpersonal difficulties both in therapy and non-therapy contexts.
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Perfectionistic self-presentation in group therapy: interpersonal behaviours and therapeutic process factors (2018)
The study investigates the associations among perfectionistic self-presentation, interpersonal difficulties, and the process of group therapy based on predictions from the Perfectionism Social Disconnection Model. The study aims to determine whether perfectionistic self-presentation negatively impacts the group therapy process generally and on change over the course of the treatment block. The study also aims to determine whether interpersonal difficulties intervene on the negative associations among perfectionistic self-presentation and group therapy processes. Sixty-nine patients within nine groups attending the Southdown Institute and receiving intensive psychodynamic interpersonal group treatment participated in the study. Patients completed the Perfectionistic Self-Presentation Scale (PSPS; Hewitt et al., 2003), the Inventory of Interpersonal Problems (IIP; Horowitz et al., 1988), the Impact Message Inventory (IMI; Kiesler & Schmidt, 1993) - patient ratings of therapists, the California Psychotherapy Alliance Scales - Group (CALPAS-G; Marmar et al., 1989), and the Curative Climate Inventory (CCI; Furhiman et al., 1986) over the course of one week of daily group therapy. Multilevel modeling analyses were used to analyze direct effects among perfectionistic self-presentation facets and alliance scales and climate factors, as well as indirect effects through interpersonal variables. Perfectionistic self-presentation facets were associated negatively with total alliance and patient contribution scales of the alliance, and positively with interpersonal problems. Perfectionistic self-presentation facets were not associated with change in alliance over the course of the treatment block, with climate factors, or with patients' ratings of therapists' interpersonal impact. Findings suggest that perfectionistic self-presentation influences interpersonal problems and the process of group therapy; however, there was no support for an indirect and intervening role for interpersonal variables in the associations among perfectionistic self-presentation and therapeutic group processes.
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Perfectionism and the cognitive and affective experience of social exclusion (2016)
Perfectionism is a multidimensional personality variable linked to a variety of maladaptive consequences and developmentally rooted in early interpersonal attachments. This has been hypothesized to predispose perfectionistic individuals to more maladaptive outcomes in response to being socially excluded. The current project reviews extant literature on the Comprehensive Model of Perfectionism described by Paul Hewitt, Gordon Flett, and colleagues, its developmental antecedents, and a review of specific vulnerability, diathesis-stress and perfectionism social disconnection models that explain perfectionistic vulnerability to stress, including social exclusion. Hypotheses regarding a moderating effect of perfectionism on cognitive and affective reactions to social exclusion were generated based on the aforementioned models. Using two undergraduate student samples, we exposed participants to a laboratory-based social exclusion experience (Cyberball) under controlled circumstances and performed a comprehensive pre- and post-task assessment of their affective and cognitive experience using a combination of explicit and implicit measures. Results indicated that concern over mistakes, perfectionistic cognitions, perfectionistic self-promotion, and nondisplay of imperfection dimensions of perfectionism were the strongest moderators of the experience of social exclusion in that individuals high on these dimensions experienced amplified post-Cyberball shame, anger, rejection, and self-critical affect and increased negative self-related thoughts, and decreased interdependence. Nondisclosure of imperfection in contrast predicted reduced rejected affect in response to social inclusion. Results are discussed in the context of extant literature in perfectionism and social exclusion domains, and in light of diathesis-stress literature and the Perfectionism Social Disconnection Model, as well as the hypothesized interpersonal underpinnings of perfectionistic behaviour.
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Master's Student Supervision
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
The impact of pathological narcissism on change in symptoms, life satisfaction, and work and social impairment in psychodynamic group therapy for perfectionism (2023)
Background: Several decades of theory suggest that pathological narcissism may limit psychotherapy success, but empirical evidence for such theories is limited and mixed. In addition, despite theoretical and empirical associations between pathological narcissism and perfectionism, no studies thus far have investigated the impact of pathological narcissism on psychotherapy outcome for patients with perfectionism. Thus, this study aimed to extend past research by investigating whether pre-treatment pathological narcissism led to smaller pre- to post-treatment reductions in 1) symptom severity, 2) life satisfaction and, 3) work and social functioning in a sample of patients with perfectionism undergoing group psychodynamic psychotherapy. Method: This sample was drawn from the UBC Perfectionism Treatment Study (Hewitt et al., 2023) and consisted of 80 treatment-seeking adults with elevated perfectionism. Patients underwent 12 sessions of psychodynamic group psychotherapy for perfectionism and completed self-report measures of pathological narcissism at pre-treatment and of symptom severity, life satisfaction, and work and social impairment at pre- and post-treatment. Results: Contrary to expectations, multilevel and multiple regression analyses indicated that pre-treatment pathological narcissism did not significantly predict post-treatment changes in symptom severity, life satisfaction or work and social impairment. Additional analyses showed that these findings held even when vulnerable and grandiose dimensions of pathological narcissism were analyzed separately. Conclusions: Despite longstanding theoretical and clinical accounts on the perniciousness of pathological narcissism in the clinical context, these results, taken together with past findings, suggest that pathological narcissism may not be associated with poorer psychotherapy outcomes in certain contexts, such as in the case of psychodynamic group psychotherapy for perfectionism. Future research should investigate whether certain variables may moderate the relationship between pathological narcissism and treatment outcome.
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Examining the treatment utility of the approach-avoidance motivation model for sexual interest/arousal disorder in women and non-binary individuals (2021)
One third of cisgender women report experiencing low sexual desire and 8% of these women meet the diagnostic criteria for Sexual Interest/Arousal Disorder (SIAD), yet treatment research for SIAD remains scarce. Research on sexual concerns among transgender women and non-binary individuals is also scarce and requires further investigation to better inform clinical practice. The Approach-Avoidance Motivation Model may be relevant to addressing sexual concerns. This model posits that different motivations for sex can be classified as either pursuing desired outcomes (approach motivation) or avoiding unwanted outcomes or consequences (avoidance motivation), and these reasons are related to sexual outcomes. The treatment utility of the Approach-Avoidance Motivation Model for SIAD was tested in a sample of cis- and transgender women, and non-binary individuals, who either met criteria for SIAD or reported no sexual concerns. Sixty-seven participants with SIAD and 96 participants with no sexual concerns completed baseline measures of sexual motivation, sexual desire, sexual satisfaction, relationship satisfaction, and partnered sexual behaviours. Participants then completed an online assessment from home that involved a writing exercise previously found to increase the salience of approach or avoidance sexual motivation, or a control writing task, then viewed a nature film and erotic film while self-reporting levels of attention. Seventy-two hours following the online assessment participants completed sexual outcome measures again. A repeated measures MANOVA assessing the impact of SIAD status and writing task condition found that participants with SIAD in the approach condition significantly increased in approach sexual motivation immediately following the manipulation but these improvements did not persist at 72 hours follow up. Interestingly participants without SIAD were found to decrease in avoidance motivation, dyadic sexual desire, and partnered sexual behaviours 72 hours following the manipulation, regardless of writing condition. There were no differences in self-reported attention to the erotic film between those with and without SIAD, or between writing condition groups. Overall, these findings did not show support for the treatment utility of this approach-avoidance motivation manipulation for SIAD given that increases in approach motivation were not maintained. Future studies might explore more long-term interventions targeting approach-avoidance motivation to address sexual difficulties.
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Parenting, attachment, and perfectionism: a test of the Perfectionism Social Disconnection Model in children and adolescents (2019)
Perfectionism is a multifaceted personality construct involving perfectionistic traits (i.e., demand for the self and/or others to be perfect), perfectionistic self-presentation (i.e., requirement of the self to appear perfect), and intrapersonal/self-relational perfectionism (i.e., automatic perfectionistic thoughts and self-recriminations). Perfectionism is a risk factor for multiple psychological and physical dysfunction across the lifespan and has been reported to be increasing over the past 30 years (Curran & Hill, 2017). Given the host of difficulties linked to perfectionism and the elevated levels of perfectionism among individuals, further research is needed to determine how perfectionism develops. Hewitt, Flett, and Mikail (2017) proposed a developmental framework of perfectionism as part of their Perfectionism Social Disconnection Model (PSDM). This model suggests that perfectionism stems from attachment insecurities rooted in asynchrony between parental behaviors and a child’s needs. The general goal of the study is to examine whether adverse parenting (i.e., authoritarian parenting, parental psychological control, and parental noninvolvement) and insecure attachment are relevant developmental factors in perfectionism. Specifically, we investigated the relationships among adverse parenting, insecure attachment, and perfectionism, as well as the mediating effect of insecure attachment on the relationship between adverse parenting and perfectionism. A total of 96 parent-child dyads with youth ranging from 8 to 15-years old completed self-report questionnaires on parenting, attachment, and perfectionism. Findings from this study suggest that adverse parenting behaviours and attachment insecurity are influential factors to various trait and self-presentational components of perfectionism. In particular, parental noninvolvement contributed to various trait and self-presentational perfectionism through insecure attachment. Study results provide further empirical support for Hewitt et al.’s (2017) developmental model of perfectionism and suggest the importance of parental noninvolvement and insecure attachment on the development of perfectionism in younger populations. Study findings also shed insight on treatment strategies for children and adolescents struggling with perfectionism.
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Perfectionism and Suicide Ideation: An Assessment of the Specific Vulnerability Hypothesis and Stress Generation Model (2012)
The relationship between trait perfectionism and suicide behaviours (see Hewitt, Flett, Sherry, & Caelian, 2006; O’Connor, 2007 for reviews) has been reported in many studies and there is very strong evidence that one interpersonal component of perfectionism, socially prescribed perfectionism (i.e., the perception that others require perfection of oneself) is particularly relevant in suicide ideation and attempt among psychiatric adolescents as well as clinical and nonclinical adults (e.g., Enns et al., 2001). However, few studies have examined the mechanism by which trait perfectionism is associated with suicidality. Hewitt and Flett (1993, 2002) suggested that perfectionism can play a moderating role in producing psychopathology by enhancing or exacerbating the aversiveness of congruent or ego-involving stressful events (i.e., Specific Vulnerability Hypothesis). Perfectionistic behaviour also can play a mediating role in its association with psychopathology by contributing to the generation of stress (i.e., Stress Generation Model). Hence, the general purpose of this paper was to examine whether perfectionism generates and interacts with life stress in influencing suicide ideation measured concurrently as well as longitudinally. The current study measured perfectionism traits, stress, depression, hopelessness, and suicide ideation among 437 community adults (mean age=58.6, men=175) six months apart. Consistent with the Specific Vulnerability Hypothesis (Hewitt & Flett, 1993), a significant Perfectionism x Stress interaction was found for self-oriented perfectionism (i.e., striving relentlessly to perfectionistic personal standards) and achievement stress in predicting Time 2 suicide ideation among female participants even after controlling for Time 1 suicide ideation and depression. Socially prescribed perfectionism, however, also interacted significantly with achievement stress to predict Time 2 suicide ideation among female participants, hence providing partial support for Specific Vulnerability Hypothesis. Furthermore, mediational analyses via bootstrapping indicated that stress (i.e., achievement stress, interpersonal stress) mediated the relationship between socially prescribed perfectionism and subsequent levels of suicide ideation for both genders. Together, the current findings support the notion that certain perfectionism traits can act as vulnerability factors that enhance or generate stresses in influencing risk of suicide ideation. Implications of the present findings for understanding the perfectionism-suicide link and assessment and treatment for perfectionistic patients are discussed.
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