The effect of experimentally induced stress on anxiety and physiology in high and low perfectionists

The effects of experimentally induced stress on anxiety and physiology in high and low perfectionists

Perfectionism and the stress response

Contents

Summary 3

Introduction......................................................................................................................................4

Hypotheses 12

Method 13

Participants.............................................................................................................................13

Apparatus...............................................................................................................................14

Screening Questionnaire................................................................................................14

Frost’s Multidimensional Perfectionism Scale 15

Spielberger’s State Trait Anxiety Inventory 15

Blood pressure monitor 15

Colour-word interference task 16

Procedure 16

Results18

Participant Characteristics 18

Data Analysis 19

State Anxiety 19

Physiological changes 20

Systolic blood pressure..........................................................................................20

Diastolic blood pressure 21

Heart rate................................................................................................................22

Subjective ratings...................................................................................................................23Discussion......................................................................................................................................24

Limitations 25

Future research 27

Conclusion.............................................................................................................................28

References 30

Appendices 34

Word Count: 6,840

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Summary

A wealth of literature exists on perfectionism and psychological outcomes, especially how

stress mediates this relationship, however there is a lack of research into how perfectionism may

influence the physiological response to stress. A sample of 43 university students was split into two

groups of high and low perfectionists, and the effects of experimentally induced stress were

observed with regards to anxiety and three physiological measures; systolic blood pressure,

diastolic blood pressure and heart rate. It was observed that neither group demonstrated an increase

in state anxiety following the stressful task, but that high perfectionists sustained a significantly

higher level of state anxiety irrespective of the introduction of stress. A significant interaction was

found between perfectionism and condition (resting, task) in relation to systolic blood pressure.

During the stressful condition diastolic blood pressure and heart rate were found to be significantly

increased relative to resting rates, regardless of group (high, low perfectionism). Few significant

differences were observed between high and low perfectionists in subjective measures, including

control, and worry. Further research in this area that has a more natural focus should be actively

encouraged, due to the potentially valuable use of any significant data in an applied healthcare

setting.

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The effects of experimentally induced stress on anxiety and physiology in high and low perfectionists

Introduction

A large amount of research dedicated to perfectionism and negative outcomes has focused

on co-existing psychological effects; to date little attention has been paid to the potential

relationship that exists between perfectionism and physiological outcomes, specifically in relation

to stress. This research therefore has the following aims; to elaborate on the form that this

relationship could take by means of linking perfectionism to psychological and resulting

physiological outcomes; to replicate existing findings linking perfectionism and anxiety; and to

provide a further dimension to this area with the addition of physiological symptoms as an outcome

of perfectionism.

Defining Perfectionism

Perfectionism has garnered an increasing amount of attention over the last few decades,

resulting in the creation of a number of scales designed to measure this construct. It has been

defined as the self-imposed need that an individual has to be perfect in every aspect of their lives,

and this is marked by the setting of extremely high personal goals and standards that they feel they

must achieve (Flett & Hewitt, 2002). However there is still disagreement between different groups

on an ultimate definition; whilst most favour a multidimensional approach, some still argue for a

unidimensional perspective that generally involves faulty cognition (Flett & Hewitt, 2002).

Multidimensional approaches posit that perfectionism arises from a variety of factors, not

just one lone characteristic. Many dichotomous accounts of perfectionism have been established

that acknowledge how an individual can be a perfectionist in a variety of ways. For example, the

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distinction has been made between normal and neurotic perfectionists; normal perfectionists set

themselves high goals, but these are reasonable, and achievement leads to positive affect in terms of

increased self-esteem; whereas neurotic perfectionists seek achievements higher than realistically

attainable, and thus the inevitable failure reduces positive affect (Hamachek, 1978, cited in Flett &

Hewitt, 2002). In addition, neurotic perfectionists are likely to be motivated by the fear of this

failure as opposed to potential positive rewards (Shafran, Cooper & Fairburn, 2002). A second

dichotomy is positive versus negative perfectionism, with both being motivated by the relevant

form of reinforcement. Positive perfectionists are motivated by the desirable feelings associated

with accomplishing a goal, and negative perfectionists are motivated by a need to avoid the fear of

failure (Terry-Short, Owens, Slade & Dewey, 1995), similar to neurotic perfectionism.

With regards to measuring multidimensional aspects of perfectionism there are two main

scales that are widely used in the psychological community (Frost, Marten, Lahart, Rosenblate,

1990; Hewitt & Flett, 1991), and whilst they both measure perfectionism they place emphasis on

different subsets of this construct.

Hewitt and Flett (1991) focused on three dimensions; self-oriented, other-oriented, and

socially prescribed perfectionism. Self-oriented perfectionism involves the setting of high

standards, and rigorously evaluating one’s behaviour with regards to these standards. They are

motivated by the need to fulfil these goals, but also by the fear of failure. Other-oriented

perfectionism is nearly identical to self-oriented, but in this case the high standards and evaluation

of behaviours are displaced onto others; for example, a husband demanding that his wife iron and

fold his shirts in an exacting fashion. Socially-prescribed perfectionism relates to an individual

holding the belief that others are setting extreme standards for them, judging their behaviour and

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stressing the need to be perfect. Hewitt and Flett’s perfectionism scale has been found to have high

internal consistency and validity (1991).

Constructed around the same period Frost’s Multidimensional Perfectionism Scale (Frost,

Marten, Lahart, & Rosenblate, 1990) measures perfectionism in six different dimensions,

combining a mix of inter- and intrapersonal factors; Personal Standards; Concern Over Mistakes;

Parental Expectations; Parental Criticism; Doubting of Actions; and Organisation. Unlike Hewitt

and Flett’s (1991) this scale does not measure perfectionism that the individual displaces onto

others. Personal Standards refer to the setting of extremely high values and strictly following these

when evaluating oneself. Concern Over Mistakes is the belief that mistakes equate to failure, and

the experience of negativity felt when mistakes are made. Parental Expectations and Parental

Criticism refer to the high goals set and the highly critical nature respectively of an individual’s

parents. Doubting of Actions involves the feelings that one hasn't completed a task to a satisfactory

level. Organisation highlights the importance that an individual places on creating and keeping

order in various aspects of their lives. Frost et al. (1990) demonstrated that their scale had good

validity and that it was internally consistent to a degree; Organisation was found to correlate lower

than the other subscales so was omitted in some of their analyses.

Shafran et al. (2002) argue for a more unidimensional account by demonstrating that the

most integral aspects of perfectionism are far fewer than multidimensional scales measure. They

believe that a model of perfectionism need only focus on the domain of self-oriented perfectionism,

and that perfectionism is created by the individual as opposed to those around them. They give the

example that others may impose perfectionist standards upon us but we do not have to respond to

these, and so other-oriented perfectionism cannot reliably account for perfectionism. The

unidimensional approach however may be too simplistic in its explanation; what they are proposing

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could be the fundamental core that predisposes an individual to become highly perfectionist, but the

multidimensional dimensions that Hewitt and Flett (1991) and Frost et al. (1990) propose that could

lead to perfectionist qualities being exhibited in an individual.

The aim of this research is to focus on multidimensional perfectionism. Unidimensional

accounts are generally widely cited in relation to psychopathological cases and so could prove to

have a limiting affect on the possible scope of any relationships investigated here. Furthermore the

existence of highly valid multidimensional perfectionism scales provides a very useful means of

measuring a variety of possible contributing factors.

Perfectionism and psychological health

An extensive search of the existing literature has revealed that the majority of research

concerned with the links between perfectionism and health specifically involves a wide variety of

negative psychological disorders.

As discussed, maladjusted perfectionism can lead to negative affect in an individual when

high standards are not achieved, and they become motivated to live their lives through a fear of

failure. It is no wonder then that some have chosen to investigate the relationship between certain

dimensions of perfectionism and depression. Hewitt and Flett (1993), using a version of their

multidimensional scale of perfectionism, demonstrated that in a group of depressed patients self-

oriented perfectionism and achievement hassles interact significantly to positively predict scores on

the Beck Depression Inventory. This indicates that, when an individual places a lot of pressure

upon themselves to be perfect, and evaluates daily events as being stressful, they risk the increased

likelihood of suffering from depression. In addition, socially-prescribed perfectionism was shown

to correlate positively with depression, something which has been successfully replicated (Martin,

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Flett, Hewitt, Krames & Szanto, 1996). It appears that depressive symptoms are more likely in

individuals who have perfectionist standards placed upon them as opposed to generated internally.

Nonetheless those who experience self-oriented perfectionism could generally be more inclined to

appraise daily hassles as stressful because they interfere with their ability to successfully achieve

perfectionism. A recent study by O’Connor, Rasmussen & Hawton (2010) managed to replicate the

findings by Hewitt & Flett (1993), demonstrating that self-oriented perfectionism interacted

significantly with acute life stress to positively predict psychological distress. That the sample was

a group of Scottish adolescents adds to the validity of this specific relationship across the lifespan.

One reported difference was that the relationship between self-oriented perfectionism and

depression was mediated more by life stress than daily hassles, although it could be argued that

these two concepts are intrinsically linked.

In more general terms of psychological wellbeing and affect, the majority of research

points towards a significant relationship between perfectionism and negative psychological

outcomes including; worry and negative affect (Chang, 2000; Dunkley, Zuroff & Blankstein, 2003);

and stress (Chang, 2000; Chang, Watkins & Banks 2004). Furthermore socially-prescribed

perfectionism has consistently been found to have significant positive associations with general

psychological distress (O’Connor & O’Connor, 2003; Van Yperen & Hagedoorn, 2008); hostility

and anxiety (Chang & Rand, 2000); and hopelessness (O’Connor & O’Connor, 2003). Significant

negative associations have been found with autonomy, environmental mastery and purpose in life

(Chang, 2006).

Hence it would appear that stress plays a significant role in mediating the relationship

between perfectionism and other negative psychological outcomes. On a basic level it has been

suggested that those who experience perfectionist tendencies tend to appraise events as more

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stressful and impose a greater amount of stress upon themselves by the setting of high standards.

But it has been further hypothesised that perfectionism interacts with stress in four ways to both

construct and maintain psychopathological states within the individual; stress generation, stress

anticipation, stress perpetuation, and stress enhancement (Hewitt & Flett, 2002). Each of these

approaches is fairly self explanatory; stress generation posits that perfectionists engage in an

increased number of behaviours that create stressful situations; stress anticipation refers to the

amplified preoccupation that perfectionists have with potential stressors; stress perpetuation is the

tendency of perfectionists to engage in behaviours that prolong stressful events such as rumination;

and stress enhancement explains how perfectionists are prone to maladaptive forms of cognitive

appraisals that function to magnify the amount of stress experienced (Hewitt & Flett, 2002). These

four approaches have been supported by various pieces of research that have found, amongst other

things, that perfectionists place a larger amount of pressure on themselves than non-perfectionists

(Beck, 1993), that perfectionism scales correlate significantly with levels of self-imposed pressure

(Flett, Parnes & Hewitt, 2001, cited in Hewitt & Flett, 2002), and that self-critical perfectionists are

more reactive to events that are perceived to be potentially stressful (Dunkley, Zuroff & Blankstein,

2003).

Psychological disorders and physiological stress

It is important to realise the links that could exist between the psychological outcomes of

perfectionism and subsequent physiological stress, in particular the area of cardiovascular disorders.

A meta-analysis by Chida & Hamer (2008) suggested that strong links appear to exist between

psychological states, such as anxiety and negative affect, and decreased cardiovascular reactivity

and poor recovery. Although this analysis was not directly measuring associations with

perfectionism, it could be inferred that a highly perfectionist individual experiencing subsequent

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anxiety, and/or negative affect could therefore be predisposed to these physiological outcomes.

This assumption suggests that in a comparison of high and low perfectionists it could be expected

that those high in perfectionism would exhibit significantly reduced physiological responses relative

to low perfectionists. Conversely, a separate study by Harleston, Smith & Arey (1965) found that,

when completing a lab-based problem solving task, highly anxious participants demonstrated much

larger increases in heart rate that were far more prolonged than those observed in low anxiety

participants. The long term effects of increased strain upon the heart and cardiovascular system can

be very serious; it increases the risk of a variety of cardiovascular disorders such as hypertension,

and research suggests that sustained heart rate levels can increase the risks of myocardial infarction

(Singh, 2003). Hence any possible links between perfectionism and cardiovascular changes could

be extremely important. This is strengthened by the findings that cardiovascular disorders share a

high comorbidity with mood and anxiety disorders, that rates of hypertension have been found to be

highly prevalent in anxiety (Huang, Su, Tzeng-Ji, Chou & Bai, 2009), and that coronary heart

disease has been demonstrated to be linked to depression (Suls & Bunde, 2005).

Nevertheless, the research discussed here does not provide evidence of direct relationships

between perfectionism and physiological health, and so it is important not to over-generalise the

findings on the basis of associations between the psychological disorders here and perfectionism.

Perfectionism and physiological health

A large amount of the literature is dedicated to perfectionism and other psychological

disorders, but searches in the psychological databases of heart rate and perfectionism, and blood

pressure and perfectionism yield just 4 relevant results. Of these there is no general consensus as to

the significant relationship between perfectionism and physiological symptoms. It has been

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suggested that no significant relationships exist between perfectionism and heart rate or diastolic

blood pressure when participants complete a potentially stressful experimental task (Besser, Flett,

Hewitt & Guez, 2008). Yet the same research did demonstrate significant interactions between

increased systolic blood pressure and high self-oriented perfectionism when coupled with poor

objective task performance, and increased systolic blood pressure and high socially-prescribed

perfectionism when coupled with negative feedback. This association, although significant, cannot

however demonstrate that perfectionism has a direct affect on the cardiovascular system. However

research concerning the specific hormones involved in the physiological stress response has

successfully demonstrated that perfectionism is positively associated with cortisol, a hormone that

acts to increase blood pressure, but that no relationship was observed between perfectionism and

norepinephrine, a hormone that actively increases heart rate (Wirtz et al., 2007). Again this

supports Besser et al (2008), in that perfectionism may exhibit links with blood pressure but not

heart rate. Wirtz, Siegrist, Rimmele and Ehlert (2008) focused on the concept of over commitment,

a behaviour linked to excessive striving, an incapacity to pull out of commitments and subsequent

exhaustion. Although not explicitly measuring perfectionism, there are obvious similarities

between the two concepts and a significant association was found between them, so this research

could be seen as relevant to this research. The findings indicated that those participants who were

grouped as being low in over commitment actually recorded lower heart rates before and after

completing a stressful public speaking task. So though this does not follow the pattern

demonstrated previously, with increases in cardiovascular pressure, they differ in that a significant

association could at least be identified with regards to heart rate. The three studies discussed here

have all been concerned with immediate effects in the cardiovascular system in response to stressful

conditions; however a piece of research conducted with a sample of Japanese women reported that

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perfectionism was significantly associated with a decreased risk of coronary artery disease

(Yoshimasu et al., 2002). This finding further adds to the inconclusive collection of research in this

particular area, though it is important to note that being categorised as a ‘perfectionist’ in the study

was determined by only one question on a 12-item questionnaire, hence it would be irresponsible to

place too much emphasis on this outcome.

The lack of significant psychological research into the physiological effects of perfectionism

is surprising as the potential outcomes would be extremely important if they were to imply a

negative effect of perfectionism on physiological health. Although previous research in this area

has not yielded any concrete, replicated findings it would be ill-considered to dismiss possible

further avenues; especially considering that links exist between perfectionism and psychological

disorders, and psychological disorders and physiological health.

Hypotheses

On a general level it is presumed that a stressful task will increase the amount of anxiety that

an individual feels under, therefore the first hypothesis is as follows:

h1) Higher post-task anxiety will be reported relative to pre-task in both high and low perfectionists.

And at a more specific level, due to the tendency for high perfectionists to respond to stress

with a more intensely anxious state, it is further hypothesised that:

h2) High perfectionists will report higher levels of state anxiety relative to low perfectionists in both

pre- and post-task measures.

With regards to the physiological response to stress it is more difficult to confidently predict

possible relationships because of the limited and mixed previous research. However based

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somewhat on the psychological literature it is expected that some differences will exist between

high and low perfectionists, specifically that:

h3) There will be differences in resting blood pressure and heart rates between high and low

perfectionists.

And that:

h4) There will be significant differences between high and low perfectionists in blood pressure and

heart rate during a stressful task.

It must be stressed that these last two hypotheses are not directional, rather that

perfectionism will have an effect on the physiological response to stress, and that the purpose of this

research is to investigate the specifics of this relationship.

Method

Participants

High perfectionist group. The data collected from the current study were collated with a

data set of 22 ‘high perfectionist’ participants collected by a postgraduate student the previous year,

whose experimental method this current study replicates. This group consisted of 11 female (50%)

and 11 male (50%) students from the University of Surrey. The ages of this group ranged from 19

years to 51 years (M = 26.73 years, S.D. = 7.58 years).

Low perfectionist group. Participation in the current study was advertised by means of an

initial email sent out to all undergraduate students in the Department of Psychology at the

University of Surrey. The email contained details of the study and invited those who were

13


interested to complete an initial screening questionnaire. Sixty-two responses were collected and

from this group 26 participants were selected who fulfilled the criteria of being a ‘low

perfectionist’. These 26 participants were asked to visit the Psychology department where they

would take part in the main study lasting 50 minutes, of this group 21 accepted (female n = 13

(61.9%), male n = 8 (38.1%)). All the participants were full-time undergraduate Psychology

students in either their first or second year of study, the ages of participants ranged from 18 years to

39 years (M = 20.48 years, S.D. = 4.67 years).

Apparatus

Screening Questionnaire. In order to screen participants as low perfectionists an initial

questionnaire was completed by all who had expressed an interest in participation. This

questionnaire was a reduced version of Frost’s Multidimensional Perfectionism Scale (1990) used

in the main study and contained 10 questions designed to measure general perfectionism. These

questions were answered using a 5-point likert scale ranging from 1 (strongly disagree) to 5

(strongly agree), and the 10 responses were totalled to make an overall score. As the cut-off for

high perfectionists was a score of 34 or above it was decided that those who scored a total of 30 or

below would qualify as being ‘low perfectionist’ and contacted to take part in the main study. A

copy of the screening questionnaire can be found in Appendix 1. The reliability of this scale in the

present study was found to be α = .77.

For the main study a battery of questionnaires was compiled for all participants to complete.

For the purpose of this study Frost’s Multidimensional Perfectionism Scale (FMPS), and

Spielberg’s State Trait Anxiety Inventory (STAI) were the only two of interest.

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Frost’s Multidimensional Perfectionism Scale (FMPS). This scale contains 35 questions,

scored on a 5-point likert scale from ‘strongly disagree’ to ‘strongly agree’, it measures the extent to

which an individual could be considered a ‘perfectionist’. The highest total score is 175, and higher

scores indicate high perfectionism. The scale specifically asks questions about 6 dimensions of

perfectionism; Concern Over Mistakes (CM); Doubting of Actions (DA); Personal Standards (PS);

Parental Expectations (PE); Parental Criticism (PC); and Organisation (O). An average score of

3.06 was found to be the median score and so was used as the cut-off point, with all those who

scored lower categorised as being ‘low-perfectionists’ and all those who scored higher categorised

as ‘high-perfectionists’. A copy of this scale can be found in Appendix 2. It was found to be highly

reliable in the current study with a Cronbach’s alpha score of α = .91.

Spielberger’s State Trait Anxiety Inventory (STAI). A shortened version of this scale

was used to measure levels of state anxiety only. State anxiety is defined as the subjective tension

or fear directly caused by a stressful situation, that passes once the stressor has been removed

(Aydin, 2009). The scale contained 20 questions answered on a 4-point likert scale from ‘not at all’

to ‘very much so’ meaning that each participant could score a maximum of 156, with higher scores

indicating higher levels of state anxiety. Items 1, 2, 5, 8, 10, 11, 14, 15, 16, 19 and 20 (I feel:

“calm”; “secure”; “at ease”; “satisfied”; “comfortable”; “self-confident”; “decisive”; “relaxed”;

“content”; “steady”; and “pleasant”) were reversed scored. This scale was administered twice

throughout the experiment in order to measure state anxiety before and after the stressful task. This

scale can be found in Appendix 3. It was found to be incredibly reliable with a total Cronbach’s

alpha score of α = .94.

Blood pressure monitor. An AnD UA-767 Digital Blood Pressure Monitor was used in all

conditions to measure heart rate and systolic and diastolic blood pressure. The cuff is secured

15


around the non-dominant upper-arm and the start button pressed by the researcher which

automatically inflates the cuff. As the cuff deflates the blood pressures and heart rate are measured

and once it is fully deflated a number appears on the screen for each, this was then recorded by the

researcher. This blood pressure monitor has been found to be highly valid and is recommended for

clinical use (Rogoza, Pavlova & Sergeeva, 2000).

Colour-word interference task. A stroop task was used as a means of inducing stress in

the participant. In this computer-based task the participant is presented with a ‘test’ colour word in

the middle of the screen and four ‘answer’ colour words along the bottom of the screen. They are

required to match the physical colour of the test word with the semantic meaning of the answer

word. The difficulty of this task arises from the physical colour and semantic meaning of the test

word being different e.g. the test word ‘red’ may be printed in the colour green and so the

participant has to select the word ‘green’ from the list of answer words. In order to maintain this

difficulty the time between each word increased throughout the task. Furthermore the difficulty of

this particular task was heightened in the current study by making it double interference i.e. the

physical colour and semantic meaning of each answer words was also different.

Procedure

Participants were provided with an information sheet outlining the basic procedural structure

and what they could expect from participation. All participants were required to read this

information and a consent form which had to be signed prior to participation, copies of these can be

found in Appendix 4. All data collection took place in a lab situated in the Psychology department

at the University of Surrey. Participants began by completing the first pack of the questionnaire

booklet containing FMPS. Once this was completed blood pressure and heart rate readings were

16


taken using an electronic blood pressure monitor, after which participants were instructed to relax

for 6 minutes before a second set of readings was taken. The second pack of the questionnaire

booklet was then filled out; this section contained two 7-point likert scales on the amount of

pressure and control the participant felt they had at that moment in time, and a shortened version of

the STAI. The participant then moved on to a computer based stroop task that was designed to

induce a stressful response in the individual. Prior to the main stroop task all participants were

provided with verbal instructions on how to complete the task and a practice task which they could

repeat if necessary. The main stroop task lasted 6 minutes, and blood pressure and heart rate

readings were taken at 3 points; after 30 seconds, 150 seconds, and 240 seconds. Immediately after

completion of the stroop task the participant completed pack 3 of the questionnaire booklet, this

contained four 7-point likert scales on the extent to which the participant felt currently under

pressure, in control, how pressured they felt during the task, and the number of mistakes they felt

they had made. After this was completed participants once again rested for 6 minutes before the

last set of blood pressure and heart rate readings were taken. The final pack of the questionnaire

booklet was now completed and this contained a replication of the shortened STAI, a set of

questions asking participants to assess physiological changes within the body during the task, and

four 7-point likert scales on the extent to which participants had thought about the stroop task since

completion, how difficult and complicated they found the stroop task, and how worried they were

about making mistakes during the task. A timetable of the main study can be found in Diagram 1

below. Upon completion of the study all participants were provided with a debrief sheet (see

Appendix 4) that outlined the purpose of the study and provided contact details should the

participant have any questions at a later date. All participants were thanked for their time and

cooperation and reimbursed with a course credit.

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Info and consent forms

Pack 1

BP and HR 1 Relax

BP and HR 2

Pack 2

Stroop instructions

Stroop task (29-35 mins)

Pack 3 Relax

BP and HR 6

Pack 4 Debrief

BP and HR 3

BP and HR 4

BP and HR 5

1-3 mins

3 - 10

mins

10 -12

mins

12 -18

mins

18 -20

mins

20 -25

mins25-29 mins 29.5

mins31.5 mins

33 mins

35-36

mins

36-42

mins

42-44 mins

44-48

mins

48-50 mins

Diagram 1. Timetable of the main laboratory study.

Results

This study was designed to test the effects of a stress inducing task on participants differing

in levels of perfectionism. Four hypotheses were stated; that higher levels of state anxiety would be

reported after a stressful task in both high and low perfectionists; that higher levels of state anxiety

would be observed in high perfectionists before and after a stressful task; that there will be

significant differences in baseline readings of blood pressure and heart rate between high and low

perfectionists; and that blood pressure and heart rate during the stressful task would be significantly

different between high and low perfectionists.

Participant Characteristics

The two groups did not differ significantly in gender, t (41) = 1.69, p = .09, d = .51, or BMI,

t (41) = -0.74, p = .47, d = .22. However a difference was found in terms of age, with the high

perfectionist group (M = 25.95 years, SD = 7.57 years) being significantly older than low

perfectionists (M = 21.5 years, SD = 5.56 years), t (41) = -2.20, p = .03, d = .68. See Table 1 below for

a summary of participant characteristics.

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High Perfectionists Low Perfectionists

Mean SD Mean SD

Age (years) 25.95 7.57 21.50 5.56

BMI 22.99 4.02 22.20 3.00

Male Female Male Female

Gender 12 9 7 15

Table 1. Means, standard deviations, and frequencies of participant characteristics.

Data Analysis

State Anxiety. It was hypothesised that state anxiety would be higher post-task relative to

pre-task in both groups, but also that high perfectionists would sustain higher levels of state anxiety

relative to low perfectionists. These effects were analysed with a Group (high, low perfectionism) x

Task (pre-, post-task) ANOVA. A significant Group main effect existed, F (1,41) = 9.42, p = .004,

partial η2 = .19, but there was no significant Task main effect, F (1,41) = 1.05, p = .31, partial η2

= .02. No significant Group x Task interaction was identified, F (1,41) = 1.67, p = .20, partial η2

= .04. Independent-samples t-tests were conducted and it was found that high perfectionists

reported higher levels of state anxiety than low perfectionists prior to the task (M = 45.38, 35.14,

S.D. = 11.45, 7.98 respectively), t (41) = -3.42, p = .001, d = .73, and after the task (M = 45.10,

37.59, S.D. = 10.96, 9.75 respectively), t (41) = -2.38, p = .02, d = 0.07. These results indicate that

although the stroop task did not significantly alter state anxiety levels within the groups, high

perfectionists did indeed maintain significantly higher levels of state anxiety relative to low

perfectionists throughout the study. This effect is demonstrated in Figure 2 below.

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Figure 2. State anxiety levels in high and low perfectionsists before and after the stroop task. Note

the significant between-groups effect, but the absence of any significant within-groups effects.

Physiological Changes. It was hypothesised that differences would exist in resting and task

measures of blood pressure and heart rate between high and low perfectionists. In order to obtain a

measure of resting heart rate and blood pressures an average was calculated using the pre-task and

post-task readings (readings 1, 2, and 6; see Diagram 1).

Systolic blood pressure. A Group (high, low perfectionists) x Condition (resting, task)

ANOVA was conducted, however the average measures of systolic blood pressure taken before and

during the stroop test were found to correlate significantly with BMI (r (41) = .47, p = .002, and r

(41) = .37, p = .01, respectively), therefore BMI was included as a covariate in this analysis. No

significant main effects were found for Group, F (1,40) = 0.08, p = .78, partial η2 = .01, or for

Condition F (1, 40) = 0.04, p = .84, partial η2 = .01, however a significant Group x Condition

interaction was reported, F (1,40) = 9.06, p = .01, partial η2 = .19. This interaction is demonstrated

in Figure 3 below, and indicates that high and low perfectionists differ in both the resting and task

measures. It would appear that low perfectionists recorded slightly higher resting rates (M =

20

0

10

20

30

40

50

Pre- Post-

Task

Stat

e A

nxie

ty

Low perfectionismHigh perfectionism


115.58, SD = 11.52) and that this rate was maintained regardless of the introduction of a stressful

condition (M`= 116.80, SD = 10.88), i.e. there was no significant difference between resting and

task systolic blood pressure, t (21) = -1.01, p = .32, d = .11. However high perfectionists initially

recorded lower resting levels (M = 112.74, SD = 10.69) relative to low perfectionists, but this was

not sustained and the group demonstrated a significant increase in systolic blood pressure during the

stressful task (M = 119.75, SD = 14.51), t (20) = -4.94, p = .001, d = .56.

Figure 3. Changes in systolic blood pressure in high and low perfectionists during the resting and

task periods.

Diastolic blood pressure. Diastolic blood pressure was analysed within a Group (high, low

perfectionists) x Condition (resting, task) ANOVA. There was no significant main effect of Group,

F (1,41) = 0.02, p = .89, partial η2 = .01, there was however a highly significant main effect of

Condition, F (1,41) = 27.53, p = .001, partial η2 = .40. No significant Group x Condition interaction

was found, F (1,41) = 0.33, p = .57, partial η2 = .01. The variable for resting diastolic blood

pressure was found to be non-parametric, for this reason two Wilcoxon tests were conducted. It

21

108

110

112

114

116

118

120

122

Resting Stroop

Condition

Systo

lic B

P



was demonstrated that there were significant increases in diastolic blood pressure between the

resting and task condition in low perfectionists (Mdn = 69.63, 74.83 respectively), Z = -2.74, p

= .01, and in high perfectionists (Mdn = 69.50, 76.33 respectively), Z = -3.47, p = .001. In other

words, diastolic blood pressure significantly increased in both groups in the task condition relative

to the resting condition, irrespective of perfectionism. This effect can be seen in Figure 4 below.

Figure 4. The increase in diastolic blood pressure during the task condition, irrespective of

perfectionism.

Heart rate. Heart rate was again analysed within a Group (high, low perfectionists) x

Condition (resting, task) ANOVA. There was no significant Group main effect, F (1,41) = 1.40, p

= .24, partial η2 = .03, however a significant Condition main effect did exist, F (1,41) = 33.59, p

= .001, partial η2 = .45. There was no significant Group x Condition interaction, F (1,41) = 0.64, p

= .43, partial η2 = .01. Two within-samples t-tests were conducted to determine the exact nature of

the effect of Condition. It was found that there were significant increases in heart rate during the

task condition in both low perfectionists (M = 70.36, 78.00, SD = 8.19, 8.67 respectively), t (41) = -

22

66

68

70

72

74

76

Resting Stroop

Condition

Dia

stolic

BP



5.00, p = .001, d = .91, and in high perfectionists (M = 74.37, 80.16, SD = 7.50, 12.36 respectively),

t (41) = -3.31, p = .004, d = .58. This effect can be seen in Figure 5 below.

Figure 5. The effect of the stroop task on heart rate in low and high perfectionists.

Subjective Ratings. In addition to the data on anxiety and physiological symptoms,

subjective ratings were also collected throughout the laboratory task. These measures included how

much pressure the participant felt under, how much control they felt they had, how difficult they

found the stroop task, and how much they had thought about the stroop task during the second rest

period. In addition, participants were asked to identify if they felt they had experienced any bodily

sensations during the task, for example a racing heart and a tingling in the hands or feet. Responses

to 18 subjective measures were collected for each participant, these responses were analysed using

either independent-samples t-tests or Mann-Whitney tests based on whether the data was parametric

or not. Significant differences were only found in 2 of these subjective measures. It was found that

low perfectionists rated themselves as having significantly more control before the task than high

perfectionists (M = 5.50, 4.43, SD = 0.91, 1.25 respectively), t (41) = 3.22, p = .002, d = .99, and

23

64666870727476788082

Resting Stroop

Condition

Hea

rt R

ate

(bpm

)



that high perfectionists rated themselves as significantly more worried about their stroop task

performance than low perfectionists (M = 5.57, 4.64, SD = 1.16, 1.56 respectively), t (41) = -2.22, p

= .03, d = .68.

Discussion

The aim of this research was to determine the effects of a stress inducing laboratory task and

whether these effects differed between high and low perfectionists.

It was hypothesised that state anxiety levels would be persistently elevated in high

perfectionists relative to low perfectionists, irrelevant of the stressful task, but that a stressful

situation would increase state anxiety in both groups. In addition to anxiety, physiological

responses in perfectionists were also examined; something that has been fairly neglected up until

now. It was hypothesised that differences would be found between high and low perfectionists in

resting and task readings of systolic and diastolic blood pressure, and heart rate. With regards to

these hypotheses directions were not stated due to the rather confused nature of previous findings in

this area.

High perfectionists did indeed recorded significantly increased levels of state anxiety

compared to low perfectionists, both before and after the stressful task. Although rather

unexpectedly, neither group recorded a significant increase in state anxiety levels following the

stroop task, meaning that these hypotheses were only partially supported. This raises the question

of whether the stroop task employed was able to elicit a stressful enough response in the

participants, and therefore whether it was the most appropriate measure to use, something that will

be discussed later. From this it could be concluded that perfectionism does indeed affect anxiety,

with those scoring higher in perfectionism sustaining elevated levels of anxiety irrespective of

24


whether or not they are currently in a stressful state. However it would be of interest to see whether

this difference exists in measures of self-reported trait anxiety as this may be what underlies the

sustained levels of state anxiety found here.

With regards to the physiological effects of stress no significant differences were found

between high and low perfectionists in both blood pressure measures and heart rate in the rest

condition, suggesting that perfectionism has no long-term sustained effects on these particular

physiological symptoms, and therefore resulting in this hypothesis being rejected. However it could

be argued that due to the majority of participants belonging to the younger demographic; the mean

age being 23.7 years, that if any long-term effects were to occur than they may not manifest until

later on in the lifespan. Conversely, significant within-groups differences were found between

resting and task measures of diastolic blood pressure and heart rate, with increases in both being

found irrespective of group subscription. Indicating that the stroop task may not have been as

redundant in inducing a stress response as initially concluded from the state anxiety measures. In

terms of systolic blood pressure no significant group or condition effects were found, but a

significant interaction between the variables was identified. It was reported that low perfectionists

demonstrated no real differences between the resting and task measures of systolic blood pressure,

but that high perfectionists exhibited a significant increase in systolic blood pressure during the

stroop task. It could be argued that whilst diastolic blood pressure and heart rate also significantly

increased during the stroop, because this effect was observed in both groups, systolic blood pressure

was the only physiological measure that interacted with perfectionism.

Limitations

25


As mentioned there may be some questions surrounding the suitability of the stroop task as a

measure designed to induce experimental stress. The basis of this is that no significant increases

were found between measures of before- and after-task state anxiety regardless of perfectionism

levels, something that was specifically hypothesised. One solution to this issue would be to keep

the stroop as the task of choice, but place more emphasis on performance as this is something that is

likely to affect high perfectionists specifically. A 2 x 2 design could be employed whereby groups

are split by perfectionism, as in this research, but then further divided into two, with one half

receiving negative feedback regarding performance and the other receiving positive feedback,

irrespective of actual performance. This type of feedback design was employed in the

aforementioned research by Besser, Flett, Hewitt & Guez (2008), and yielded significant

physiological changes suggesting that this would be a useful alteration to the current methodology.

Alternatively a change could be made to the task used; the use of difficult arithmetic questions may

be a good stress-inducing measure as those individuals high in perfectionism may respond

negatively to feelings of making mistakes, or not performing to a high enough standard. Of course

any change in the methodology does not overcome the issue that it is very difficult to assess

whether both high and low perfectionists are experiencing the same level of stress. In other words,

if significant changes are observed in systolic blood pressure during a stressful task in high

perfectionists, it would be difficult to identify the exact reasons why. Both high and low

perfectionists could be perceiving the same levels of stress but an aspect of high perfectionism

could exist that heightens the physiological response to this stress. Alternatively a particular

stressful task may only elicit a stressful response in high perfectionists, and so low perfectionists

don’t experience a change in blood pressure because they don’t actually feel any stress. This may

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be a rather tenuous argument but it is one that, if supported with empirical evidence, could be of

importance in this research.

A second limitation of this research was the use of a young, student sample. It could be

argued that students are likely to experience a large amount of stress during their time at university,

and therefore did not respond positively to the stressful task in this research, however this is

something that could be overcome with the abovementioned methodological changes. Also, as

previously alluded to, a possible reason as to why differences were not found between high and low

perfectionists in resting levels of physiological measures was because the participants were sampled

from a fairly young demographic. The implication of this being that participants were too young to

exhibit many signs of sustained physiological stress; hypertension and cardiovascular diseases are

most commonly found in older adults (Marcovitch, 2006). Both of these limitations could be

overcome by using a sample with a broader age range.

Future Research

Although the current research did not produce as many significant differences between high

and low perfectionists as initially hypothesised it does not mean that this is not a highly important

area of research that should be expanded. As mentioned changes could be made with regards to the

methodology, with the most important change being the type of measure used to induce stress in the

experimental condition. In addition to this a larger and more demographically varied sample should

be employed in order to produce data that is far more generalisable, and of more use to a wider

range of groups, for example within the healthcare and therapeutic professions.

From a psychological perspective it would be of interest to investigate whether differences

exist between specific dimensions of perfectionism. The current research employed Frost’s MPS

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(1990), and so groups could be compared on the basis of scores on each of the six dimensions could

be compared. Furthermore a large amount of the literature on perfectionism uses the MPS

developed by Hewitt and Flett (1991), which investigates perfectionism as self-oriented, other-

oriented, and socially prescribed. It may then be of even more use to repeat the current research

with this scale instead in order to produce findings that are more grounded in the current literature,

and therefore more relevant.

It is difficult to move away from a laboratory-based focus due to the need to be able to

measure the direct effects of stress on physiological symptoms. But future research could also

investigate the physiological effects of real-life stressful events on perfectionists by means of self-

reported stressful incidences and longitudinal measure of blood pressure. In this case the

physiological effects of interest would not be short-term, as in the current research, but long-term,

thus rendering them more useful in a real world context as it is undeniably the long-term effects that

have the most serious health consequences. The advantages of this more realistic approach

however would be countered by the relationships drawn between stress and physiology mediated by

perfectionism being far more speculative in nature.

Conclusion

The current research partially fulfilled what it set out to do. On one hand it was able to

replicate previous findings that perfectionism influences the relationship between stress and

anxiety, but it also failed to provide any definitive conclusions as to whether or not perfectionism

plays the same role between stress and the physiological response. Although this is disappointing it

could be suggested that research into the area of perfectionism and physiological health should not

be dismissed. This is a very important area, and one that could make significant contributions to the

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ways in which maladaptive perfectionism is dealt with in an applied setting. It is imperative

however that if significant progress is to occur that changes are made to the methodology

employed; to date the majority of research conducted is experimental or laboratory-based, and so

may not accurately represent the processes that naturally occur on a day-to-day basis in response to

daily hassles and stressors. Nevertheless a significant interaction was found between perfectionism,

systolic blood pressure, and stress which is a promising start, and could indicate that the

physiological response to stress is influenced by perfectionism.

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Appendix 1

Screening Questionnaire

Strongly Disagree Disagree

Neither Agree or Disagree

Agree Strongly Agree

1I never felt I could meet my parents’

expectations1 2 3 4 5

2I tend to get behind in my work because I repeat things over

and over

1 2 3 4 5

3 I am a neat person 1 2 3 4 5

4I never felt I could meet my parents’

standards1 2 3 4 5

5If I do not do as well

as other people it means I am not as

good as them

1 2 3 4 5

6I set higher goals

for myself than most people

1 2 3 4 5

7 I have extremely high goals 1 2 3 4 5

8If I do not do well all the time people will

not respect me1 2 3 4 5

9It takes me a long

time to do something right

1 2 3 4 5

10 I try to be a neat person 1 2 3 4 5

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Appendix 2

Frost’s Multidimensional Perfectionism Scale (1990)

SD D N A SA

My parents set very high standards for meOrganisation is very important to meAs a child I was punished for doing things less than perfectlyIf I do not set the highest standards for myself I am likely to end up as a second rate personMy parents never tried to understand my mistakesI am a neat personIt is important to me to try to be thoroughly competent in everything I do I try to be an organised personIf I fail at work/university I am a failure as a personI should be upset if I make a mistakeMy parents wanted me to be the best at everythingI set higher goals for myself than most peopleIf someone does a task at work/university better than me I feel like I failed the whole task

SD D N A SA

If I fail partly it is as bad as being a complete failureOnly outstanding performance is good enough in my familyI am very good at focusing my efforts on achieving a goalEven when I do something very carefully I often feel that it is not being done quite rightI hate being less than the bet at thingsI have extremely high goalsMy parents have expected excellence from mePeople will probably think less of me if I make a mistakeI never felt like I could meet my parents expectationsIf I do not do as well as other people it means I am an inferior human beingOther people seem to accept lower standards for themselves than I doIf I do not do well all the time people will not respect meMy parents have always had higher expectations for my future than I haveI try to be a neat personI usually have doubts about the simple everyday things that I doNeatness is very important to me

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SD D N A SA

I expect higher performance in my everyday tasks than most peopleI am an organised personI tend to get behind in my work because I repeat things over and overIt takes me a long time to do something ‘right’The fewer mistakes I make the more people will like meI never felt like I could meet my parents standards

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Appendix 3

Spielberger’s State Anxiety Scale

Not at all Somewhat Moderately so Very much so

I feel calm

I feel secure

I am tense

I feel strained

I feel at ease

I feel upset

I am presently worrying about possible misfortunes

I feel satisfied

I feel frightened

I feel comfortable

I feel self-confident

I feel nervous

I feel jittery

I feel decisive

I am relaxed

I feel content

I am worried

I feel confused

I feel steady

I feel pleasant

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Appendix 4

Information Sheet, Consent Form and Debrief Sheet

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The effect of experimentally induced stress on anxiety and physiology in high and low perfectionists

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