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Behavior Therapy 40 (2009) 260 – 271

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The Roles of Persistence and Perseveration in Psychopathology
Lucy Serpell
University College London and Central and North West London NHS Foundation Trust

Glenn Waller
Institute of Psychiatry, King's College London, and Central and North West London NHS Foundation Trust

Pasco Fearon
University of Reading

Caroline Meyer
University of Loughborough

Two constructs were hypothesized to be of importance in psychological disorders: persistence (the ability to keep going to reach a goal, even when the task is difficult or drawn out) and perseveration (the tendency to continue a behavior, even when it ceases to be effective or rewarding). These are contrasted with perfectionism (having high standards for oneself or others). A measure was developed to address these constructs (the Persistence, Perseveration and Perfectionism Questionnaire; PPPQ). The PPPQ was administered to 325 nonclinical participants, alongside a measure of psychological disturbance. Factor analysis resulted in a 22-item version of the measure, consisting of subscales with good psychometric properties corresponding to the 3 theoretical constructs. Persistence was associated with lower levels of psychopathology, whereas persevera-

tion was associated with higher levels of psychopathology. Perfectionism was weakly associated with psychopathology. Further work is needed to develop these constructs with clinical groups, but the findings support the hypothesis that persistence is an adaptive construct whereas perseveration is maladaptive.

The Roles of Persistence and Perseveration in Psychopathology
Personality and cognitive styles have commonly been found to be associated with different domains of psychopathology (Arnkoff & Glass, 1982; Ingram & Kendall, 1992; Macleod & Mathews, 1991; Marcus, Gurley, Marchi, & Bauer, 2007; Zohar, LaBuda, & Moschel-Ravid, 1995). One such domain is the pattern of compulsivity that underpins many psychological disorders. That pattern underlies the behaviors that are found in disorders such as obsessive-compulsive disorder, compulsive exercise, eating disorders, and neurological disorders (Ames, Cummings, Wirshing, Quinn, & Mahler, 1994; Davis, Kapstein, Kaplan, Olmsted, & Woodside, 1998; Matsunaga, Kiriike, Iwasaki, Yamagami, & Kaye, 1999; Serpell, Hirani, Willoughby, Neiderman, & Lask, 2006; Serpell,

Research reported in this paper was submitted for the Doctorate in Clinical Psychology at University College London by the first author. The authors would like to thank Janet Feigenbaum, Howard Steele, Ann Schlotmann and Nick Harrison for help with recruitment. Address correspondence to Lucy Serpell, Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB; e-mail: lucy@serpell.com.
0005-7894/08/0260–0271$1.00/0 © 2008 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.

2002. In keeping with learned industriousness theory (Eisenberger. It is more likely to be voluntary (i. Those factors will have different levels of adaptiveness. However. & Dewey. it may be useful to consider the functions of the compulsive behaviors. Salkovskis.. 2003. Cooper. & Fairburn. which is associated with targeted. Vitousek. Although it can be seen in neurological damage 261 (Ames et al.. Terry-Short. Powers. Enns et al. As defined here. the current research attempted to develop a self-report measure of persistence and perseveration and validate it against a measure of psychopathological characteristics in a nonclinical group of young adults. associated with success in a smoking-cessation trial (Brandon. persistence is the ability to continue with an activity in order to reach a higher-order goal. Herzog. It is most clearly seen in the safety-seeking behaviors that characterize the anxiety disorders (e. we hypothesize that persistence and perseveration will form distinct factors. 2001). Given this model. 2003). 2003). it has a tendency to be continued rather than stopped). & Lazev. Shafran et al. but that have the side effect of preventing disconfirmation of unrealistic fears (Salkovskis. task persistence is linked with a history of reward for high levels of effort. Frost & Steketee. Cox. It can be seen as an adaptive trait. Another way of conceptualizing persistence is in terms of Perceptual Control Theory (PCT. To summarize. and hence. 1973). Mansell. which is not under conscious control.persistence and perseveration Livingstone. working to standards compatible with those of the American .. persistence overlaps with the concept of sustained attention. 1997. 2002. Shafran & Mansell. but the cognitive components differ markedly. even when the task is arduous or lasts for a long time (Lufi & Cohen. potentially explaining why different measures of perfectionism fail to correlate well and why perfectionism is presented as either adaptive or maladaptive in different models (Chang et al. whereas perseveration involves either the pursuit of lower-order goals at the expense of keeping higher-order goals in mind. 2005. 2002). & Lask. Neiderman. Shafran.. Safety-seeking behaviors are behaviors that are used to prevent threat from being realized. Chang. Method Ethical approval for the study was obtained from the local Research Ethics Committee. 1982. 2004. 1987). For example.. This is a relatively automatic process. Juliano. Owens.e. Perseveration is broadly a maladaptive trait. even if arduous or boring) or might be perseverant (i. This theory suggests that behavior is managed using a hierarchical goal structure. perfectionism can also be an adaptive characteristic (Bieling. & Clara.. perseveration is also a characteristic of functional disorders. Salkovskis. even when the task is difficult or takes a long time—persistence. & Cotterell. Successfully managing the pursuit of goals requires flexible awareness throughout the hierarchy.g. continuing because once the activity has started. 2004. Different definitions and measures of perfectionism appear to contain different degrees of each of these constructs. It is suggested that this kind of flexible awareness is demonstrated within persistent responding. The behaviors characteristic of persistence and perseveration may be superficially similar. 1996. & Gelder. 1995). A contrasting function is the tendency to continue a particular learned response or behavior. Instead of simply treating compulsivity as a manifestation of perfectionism. there is evidence that high persistence is a positive trait.. One such function is the ability to keep going with a behavior or activity to reach a goal. Enns. Carver & Scheier. Irvin. or (even more problematically) the pursuit of a behavior which was originally intended to meet a goal. whereas perseveration is likely to be a vulnerability factor for psychological distress. even when it ceases to be rewarding—perseveration. & Banks. wherein lower-order goals are directed in the service of higher-order goals. as that disorder is motivated by an attempt (albeit misguided) to achieve the higher-order goal of avoiding future negative consequences. Hackmann. Clark. someone who brushes their teeth for 5 minutes might be persistent (deciding to do so for a long time because it is seen to be necessary. perseveration cannot be as easily applied to understanding the repetitive behaviors seen in obsessivecompulsive disorder.e. Israeli. goal-related behaviors. under some degree of conscious control). & Antony. However. Davis.. For example. Wells. 1997. but without continuing to consider whether the goal has been met or is still relevant. perseveration is the tendency to continue with a particular behavior or activity beyond the point at which the behavior ceases to be appropriate or rewarding. Persistence is likely to be a protective factor. 2002. It has been suggested that the core pathology behind such behaviors is perfectionism (Bulik et al. as described by Barkley (1997). different patterns of association with psychopathology. 2002. 2004. As no measure exists that contrasts these two constructs directly. Watkins. 1996). 1992). 1994). In contrast. 1999) and in superstitious behaviors. Slade. Kuhlman.

All emailed responses were printed out for data entry and to maintain anonymity. 1976). which make up nine subscales (Somatization. This sample consisted of undergraduate and postgraduate students (51. 1993. perseveration and perfectionism again (between 7 and 14 days after they had originally completed it). Obsessive-Compulsive.8%) completed and returned the measure. Nonstudents were recruited via email— friends and acquaintances of the first author were emailed to request their participation with questionnaires sent as an attachment. Anxiety. Lipman. In order to determine whether these constructs were sufficiently well defined that they could be distinguished from perfectionism.262 serpell et al. Factor analysis was used to establish the factor structure of the new measure.0). measures Development of the self-report measure of persistence and perseveration. The respondents’ mean age was 22. the participants completed the BSI. Phobic Anxiety. as this yielded a more meaningful outcome than the unrotated solution. & Covi. Interpersonal Sensitivity.. which is a measure of overall symptom severity on all subscales. 5 = totally true of me). The BSI consists of 53 items.1%) and adults in full. using a 5-point Likert-type scale (0 = not at all true of me. It is also possible to calculate a Global Severity Index.64). and students were asked to return them using internal university mail. 11. rather than to reduce the number of items (Floyd & Widaman. Derogatis et al. In addition to those 28 items. Eleven items were generated for each construct. Hostility. Each was rated by the sample of 325 participants. concern over mistakes and the importance of organization and order1 ). Psychoticism). and 42 (80. (1 = does not fit the definition at all. 1974. Rickels.or part-time employment (48. 1995). Questionnaire packs could be returned by email or post. The response rate was 34%. & Rock. 7 = fits the definition very well). Shaw. which were relatively distinct and pure descriptors of the construct. This items was generated without reference to that previous scale. 8 reflecting perseveration. Derogatis. participants To ensure a sufficient sample for factor analysis (Mundfrom. a sample of 325 participants completed the measures. and 254 (78. Derogatis. Questionnaire packs were handed out. & Ke. as the goal was to explore the multivariate factor structure of the measure. The BSI has good psychometric properties (Derogatis. A non-orthogonal solution (direct oblimin) failed to converge. covering different aspects of perfectionism (including high personal standards. Paranoid Ideation. Uhlenhuth. Derogatis & Melisaratos. and 9 reflecting perfectionism).4 years (SD = 6. Nonstudent participants returned the questionnaires by email. 1991). a subset of participants were asked to complete the measure of persistence. 1993. 1976). 2005). A cover sheet was included on which participants could provide contact details to be entered into a drawing to win a £25 book token. For test-retest purposes. Fifty-two participants (a mixture of students and nonstudents) were contacted for this purpose. Rickels. Exploratory factor analysis was used (rather than principal components analysis). 28 items were retained (11 reflecting persistence. A varimax rotation was used for the final solution. Items were retained if the mean rating on one of the constructs was greater than 5 and if this mean was at least one standard deviation above the mean ratings on both of the other two constructs. using a Likert-type scale It should be noted that one item that was generated for this measure (qOne of my goals is to be perfect in everything I doq) is the same as an item on the Hewitt-Flett Multidimensional Perfectionism Scale (Hewitt & Flett. The 33 resulting items were given to 27 independent raters. who were educated to at least the graduate level and were naïve to the hypotheses of the study. Derogatis. Depression. a well-validated measure of a range of psychiatric symptoms. An initial pool of items was generated by the researchers to reflect the constructs of persistence and perseveration. Cronbach's . The BSI is a short version of the Symptom Checklist-90 (SCL-90.9%). Thus. The perfectionism items aimed to be heterogeneous. Five items failed to meet these criteria. items were generated that reflected that construct. Psychological Association and the British Psychological Society. Brief Symptom Inventory (BSI. data analysis All analyses were conducted using SPSS (v. Those 28 items are given in Table 2. They were also asked to pass on the questionnaire pack to their own friends and acquaintances. Student participants were recruited by attending lectures and asking for their participation. 1983). 1 procedure Student participants returned the two measures by mail.2%) were female. These individuals were given the construct definitions (as outlined in the Introduction and above) and were asked to rate each of the 33 items according to how well it matched each of the three constructs. indicating that they were not as distinctive as necessary.

indicating that there were no items that needed to be reverse-scored. A further three items loaded onto two scales at roughly similar levels and were therefore not clear descriptors of a distinct construct.48) (0.75) (0. this time forcing a three-factor solution (with a varimax rotation) and imposing a cut-off of a factor loading of . Therefore.31) (0.78 1.74) (0. it was included in the factor on which its loading was highest.64) 21.59) (0.51) (0. If an item loaded on more than one factor at . their mean BSI scores generally fell between the norms for adolescents and adults.32 0. suggesting that the subscales are reasonably independent and that they measure sufficiently distinct constructs. but it loaded more strongly on the perfectionism factor. multiple linear regression was used to establish the relationship between the resultant scales and psychopathology (i.22.69) (0. Therefore.34 0. After removal of these six items. BSI = Brief Symptom Inventory. those labels are used hereafter for the scales.7 suggested by Nunnally (1978). The internal consistency of each scale was acceptable.94 0.40 or greater. unless the two loadings were close to identical.persistence and perseveration alpha was calculated to determine the internal consistency of subscales.30 0.45) (0.86) (0. and Factor 3 corresponded to Perfectionism. factor analysis Factors were included if they had eigenvalues greater than 1 and if examination of the scree plot indicated that it was appropriate to do so.62 0..68) (0.30) 0. All item loadings were positive.84) (0.45 1.68 0. perseveration-perfectionism: r = .83 0.79) (0.7) 50.01 0.63 0.82) (0.43 0. as one would expect for this group.73) Notes.0 (14. although the Cronbach's alpha for Factor 2 (Perseveration) was slightly below the level of 0.30 0. 263 Results sample characteristics Table 1 shows the participants’ means on the BSI scales.69) (0. Factor 2 corresponded to the construct of Perseveration.4 (6.66 0.49 (0. 1983). Nonpatient norms from Derogatis & Melisaratos (1983).17 0. A threefactor solution was the most appropriate. perseveration and perfectionism).10) 66.8% male 46.40) (0.85) (0. Finally.46) (0.01.63 0. and test-retest reliability was determined using Pearson's correlations and paired-sample t-tests.29 0.55) (0.61) (0. Two items had loadings below the cut-off on all three scales and were removed from consideration. p b .82 0.35 0.15 (0. BSI subscale scores). persistence-perfectionism: r = . Factor 1 corresponded to the hypothesised construct of Persistence.02 0.56) (0.42) (0.54 1.36) (0.91 0. One item was deleted because it was originally developed to be a perseveration item.48) (0. Intercorrelations between subscales were generally statistically significant.40 for each item to be included.01.64) 0. the analysis was repeated.5% male 0.39. p b . p b .13 0. comparing them with published norms (Derogatis & Melisaratos.01). Removing the item with the lowest itemtotal correlation did not improve the internal consistency of this subscale. but low to moderate in size (persistence-perseveration: r = .64) (0.e. in keeping with the study's hypothesis (distinct factors of persistence. Six items were removed from the measure at this point (see Table 2). It is noteworthy that the persistence-perseveration Table 1 Levels of psychopathology (mean scores and SDs) on Brief Symptom Inventory scales and comparison with nonpatient norms Measure Current study (N = 325) Adult nonpatient norms (N = 974) Adolescent nonpatient norms (N = 2402) Demographics Age (years) Gender BSI subscale Global Somatization Obsessive-compulsive Interpersonal sensitivity Depression Anxiety Hostility Phobic anxiety Paranoid ideation Psychoticism 22. .64) (0. The loadings of the 28 items on each of the three factors are shown in Table 2. and are shown in Table 2.45) (0.73 (0. In keeping with the sample's mean age.64) (0.8 (1.47.99 0.35 0.62 0.28 0. Cronbach's alphas for the three subscales were calculated. Their scores were in the nonclinical range.7% male 15.

514 18 . Results of factor analysis on the Persistence.274 .543 .580 . I would make sure I had all the relevant paperwork and measurements ready If I have an appointment.305 . I often feel that it is not quite right When shopping in the supermarket.179 . I will keep trying to resolve things..690 10 .067 −.183 . even though I know that they are not being picked up or responded to When I phone someone to get a decision.159 .349 −.453 .458 .420 .023 .066 .035 .623 .281 .123 .078 21 .468 .046 . even when it gets difficult If I have a problem in my relationship.528 . I walk down the aisles one-by-one until I have covered the whole store.336 .160 .063 .087 7 .478 .622 .151 .066 −.236 . I tend to stay up working late into the night. Perseveration and Perfectionism Questionnaire (Varimax rotation) No.191 .063 . making a revision timetable to ensure I get everything done One of my goals is to be perfect in everything I do .539 .111 .031 −.084 . even if this takes a long time Once I have decided to do something.503 −.264 Table 2 serpell et al.095 .669 .292 −. even if some of the parts are of no interest Factor 3 .160 26 1 3 28 . I keep going until I have read all the necessary material.212 . Item Factor 1 2 3 20 12 4 5 14 15 11 23 Factor 1 .519 .668 . I am likely to plan carefully which topics I will need to cover.161 2 −. rather than giving up quickly People describe me as someone who can stick at a task.091 . even when the deadline for the decision has passed When studying for an important test. if I get an engaged tone then I tend to keep ringing back every minute or so.Persistence I tend to keep going with a long task until it is complete.102 6 −. I do not stop until I find an answer If a friendship seems to be running into difficulties. even if I only need a couple of items When calling a tradesman to arrange for him to come to my home.Perseveration I keep trying to sort out problems in a relationship.g.301 −.544 .032 . I may continually ring and leave messages on the same number. in case it's just a hiccup If I am trying to get to an appointment but my car has broken down.Perfectionism When calling a tradesman to arrange for him to come to my home. train or taxi) Factor 2 .435 . even though I know I am no longer taking in the material and that the studying will not help my performance When reading a book or magazine. I often feel that I must begin at the first page and read through to the very end. even if I know it's not going to survive Sometimes I find myself continuing to do something even when there is no point in carrying on Even when I do something very carefully.626 9 24 .481 . finding out if I can get a bus. I will work hard at sorting it out.107 16 . even when the concepts are difficult to understand If I try to solve a problem or puzzle.234 −.526 . I do my best to get there in time by investigating other routes (e. I always check my travel arrangements carefully in advance to make sure that I have plenty of time to get there and not be late I hate making mistakes If I have an important test coming up.049 .293 .173 . I keep going until I reach my goal When reading a book or magazine.149 .

64 . The mean time between the two completions for the test-retest group was 9. item on the subscale. it was decided to include only those participants who had completed the measure within 3 weeks of its initial completion. possible scores range from 1 to 5. 3 Although a scoring method based on item weights would be somewhat more accurate than the item mean method. If there are missing data for one 2 These item numbers correspond to items in the 22-item version of the PPPQ (Appendix 1).224 Eigenvalue Percentage of variance accounted for Cronbach's alpha Mean score for total sample Standard deviation 6.77 ⁎ These items were not included in the final scales for theoretical reasons (see text) or because they did not load sufficiently strongly or uniquely on any scale. Item Factor 1 2 265 3 17 When calling a tradesman to arrange for him to come to my home.37 0. Test-retest reliability for the PPPQ was adequate. 15. I will keep trying to get there. I keep going until I have finished. Perseveration (eight items – numbers 2.078 .011 . the subscale score can still be calculated by taking the mean of the remaining items. as the subscale scores at Time 1 .persistence and perseveration Table 2 (continued) No. Of the 42 who responded.704 3.459 .15 0. even though I have missed the appointment time If an item I wish to buy is not available in one shop.42 8.279 . indicating that these constructs have the least overlap. Thus. 22). 5. some took longer than 2 weeks to complete the questionnaire. 18). 21). 4.475 .60 5. of whom 21 (54%) were students (undergraduate or postgraduate) and 18 (46%) were working. 14.34. adding scores and dividing by the number of items). 8.437 27 8 . 6. there is little difference in factor scores using the two methods. To reduce the risk of data being influenced by intervening life events. association was the weakest. characteristics and scoring of the final version of the measure Following the factor analysis. in practice. then the subscale score should not be calculated (this procedure has been followed for the current analysis). the PPPQ (see Appendix 1) consists of 22 items. 7.19 22.2 Scores on each subscale are calculated by taking the item mean for the subscale (i.232 .094 .386 .355 . and Perfectionism (six items – numbers 1.3 Hence.637 2.761 3. I will continue trying different shops until I find one that stocks the item . 10. 16. rather then getting distracted by other things If I have an important appointment and am running very late. 13. if more than one item on a subscale has missing data. and that the item-mean method is generally preferable as it makes subscales easier to calculate and interpret. Floyd and Widaman (1995) point out that.483 . 9. 12.486 .203 . 11. I carefully plan my reading so that I make sure I do not miss any important parts If I do something less than perfectly.309 . the final measure (PPPQ) was formulated by re-randomizing the remaining items. with higher scores indicating higher levels of that trait. range = 4–19 days).304 .465 . Pearson's correlations and paired-sample t-tests were conducted to compare subscale scores on the PPPQ at Time 1 and Time 2. 19.61 2. However.326 .20 0. test-retest reliability Participants in this part of the study were asked to complete the measure between 7 and 14 days after it had initially been completed. This left 39 participants for this part of the analysis.e. if I have decided to revise a topic. 20. I feel like a failure When studying for an important test.1 .139 .51 days (SD = 3.458 13 19 25 22 . I try all the contact numbers I have for him in the hope of catching him Unassigned items ⁎ I set high standards for myself When reading a book or magazine.70 .61 1. 17..133 . divided into three subscales: Persistence (eight items – numbers 3. rather than the original 28 items.

01 level (2-tailed) . perseveration and perfectionism. and perfectionism with slightly fewer.022 −.80.197 ⁎⁎ . p b . In contrast. A significant negative correlation was found between age and perseveration (r = -. Perseveration and Perfectionism Questionnaire BSI scale PPPQ scale Persistence Perseveration Perfectionism Somatization Obsessive-compulsive Interpersonal sensitivity Depression Anxiety Hostility Phobic anxiety Paranoia Psychoticism . clinical validation: associations of pppq scores with psychopathology Pearson's correlations were used to examine the individual relationships between PPPQ and BSI subscales (see Table 3)..001).124 Notes. Obsessive-Compulsive. p b .331 ⁎⁎ . the only relationship between demographic factors and PPPQ scores was a negative relationship between perseveration and age.275 ⁎⁎ . Given that the PPPQ scales were all associated with each other. the acceptable alpha level was set at . and Time 2 were strongly and significantly correlated for persistence (r = .001) and there was no significant difference in scores over time (t b 1. in all cases). Finally. consistent with the hypothesis that perseveration Table 3 Correlations (Pearson's r) between subscales of the Brief Symptom Inventory and the Persistence. it was a less powerful factor than perseveration. The alpha level was set to . p b . Age was included as a potential predictor. given its association with perseveration (above).381 ⁎⁎ .136 . but no other correlations were significant.79. perseveration (r = .01 to reduce the likelihood of a Type I error resulting from multiple correlations.049 . ns. indicating that perseveration is stronger at the younger end of this age range.014 −.014 −.352 ⁎⁎ .001). p b . it was important to determine the Discussion This paper reports the development of a self-report measure of persistence and perseveration.468 ⁎⁎ .89. correcting for age differences between the groups).206 ⁎⁎ . Perseveration was associated with the greatest range of BSI psychopathology scales.385 ⁎⁎ .29. corresponding to the hypothesized distinct constructs of persistence. Only the statistically significant independent variables are shown.011 −. BSI scales).236 ⁎⁎ .01.106 .05 level (2-tailed) ⁎⁎ Correlation is significant at the 0. Perseveration was consistently the best predictor of psychopathology. Paranoid Ideation).395 ⁎⁎ . The factor analysis demonstrated three factors that were both psychometrically and clinically valid.73.159 ⁎ . ⁎ Correlation is significant at the 0. PPPQ = Persistence. The three constructs were related to psychopathology in different ways. pattern of association when those intercorrelations were accounted for. To summarize. Table 4 shows the relationships between the independent variables (PPPQ scales and age) and each BSI scale.001) and perfectionism (r = . BSI = Brief Symptom Inventory.330 ⁎⁎ .027 −.054 . It was significantly positively associated with all BSI subscales. To reduce the risk of Type I errors. Although perfectionism was positively associated with some aspects of psychopathology (Global BSI. Therefore. Perseveration and Perfectionism Questionnaire. t-tests showed no significant differences in PPPQ subscale scores across genders.266 serpell et al. Nor were there any differences in PPPQ scores between the students and the nonstudents (MANCOVA. Depression.125 . relationship between pppq subscales and demographic variables Pearson's correlations were calculated between the PPPQ subscales and age. designed to distinguish those constructs that are adaptive/ healthy and maladaptive/unhealthy in a nonclinical group.398 ⁎⁎ .e. as measured by the BSI (even when the impact of age was taken into account). multiple regression analysis was used to test the relationship between PPPQ subscales and psychopathology (i.053 . Persistence was not associated with any elements of psychopathology. Phobic Anxiety. persistence was negatively associated with most types of psychopathology (high persistence was associated with lower psychopathology scores on all but three BSI subscales). Interpersonal Sensitivity.192 ⁎ .084 .

1978.35 3.35 .00 2. Bouvier..001 . Perfectionism as measured in this study was a less pathological trait than perseveration.41 5.001 .02 .34 .13 1.03 Notes. Shafran et al.g.29 . PPPQ = Persistence. whereas persistence is an adaptive/healthy trait (e.g.001 .001 12.1% 14. is a maladaptive/unhealthy trait (e.78 2.11 .04 .g. testing Persistence.24 6.. to relax.001 .16 .25 −. indicating the value of reinforcement for effort (Eisenberger et al.0% Psychoticism 13.46 2. Brandon et al.52 .02 .32 2.24 −. For example.80 2. a fear of making an unspecified error. Perseveration and Perfectionism Questionnaire. 2002) might reflect cases with comparatively high levels of perseveration and low levels of persistence.19 . 2003).05 . Salkovskis. as it was not associated with depression in this study. However.71 2.71 24.001 15. Such a formulation avoids the circular thinking inherent in the definition of such constructs of perfectionism (Vitousek.02 .0% Persistence Perseveration Perfectionism Age Perseveration Age Persistence Perseveration Perfectionism Persistence Perseveration Perfectionism Persistence Perseveration Perseveration Persistence Perseveration Age Perseveration Perfectionism Persistence Perseveration Perfectionism Age Persistence Perseveration Age 3.'s (1996) findings.16 −.68 2. The psychopathological role of perfectionism in its purer form is less clear.001 . because the goal is definable (and hence achievable). We tentatively suggest that clinical descrip- tions of “clinical” or “neurotic” perfectionism (e.g.. 2003). 1999). Hamachek. whether or not that behavior is adaptive depends on whether the individual is driven by perseveration (e. allowing that the behaviors of “healthy” and “unhealthy” perfectionist individuals can be driven by different functions of the same behaviors. showing only weak associations with some elements of psychopathology.33 5..001 .32 5..g.001 ... Perseveration and Perfectionism Questionnaire subscales as predictors of Brief Symptom Inventory subscales (including age as an independent variable) BSI subscale Overall effect F P % variance Independent predictors Variable t Beta P Global 24.001 . to meet friends) if the behavior is driven by persistence.g.5 16.001 .15 .14 4.13 −.001 18.001 . BSI = Brief Symptom Inventory.36 −.51 .64 5.3% Somatization Obsessive-compulsive 11.13 ..35 .31 .28 −.005 ..32 −.21 .001 . .g.001 .persistence and perseveration Table 4 267 Multiple regression analyses.13 −..33 5.85 4. 2003).30 8.001 . a desire to be sure that the point has been understood).4% 24.29 7.26 . an individual preparing for an examination might be labeled as perfectionist as a result of revising hard. That individual will only be able to stop revising (e.001 14..80 .001 .14 .5 14. The present findings support the hypothesis that perseveration is a risk factor in a wide range of psychological disorders.03 .42 .9% 9% Phobic anxiety Paranoid ideation 14.03 .001 .16 −.0% Interpersonal sensitivity 17.88 .97 2. 1996.001 15. They also support the hypothesis that persistence is a protective factor.006 . 1992) and potentially explaining the resilience of some individuals in the face of high levels of life stressors (e.04 .97 2.06 .11 −.78 3. potentially manifesting as compulsivity and safety-seeking behaviors.001 .1% 17.2% Depression Anxiety Hostility 14.05 2.001 .19 . Salkovskis et al.96 2.009 .07 3.36 2.44 .001 .001 23.18 −.28 7. or following an openended rule to study continually) or by persistence (e. in contrast with Hewitt et al.02 .14 −.14 .

it will be critical for future research to examine the PPPQ's clinical validity with patient groups who demonstrate compulsive features and the use of safetyseeking behaviors. 2007). shifting perspective and examining a range of possible solutions or approaches to problems.. perfectionism. the low response rate in the current study might have resulted in those who responded being unrepresentative of the normal population in some way. This is an empirical question. an approach used to improve cognitive flexibility and “seeing the wood for the trees” (Davies & Tchanturia. Future studies should examine the relationship between the new measure and preexisting measures of related constructs (such as attentional control.g. and access to more diverse populations. and experiential avoidance). one more maladaptive). although Naglieri et al. completion . For example. Such findings will elucidate whether the PPPQ is tapping elements of preexisting scales or measuring new concepts. Davies. which could be addressed through examining the association of these PPPQ scales and appropriate measures of adaptive and maladaptive perfectionism. The correlations between the perseveration and persistence subscales and a large number of the subscales of the BSI suggest that these may be additional “core processes” (one more adaptive. However. It is also necessary to determine whether the use of email contacts for recruitment could have influenced the results.g. of homework tasks). Many of these aspects could be addressed within a cognitive behavioral approach. Patients’ levels of task persistence might also indicate their suitability for treatments such as cognitive-behavioral therapy. Such studies might also examine the impact of these two core constructs on therapy outcome. 2006a. self-efficacy. cognitive-behavioral therapy). An additional limitation is that the discriminant validity of the PPPQ has not been established. It should be acknowledged that the crosssectional nature of the current study is a limitation.. and prospective studies are needed to determine the development. the findings of a protective role of persistence suggests that there is a potential role for “effort training. Without prospective methodology. there might also a role for Cognitive Remediation Therapy. 2006b). It is possible that the attempt to make the perfectionism scale heterogeneous may have meant that some items (such as those concerned with organization and order) did not tap core aspects of perfectionism. in order to determine the clinical validity of the PPPQ. 2006). 1992). high levels of persistence might predict a lower likelihood of dropping out of treatment and a greater engagement in the process (e. It may be that the perfectionism scale should be revised in line with recent research relating to the core components of the perfectionism construct (e.. & Campbell. (2004) conclude that there are advantages as well as disadvantages to using this method of administration (compared to pencil-and-paper methods). An alternative possibility is that persistence and perseveration are simply alternative ways of labeling the constructs of adaptive and maladaptive perfectionism. It will be important for future research to examine the psychometric properties of the PPPQ in a range of clinical samples. activity scheduling). maintenance and casual links of these traits. assisting the patient to continue in the face of challenges. This approach stands in contrast to the recent proliferation of specific cognitive behavioral models developed for different conditions and suggests that such conditions have many commonalities as well as differences (e. It will also be necessary to determine whether the perseveration scale's construct validity is enhanced in clinical groups.. as use of electronic methods might encourage accuracy of scoring. whereas high perseveration may result in poorer outcomes from therapies that require flexible thinking and taking alternative perspectives on problems (e.” in which individuals are trained to increase persistence by manipulating the schedule on which rewards are given for particular behaviour (Eisenberger et al.. In clinical terms. This possibility should also be explored in future research.268 serpell et al. Adaptations of these techniques might be a useful addition to current therapy techniques (e. maladaptive perfectionism and perseveration) predict the same or distinct elements in the variance in measures of psychopathology. The work of Harvey and colleagues (2004) and others has suggested that certain dysfunctional processes may be common to a range of psychological disorders. Tchanturia. in which persistence is more likely to be an asset.g. Norton.g. which could lend support to a transdiagnostic approach. In particular. Dunkley et al.. Finally. 2005. The more pathological facet of perseveration might indicate the need for therapies that enable individuals to refocus their attention on higher order goals. The validity of the PPPQ needs to be determined with a wider age range. honesty in participants.g. it is not possible to show that perseveration and persistence are actually responsible for exacerbating or reducing/ protecting against psychological symptoms. Such research should also consider whether the hypothesized corresponding constructs (adaptive perfectionism and persistence.

even when the concepts are difficult to understand. 2. I keep trying to sort out problems in a relationship. I am likely to plan carefully which topics I will need to cover. 11. I try all the contact numbers I have for him in the hope of catching him. 7. even when the deadline for the decision has passed. I would make sure I had all the relevant paperwork and measurements ready. even if some of the parts are of no interest. 16. I keep going until I reach my goal. I tend to keep going with a long task until it is complete. Once I have decided to do something. 10.persistence and perseveration 269 Appendix 1. When calling a tradesman to arrange for him to come to my home. 17. Persistence. I will keep trying to resolve things. I hate making mistakes. even if this takes a long time. I do not stop until I find an answer. People describe me as someone who can stick at a task. Please read each item carefully and place a tick in the column that most applies to you. Perseveration and Perfectionism Questionnaire (PPPQ) Instructions: This questionnaire contains a number of statements about how people might behave or think. If I have an important test coming up. 12. When reading a book or magazine. When studying for an important test. 9. even though I know that they are not being picked up or responded to. When calling a tradesman to arrange for him to come to my home. I keep going until I have read all the necessary material. If I have a problem in my relationship. When calling a tradesman to arrange for him to come to my home. If a friendship seems to be running into difficulties. even if I know it's not going to survive. 14. Even when I do something very carefully. 19. When I phone someone to get a decision. I often feel that I must begin at the first page and read through to the very end. When reading a book or magazine. I tend to stay up working late into the night. if I get an engaged tone then I tend to keep ringing back every minute or so. I may continually ring and leave messages on the same number. 6. If I try to solve a problem or puzzle. 3. even when it gets difficult. If I have an appointment. even though I know I am no longer taking in the material and that the studying will not help my performance. 5. . 8. in case it's just a hiccup. One of my goals is to be perfect in everything I do. making a revision timetable to ensure I get everything done. Not at all true of me A little true of me Somewhat true of me Very true of me Totally true of me 1. rather than giving up quickly. 4. I will work hard at sorting it out. 13. 18. 15. I always check my travel arrangements carefully in advance to make sure that I have plenty of time to get there and not be late. I often feel that it is not quite right.

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