Does Mindfulness-Based Cognitive Therapy Reduce the Risk of Alcohol Use Disorder Among Perfectionist College Students? a Stage 1 Pilot Randomized Control Trial

Background and Purpose: College students who describe themselves as perfectionists are more vulnerable to stress, negative affect, and alcohol use disorder. South Korean college students face intense competition for college admission and employment, so they are extremely likely to become perfectionists to meet their own and their society’s standards and expectations. Alcohol consumption has been found to regulate negative affect and to temporarily reduce the adverse effects of perfectionism. Despite the high risk of perfectionism and alcohol use disorder among college students, insufficient attention has been paid to the development of evidence-based interventions for alcohol use disorder in this population. Mindfulness-based cognitive therapy (MBCT) was developed to reduce the relapse of depression and has been found to provide benefits for other mental health and substance abuse problems. This study explores the efficacy of MBCT in reducing the risk of alcohol use disorder among college students by reducing perfectionism and increasing mindfulness.

Methods: A pilot randomized clinical trial was conducted in South Korea in 2026 with 25 college students, ages 18 to 24, who were identified as having a risk of alcohol use disorder and perfectionism. Block randomization was used to assign them to the experimental (n = 13) and control (n = 12) groups. The experimental group participated in eight weekly sessions of MBCT, each lasting two hours, delivered by a qualified MBCT and CBT practitioner. The control group received weekly two-hour CBT-based psychoeducation for 8 weeks, delivered by the same practitioner. The Hewitt Multidimensional Perfectionism Scale (HMPS) was used to assess perfectionism, and the Alcohol Use Disorders Identification Test–Korean (AUDIT-K) was used to assess the risk of alcohol use disorders. The Five Facet Mindfulness Questionnaire (FFMQ) was used to assess the magnitude of mindfulness among participants in both groups. Measurements were taken at two points (pre and post) for all 25 subjects. Data analyses were performed in SPSS 27 with descriptive statistics and independent sample t-test. A linear mixed model (LMM) was fitted for each outcome variable with fixed effects for group, time, and their interaction, and a random intercept for subjects.

Results: No baseline differences were observed between the MBCT and CBT groups, indicating initial comparability of the two groups. Linear mixed model analyses showed improvements over time in several outcomes, including a substantial reduction in perfectionism (HMPS; β = −37.750, p < .001). The MBCT group exhibited a greater decline in AUDIT-K scores than the CBT group (β = −1.410), although this effect was not statistically significant. Most group-by-time interactions were non-significant, likely due to limited power. A significant interaction was observed only for mindfulness (FFMQ; β = 22.603, p < .05), favoring MBCT.

Conclusion and Implications: Overall, the findings suggest that both interventions may be beneficial for reducing perfectionism, with MBCT showing preliminary promise for reducing alcohol use risk among college students with high perfectionism. The identified pattern supports the potential value of MBCT for this high-risk population and underscores the need for a larger, adequately powered study to further evaluate its efficacy and mechanisms.