Loneliness in narcissistic vulnerability: Examining domains of personality functioning.

Research has indicated loneliness to be a detrimental correlate of narcissistic vulnerability. However, no research has examined if this relationship persists across time or why it occurs. The present study explores the link between narcissistic vulnerability and loneliness across time and examines which domains of personality dysfunction (i.e., identity, self-direction, empathy, and intimacy) may account for why narcissistic vulnerability is related to loneliness. Adult participants (N = 298) were recruited from Prolific and completed study questionnaires assessing narcissistic vulnerability, narcissistic grandiosity, loneliness, domains of self and interpersonal functioning, and neuroticism. Two months later, participants repeated the measure of loneliness. Correlations among all study variables were calculated, followed by linear regression analyses to investigate how personality functioning domains may mediate the longitudinal relationship between narcissistic vulnerability and loneliness. The effects of baseline loneliness, relationship status, and trait neuroticism were controlled for. Narcissistic vulnerability, but not narcissistic grandiosity, was associated with loneliness at baseline and 2 months later. Intimacy functioning, but not identity, self-direction, or empathy functioning, was a significant mediator of the relationship between narcissistic vulnerability and loneliness over time. These findings suggest that narcissistic vulnerability may contribute to the development or maintenance of loneliness across time, highlighting the role of impaired intimacy functioning in this relationship. The impact of these findings on our understanding of interpersonal functioning in narcissistic vulnerability, as well as clinical implications, is discussed.

A roadmap to address stress in graduate students: How to develop and disseminate a student-led single-session evidence based intervention.

Objective: This manuscript describes an evidence-based, student-led, single-session group intervention to support emotional wellbeing among graduate students. The present objective is to provide a roadmap for other universities. Participants: Key participants include clinical psychology graduate students (leader and workshop facilitators), faculty supervisor, representatives from receiving departments or schools, and institutional advocates. Methods: The two-hour workshop was based on four core transdiagnostic cognitive behavioral skills, including psychoeducation about emotions, mindful emotional awareness, cognitive flexibility, and behavior change. The workshop was designed and continues to be led by trained graduate students. Results: Key steps and lessons learned are presented for the exploration, preparation, implementation, and sustainment phases. Conclusions: This program has the potential to be flexibly replicated at other universities to assist with graduate student mental health. It provides unique supports for recipients and unique training opportunities for student facilitators.

Grandiose narcissism influences the phenomenology of remembered past and imagined future events.

Little empirical work has examined future thinking in narcissistic grandiosity. We here extend prior work finding that people scoring high in grandiosity have self-bolstering tendencies in remembering past events, and we consider whether these tendencies extend to imagining future events. Across an initial study (N = 112) and replication (N = 169), participants wrote about remembered past events and imagined future events in which they embodied or would embody either positive or negative traits. Participants then rated those events on several subjective measures. We find that people scoring higher in grandiosity remember past events in which they embody positive traits with greater detail and ease than past events in which they embody negative traits. These same effects persist when people scoring high in grandiosity imagine possible events in their future. Those scoring higher in grandiosity endorse thinking about positive events in their past and future more frequently than negative events, and they judge positive future events as more plausible than negative future events. These tendencies did not extend to objective detail provided in their written narratives about these events. Taken together, these findings demonstrate that grandiosity is associated with self-bolstering tendencies in both remembering the past and imagining the future.

Functional fantasies: the regulatory role of grandiose fantasizing in pathological narcissism.

Introduction: Pathological narcissism is characterized by maladaptive efforts to maintain a bolstered but fragile sense of self. Clinical theory suggests that grandiose fantasizing may be one form of this self-regulation. However, no empirical research has directly assessed the regulatory function of grandiose fantasizing in narcissism. Here, we examine (1) whether people scoring higher in narcissism choose to engage in grandiose fantasizing to regulate themselves when they are feeling down and (2) whether grandiose fantasizing is a more efficacious self-esteem and affect regulator for people scoring higher in narcissism than it is for those scoring lower in narcissism. Methods: Adult participants (N = 189) completed a self-report measure of narcissism and were randomized to either a negative mood induction or filler task condition. Then, participants wrote about a future event to make themselves feel better, choosing between a positive affect word or a grandiose word to guide their writing. Throughout the study, participants reported their state positive and negative affect and self-esteem. A secondary sample (N = 128) of adult participants rated the future event writing of the original participants. Results: Supporting the validity of the study design, grandiose future events significantly differed from positive future events (e.g., they were rated by independent raters as less plausible, more ambitious, more active, and occurring further in the future). Participants scoring higher in narcissism and participants who experienced larger increases in negative affect were more likely to choose to engage in grandiose fantasizing. Grandiose fantasizing was more effective at decreasing negative affect among participants scoring higher in narcissism than those scoring lower in narcissism, whereas positive future thinking was equally effective at decreasing negative affect across levels of narcissism. Discussion: This study demonstrates that people scoring higher in narcissism are more likely to choose to engage in grandiose fantasizing to make themselves feel better. It further demonstrates that grandiose fantasizing is a more efficacious affect regulator for those scoring higher in narcissism.

Corrective Experiences to Enhance Trust: Clinical Wisdom From Good (Enough) Psychiatric Management.

Unstable trust within social interchange underlies the symptom constellation of borderline personality disorder (BPD), resulting in preoccupation with intense dyadic relationships, limited capacity for social collaboration, and constricted social networks. Good Psychiatric Management (GPM) provides a distilled formulation of how interpersonal hypersensitivities drive the engine of BPD's symptomatic oscillations in both affect and attachment. The authors summarize clinically relevant conclusions from the empirical literature on trust in BPD, synthesize it with selected ideas from other empirically supported interventions, and distill a formulation of how the GPM approach can address problems of trust in BPD with strategies most clinicians can use to improve their work with patients. GPM's clinical management approach utilizes common factors in psychotherapy to structure collaboration with patients to be accountable partners in treatment, rely on themselves more to diminish unrealistic demands on others, and function more effectively in arenas that expand and stabilize their social network.

Hurting the Grandiose Self: Examining Presence, Frequency, and Functions of Nonsuicidal Self-Injury in Pathological Narcissism.

The present study examines whether dimensions of pathological narcissism are associated with the presence, frequency, and function of nonsuicidal self-injury (NSSI). Adults (N = 252) completed questionnaires assessing narcissistic grandiosity, narcissistic vulnerability, fluctuation between these narcissistic states, and borderline personality disorder (BPD) symptoms. Those with a history of NSSI (n = 105) also reported the method, frequency, and function of their NSSI engagement. When controlling for co-occurring BPD symptoms, there were very few associations between vulnerability, grandiosity, and narcissistic fluctuation and NSSI presence and frequency. However, a clear pattern emerged regarding NSSI functions. Although vulnerability and narcissistic fluctuation were not associated with any functions of NSSI when co-occurring BPD symptoms were controlled for, grandiosity was positively associated with all interpersonal functions of NSSI (e.g., peer bonding, revenge) and negatively associated with the intrapersonal function of affect regulation. These results suggest a unique relationship between narcissistic grandiosity and NSSI that may inform clinical intervention.

Helpful for all? Examining the effects of psychotherapy treatment history on outcomes of single session, transdiagnostic cognitive behavioral interventions for university students.

Brief, transdiagnostic interventions are an efficient form of mental health care for resource-limited settings like universities. Little research, however, has examined for whom these treatments are most effective. One important factor may be psychotherapy treatment history. Here, we evaluate if treatment history influences the effects of a single-session cognitive behavioral group intervention with optional digital follow-up support across two independent, university-based studies. Undergraduate (N = 143) and graduate (N = 51) students reported their psychotherapy treatment history and completed self-report measures of emotional health before and approximately 1-month following the intervention. Across both samples, psychotherapy treatment history did not moderate changes in depression, anxiety, or emotional avoidance following the intervention. However, participants who were currently receiving psychotherapy began the workshop with lower coping self-efficacy than peers with no prior psychotherapy and saw larger gains in coping self-efficacy at follow-up. Results suggest that regardless of whether a student has previously received psychotherapy, they may benefit from brief, group transdiagnostic interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of Group Psychotherapy for Nonsuicidal Self-Injury: A Meta-Analysis.

Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.

A Cognitive-Behavioral Formulation of Narcissistic Self-Esteem Dysregulation.

Narcissistic personality disorder (NPD) is a commonly encountered diagnosis, affecting approximately 1%-6% of the population, with no evidence-based treatments. Recent scholarship has focused on self-esteem dysregulation as a key component of NPD: Excessively high expectations for oneself and how one should be treated leads to brittle self-esteem and maladaptive reactions to self-esteem threats. The current article builds on this formulation, introducing a cognitive-behavioral model of narcissistic self-esteem dysregulation that clinicians can use in providing a relatable model of change for their patients. Specifically, symptoms of NPD can be seen as a set of cognitive and behavioral habits that serve to regulate difficult emotions emerging from maladaptive beliefs and interpretations of self-esteem threats. This perspective renders narcissistic dysregulation amenable to cognitive-behavioral therapy (CBT) in which patients learn skills that help them gain awareness around these habitual reactions, reshape cognitive distortions, and engage in behavioral experiments that serve to transform maladaptive belief systems that consequently free them from symptomatic reactions. Here, we provide a precis of this formulation and examples of how CBT skills can be used to treat narcissistic dysregulation. We also discuss future research that could provide empirical support for the model and test the efficacy of CBT approaches to NPD. Conclusions focus on the notion that narcissistic self-esteem dysregulation likely varies continuously in the population and transdiagnostically across disorders. Greater insight into the cognitive-behavioral mechanisms of self-esteem dysregulation could foster tools for ameliorating distress both in people with NPD and the general populace.

A meta-analysis of treatment as usual for borderline personality disorder.

In the era of evidence-based medicine, "treatment as usual" (TAU) for borderline personality disorder (BPD) is often considered ineffective or even iatrogenic. To evaluate the effects of TAU, this meta-analysis examined published data from the TAU arms of randomized controlled trials of manualized psychotherapies for BPD. Studies were selected through a comprehensive bibliographic search. A total of 16 studies met inclusion criteria. Comprehensive Meta-analysis V3 software was used for computing and pooling effect sizes. For the primary outcome category of BPD symptoms, Hedges' g showed a small-to-moderate improvement for patients in TAU conditions (11 studies; g = 0.371; 95% confidence intervals [CI: 0.246, 0.495]). Secondary outcomes included general psychopathology, global functioning, and self-harm/suicidality. Hedges' g indicated small improvements in general psychopathology (14 studies; g = 0.119; 95% CI [0.025, 0.214]) and global functioning (10 studies; g = 0.254; 95% CI [0.123, 0.384]). No significant effect was found for changes in self-harm/suicidality (four studies; g = 0.003; 95% CI [-0.193, 0.199]). These findings question the notion that TAU for BPD is inherently iatrogenic. Thus, in the absence of specialized treatment for BPD, standard available care may be a practical option. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

What Works in the Treatment of Borderline Personality Disorder.

PURPOSE OF THE REVIEW: This review summarizes advances in treatments for adults with borderline personality disorder (BPD) in the last 5 years. RECENT FINDINGS: Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy (DBT), and the adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD) and BPD. Studies on pharmacological interventions remain limited and have not provided evidence that any specific medications can provide stand-alone treatment. SUMMARY: The research on treatment in BPD is leading to a distillation of intensive packages of treatment to be more broadly and practically implemented in most treatment environments through generalist care models and pared down forms of intensive treatments (e.g., informed case management plus DBT skills training groups). Evidence-based integrations of DBT and exposure therapy for PTSD provide support for changing practices to simultaneously treat PTSD and BPD.