Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
Department of Psychology, University of Münster, Münster, Germany.
Lancet Psychiatry. 2023 Dec;10(12):955-965. doi: 10.1016/S2215-0366(23)00293-6. Epub 2023 Oct 13.
Narcissistic personality traits have been theorised to negatively affect depressive symptoms, therapeutic alliance, and treatment outcome, even in the absence of narcissistic personality disorder. We aimed to examine how the dimensional narcissistic facets of admiration and rivalry affect depressive symptoms across treatment modalities in two transdiagnostic samples.
We did a naturalistic, observational prospective cohort study in two independent adult samples in Germany: one sample pooled from an inpatient psychiatric clinic and an outpatient treatment service offering cognitive behavioural treatment (CBT), and one sample from an inpatient clinic providing psychoanalytic interactional therapy (PIT). Inpatients treated with CBT had an affective or psychotic disorder. For the other two sites, data from all service users were collected. We examined the effect of core narcissism and its facets admiration and rivalry, measured by Narcissistic Admiration and Rivalry Questionnaire-short version, on depressive symptoms, measured by Beck's Depression Inventory and Patient Health Questionnaire-Depression Scale, at baseline and after treatment in patients treated with CBT and PIT. Primary analyses were regression models, predicting baseline and post-treatment depression severity from core narcissism and its facets. Mediation analysis was done in the outpatient CBT group for the effect of the therapeutic alliance on the association between narcissism and depression severity after treatment.
The sample included 2371 patients (1423 [60·0%] female and 948 [40·0%] male; mean age 33·13 years [SD 13·19; range 18-81), with 517 inpatients and 1052 outpatients in the CBT group, and 802 inpatients in the PIT group. Ethnicity data were not collected. Mean treatment duration was 300 days (SD 319) for CBT and 67 days (SD 26) for PIT. Core narcissism did not predict depression severity before treatment in either group, but narcissistic rivalry was associated with higher depressive symptom load at baseline (β 2·47 [95% CI 1·78 to 3·12] for CBT and 1·05 [0·54 to 1·55] for PIT) and narcissistic admiration showed the opposite effect (-2·02 [-2·62 to -1·41] for CBT and -0·64 [-1·11 to -0·17] for PIT). Poorer treatment response was predicted by core narcissism (β 0·79 [0·10 to 1·47]) and narcissistic rivalry (0·89 [0·19 to 1·58]) in CBT, whereas admiration showed no effect. No effect of narcissism on treatment outcome was discernible in PIT. Therapeutic alliance mediated the effect of narcissism on post-treatment depression severity in the outpatient CBT sample.
As narcissism affects depression severity before and after treatment with CBT across psychiatric disorders, even in the absence of narcissistic personality disorder, the inclusion of dimensional assessments of narcissism should be considered in future research and clinical routines. The relevance of the therapeutic alliance and therapeutic strategy could be used to guide treatment approaches.
IZKF Münster.
For the German translation of the abstract see Supplementary Materials section.
自恋人格特质被认为会对抑郁症状、治疗联盟和治疗结果产生负面影响，即使在没有自恋型人格障碍的情况下也是如此。我们旨在研究在两个跨诊断样本中，钦佩和竞争这两个维度的自恋特质如何影响不同治疗方式下的抑郁症状。
我们在德国的两个独立成人样本中进行了自然主义、前瞻性队列研究：一个样本来自提供认知行为治疗（CBT）的住院精神病诊所和门诊治疗服务，另一个样本来自提供精神分析互动治疗（PIT）的住院诊所。接受 CBT 治疗的住院患者患有情感或精神病障碍。对于其他两个地点，收集了所有服务使用者的数据。我们通过短版自恋钦佩和竞争问卷（Narcissistic Admiration and Rivalry Questionnaire-short version）来衡量核心自恋及其钦佩和竞争特质，来评估其对接受 CBT 和 PIT 治疗的患者在治疗前后的抑郁症状（贝克抑郁量表和患者健康问卷抑郁量表）的影响。主要分析是回归模型，从核心自恋及其特质来预测基线和治疗后抑郁严重程度。在门诊 CBT 组中进行了中介分析，以评估治疗联盟对自恋与治疗后抑郁严重程度之间关联的影响。
该样本包括 2371 名患者（1423 名女性[60.0%]和 948 名男性[40.0%]；平均年龄 33.13 岁[标准差 13.19；范围 18-81]，其中 517 名住院患者和 1052 名门诊患者在 CBT 组，802 名住院患者在 PIT 组。未收集种族数据。CBT 的平均治疗持续时间为 300 天（标准差 319），PIT 为 67 天（标准差 26）。核心自恋在两组中都不能预测治疗前的抑郁严重程度，但竞争特质与基线时更高的抑郁症状负担相关（CBT 为 2.47 [95%CI 1.78 至 3.12]，PIT 为 1.05 [0.54 至 1.55]），而钦佩特质则表现出相反的效果（CBT 为-2.02 [-2.62 至-1.41]，PIT 为-0.64 [-1.11 至-0.17]）。在 CBT 中，核心自恋（β 0.79 [0.10 至 1.47]）和竞争特质（0.89 [0.19 至 1.58]）预测了较差的治疗反应，而钦佩特质则没有影响。在 PIT 中，自恋对治疗结果没有影响。在门诊 CBT 样本中，治疗联盟中介了自恋对治疗后抑郁严重程度的影响。
由于自恋在跨精神障碍的 CBT 治疗前后都会影响抑郁严重程度，即使在没有自恋型人格障碍的情况下也是如此，因此在未来的研究和临床常规中应考虑包含对自恋的维度评估。治疗联盟和治疗策略的相关性可以用来指导治疗方法。
IZKF 明斯特。
