The Effectiveness of an Intervention Protocol Based on Multidimensional Spiritual Therapy on Reducing Narcissistic Symptoms and Improving Personality Functions in Narcissistic Personality Disorder: A Case Study

Document Type : Research Paper

Authors

1 Ph.D. Student in Psychology, Department of Psychology, Faculty of Humanities, Islamic Azad University, Saveh Branch, Saveh, Iran.

2 Professor, Ph.D. in Psychology, Department of Psychology, Faculty of Behavioral Sciences, Research Institute of Hawzeh and University, Qom, Iran.

3 Assistant Professor, Ph.D. in Psychology, Department of Psychology, Faculty of Literature and Humanities, University of Qom, Qom, Iran.

4 Assistant Professor, Ph.D. in Educational Psychology, Department of Psychology, Faculty of Humanities, Islamic Azad University, Saveh Branch, Saveh, Iran.

10.30471/psy.2024.9947.2219

Abstract

Introduction: Narcissistic personality disorder, a pervasive pattern of grandiosity, is a need for admiration, the lack of empathy that develops in early adulthood and is present in various contexts. The characteristics such as variable and vulnerable self-esteem along with attempts to regulate it through approval-seeking and grandiosity, arrogant and demeaning behaviors and attitudes, excessive need for admiration, a sense of entitlement, and high sensitivity to criticism disrupt their personality functions, namely identity, self-direction, empathy, and intimacy. Their goal in interacting with others is to protect their fragile self-esteem; thus, they do things that will lead to coldness and disgust from others. Narcissistic personality disorder is chronic and resistant to treatment and imposes intangible costs on the treatment system by causing individual-social functional damages, disruption of emotional and family relationships, and inadequate quality of life. To address these, it is essential to find effective methods. Given the importance of spirituality in the treatment of this disorder, and its culture-influenced nature, it is necessary to pay attention to cultural-religious issues in treatment. Spiritual interventions, by creating a person's true understanding of themselves, God, and others and transforming God-concept themselves into God-concept, cause the person to feel valuable and distance themselves from narcissistic characteristics. This research aimed to study the effectiveness of an intervention protocol based on multidimensional spiritual therapy, which is a culturally appropriate intervention method that focuses on the authentic spiritual dimension of humans, on reducing narcissistic symptoms and improving personality functions among people with narcissistic personality disorder.
Method: In this research, a classical A-B-C quasi-experimental single-subject design with multiple baselines using different subjects and continuous assessment with follow-up periods was applied. Three women with narcissistic personality disorder who were referred by psychotherapist colleagues and psychotherapy centers in 2023 entered the treatment process through the judgmental sampling based on entry and exit criteria. Pincus's (2009) Pathological Narcissism Inventory (PNI) and Janbozorgi's (2020) personality function questionnaires were used to collect the data. Data analysis was performed using visual analysis at two levels within and between situations. At the within-situation level, the median and mean central indices were examined during the baseline, intervention, and follow-up stages through visual plotting patterns of change in level, stability, and trend for each client regarding narcissism and personality functions scores. At the inter-situational level, the Percentage of Non-overlapping Data (PND) and the Percentage of Overlapping Data (POD) were calculated. The stable change index, effect size, or percentage of improvement was also used in the analysis of the results. In the first stage, the dependent variables were measured in several sessions until stability was achieved. After drawing the baseline of the variables, the treatment process was performed in twenty individual sessions of 45-60 minutes and the variables were measured and recorded four times during the intervention. In the third stage, in order to stabilize and maintain the effect of the intervention, all three clients were examined in two-week, one-month, and three-month follow-up sessions.
Results: Clients' narcissism scores decreased during the intervention and follow-up stages, indicating the effect of the intervention on narcissism symptoms. The overall improvement percentage index at the end of the intervention sessions (50%), after the follow-up (56%) and the rate of the stable change index (above 1.96) showed that the change and reduction in the clients' narcissism symptoms were statistically significant (at the 0.05 level). The percentage of non-overlapping data (100%) indicated the high effect of the intervention on reducing narcissism symptoms. Figure 1 shows the changes in the clients' narcissism scores in all three stages.
Figure 1. Clients' narcissism scores on the Pathological Narcissism Inventory (PNI) in the baseline, intervention, and follow-up stages
In the intervention stage, personality functions improved in all three clients except intimacy in the third client, and the trend from baseline to intervention was negative and decreasing. The overall improvement percentage index at the end of the intervention sessions (50.6%) and after the follow-up (54.5%) indicated the effect of the intervention on the clients' personality functions. The stable change index (above 1.96) showed that the change and improvement in the clients' personality processes and functions were statistically significant (at the 0.05 level). The change in the clients' personality functions in all three stages is shown in Figure 2. The percentage of non-overlapping data indicated the high effectiveness of the intervention sessions on the identity and empathy of the first client (100%) and its moderate effectiveness on her self-direction and intimacy (50%), high effectiveness on all personality functions of the second client (self-direction, 75% and the rest, 100%), and identity, self-direction, and empathy (100%) of the third client.
Figure 2. Clients' personality functions scores on Janbozori's personality function questionnaire in the baseline, intervention, and follow-up stages
Discussion: The results of the intervention showed that the intervention based on multidimensional spiritual therapy was effective in reducing narcissism symptoms and improving the personality functions of people with narcissistic personality disorder. In this intervention, with confronting anti-rational forces and removing obstacles to their action, the basis for distancing from narcissistic symptoms was provided. Receiving a definition of God as the eternal and everlasting truth of the world and the self as a being dependent on Him led to the formation of a spiritual identity in the clients, which integrated the rest of their relationships and actions, and they were able to achieve identity coherence from identity instability. The identity coherence led to peace, responsibility, and purposefulness, and provided the basis for self-direction. Awareness of the Lordship, by creating a feeling of a reliable and supportive base, moderated the excessive need to attract attention and support from others. The improvement of empathy and intimacy functions can be related to the organization of spiritual identity, the real perception of others (otherness-concept) and the understanding of common points, which changed the feeling of superiority into a feeling of equality and sharing, and strengthened the empathy. Paying attention to the purpose of life highlighted the meaningfulness of life, and instead of engaging in unrealistic fantasies or mental ruminations, the individual was able to focus on the real life of the present.
According to the results obtained, it can be said that the spiritual intervention method has the sufficient efficiency and effectiveness in reducing narcissistic symptoms and improving the personality functions of people with narcissistic personality disorder; as a result, spiritual intervention can be applied to control narcissistic symptoms.

Keywords

References

  1. بک، آرون؛ فریمن، آرتور و دنیس دیویس (2004)، شناخت درمانی برای اختلالات شخصیت. ترجمه داود کربلایی، محمد میگونی و علی­اکبر فروغی (1395)، تهران: ارجمند.
  2. ترشابی، ملیحه؛ رسول‌زاده طباطبایی، سیدکاظم؛ بشارت، محمدعلی و علی عسگری (1395)، «بررسی اعتبار و ساختار عاملی نسخه فارسی سیاهه خودشیفتگی آسیب­شناختی». فصلنامه اندازه­گیری تربیتی، س6، ش22، ص115−134.
  3. جان­بزرگی، مسعود (1377)، «بررسی اثربخشی روان­درمانگری با و بدون جهت­گیری مذهبی اسلامی بر اضطراب و تنیدگی». مجله روان­شناسی، س2، ش8، ص344−367.
  4. جان­بزرگی، مسعود (1398)، درمان چندبعدی معنوی یک رویکرد خداسو برای مشاوره و روان‌درمانگری. قم: پژوهشگاه حوزه و دانشگاه.
  5. جان­بزرگی، مسعود؛ نوحی، شهناز؛ ناصری فدافن، ملکه؛ حیدری­زاد، مهدیه و عرفانه جان­بزرگی (1401)، «ساخت، استانداردسازی و هنجاریابی پرسشنامه کارکرد شخصیت براساس DSM-5». مجله روان­شناسی سلامت بالینی، س1، ش1، ص29−41.
  6. چگینی، مریم؛ دلاور، علی؛ بنفشه غرایی. (1392). «ویژگی‌های روان‌سنجی پرسشنامه بالینی چندمحوری میلون 3». پژوهش‌های نوین روان شناختی، 8 (29)، 135-163.
  7. حسینی سمنانی، صدیقه؛ جان‌بزرگی، مسعود؛ انصاری، حسن و فاطمه شاطریان محمدی (1403)، «تدوین پروتکل درمانی اختلال شخصیت خودشیفته مبتنی بر درمان چندبعدی معنوی و منابع اسلامی». مطالعات اسلام و روان‌شناسی، 18 (35)،186−216.
  8. خدایاری‌فرد، محمد و مریم صیاد شیرازی (1394)، «اثربخشی خانواده درمانی شناختی– رفتاری بر اختلال شخصیت خودشیفته: مطالعه موردی». رویش روان‌شناسی، س4، ش10، ص25−40.
  9. سلیمانی، مهدی؛ پاست، نگین؛ مولایی، مهری؛ محمدی، ابوالفضل؛ دشتی­پور، معصومه؛ صفا، یاسمین و آیرون پینکاس (1394)، «ویژگی­های روان­سنجی مقیاس خودشیفتگی مرضی». روان­شناسی معاصر، س10، ش1، ص95−110.
  10. شریفی، علی اکبر؛ مولوی، حسین و کوروش نامداری (1386). «رواﻳﻲ تشخیصی آزﻣﻮن بالینی ﭼﻨﺪﻣﺤﻮری میلون 3». داﻧﺶ و ﭘﮋوﻫﺶ در روانﺷﻨﺎﺳﻲ، 9 (34)، 27-38.
  11. شکربیگی، نرگس و رضوان شکربیگی (1402)، «عوامل مؤثر بر تقویت آینده­نگری و هویت دینی با تأکید بر قرآن و حدیث». فصلنامه علمی قرآن و علوم اجتماعی، س3، ش1، ص57−93.
  12. طباطبایى، محمد حسین‌ (1374)، تفسیر المیزان. ترجمه محمدباقر موسوی همدانی، چ5،‌ قم: دفتر انتشارات اسلامی.‌
  13. قدرتی میرکوهی، مهدی و مژگان ذکری (1397)، «اثربخشی روان نمایشگری بر اختلال شخصیت خودشیفته، انزوای اجتماعی، فقدان همدلی و بی‌اشتهایی عصبی». مطالعات روان‌شناختی، س14، ش4، ص139−156.
  14. قدوسی، سیدابوالفضل و رحیم میردرکوندی (1392)، «بررسی مفهوم روان­شناسی کبر در منابع اسلامی و مقایسه آن با خودشیفتگی». نشریه معرفت، س20، ش192، ص83−94.
  15. گابارد، گلن (1396)، روان پزشکی روان پویا، ترجمه فرهاد شاملو؛ فرهاد فریدحسینی؛ ندا فرزانه؛ محیا مجاهدی؛ گل‌مهر شاملو رضایی (2014)، تهران: ابن‌سینا.
  16. سلطان محمدلو، سپیده؛ غرابی، بنفشه؛ فتحعلی لواسانی، فهیمه و محمدرضا گوهری (1392)، «بررسی ارتباط بین سیستم‌های فعال‌ساز رفتار، دشواری در تنظیم هیجانی و فراشناخت با نگرانی». پژوهش‌های علوم شناختی و رفتاری، 3(2): ص85−100.
  17. مرادی اورگانی، عیسی؛ فاتحی‌زاده، مریم؛ احمدی، احمد و عذرا اعتمادی (1397)، «تأثیر درمان بین فردی فراشناختی بر کیفیت زناشویی مرد خودشیفته: مطالعه موردی». پژوهش­های کاربردی روان­شناختی، 9(1): ص1−24.
  18. مروتی، سعید؛ حسینی­نیا، محمدرضا و فاطمه سیفعلی­ئی (1398)، «خودآگاهی و کارکردهای تربیتی آن در بهبود روابط اجتماعی انسان در قرآن و حدیث». آموزه­های تربیتی در قرآن و حدیث، 4(2): ص1−18.
  19. مصباح یزدی، محمدتقی (1382)، یاد او. چ2، قم: مؤسسه آموزشی و پژوهشی امام خمینیe.
  20. نوفروستی، اعظم و حمیدرضا حسن­آبادی (1397)، «تحلیل داده­ها در طرح­های آزمایشی تک آزمودنی». رویش روان‌شناسی، س7، ش12، ص291−
  21. American Psychiatric Association (2022), Diagnostic and Statistical Manual of Mental Disorders, DSM-5-TR, Fifth Edition, Text Revision. Washington, DC.
  22. Bateman, A. & Fonagy, P. (2016), Mentalization-based treatment for personality disorders: A practical guide, Oxford University Press.
  23. Böhmer, M. (2016), Does psychiatry need religion and spirituality in its treatment approach? Narcissism as an example, South African Journal of Psychiatry”, 22(1): 1-6.
  24. Brummelman, E., Thomaes, S., Nelemans, S. A., Orobio de Castro, B., Overbeek, G. & Bushman, B. J. (2015), Origins of narcissism in children, Proceedings of the National Academy of Sciences of the United States of America, 112(12): 3662- 3659.
  25. Butcher, J.N., Hooley, J.M. & Mineka, S. (2014), Abnormal psychology, 16th ed. Publisher: Pearson, United States of America.
  26. Campbell, W. K. & Miller, J.D. (2011), The handbook of narcissism and narcissistic personality disorder: theoretical approaches, empirical findings, and treatments, Published by John Wiley & Sons, Inc., Hoboken, New Jersey.
  27. Choi-Kain LW., Simonsen, S. & Euler, S. (2022), “A mentalizing approach for narcissistic personality disorder: Moving from "me-mode" to "we-mode", American Journal of Psychotherapy”, Jan 1;75(1):38-43.
  28. Comer, R.J. (2015), Abnormal Psychology, Ninth edition, Worth publisher, New York.
  29. Currier, J.M., Foster, J.D., Abernethy, A.D., Wit Vliet, Ch., Luna, L.M., Putman, K.M., Schnitker, S.A., VanHarn, K. & Carter, J. (2017), “God imagery and affective outcomes in a spiritually integrative inpatient program”, Psychiatry Research, 254, 317- 322.
  30. Dashineau, SC., Edershile, EA., Simms, LJ. & Wright, AGC. (2019), Pathological narcissism and psychosocial functioning, Personality Disorders: Theory, Research and Treatment, 10(5), 473–478.
  31. Di Pierro, R., Di Sarno, M, Preti, E. & Di Mattei, V. (2017), The Role of Identity Instability in the Relationship Between Narcissism and Emotional Empathy, Psychoanalytic Psychology, 35(2), DOI:10.1037/pap0000159.
  32. Di Pierro, R., Mattavelli, S. & Gallucci, M. (2016), Narcissistic traits and explicit self-esteem: The moderating role of implicit self-view, Frontiers in Psychology, 7, Article ID 1815.
  33. Dimaggio, G., Procacci, M., Nicolò, G., Popolo, R., Semerari, A., Carcione, A. & Lysaker, PH. (2007), Poor Metacognition in Narcissistic and Avoidant Personality Disorders: Four Psychotherapy Patients Analysed Using the Metacognition Assessment Scale, Clinical Psychology and Psychotherapy, 14, DOI: 10.1002/cpp.
  34. Dimaggio, G., Valeri, S., Salvatore, G., Popolo, R., Montano, A. & Ottavi, P. (2014), “Adopting Metacognitive Interpersonal Therapy to Treat Narcissistic Personality Disorder with Somatization”, Journal of Contemporary Psychotherapy, 44, 85–95.
  35. Drozek, RP. & Unruh, BT. (2020), “Mentalization-Based Treatment for Pathological Narcissism”, Journal of Personality Disorder. 34 (Suppl): 177-203.
  36. Fatfouta, R. & Schwarzinger, D. (2023), A toxic mix: Explicit and implicit narcissism and counterproductive work behavior, Applied Psychology, 1– 14.
  37. Fatfouta, R.; Gerlach, T. M.; Schröder-Abé, M. & Merkl, A. (2015). “Narcissism and lack of interpersonal forgiveness: The mediating role of state anger, state rumination, and state empathy”. Personality and Individual Differences, 75, 36-40.
  38. Flannelly, KJ. (2017), Religious Beliefs, Evolutionary Psychiatry and Mental Health in America, Evolutionary Threat Assessment Systems Theory, USA, Springer International Publishing, http://www.springer.com/series/13437.
  39. Hobbs, LR. (2022), A Group Music Therapy Method to Promote Mentalization Skills in Clients with Narcissistic Personality Disorder, Expressive Therapies Capstone Theses, 559. https://digitalcommons.lesley.edu/expressive_theses/559.
  40. Huguelet Ph., Mohr, SM., Olié, E., Vidal, S., Hasler, R. & Prada, P. (2016), Spiritual meaning in life and values in patients with severe mental disorders, J Nerv Ment Dis, 2016, Jun; 204:409.
  41. Huguelet, Ph. & Koenig, H. G. (2009), Religion and Spirituality in Psychiatry, Published in the United States of America by Cambridge University Press, New York.
  42. Johnstone, B., Cohen, D., Bryant, KR., Glass, B. & Christ, SE. (2015), Functional and structural indices of empathy: Evidence for self-orientation as a neuropsychological foundation of empathy, Neuropsychology, 29(3):463-72.
  43. Khalsa, GH. & Mijares, Sh. (2005), The Psychospiritual Clinician's Handbook: Alternative Methods for Understanding and Treating Mental Disorders, Routledge, 1st Edition.
  44. Kramer U., Pascual-Leone A., Rohde KB. & Sachse R. (2018), “The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study”, Clinical psychology amp; psychotherapy, 25(2), 272-282.
  45. Miller, JD., Campbell, WK. & Pilkonis, PA. (2007), Narcissistic Personality Disorder: Relations with distress and functional impairment”, Compr Psychiatry, 48(2): 170–177.
  46. Miller, JD., Widiger, TA. & Campbell, WK. (2015), “Narcissistic personality disorder and the DSM-V”, Journal of Abnormal Psychology, 119(4), 640.
  47. Pincus, AL. & Lukowitsky, MR. (2010), Pathological Narcissism and Narcissistic Personality Disorders, Annual Review of Clinical Psychology, 6: 421-446. DOI: 0.1146/annurev
  48. Pincus, AL., Ansell, EB., Pimentel, CA., Cain, NM., Wright, AGC. & Levy, KN. (2009), The initial construction and validation of the Pathological Narcissism Inventory, Psychological Assessment, 21(1), 379-365.
  49. Polit, DF., Beck CT. & Owen SV. (2007), Is the CVI an Acceptable Indicator of Content Validity? Appraisal and Recommendations, Res Nurs Health. 30(4):459-67. doi: 10.1002/nur.20199
  50. Reed-Knight, B. & Fischer, S. (2011), Treatment of narcissistic personality disorder symptoms in a dialectical behavior therapy framework: A discussion and case example. In W. K. Campbell & J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings and treatments, 466–475.
  51. Ronningstam, E. (2016), “Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications”, Current Behavioral Neuroscience Reports, 3(1), 34-42.
  52. Sachse, R. (2019), Case conceptualization in clarification-oriented psychotherapy, Case formulation for personality disorders: Tailoring psychotherapy to the individual client. Elsevier Academic Press, 113–135.
  53. Silton, NR., Flannelly, KJ., Galek, K. & Ellison, CG. (2013), Beliefs About God and Mental Health Among American Adults, Journal of Religion and Health, 52(1), DOI 10.1007/s10943-013-9712-3.
  54. Simard, P., Simard, V., Laverdière, O. & Descôteaux, J. (2023). The relationship between narcissism and empathy: A meta-analytic review, Journal of Research in Personality, 102, https://doi.org/10.1016/j.jrp.2022.104329.
  55. Unterrainer, HF. (2023), “The Multidimensional Measurement of Religious/Spiritual Well-Being: Recent Developments in Scale Validation and Clinical Applications”, Religions. 14: 882. 1-14.
  56. Urbonaviciute, G. & Hepper, E. G. (2020), When is narcissism associated with low empathy? A meta-analytic review, Journal of Research in Personality, 89, Article 104036. https://doi.org/10.1016/j.jrp.2020.104036.
  57. Young, JE., Klosko, JS. & Weishaar, ME. (2003), Schema therapy: a practitioner’s guide, NewYork, A Division of Guilford.

Files

Share

How to cite

Statistics