Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34050
Title: Narcissistic dimensions and depressive symptoms in patients across mental disorders in cognitive behavioural therapy and in psychoanalytic interactional therapy in Germany: a prospective cohort study.
Austin Authors: Richter, Maike;Mota, Simon;Hater, Leonie;Bratek, Rebecca;Goltermann, Janik;Barkhau, Carlotta;Gruber, Marius;Repple, Jonathan;Storck, Michael;Blitz, Rogério;Grotegerd, Dominik;Masuhr, Oliver;Jaeger, Ulrich;Baune, Bernhard T;Dugas, Martin;Walter, Martin;Dannlowski, Udo;Buhlmann, Ulrike;Back, Mitja;Opel, Nils
Affiliation: Department of Psychology, University of Münster, Münster, Germany.
Department of Psychology, University of Münster, Münster, Germany.
Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
Institute for Translational Psychiatry, University of Münster, Münster, Germany.
Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
Institute of Medical Informatics, University of Münster, Münster, Germany.
Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
Institute for Translational Psychiatry, University of Münster, Münster, Germany.
Asklepios Clinic Tiefenbrunn, Göttingen, Germany.
Department of Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne Parkville, VIC, Australia; Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany.
Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany.
Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany; German Center for Mental Health (DZPG), Germany.
Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany.
Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany; German Center for Mental Health (DZPG), Germany.
Medicine (University of Melbourne)
Issue Date: Dec-2023
Date: 2023
Publication information: The lancet. Psychiatry 2023; 10(12)
Abstract: 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34050
DOI: 10.1016/S2215-0366(23)00293-6
ORCID: 
Journal: The lancet. Psychiatry
PubMed URL: 37844592
ISSN: 2215-0374
Type: Journal Article
Appears in Collections:Journal articles

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