Introduction
Narcissistic Personality Disorder (NPD) is characterized by persistent grandiosity, a need for excessive admiration, and a pronounced lack of empathy, posing substantial challenges to psychotherapeutic efforts. Recent advances suggest that psychedelic therapies, particularly those inducing ego dissolution, might offer new pathways for treatment. This concept paper examines the potential of psychedelic-induced authentic self-construction for treating NPD, integrating Acceptance and Commitment Therapy (ACT) and psychodynamic principles, and discusses preliminary findings from a pilot project, including considerations for the risks associated with psychedelic therapy.
Theoretical Background
Psychedelic substances such as LSD, psilocybin, and DMT have been observed to prompt ego dissolution—a state where traditional self-boundaries are diminished, potentially leading to increased empathy and decreased self-centeredness. This process can be particularly beneficial for individuals with NPD, addressing their inflated self-importance and lack of empathy. Carl Jung’s concepts of individuation align with the therapeutic goals of psychedelics, suggesting that altered states can facilitate a reevaluation and integration of neglected or exaggerated self-aspects.
Study Design
This pilot project utilized a pre-test/post-test design to evaluate the impact of psilocybin-assisted therapy on individuals diagnosed with NPD. This approach allowed for detailed measurement of changes in participants’ psychological states and behaviors, providing a robust framework for assessing the effects of the intervention.
Participants
The study enrolled 11 adult participants,3 female and 8 male each assessed as having moderate to significant maladaptive personality features or traits using Millon Clinical Multiaxial Inventory criteria. Prior to participation, each individual provided informed consent, having received a comprehensive overview of the study’s objectives, methods, potential risks, and benefits.
Pre-Treatment Preparation
Four preparatory sessions were held to understand each participant’s cognitive processes and maladaptive behaviors with the aim to tailor therapeutic intentions.
Treatment Protocol
Participants received three psilocybin treatments within a seven-day span, in a controlled clinical environment under the supervision of experienced therapist dyads. Integration sessions followed each treatment, focusing on incorporating the insights gained into therapeutic objectives. These sessions were essential for processing the psychedelic experiences meaningfully within the therapeutic context.
Post-Treatment Integration
After completing the psilocybin treatments, two integration sessions were conducted within three days to help participants fully assimilate their experiences into daily life. Ongoing therapy was offered as needed to support continuous psychological and spiritual growth.
Therapeutic Framework
Throughout the project, the Acceptance and Commitment Therapy (ACT) framework was utilized due to its emphasis on values, acceptance, and mindfulness. This approach is particularly suited to psychedelic therapy, enhancing the treatment by aligning with each client’s core values, which in turn facilitates a “calibration of the ego” through integration of journey insights. This method promotes sustained psychological flexibility, improves coping in vulnerable states, and fosters genuine well-being.
Assessments
The Mystical Experience Questionnaire (MEQ) and the Millon Clinical Multiaxial Inventory (MCMI) were administered before the first treatment and after the final integration session to evaluate the depth of mystical experiences and changes in narcissistic traits, respectively. These tools were crucial for quantifying the intervention’s impact on the core symptoms of NPD and the overall efficacy of the treatment.
Safety Considerations and Potential Risks
While the potential benefits of psychedelic therapy in the treatment of NPD are promising, there are significant risks, particularly given the fragile nature of narcissistic egos. The process of ego dissolution, although therapeutic, can provoke intense emotional responses and potentially traumatic experiences (“bad trips”), especially in individuals with NPD who may have an underlying vulnerability masked by their narcissistic traits. The setting and presence of skilled therapists are crucial to manage and mitigate these risks and managing difficult experiences.
Preliminary Findings
Early analysis showed a negative correlation between the intensity of mystical experiences and post test narcissism scores, suggesting that profound psychedelic experiences might reduce narcissistic traits by enhancing self-awareness and empathy.
Discussion and Future Directions
This pilot project’s promising results underline the potential of psychedelic therapy combined with ACT for fostering authentic self-construction in individuals with NPD. Future research should focus on expanding these preliminary findings through larger-scale studies and exploring the long-term effects of this treatment approach, with an emphasis on developing robust protocols to manage the psychological risks associated with psychedelic therapy.
References
PsychedelicNewsWire. (2024). Study Suggests Psychedelics May Encourage Connectedness, Reduce Narcissism. PsychedelicNewsWire. Available at: https://www.psychedelicnewswire.com/2024/04/19/study-suggests-psychedelics-may-encourage-connectedness-reduce-narcissism
PsyPost. (2023). Awe-inspiring psychedelic trips reduce narcissism by boosting connectedness and empathy, study suggests. PsyPost. Available at: https://www.psypost.org/2023/12/awe-inspiring-psychedelic-trips-reduce-narcissism-by-boosting-connectedness-and-empathy-study-suggests-62007
Sloshower, J., Guss, J., & Krause, R. (2020). The Yale Manual for Psilocybin-Assisted Therapy of Depression (using Acceptance and Commitment Therapy as a Therapeutic Frame). https://doi.org/10.31234/osf.io/u6v9y
Tripsitter.com. (2023). Can Psychedelics Treat Narcissism? (Emerging Field of Study). Tripsitter. Available at: https://tripsitter.com/psychedelics-treat-narcissism
van Mulukom, V., Patterson, R. E., & van Elk, M. (2023). Broadening Your Mind to Include Others: The relationship between serotonergic psychedelic experiences and maladaptive narcissism. Journal of Psychopharmacology. doi:10.1177/02698811231142000