A Randomized Controlled Trial Comparing Two Treatments for Vulnerable and Grandiose Narcissism: Unified Protocol vs. Schema‐Focused Therapy

In this study, we compared the efficacy of schema-focused therapy (SFT) versus the unified protocol (UP) in reducing symptom severity of narcissistic personality disorder (NPD) and its common features. We also compared their ability to reduce grandiose and vulnerable symptoms of NPD. One hundred and fourteen individuals were randomly assigned to these groups. Severity of NPD was significantly reduced to an equivalent degree in both treatment groups across a 12-month follow-up period. SFT group showed significantly greater reduction in measures of narcissistic grandiosity, while UP group showed a significantly greater reduction in narcissistic vulnerability, anger, shame and emotion dysregulation. Patients with a vulnerable presentation showed significantly greater reduction in fear of intimacy and shame severity, while patients with a grandiose presentation showed significantly greater reduction in identity disturbance, anger control and neuroticism. Results suggest that both SFT and UP can play a useful role in mitigating symptoms of NPD.