How to curb the effects of narcissism: Caring about other people

Overview

Introduction

Events or circumstances that encourage individuals to care about other people may diminish narcissistic tendencies. That is, at some times, individuals experience a strong urge to be perceived as high in status, power, importance, and dominance, collectively labelled as agency. To fulfill this urge as rapidly as possible, individuals will tend to inflate their capabilities and achievements or denigrate the behaviour of other people—behaviours that typify narcissism. That is, narcissism tends to emanate from motives that revolve around agency. Therefore,

if these individuals experience an urge to establish trusting, reciprocal, and supportive relationships instead, collectively labelled as communal motives, this pursuit of agency might diminish
hence, the manifestations of narcissism could subside as well.

Positive, communal statements

Jordan et al. (2014) analysed data from several unpublished studies to assess this possibility. For example, in one study,

participants were instructed to type content into a computer
every 15 seconds, they heard a tone
in response to this tone, depending on the condition in which they had been assigned, they repeated the statement “I am a loveable person” to themselves, “I am a caring person” to themselves, or no statement,
next, all participants completed the narcissistic personality inventory.

As the findings revealed, in contrast to the other conditions, participants who reminded themselves they are caring—a statement that epitomises a communal orientation—exhibited less narcissism. Specifically, these individuals reported diminished levels of entitlement and exploitation: one of the most maladaptive facets of narcissism. So, reminders of their communal tendencies reduced narcissism. This finding is consistent with the notion that events or circumstances that encourage individuals to care about other people may override some narcissistic tendencies.

Memories about caring

In another study that Jordan et al. (2014) outlined, some participants were encouraged to describe times which they cared about someone else, experiencing concern, love, or acceptance towards another person. In the control conditions, participants either recounted the routine they follow in the morning or a time in which they felt intelligent. Again, after these tasks ended, participants completed the narcissistic personality inventory. As the results showed

compared to the control conditions, participants who recalled times in which they cared about someone else were not as likely to report entitlement and exploitation,
because memories of care were more likely than memories of intelligence to diminish this facet of narcissism, these results cannot be ascribed to positive memories in general; instead, only memories of caring, or similar communal motives, appear to diminish narcissism.

Inductions of empathy

Inductions of empathy also diminish narcissism. In a further study that Jordan et al. (2014) outlined, participants read an article in which a woman had been confined to a wheelchair after a car accident. The accident had killed her sister. While reading the article

to diminish empathy, some participants were instructed to remain detached and to interpret the story as objectively as possible,
to induce empathy, other participants were instructed to direct their attention to how the woman in this narrative would feel.

After reading the articles, participants completed the narcissistic personality inventory. If empathy had been induced, all facets of narcissism subsided. This impact of empathy did not depend on initial levels of narcissism.

An interdependent self-construal

Many events and circumstances affect how individuals perceive themselves. For example,

sometimes, individuals primarily define themselves by their relationships or the groups to which they belong, called an interdependent self-construal,
on other occasions, individuals primarily define themselves by their distinct and unique qualities, called an independent self-construal.

An interdependent self-construal tends to elicit communal motives, such as the need to care for people, and thus should diminish narcissism. As Jordan et al. (2014) revealed collated evidence that corroborates this possibility. In these studies, researchers utilised several techniques to prime an interdependent self-construal or independent self-construal in North American participants. For example,

to prime an interdependent self-construal, participants described the similarities between themselves and their friends or family; to prime an independent self-construal, participants described the differences between themselves and their friends or family (cf., Traﬁmow et al., 1991),
to prime an interdependent self-construal, participants counted the number of times plural pronouns, such as we or ours, appeared in a story; to prime an independent self-construal, participants counted the number of times singular pronouns, such as I or mine, appeared in this story (Gardner et al., 1999).

If an interdependent, rather than independent, self-construal had been primed, participants subsequently reported diminished levels of narcissism. These results are also compatible with the notion that, whenever individuals feel concern or care towards other people, they are not as susceptible to narcissism.

Training that fosters empathy

Introduction

As Jordan et al. (2014) revealed, activities that foster empathy tend to diminish narcissism. Thus, to stem narcissism, organisations need to identify and to implement practices that promote empathy. Fortunately, organisations have implemented a range of strategies to foster empathy in health practitioners and other professionals. For example, participants might be invited to

observe a photo of someone in a wheelchair or a similar setting and to discuss, with other individuals, the difficulties this person may experience (Ahmad et al., 2020),
participate in a role-play in which they assume the role of a typical client, such as one of their patients (Bowden et al., 2020) or to improvise various scenes that are common in their job, called creative drama (Kahriman et al., 2016),
experience the challenges their clients might endure, such as wear an age simulation suit in which they are exposed to the physical impediments that affect their elderly patients (Fernandez-Gutierrez et al., 2022),
play computer games in which they assume the role of characters with disabilities (Sterkenburg & Vacaru, 2018),
interact with dying patients, such as read stories or hold their hand (Hojat et al., 2020),
follow a diet plan or a similar intervention that was imposed on their patients (Harris et al., 2018),
share their dreams, hopes, or personal losses with another person (Blagrove et al., 2021; Cacciatore et al., 2015),
reflect upon their biases and thoughts after listening to a patient (Haley et al., 2017), and
listen to a series of instructions that evokes a state of mindfulness and compassion (Bellosta-Batalla et al., 2020; Cochran & Peters, 2023; Garrote-Caparrós et al., 2022).

Which kinds of training foster empathy

When individuals feel empathy and compassion towards another person, narcissism tends to subside. Admittedly, not all variants of empathy are likely to diminish narcissism to the same extent.

Researchers differentiate many variants of empathy, such as affective empathy, cognitive empathy, and empathic concerns. For example, Wu, Yao, et al. (2024) differentiate four variants of empathy:

affective empathy—or the tendency of some people to automatically experience the emotional, sensory, and bodily states of another individual, largely underpinned by mirror neurons (e.g., Gallese & Goldman, 1998),
cognitive empathy—or the capacity of individuals to infer, label, and understand the consequences of the emotions, beliefs, and intentions of other individuals (Preston & de Waal, 2002), sometimes called theory of mind (Premack & Woodruff, 1978) or mentalising (Frith & Frith, 2003),
motivational empathy—or the motivation to help other people, similar to empathic concern and compassion, and
behavioural empathy—or the capacity to communicate understanding and other supportive responses.

According to Jordan et al. (2014), caring for other people—and thus affective and motivational empathy—are especially likely to decrease narcissism. To foster this empathy in staff, such as nurses, teachers, and other professionals, organisations have introduced a raft of training programs. Wu, Yao, et al. (2024) conducted a meta-analysis to ascertain which kinds of empathy training are most effective. Specifically, these authors classified empathy training into three main approaches: subject-oriented, other-oriented, and socially-oriented.

During subject-oriented training, participants learn how to change their own characteristics or attributes—characteristics or attributes that can facilitate empathy. For example, participants may learn

techniques on how to recognise emotions in other people,
how to regulate their emotions during conversations, potentially to facilitate their empathy,
how to undertake loving-kindness meditation or other strategies that are designed to foster compassion,
the importance of empathy to daily life.

During other-oriented training, participants learn more about the needs and motivations of other people. This understanding of other people may facilitate empathy. For instance, participants may

watch movies or listen to stories about the challenges that diverse individuals may experience,
discuss with other people their dreams, worries, and so forth.

Finally, during socially-oriented training, participants learn how to enhance their capacity to interact and to relate with other people, ultimately to facilitate empathy. To illustrate, they may

learn how to communicate more effectively to facilitate understanding,
learn how to enjoy social interactions more,
meet with colleagues to discuss challenges, called Balint groups in the health field,
participate in role-plays in which they pretend to assume various aspiring roles, and so forth.

The meta-analysis of 110 studies that Wu, Yao, et al. (2024) conducted revealed that training programs, in general, did not boost empathy appreciably or sustainably. However, socially-oriented training was most effective, significantly bolstering all four variants of empathy. Improvements in motivational empathy, but not the other variants, were more likely to last several months or longer. Subject-oriented and other-oriented training tended to improve only cognitive empathy.

Interventions that foster compassion

Overview

As Jordan et al. (2014) showed, when individuals experience a sense of care or compassion towards other people, narcissism dissipates. Therefore, to stem narcissism, practitioners and organisations should uncover and introduce programs or initiatives that cultivate this compassion. In his synthesis of the literature, Kirby (2017) differentiated eight interventions that practitioners and researchers have developed to foster compassion:

meditation experiences in which individuals, while their eyes are closed, imagine they can relieve suffering in themselves and other people, called compassion meditation, or direct feelings of care and kindness to themselves and other people, called loving-kindness meditation,
compassion-focussed therapy (Gilbert, 2020; Gilbert & Simos, 2022)—a psychotherapy in which participants develop capacities that overcome the obstacles to compassion—such as distress tolerance, empathy, sympathy, mentalising, mindfulness, acceptance, and appreciation,
mindful self-compassion (Germer & Neff, 2019; Neff & Germer, 2018)—in which participants complete a range of activities, such as letter writing, guided imagery, meditation, and speaking to an empty chair to represent themselves—to foster self-compassion as well as learn how to manage the shame or anger that self-compassion can initially evoke, called backdraft,
compassion cultivation training (Jazaieri et al., 2014)—in which participants complete compassion meditation and loving-kindness meditation, imagine they can supplant the suffering of other people with joy, and then contemplate how they can embed compassion into their daily lives,
cognitively-based compassion training (Reddy et al., 2013; see also Ash et al., 2021)—in which participants develop appreciation, gratitude, empathy, and compassion during guided meditation,
cultivating emotional balance (Kemeny et al., 2011; Sansó et al., 2017)—in which participants learn to recognise emotions in themselves and other people, coupled with psychoeducation, meditation, yoga, and other movement practices,
being with dying programme (Halifax, 2024)—in which practitioners who provide care to dying patients undertake a range of activities, including five steps on how to communicate supportively and compassionately: goal setting, reablement, assessment, complementary therapy, and emotional support,
the Re-Source Training Protocol (Singer et al., 2015)—in which individuals complete training in attention and mindfulness to optimise their presence during interactions as well as complete other exercises to facilitate compassionate emotions, motivations, and perspectives.

Each intervention is unique. For example, compassion-focussed therapy is a therapeutic modality that, unlike the other interventions, can be adapted to suit each client and is predicated on attachment theory and neurophysiological research. Mindful self-compassion is primarily confined to self-compassion. Cultivating emotional balance largely revolves around understanding emotions.

After evaluating the evidence of each approach, Kirby (2017) suggested that compassion meditation and loving-kindness meditation have been shown to be effective in diverse settings, including clinical populations. The other interventions have been investigated only outside the clinical setting. Most of these interventions have been subjected to a few randomised control trials (e.g., Albertson et al., 2014; Arimitsu, 2016; Dodds et al., 2015; Jazaieri et al., 2013, 2014; Kelly & Carter, 2015; Kemeny et al., 2012; Pace et al., 2009, 2013; Smeets et al., 2014) and shown to generate some benefits.

Compassion-focussed therapy: An overview

Paul Gilbert (2010, 2014 ) developed compassion-focused therapy to help clients who cannot regulate emotions effectively, especially shame, guilt, anxiety, and perfectionism. During the therapy, clients learn to manage suffering, in themselves and other people, with courage, warmth, wisdom, and support instead of criticism or avoidance. Practitioners define compassion not as indulgence but as a sensitivity to suffering in themselves and other people as well as a commitment to alleviate or to prevent this suffering. Thus, compassion entails care and courage.

This approach integrates several distinct theories and traditions.

For instance, consistent with evolutionary psychology, therapists inform candidates that brains evolved to detect hazards, to prevent rejection, to monitor social rank, and to compete with other people to secure resources—rather than to elicit happiness. This tradition, therefore, normalises emotional suffering. Suffering is not the fault of anyone but embedded in our genes.
Therapists also invoke the tenets of attachment theory. According to this theory, children whose caregivers were soothing and supportive learn to feel safe and comforted in stressful circumstances. Children whose caregivers were neglectful, abusive, or unpredictable do not learn to feel comforted in these settings. They cannot, therefore, sooth themselves as effectively.
Affective neuroscience tends to differentiate three interacting motivational systems, each coinciding with distinct emotions. First, the threat system elicits aggression, escape, submission, and other responses that facilitate survival. Second, the drive system elicits the motivation and effort that individuals need to achieve goals and to acquire resources. Third, the soothing or affiliative system elicits the emotions and behaviours that foster relationships and attract support.

Many clients have not developed effective soothing systems. The underling goal of compassion-focussed therapy is to address this shortfall. That is, compassion-focussed therapy is designed to enable clients to develop their compassionate self—that facet of themselves that is warm, courageous, wise, and committed to wellbeing. Clients learn to access this compassionate facet of themselves to reach decisions. Accordingly, clients learn to approach, rather than to shun, suffering over six main phases:

Phase 1: Psychoeducation. Clients learn about the three motivation systems, why suffering has evolved, and the benefits of compassion over excessive self-criticism or shame.
Phase 2: Developing compassionate capacities. Clients learn exercises to regulate their emotions and thus activate their soothing system, such as deep breathing, grounding, mindfulness, and slowing down.
Phase 3: Compassionate imagery. Clients learn to evoke images to magnify this feeling of safeness, such as images of a compassionate place, person, or self.
Phase 4: Working with self-criticism. Clients learn to identify moments in which they are critical of themselves as well as how to detach from these criticisms and respond compassionately to these concerns. Over time, they perceive these criticisms of themselves as source of insight rather than as threats to dismiss.
Phase 5: Compassionate behaviour. Clients initiate compassionate behaviour, to themselves and other people, such as learn how to assert their needs, request help, or rectify fractured relationships.
Phase 6: Integration. Clients learn to evoke the compassionate facets of themselves to guide their lives. In response to challenges, they consider which emotion system is activated and how their compassionate self could respond.

To acquire these capabilities, client may attempt a range of exercises. For example, they might undertake chair work, in which one chair represents their inner critic and another chair represents their compassionate self. They could then shift between chairs to explore a dialogue between these facets of themselves. In addition, clients may

deliberately immerse themselves in settings they fear while activating the soothing system,
complete a mindfulness exercise in which they observe their criticisms of themselves,
write a compassionate letter to themselves, and so forth.

This approach may be helpful to clients who experience depression, anxiety disorders, OCD, PTSD, eating disorders, and perfectionism. To facilitate progress, therapists need to model compassion and, for example, exhibit kindness but also the courage and curiosity to engage with suffering, devoid of judgment or blame.

Compassion-focussed therapy: Randomised control trials

Randomised control trials have been conducted to examine the efficacy of compassion-focussed therapy in particular settings. For example, Braehler et al. (2013) explored whether compassion focused therapy could be applied to treat psychosis. Specifically, 40 individuals who had been diagnosed with schizophrenia were assigned to one of two conditions:

22 of the participants attended group sessions of compassion-focussed therapy, comprising 16 sessions, each lasting 2 hours, as well as treatment as usual,
the remaining 18 participants received treatment as usual but no compassion-focussed therapy.

Before and after the intervention, during an interview, participants were prompted to discuss a psychotic experience and recovery. Next, two research assistants coded the transcripts to measure the extent to which these narratives exhibit compassion and avoidance. Specifically,

to code compassion, the research assistants identified instances in which the participants referred to warmth, acceptance, and understanding, of themselves and other people, when discussing the painful facets of psychosis,
to code avoidance, the research assistants identified instances in which the participants appeared to minimise or shun the adverse facets of their experiences, partly manifesting as few autobiographical or emotional memories.

In addition, after the intervention, a researcher administered the Clinical Global Impression-Improvement Scale (Guy, 1976). This scale assesses whether the participants improved or deteriorated because of the intervention. Finally, before and after the intervention, participants completed a range of instruments, such as Beck Depression Inventory-II, the Positive and Negative Affect Scale, and the Fear of Recurrence Scale (White & Gumley, 2009). Participants also completed the Personal Beliefs about Illness Questionnaire-Revised to assess the extent to which they felt their psychosis provokes social marginalisation, shame, and other problems (Birchwood et al., 1993).

The data suggested that compassion-focussed therapy was effective. In particular, compared to the participants who were assigned to the control condition, participants who received compassion-focussed therapy

reported a significant increase in compassion—an increase that coincided with a decrease in depression, social marginalisation, shame, and other problems,
were more likely to improve clinically.

The compassion cultivation training program: Introduction

Goldin and Jazaieri (2017) outlined a program called compassion cultivation training—a program that was primarily developed at Stanford University. The standard program typically comprises eight weekly sessions, each lasing two hours. Usually, about 20 to 30 participants attend each session. Certified practitioners facilitate these courses. The participants are informed that

initially, they may experience some distress or other unpleasant emotions, but these emotions are likely to subside over time,
they should practice 15 minutes a day initially and progress to 25 to 35 minutes a day later, guided by audio recordings of meditations and other exercises,
they should also attempt to integrate the practices they learn into daily life.

Each class or session entails

a short meditation,
discussions, initially in smaller groups, of their experience with the homework during the week,
an introduction of the technique that will be discussed this week,
reading inspiring stories or other exercises to generate warm feelings of connection to other people,
a longer meditation around the technique of this week, followed by a debrief,
allocation of another homework assignment
a closing activity.

Across the eight sessions, participants are exposed to six main steps or techniques:

setting and focussing the mind—in which participants learn to breathe deeply, count their breath cycles, as well as observe thoughts and emotions dispassionately, similar to mindfulness, primarily to facilitate subsequent meditations,
loving-kindness and compassion towards a loved person—in which participants cultivate and immerse themselves in feelings of warmth, tenderness, concern, and connectedness, initially to someone they love,
love and compassion towards themselves—in which participants, across two sessions, learn to direct these feelings of warmth, tenderness, concern, and appreciation to themselves, experiencing a sense of acceptance rather than judgement,
embracing shared common humanity and appreciation of other people—in which participants recognise that everyone shares the pursuit of happiness, freedom from suffering, and similar needs, called common humanity, before they gradually learn to care for other people, such as a loved one, a neutral person, a difficult person, an outgroup member, and then all living beings,
further cultivating compassion to other people—in which participants extend the previous step and recognise that everyone depends on offering and receiving kindness as well as compassion and also deserves happiness and freedom from suffering,
active compassion practice—in which participants attempt to identify opportunities to diminish the suffering of other people.

The compassion cultivation training program: Randomised control trials

To investigate the efficacy of compassion cultivation training, Jazaieri et al. (2013) conducted a randomised control trial. In this study, 60 participants received compassion cultivation training and 40 participants were assigned to a waitlist control. Before and after this program was implemented, participants completed a series of measures including the

Fears of Compassion Scales (Gilbert et al. 2010), comprising 10 items that assess concerns around feeling compassion to other people, such as “People will take advantage of me if they see me as too compassionate”, 13 items that assess concerns around receiving compassion from other people, such as “I often wonder whether displays of warmth and kindness from others are genuine”, and 15 items that assess concerns around compassion towards themselves, such as “I feel that I do not deserve to be kind and forgiving to myself”,
the Self-Compassion Scale (Neff, 2003a), to measure the extent to which individuals feel compassion towards themselves, exemplified by items like “I try to see my failings as part of the human condition”.

In contrast to the waitlist control condition, participants who completed compassion cultivation training exhibited significant increases in compassion (Jazaieri et al., 2013). That is, they were not as inclined to express concerns or fears about experiencing compassion to other people, receiving compassion from other people, or directing this compassion to themselves. Similarly, their scores on the self-compassion scale increased significantly. These findings attest to the benefits of compassion cultivation training.

Cognitively-based compassion training: An introduction

Negi (2005) outlined the key tenets and practices that underpin cognitively-based compassion training. This program equates compassion with the desire to free other people—that is, all humans—from suffering. Participants generally attend two sessions a week over about ten weeks. During most sessions, these individuals listen to insights about a topic, complete some exercises that illustrate the key principles of this topic, and participate in a guided meditation to reinforce or to apply these principles. The training entails eight stages.

First, participants learn to regulate their attention. Specifically, they complete a guided meditation in which, for example, they direct their attention to their breath.
Second, participants learn to direct their attention to their thoughts, feelings, and reactions. For example, they learn to observe their feelings in response to events that evoked anger and love—but without judgement. They also learn about how thoughts and assumptions can provoke stress and shape their perceptions—with reference to how even subliminal images can affect evaluations.
Third, participants learn that many of their thoughts emanate from the universal need to seek happiness and to free themselves from suffering. They learn how their expectations and thoughts about problems, such as divorce, instead of the problems themselves, are often the main sources of suffering. They also learn about neuroplasticity, partly to demonstrate the capacity of individuals to change how they think fundamentally and to address these sources of suffering. And, during guided meditation, they commit to their goal to transform unhelpful thoughts.
Fourth, participants recognise their tendency to react differently to friends, enemies, strangers, and other clusters of individuals in their life. They next learn that everyone is alike, in their pursuit of happiness and yearning to forego suffering, and thus deserve the same response to similar challenges in their life. They develop the capacity to experience feelings about the misfortunes of other people, including strangers, as if reacting to the problems of a cherished friend. To achieve this goal, they consider how a stranger now could become a cherished friend in the future; hence, this distinction between strangers and friends is not as enduring as assumed.
Fifth, to develop a sense of appreciation and gratitude, participants contemplate the degree to which everyone depends on countless other people every day. For example, during guided meditation, they consider how the kindness or contributions of other individuals were central to their successes and achievements—including trivial benefits such as the clothes they wear. They consider how they would like to repay these individuals. They also contemplate how they could feel gratitude to someone who may have behaved unkindly, such as grateful because of the insights they derived from these unpleasant experiences.
Sixth, to develop affection and empathy towards other individuals, they consider not only the kindness of people but also the drawbacks they experience if they pursue only their own needs—such as impaired relationships and a tarnished reputation. Similarly, they learn that selfish motives can elicit stress and impair health.
Seventh, individuals develop a desire to boost the happiness of other people and free these individuals from suffering. To achieve this goal, they may imagine the difficult people in their life as children, grappling with their world. And, during guided meditation, they envisage the suffering, first of their loved ones, and then friends, acquaintances, rivals, and strangers.
Finally, participants shift from merely the wish or desire that other people are happy to a commitment in which they proactively assist other individuals. They seek opportunities to intervene, striving to redress the challenges and diminish the suffering that other people experience—first their loved ones and then friends, acquaintances, rivals, and strangers.

Cognitively-based compassion training: Randomised control trials

A variety of randomised control trials have been conducted to assess the efficacy of cognitively-based compassion training. These studies have examined the efficacy and experience of cognitively-based compassion training in adolescents (Pace et al., 2013; Reddy et al., 2013), survivors of breast cancer (Dodds et al., 2015), and undergraduate students (Pace et al., 2009). To assess the effects of cognitively-based compassion training, researchers have measured a range of outcomes, including physiological indices, such as levels of C-reactive protein (Pace et al., 2013) and activity in the amygdala (Desbordes et al., 2012), as well as depression and intrusive thoughts (Dodds et al., 2015).

In general, the results have been promising but not definitive. That is, studies have not convincingly revealed that cognitively-based compassion training is more likely than standard care to address symptoms or improve behaviour enduringly. Nevertheless, these studies have revealed some encouraging findings. For example

in one study of breast cancer survivors (Dodds et al., 2015), relative to a waitlist control condition, participants who received cognitively-based compassion training did reported diminished levels of depression, fatigue, and avoidance of intrusive thoughts, although the sample size was only 33 and fewer benefits were observed one month later,
in another study (Pace et al., 2013), cognitively-based compassion training did not significantly reduce C-reactive protein, an inflammatory biomarker, compared to a waitlist control group—but participants who practiced the techniques more frequently did reveal the hypothesised decrease in this biomarker,
in the study that Desbordes et al. (2012) published, relative to an active control group, participants who completed cognitively-based compassion training displayed diminished activity in the right amygdala in response to unpleasant images—a sign of resilience—although this effect was not significantly at the 0.05 level.