Consciousness and how it got to be that way

Sunday, September 2, 2018

Procrastination Variants: Narcissistic Subtype

This post is research only and should not be taken as medical advice or treatment recommendations.


Many things in psychology are multicausal, and/or have subtypes. Initially this causes difficulties in trying to study them. Lumping together different illnesses has obscured the truth many times in the history of neuroscience and mental health, and is certainly still doing it now. (In the early twentieth century most physicians would have considered schizophrenia, autism, intellectual disability and dementia the same thing, and now most educated Westerners have some idea that at least these are different conditions, if not what the symptoms are.)

Procrastination is a problem for a lot of people that gets surprisingly little attention in the psychology literature, relative to its prevalence and the amount of suffering it engenders. A simple model relies on executive dysfunction affecting set-switching, and it works like this. You want to accomplish B, but you have to do A first to get to B. A is unpleasant and merely an instrumental goal. If you have poor executive function, you can't get yourself to start doing A; you "put it off". Or, you're already doing X, which although unrelated is much more fun in the moment than A would be, so you REALLY can't get yourself to start.

No doubt this model does usefully describe many people's experience, and even for the people best described by the model I'll advance below, an executive function deficit probably does play a part to some degree in just about every chronic procrastinator. But the pattern many people describe has several inconsistencies that suggest that what's really motivating the procrastination is avoiding the threat of ego injury - especially in narcissists, to whom any damage to self-worth by being less than perfect in a core value is destructive and terrifying.

I've made a number of observations from scouring the limited literature, as well introspection, observation of patients, and reading others' introspection, that suggest to me that for a large subpopulation of procrastinators at least, the problem is driven mostly by character rather than executive dysfunction. Even before looking at the literature, based entirely on my observations in the clinic, I noticed a commonality in the patients who would complain of procrastination difficulties. They're usually male and middle-aged or younger. They often display a degree of alexithymia, or even more interestingly, very specific alexithymia, toward anxiety only - they either never notice that they feel anxious, cannot name it when they do, or actively deny feeling anxious. I often suspect that this is motivated by anxiety being an ego dystonic emotion in male narcissists (to be anxious is to be weak, which is unacceptable.) In treating these patients, I've measured their symptoms and progress with the Irrational Procrastination Scale in my practice (hereafter IPS), though you can also find the Pure Procrastination Scale (Steel 2010), and two comparisons (Svartdal et al 2016, Svartdal and Steel 2017.) (Steel has his own site here with more information.) I've never taken objective data on narcissistic personality though the instrument most commonly used is the Narcissistic Personality Inventory (the NPI.)

Literature review shows two things: a small literature investigating possible procrastination subtypes, and a tiny but intriguing signal about a narcissism-procrastination connection. There are a few more papers indexed by procrastination and compulsive personality, among them Primac's paper showing the success of a brief therapeutic intervention in compulsive personality decreasing both narcissism and procrastination. Of the three procrastination subtypes noted in the literaure (avoidant, arousal, and decisional procrastinators) narcissistic procrastinators as I describe them below would most closely match the avoidant subtype. Some studies have found differences in the subtypes, for example in their activity at different times of day (Díaz-Morales et al 2008.) However Steel in 2010 performed a meta-analysis concluding that there is no evidence for the subtypes as distinct entities. Lyons and Rice (2014) reported on avoidance and arousal procrastination subtypes specifically and found relationships with secondary psychopathy and the Entitlement/Exploitativeness facets of the NPI. In contrast Nawaz et al (2018) did not find a correlation between the IPS and the NPI. Shame is known to be at the core of pathology in narcissism, and Fee and Tangney (2000) found correlations in procrastinators between shame, but not guilt. Wohl et al (2010) found that students who forgave themselves for procrastinating while studying were better able to overcome study procrastination in the future, again suggesting a role for shame in the behavior. Mann (2004) noted avoidance effects proportionate to narcissistic injury in undergraduates. There is a slightly stronger signal for procrastination and obsessive personality - suggesting a common thread of perceived poor self-efficacy. A study comparing procrastinators versus non-procrastinators did not find differences in the cognitive abilities they measured, but did conclude that "Further research must provide evidence for persistent procrastination as a personality disorder that includes anxiety, avoidance, and a fear of evaluation of ability" (Ferrari 1991.)

What all this strongly suggests is that narcissism plays a role in procrastination, if not in all impacted procrastinators, then in a significant subpopulation. In addition to the literature cited here, here are the observations I've made of patients that support a narcissistic subtype of procrastinator and a mechanism for the behavior.

CLINICAL OBSERVATIONS
  1. Some procrastinators have reported that being sick or sleep deprived makes it easier for them NOT to procrastinate. This flies in the face of the executive dysfunction hypothesis. They say, basically, "I'm already miserable, so why not just do the thing I don't want to do." This suggests that what they're avoiding with procrastination is something that makes them feel generally bad, and when they already feel that way, there's no point in avoiding the task.
  2. This subtype of procrastinator doesn't just forget about the task. They usually don't just forget to do it; or, remember, but not feel like it, and just put it out of their minds. It's actually continually on their minds while they're avoiding it. This is also very unlike executive dysfunction.
  3. Many procrastinators have the experience of having TWO things they're procrastinating about, and they switch which one they're avoiding. This pattern is possibly the most instructive of all of them here, because of how irrational it otherwise is without this model. For example, someone is supposed to do A all day, but avoid it. Then a deadline approaches for B (say, they're supposed to start getting ready to leave for an important meeting.) Then they actually do start doing A! If they're concerned about being injured by not doing perfectly at these activities, at some point anticipation of B (which they think they will do badly at) builds so much that they need some distraction. Now, the prospect of failing at A is further away and therefore not as painful, and they'll be partly distracted from A by impending B anyway - but more importantly, they'll be distracted from thinking about failing at B by doing A half-assed (and in narcissism, there is often constant activity to avoid feelings of worthlessness with superficial productivity.) Tim Urban's description of this phenomenon is here in cartoon form, but briefly, it's time for him to leave for an appointment - Task B - when the Procrastination Monkey says "that work you were trying to do all day, I've changed my mind and suddenly I'm into it.") Note that strong focus on another task is not what you would expect from impulsivity either.
  4. Sometimes, once a procrastinator begins working on the avoided task, they explode with anger if they have to move on to something else. At first glance this would appear to be a perfect example of poor set-switching and therefore eminently explainable by the executive dysfunction model (autism spectrum people do this too) but you can actually differentiate based on the nature of the task - if you can switch to a self-worth-supporting activity, the narcissistic procrastinator would resist less, while to the autistic person the nature of the new task would not matter. In fact the more fun-for-its-own-sake is the new task, the more the narcissistic procrastinator would resist (don't you dare ask them to play video games once they finally get started on the previously-avoided task! But asking them to work on a boring, important tax document might be alright.)
  5. Procrastinators often use words to describe the way they feel like "worthless" or "useless", classic for wounded narcissists. They absolutely consider their procrastination a huge problem. Contrast with ADHD patients who avoid work, for whom the avoidance is often fairly ego-syntonic.
  6. Many procrastinators describe doing pointless, un-fun busywork while worrying about the thing they're supposed to be doing. Tim Urban has a related idea called the "dark playground", but on the dark playground you can do fun things (while feeling guilty about them); I'll call this domain "busywork purgatory". Tellingly, it's always meaningless busywork. It's never something fun (well I'm not doing it, might as well play video games); it's not something else important. It's trivial, and it's usually something continuously attention-occupying that can be completed that day (for a burst of that feeling of accomplishment.) Many people have experienced the urge to clean the dorm room instead of studying, but dorm room cleaning is actually more useful than most busywork purgatory activities.
  7. A culturally-influenced aspect: in modern America there is a premium on productivity and success over most other characteristics. In a culture where (for example) loyalty to religion or family is most prized, I would expect that instead of busywork purgatory, the procrastinator gets stuck in prayer purgatory or doing-things-for-your-family purgatory, to prop up their self-worth.
  8. Probably the most disabling impact of this procrastination subtype: people reverse prioritize, spending more time on unimportant activities and starting them earlier and more easily. I've heard procrastinators say that they can tell how important they think something is by how easily they work on it or how relaxed and creative they can be about it (see this Tweet by someone who appears to be admitting to reverse prioritization.) With executive dysfunction alone, you would expect random order of work with respect to actual priorities, as opposed to a reverse ordering. Procrastinators are therefore often able to be quite productive at something that is not important to them. Paradoxically, if their productivity and success lead that thing to be a central part of how they measure their self-worth, they will start procrastinating at it. People will described starting to feel "trapped" and that's when they start to procrastinate. I would argue the behavior is not reactance but rather avoidance of ego-threat. Again, pure executive dysfunction would predict no success at anything, not reverse-prioritized" at a thing that is deemed unimportant.
  9. Some procrastinators suggest that recent successes make them less likely to procrastinate, possibly because they have an expectation of a positive outcome as a result of their efforts, rather than only negative outcomes (and this thought distortion is actually reinforced by reality in previous instances; part of the problem is that their outcomes really are negative, and they've taught themselves this quite effectively.) This also suggests that the problem is not only do narcissistic procrastinators envision a negative outcome in the end, they get no positive feedback from the intermediate steps along the way because there's no feedback in the form of external praise. Thinking about it this way, there's literally no reason to start the task, because it will be at best neutral while you're doing it, and then bad when you finish.
  10. A bizarre compensation behavior I've heard from multiple procrastinators is the pattern of performing an otherwise important task out of context, after the fact, and alone (where it has no value to anyone.) Bizarrely they will act like their completion of the task is exactly equivalent to having done it in the normal manner and time, all the while knowing exactly how childish and strange it is. I know of one person who was going to run a marathon, then showed up to the deserted starting line four hours late, ran the course, then actually emailed the organizers to yell at them - "What kind of a race is this? No aid stations?" (because they had long been taken down) "No one to hand me a finisher's medal at the end?" (Yes, because the race was over and everyone had gone home.) This person actually followed up for a while with angry phone calls and emails, fully aware how ridiculous it must sound but feeling compelled to do so; he said if he hadn't done this he would've felt "weak", classic for a male narcissist. Another example of this bizarre behavior was one procrastinator who routinely waited until after customer service lines shut down for the day to call (his bank, to change his password, etc.) He wasn't aware of doing it intentionally, but repeatedly noticed that it was 5:02pm, and it was time to call his bank. He would leave angry messages if there were voicemails, post tirades on companies' social media feeds, etc. He said he noticed he felt a strange satisfaction and even comfort in getting angry, and admitted to being oddly disappointed on those occasions when he called and got a live person who could help him. He stated the task was usually one where he wasn't sure if he would be successful or would know how to "navigate the system" to a successful outcome.
  11. The types of tasks that this subtype procrastinates on are rarely solo activities, or tasks with certain outcomes. Going for a solo hike, even one which involves complex planning, does not threaten to ego-injure the person with possible failure, nor does it provide an opportunity to fail in front of anyone else.
  12. If the person is angry at someone, especially at an authority figure telling them to do the task (less likely a competing peer), the procrastinator will engage in very thinly-veiled passive aggression by doing a previously-avoided task well and on-time, often fantasizing that they are frustrating the expectations of the authority who expects them to be late. Anger at authority cannot be the sole explanation, since the person knows that they are doing what the authority wants. Being less likely to behave this way toward peers is not as good an explanation as fear of ego-injury from credible critics (low confidence in success in front of peer competitors who are credible critics is less tolerable than say, a boss who the person is angry at and no longer considers credible.) While the sympathetic activation could be responsible for the focus (again, arguing for a simple executive dysfunction model), anger is known to focus narcissists.

Synthesizing these observations, the narcissistic subtype of procrastination is not the same as the avoidant subtype, but of the three traditionally considered subtypes, avoidant is the most similar. The model for the narcissistic or ego-threat subtype of procrastination is as follows. A person with some traits of a fragile narcissist, likely in the context of some executive dysfunction, encounters some task they have to do. This task is part of a series of actions leading to a goal that they intellectually want, which they consider quite important to their core identity - a way that reflects on who they are and want to be, in front of other people, especially those who can credibly criticize them. Because they have poor confidence and/or unrealistically high standards, they feel they are likely not to succeed. Given their character structure of having a fragile self-worth that must be propped up with perfect external achievements, this is a profound ego-threat, and they feel anxiety contemplating the outcome of the task. Consequently they avoid doing it, but not thinking about it. They substitute either activities which distract them with continuous activity and certain near-term positive outcomes (no matter how trivial) or another otherwise-avoided important activity, but one which is farther in the future (and therefore, the ego-threat is farther off as well.) They finally undertake the avoided task when the time is so low and the threat looming so immediately that their awareness of the damage they're doing to themselves overwhelms the comfort they get by distracting themselves. If there is some way for the person to feel they can say to others they completed the task but WITHOUT exposing themselves to criticism and ego-threat, they'll do that, sometimes even if it's patently ridiculous; e.g. doing the task when no one else sees them and after it no longer matters. If the person already feels bad in general (from physical illness) or angry, even at an authority figure telling them to do the task, they are paradoxically more able to complete the task.


TREATMENT

My complaints about the paucity of procrastination research are partly driven by having treated it in my own practice, and having to round up what little evidence there is and then use "clinical judgment" for the rest. To round up the pharmacotherapy options: there are basically none, and in particular, there are none for the subtype I propose here. There is very indirect evidence for amphetamines (in one paper, college students abusing amphetamines reported less procrastination) but again, if these are all procrastinators mixed together, that's exactly what you would expect to see. I tried propranolol with a patient who had comorbid non-pathological social anxiety, used it a couple times and thought it helped, but he was much more successful with CBT (more on this shortly.) There is no evidence on Pubmed for other stimulants, benzodiazepines, beta blockers, or the SSRIs and SNRIs available on the US market. I've had people report that caffeine makes them work faster and focus and lifts their mood, but in fact after it wears off they realize that caffeine just helped them do more tasks in "busywork purgatory" - it didn't help them focus on the true high-value tasks.

The best evidence for successful treatment is from psychotherapy, specifically for CBT, which is also what has far-and-away worked the best in my own experience. Rozental et al have two studies which show among other things that in-person CBT with a therapist is the same at end of treatment as internet-based self-guided CBT, but the in-person people maintain their improvements better over time. Improvement was was over a full standard deviation from the control (!) but only about a third of participants improved - also consistent with my own experience that it doesn't help everyone, but the ones that get it, really get it.

This treatment does not differentiate by subtype or provide information that would let us infer about the relative benefit for narcissistic vs other mechanisms of procrastination. So what would I expect would be most successful approaches in CBT for narcissistic procrastination? (These therapeutic maneuvers are inferred from the model of narcissistic subtype procrastination above, but should be tested empirically in placebo-controlled studies and therefore remain speculative.)
  • Exposure therapy for failure and criticism of your core attributes. As a therapist - have the patient make a list of the things they consider core important attributes, skills, and values they offer, and people who are qualified to evaluate them against those standards. Perform role-play or imaginal exposure.
  • Learn to identify the anxiety that comes up when you start to avoid something - name it and develop a counter-habit, like working on the task for five minutes. As a therapist - have the patient tell you tasks that they procrastinate on. "Ambush" them during therapy, mentioning one of them out of the blue, then hit "pause" and ask the patient what it made them think of and how it made them feel. Keep a journal with successes of when they successfully fought back against the feeling outside of therapy, where it worked for at least five minutes (only track the successes, not the failures.)
  • Enlist a significant other, roommate, family member etc. to check up on you and give positive support when you finish tasks. (And don't avoid asking them out of shame, worrying you'll appear weak, etc. which is why this usually doesn't happen.)
  • Develop a habit of remembering that the individual steps do have value, even if you have to imagine others praising you for completing them. Envision a realistic positive outcome and how it will feel. Break things down into very very small steps, remind yourself this is how successful people do it (don't minimize by saying that means you're weak) and then pay attention to how you knock out these tasks - a success spiral.
  • Radical acceptance and forgiveness - we have certain abilities, we're going to screw up sometimes, and we're fine the way we are. Be consciously aware that castigating yourself mentally is not going to help you change, and in fact will do the opposite.

AFTERWORD: Why is Procrastination Seemingly So Much More Prevalent Now?

Procrastination is certainly not new in this or the last century. What does seem to be new is the number of people affected by it, and there's probably an easy answer for why that would be so. When you're stuck in the Malthusian grind like most of our ancestors were until about a century ago, your life is a series of constant emergencies, and we should expect that our brains are adapted to focus in this way, on near-term impending disasters with short time horizons and only a few concrete elements. (Starvation, fights, etc.) And indeed procrastinators often do quite well under pressure - they often report this as an excuse early on in their lives for why they always work up to the deadline, until they're honest with themselves about how out of control their behavior really is. (This is also borne out in the literature on the arousal subtype of procrastination.) It's interesting that stoicism as a coherent philosophy of classical antiquity was largely a philosophy of patricians, and its texts contain lots of subtle signals about their status by complaining that it was hard for them not to waste their time, i.e. not to procrastinate with trivia. This might have been a problem for an emperor or senator, but a subsistence farmer in a Roman province rarely had the luxury of stretches of time without highly activating direct threats to survival. Today we all live better than senators did in that era, which is to say we all have stretches of unstructured time and no threats to our survival - although notice that the things that finally do motivate us, even in procrastination, are all perceived threats.

There is also speculation that narcissism has become more prevalent as time has marched on. This is less than a settled point and I won't do into the debate here, but if that's the case, and narcissism does contribute to procrastination, you would expect to see more procrastination.

A third possibility is the cognitive parallel to the hygiene hypothesis. Immune systems, when not challenged sufficiently by invading pathogens, get very paranoid, and are more likely to mount autoimmune attacks. In the comparatively sterile modern environments where we now live, this is a problem. In the same way, in the absence of constant emergencies, the human threat detection system has more false alarms, and the one threat that does still exist is the threat of criticism, disapproval, and being perceived as weak (especially if you're male.) While such disapproval in the paleolithic could result in your death if you were thrown out of the tribe, today it seldom means anything of the sort. Un-learning our exaggerated social threat responses will likely be the central mental health task of the twenty-first century.


REFERENCES

Díaz-Morales JF1, Ferrari JR, Cohen JR. Indecision and avoidant procrastination: the role of morningness-eveningness and time perspective in chronic delay lifestyles. J Gen Psychol. 2008 Jul;135(3):228-40. doi: 10.3200/GENP.135.3.228-240.

Fee RL., Tangney JP. Procrastination: a means of avoiding shame or guilt? J Soc Behav Personal. (Special issue: Procrastination: current issues and new directions). 2000;15:167–184.

Ferrari JR. Compulsive procrastination: some self-reported characteristics. Psychol Rep. 1991 Apr;68(2):455-8.

Lyons M, Rice H. Thieves of Time: Procrastination and the Dark Triad of Personality. Personality and Individual Differences Volumes 61–62, April–May 2014, p. 34-37

Mann MP. The adverse influence of narcissistic injury and perfectionism on college students' institutional attachment. Personal indiv Diff. 2004;36:1797–1806.

Nawaz H, Shah SIA, Mumtaz A, Sohail Chughtai A. (2018). Alarming trend of procrastination and narcissism among medical undergraduates. From Researchgate.

Primac DW. Measuring change in a brief therapy of a compulsive personality. Psychol Rep. 1993 Feb;72(1):309-10.

Rozental A, Forsell E, Svensson A, Andersson G, Carlbring P. Internet-based cognitive-behavior therapy for procrastination: A randomized controlled trial. J Consult Clin Psychol. 2015 Aug;83(4):808-24. doi: 10.1037/ccp0000023. Epub 2015 May 4.

Rozental A, Forsström D, Lindner P, Nilsson S, Mårtensson L, Rizzo A, Andersson G, Carlbring P. Treating Procrastination Using Cognitive Behavior Therapy: A Pragmatic Randomized Controlled Trial Comparing Treatment Delivered via the Internet or in Groups. Behav Ther. 2018 Mar;49(2):180-197. doi: 10.1016/j.beth.2017.08.002. Epub 2017 Aug 5.

Steel, P. (2002). The Irrational Procrastination Scale. PhD Thesis, unpublished.

Steel, P. (2010). Arousal, avoidant and decisional procrastinators: do they exist? Pers. Individ. Dif. 48, 926–934. doi: 10.1016/j.paid.2010.02.025

Svartdal F, Pfuhl G, Nordby K, Foschi G, Klingsieck KB, Rozental A, Carlbring P, Lindblom-Ylänne S, Rębkowska K. On the Measurement of Procrastination: Comparing Two Scales in Six European Countries. Front Psychol. 2016 Aug 31;7:1307. doi: 10.3389/fpsyg.2016.01307. eCollection 2016.

Svartdal F, Steel P. Irrational Delay Revisited: Examining Five Procrastination Scales in a Global Sample. Front Psychol. 2017; 8: 1927. Published online 2017 Nov 3. doi: 10.3389/fpsyg.2017.01927

Wohl MJA, Pychyl TA, Bennett SH. I forgive myself, now I can study: How self-forgiveness for procrastinating can reduce future procrastination. Personality and Individual Differences. Volume 48, Issue 8, June 2010, p. 926-934

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