Prof. Sam Vaknin on Cold Therapy (New Treatment Modality)


Prof. Sam Vaknin (YouTubeTwitterInstagramFacebookAmazonLinkedIn) is the author of Malignant Self-love: Narcissism Revisited (Amazon) as well as many other books and ebooks about topics in psychology, relationships, philosophy, economics, international affairs, and award-winning short fiction. He is Visiting Professor of Psychology, Southern Federal University, Rostov-on-Don, Russia (September, 2017 to present) and Professor of Finance and Psychology in SIAS-CIAPS (Centre for International Advanced and Professional Studies) (April, 2012 to present). Here we talk about his work on treating narcissism with Cold Therapy.

Scott Douglas Jacobsen: Narcissism seems lifelong, immutable. You have commented, eloquently, about Narcissistic Personality Disorder and the lifetime ‘devoured’ by it, in an Instagram post (vakninsamnarcissist, 2020).[1] Yet, your intervention, Cold Therapy, is effective with Narcissism (and depression). What was the original insight into the first developments of Cold Therapy?

Prof. Sam Vaknin: That, exactly like Borderline Personality Disorder, Narcissistic Personality Disorder is a post-traumatic condition, a form of complex trauma. So, Cold Therapy is based on two premises: (1) That narcissistic disorders are actually forms of CPTSD; and (2) That narcissists are the outcomes of arrested development and attachment dysfunctions. Consequently, Cold Therapy borrows techniques from child psychology and from treatment modalities which used to deal with PTSD.

Jacobsen: In “Cold Therapy and Narcissistic Disorders of the Self” (Vaknin, 2018), you list “four misconceptions about pathological narcissism.”[2]  Why have those been the misconceptions, in particular?

Vaknin: Pathological narcissism is not merely a regression to an earlier childhood developmental phase, although such infantilization is a core psychodynamic of the disorder. There is so much more to it than that!

It is also not only a psychological defense, although narcissistic defenses and cognitive distortions play a key role in the pathology.

Narcissism is not simply an organizing principle or a schema, though, like every addiction (to narcissistic supply, in this case), it helps the addict to make sense of the world (is hermeneutic) and provides goal-orientation and direction. It comes replete with rituals, order, and structure (is an exoskeleton).

Finally, it is not strictly a personality disorder. The personality is intact and highly adaptive. Narcissism is a post-traumatic condition, amenable to trauma therapies. Like in every other form of complex trauma, emotions get dysregulated or repressed and cognitions get distorted.

Jacobsen: How are narcissistic disorders complex post-traumatic conditions, and forms of arrested development and attachment dysfunctions? How are both pampering and punishing a child, or an adolescent, forms of abuse in the creation of a narcissist?

Vaknin: Pathological narcissism is a reaction to prolonged abuse and trauma in early childhood or early adolescence. The source of the abuse or trauma is immaterial – the perpetrators could be parents, teachers, other adults, or peers. Pampering, smothering, spoiling, and “engulfing” the child are also forms of abuse because they do not allow the child to separate from the parent and to confront reality as an agent of personal growth and development.

See these:

Narcissistic and psychopathic parents and their children – click on the links:!topic/NARCISSISTIC-PERSONALITY-DISORDER/kA1vtsqWAiI

The Genetic Underpinnings of Narcissism

The early childhood traumas of the narcissist prevent him (or her) from completing the process of separation-individuation. S/he is not permitted to develop boundaries and to become an individual. S/he freezes in time as a Puer Aeternus, a Peter Pan.

The narcissistic child reacts by avoiding the offending and hurtful parent, an insecure attachment style that becomes entrenched throughout the lifespan. He creates the False Self and outsources many Ego boundary functions, rendering him dependent on the appraising gaze of others to buttress his grandiose, inflated self-image. Gradually, he develops an addiction to confirmatory input (narcissistic supply) because he cannot regulate and stabilize his internal environment without it.

Jacobsen: What portions of the nervous system in early childhood and early adolescence seem most impacted by the long-term abuse and trauma to create Narcissism, if known?

Vaknin: Not known. There are many studies about the neuroplastic effects of childhood abuse and trauma on the brain, but none of them is specific to NPD. There are studies about brain abnormalities in Borderline and Antisocial Personality Disorders (psychopathy).

Jacobsen: How are narcissistic disorders interpersonal disorders rather than disorders of the self?

Vaknin: The concept of “individual” which regrettably permeates modern psychology is counterfactual. We are formed fully via relationships with others. To conceive of the Self as an outcome of narcissistic introversion (Jung) is disastrously mistaken.

Disorders of the personality are, therefore, problems in inter-relatedness (as the object theorists in the UK in the 1960s had postulated). Narcissism is no exception. The DSM V has adopted this stance in its Alternate Model of NPD (p. 767). I had been advocating it since 1997.

Jacobsen: What are the goals of Cold Therapy?

Vaknin: The main two therapeutic goals are to render the False Self redundant and so drive it to atrophy (“use it or lose it”) and to eliminate the need for narcissistic supply and the dysphorias that accompany its deficiencies.

In short: to get rid of the grandiosity dimension in Narcissistic Personality Disorder (NPD).

To process trauma via skilled reliving (owning the trauma and surviving retraumatization);

To foster more adaptive functioning that is not dependent on outsourced regulation, cognitive distortions (like grandiosity), and artificial constructs (like the False Self);

Replace negative coping (such as avoidance, withdrawal, defiance, or fantasy) with positive coping strategies;

To integrate distressing materials (thoughts, feelings, memories);

To lead to the internal resolution of dissonances, resulting in an equilibrium and homeostasis;

Help the client to evolve life skills such as resilience, empathy, and ego regulation.

Jacobsen: Why are no known, well-established therapies effective in the treatment of narcissistic disorders?


Behavior Therapy

Replaces problem behaviors with constructive ones via conditioning and reinforcement.

Cognitive Therapy

Changes negative automatic thoughts and schemas that lead to attributional and other biases as well as errors in order to alter problematic behaviors and dysfunctional feelings and behaviors.


Third wave of behavior therapy:

Primacy of therapeutic relationship, learning principles, analyze triggers and environmental cues, explore schemas and emotions, utilize modelling, homework, and imagery.

Dialectical Behavior Therapy (DBT)

Developed by Linehan in 1993 to treat BPD, but used with other personality disorders and disorders of mood, anxiety, eating, and substance abuse. It is deployed mainly with female patients in inpatient or residential settings.

Emphasizes emotional and affect regulation rather than cognitions. 

Concerned with how were schemas formed via dialectic conflicts: seeks to connect affect and need to cognitive inference processes and belief systems so as to be reinterpreted with greater self-awareness.

Identifies fixation or perseveration causes by early developmental deprivation and protective attentional constriction.

Examines effects of negative reinforcement through emotional avoidance or inadequate coping skills rewarded through the partial reinforcement effect.

Involves individual therapy, group skills training, phone contact, and therapist consultation. Focuses on using validation and problem solving to counter severe behavioral dyscontrol, issues of quiet desperation, problems of living, and reducing incompleteness.

Cognitive Behavior Analysis System of Psychotherapy (CBASP)

Developed by McCullough and adapted by Sperry. Not used with BPD.

Clients learn to analyze life situations and manage daily stressors. They evaluate which thoughts and behaviors prevent desired outcomes.

Elicitation and remediation: questions about the situation, the client’s role and functioning in it, and the desired outcome lead to a revision of counterproductive behaviors and cognitions.

Replaces emotional reasoning with consequential one.

Mindfulness-based Cognitive Therapy (MBCT)

Developed by Teasdale.

Fosters aware focus on thoughts, feelings, and experiences in the present with an attitude of acceptance and without analysis or judgment. 

Pattern-focused Psychotherapy

Developed by Sperry

Pattern: predictable, consistent, self-perpetuating style of thinking, feeling, acting, coping, and self-defense. Can be adaptive (competent) or maladaptive (inflexible, ineffective, inappropriate, cause symptoms, impair functioning and satisfaction).

Therapy consists of replacing hurtful maladaptive patterns (situational interpretations and behaviors) with helpful adaptive ones. 

Schema Therapy

Developed by Young

Changes maladaptive schemas: 18 enduring and self-defeating ways of regarding oneself and others, arranged in 5 domains. Schemas are perpetuated through coping styles: schema maintenance, avoidance, and compensation.

Schemas can be reconstructed, modified, interpreted, or camouflaged. 

TABLE 1.2 Maladaptive Schemas and Schema Domains

Disconnection and Rejection

• Abandonment/Instability: The belief that significant others will not or cannot provide reliable and stable support.

• Mistrust/Abuse: The belief that others will abuse, humiliate, cheat, lie, manipulate, or take advantage.

• Emotional Deprivation: The belief that one’s desire for emotional support will not be met by others.

• Defectiveness/Shame: The belief that one is defective, bad, unwanted, or inferior in important respects.

• Social Isolation/Alienation: The belief that one is alienated, different from others, or not part of any group.

Impaired Autonomy and Performance

• Dependence/Incompetence: The belief that one is unable to competently meet everyday responsibilities without considerable help from others.

• Vulnerability to Harm or Illness: The exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it.

• Enmeshment/Undeveloped Self: The belief that one must be emotionally close with others at the expense of full individuation or normal social development.

• Failure: The belief that one will inevitably fail or is fundamentally inadequate in achieving one’s goals.

Impaired Limits

• Entitlement/Grandiosity: The belief that one is superior to others and not bound by the rules and norms that govern normal social interaction.

• Insufficient Self-Control/Self-Discipline: The belief that one is incapable of self-control and frustration tolerance.


• Subjugation: The belief that one’s desires, needs, and feelings must be suppressed in order to meet the needs of others and avoid retaliation or criticism.

• Self-Sacrifice: The belief that one must meet the needs of others at the expense of one’s own gratification.

• Approval-Seeking/Recognition-Seeking: The belief that one must constantly seek to belong and be accepted at the expense of developing a true sense of self.

Overvigilance and Inhibition

• Negativity/Pessimism: A pervasive, lifelong focus on the negative aspects of life while minimizing the positive and optimistic aspects.

• Emotional inhibition: The excessive inhibition of spontaneous action, feeling, or communication—usually to avoid disapproval by others, feelings of shame, or losing control of one’s impulses.

• Unrelenting Standards/Hypercriticalness: The belief that striving to meet unrealistically high standards of performance is essential to be accepted and to avoid criticism.

• Punitiveness. The belief that others should be harshly punished for making errors.

Sperry, Len, “Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders: Assessment, Case Conceptualization, and Treatment”, 3rd Edition, 2016, Routledge

Transference-focused Psychotherapy

Developed by Kernberg

Infants form internal representations of self-others (objects) connected via affect. A personality disorder occurs when positive and negative representations fail to integrate later in life. Such splitting affects all relationships, including the therapeutic one.

Transference to the therapist exposes the faulty relationship template and allows for its empathic correction. Identity integration is accomplished as the patient experiences negative emotions in a safe environment.

Mentalization-based Treatment (MBT)

Developed by Bateman and Fonagy.

Experience secure attachment and enhancing impulse control by empathically and insightfully reflecting on and correctly labelling one’s state of mind, especially one’s powerful emotions, and cognitive errors. This leads to improves relational skills.

Developmental Therapy

Developed mainly by Blocher, Citright, and Sperry

Regards problems in personal growth and needs satisfaction on a dimensional continuum from disordered to adequate to optimal.

Cold Therapy

Developed by Vaknin

Jacobsen: What are the first steps in formal identification and opening treatments of a narcissist with Cold Therapy?

Vaknin: The client present with a diagnosis of NPD by a clinician.

Cold Therapy consists of the re-traumatization of the narcissistic client in a hostile, non-holding environment which resembles the ambience of the original trauma. The adult patient successfully tackles this second round of hurt and thus resolves early childhood conflicts and achieves closure rendering his now maladaptive narcissistic defenses redundant, unnecessary, and obsolete.

Cold Therapy makes use of proprietary techniques such as erasure (suppressing the client’s speech and free expression and gaining clinical information and insights from his reactions to being so stifled). Other techniques include: grandiosity reframing, guided imagery, negative iteration, other-scoring, happiness map, mirroring, escalation, role play, assimilative confabulation, hypervigilant referencing, and re-parenting. It is proving to be an effective treatment for major depressive episodes (see this article about the link between pathological narcissism and depression and this article about depression and regulatory narcissistic supply in narcissism).

More about the therapy:

Jacobsen: Thank you for the opportunity and your time, Professor Vaknin.

Vaknin: Thank you again for your interest in my work.


Vaknin, S. (2018). Cold Therapy and Narcissistic Disorders of the Self. Journal of Clinical Review & Case Reports, 3(6), 29-36.

vakninsamnarcissist. (2020, January 31). [Prof. Vaknin reflects on life with NPD and the creation of Cold Therapy]. Instagram.


[1] Vaknin’s Instagram post (2020), in full, stated:

What a cruel irony it is that I have developed Cold Therapy – the first ever effective treatment (cure, really) for Narcissistic Personality Disorder (NPD) – too late to benefit from it myself.

I am 59 years old, my health is failing. My mental illness had consumed my life – is still devouring it – as surely as the bush fires ravage homes in Australia, leaving only the ashes of Me behind.


I will block anyone who gives me the feel good New Age crap about how it is never too late in life. Life has an expiry date beyond which it is all blood and tears and stools and wallowing in your own stench of decomposing physical and mental decrepitude. So back off with your American anodyne platitudes about how every age has its charms. Old age sucks 100%. We lie to ourselves about it in order to survive somehow in the face of our own vanishing dismemberment.

NPD is the slowest invisible cancer – but of the soul and mind. It is spiritual AIDS with nothing to abet it. It is all-pervasive, relentless, and merciless. It starts at age 3. It causes people around the narcissist to hurt and torment him purposefully and profusely as a way of getting back at him for his egregious abuse. It is Inferno and I have been its Dante since 1995. No Beatrice can help me, no god, no healer. I have been doomed by my own progenitor to a life of itinerant, profound, debilitating hurt, unlovable, shunned like a leper, feared and loathed and mocked in equal measures.

It is with impotent rage that I bequeath Cold Therapy to a world I care nothing for or about. Rage at the injustice of healing and aiding millions with my pioneering work since 1995 – except the only person who most deserved my love and my devotion and my succor: Sam.

See vakninsamnarcissist (2020).

[2] Vaknin, in “Cold Therapy and Narcissistic Disorders of the Self” (2018), stated:

a. It is not only a regression to an earlier childhood developmental phase;

b. It is not merely a psychological defense;

c. It is not simply an organizing principle or a schema;

d. It is not a personality disorder.

See Vaknin (2018).

Image Credit: Sam Vaknin.


  1. So sorry to read about your life. I am exactly the same age. A part of our age is facing opportunities that have gone with the windows of time. It is good that you created this therapy. Is there a mythical figure that has done this too? without being able to heal himself? Like a figure in a Greek Myth?

  2. I watched several of your videos because I recently broke up with someone, who acted narcissically at times, yet on reading all that I could find, I concluded he is avoidant dismissive. He also has PTSD and is an alcoholic.
    Thank you for all your work on social media. I particularly enjoyed your interview in “Shot” magazine. For some reason this has cheered me. Thank you for putting yourself out there. I am curious what that does for you! Would you tell me? Do you have to be courageous to do that?

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