Perhaps but I tend to think of the mechanism as more dissociative, a detachment from the consequences of reality but more for emotional release than self-defense: like the fans at a wrestling match, yelling at the heel while belief is suspended and reflection minimized so the actual consequences in policy and lives are effectively ignored rather than actively denied.
They are (mostly) clinically sane I suppose but what gets me as much as their indifference to the suffering of people-not-like-them is the utter vulgarity of their beliefs. My reaction to them as much as anything is sheer astonishment that an adult could not only find but give public credence to the idiocies of a Trump or Q and not be institutionalized.