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SYMPOSIUM 1 | DAY 1: 10.30 AM - 12.00 PM

Schema Therapy for Older Adults 

by A.C. Videler, M.A. Ouwens, S.M.J. Heijnen-Kohl, and Marjolein Legra

Chair: Arjan Videler


This symposium gives an overview of the current innovative research in the highly underexplored field of personality pathology in older adults. Until very recently, no studies had been conducted whatsoever into the treatment of personality disorders in later life, nor into schema therapy in older adults. In this symposium four studies are presented into schema therapy and schema theory in later life. The first study, which was recently published, showed the effectiveness of schema therapy as a treatment for cluster C personality disorders in older adults by means of a multiple baseline case series design. The second study, which will be presented, concerns a multiple baseline design for assessing the effectiveness of schema therapy for borderline personality disorder in later life. The third study in this symposium elaborates on a previous study which showed that a brief form of group schema therapy is feasible in older adults with recurrent mood disorders and maladaptive personality traits, but somewhat less effective compared to younger adults. This study is currently ongoing and explores whether adaptations for older adults with personality disorders enhance its feasibility and effectiveness. The last presentation of this symposium discusses the results of a study in which the schema-structure of the Dutch Schema Questionnaire for the Elderly (YSQ-SFE) is explored in older adults in the general population.

Segment 1

Title: Schema therapy for cluster C personality disorders in older adults

Presenter: Arjan Videler

Schema therapy for cluster-C personality disorders in older adults 

Arjan Videler, GGz Breburg, Tilburg, the Netherlands. 

Introduction 

Schema therapy (ST) is an effective treatment for personality disorders (PDs) in adults. Nevertheless, the efficacy of individual ST in older adults is unknown. Because cluster C PDs are more stable across the lifespan, we studied the effectiveness of ST in cluster C PDs. Method Multiple baseline case series design (N=8) in older adults with cluster C PDs (63-76 years). After a random baseline, 40 weekly ST sessions were given, followed by 10 booster sessions. As primary outcomes, participants rated the credibility of dysfunctional core beliefs. Secondary outcomes were psychological distress, quality of life, and PD diagnosis. Intermediate variables were early maladaptive schemas. Data were analyzed through time series analysis using mixed regression. 

Results 

Decreasing credibility of dysfunctional core beliefs during treatment, but not during baseline and follow-up conditions; scores were stable during follow-up and significantly lower compared to baseline, with high effect sizes. Significant decrease of psychological distress in all patients, and 7 out of 8 patients remitted from PD diagnosis. 

Discussion 

Schema Therapy appears effective in the treatment of cluster-C Personality Disorders in older adults. This is the first research into treatment of PDs in older adults. Adaptations for ST in later life are discussed. 

Conclusion 

This study is a scientific breakthrough in the domain of psychotherapy for PDs in later life. 

Videler, A.C., van Alphen, S.P.J., Rossi, G., van der Feltz-Cornelis, C.M., van Royen, R.J.J., & A. Arntz. (2017). Schema therapy in older adults: A multiple baseline case series. 

Aging and Mental Health. Epub ahead of print Videler, A.C., van Royen, R.J.J., van Alphen, S.P.J., Rossi, G., & van der Feltz-Cornelis, C.M. (2017). 

Adapting schema therapy for personality disorders in older adults. International Journal of Cognitive Therapy, 10, 62-78.

Segment 2

Title: ndividual schema therapy for older adults with borderline personality disorder

Presenter: Matchteld Ouwens

Individual schema therapy for older adults with borderline personality disorder M.A. Ouwens, GGz Breburg, Tilburg, the Netherlands. 

Introduction 

Until recently, no studies had been conducted into the effectiveness of the treatment of personality disorders in later life. A recent multiple-baseline study showed that schema therapy is effective for older adults with cluster-C personality disorders. The aim of the present study is to investigate whether individual schema therapy is an effective treatment for older adults with borderline personality disorder (BPD). The Method Multiple baseline design is with 8 patients with a primary diagnosis of BPD. Length of baseline phase is randomized between participants. Next, 40 sessions of schema therapy are given, succeeded by a six months follow-up with monthly booster sessions. Primary outcome is the weekly assessed credibility of dysfunctional core beliefs. Secondary outcomes are strength of schemas, frequency of maladaptive modes, personality disorder criteria, psychological symptoms and quality of life. 

Results 

This study is currently being conducted. 

Discussion 

Methodological and clinical issues will be discussed, in particular ways for adequately assessing BPD in later life, considering the differential presentation of BPD in older adults. 

Conclusion 

This is the first study of a psychotherapy, in this case schema therapy, for BPD in later life. 

van Alphen, S.P., van Dijk, S.D., Videler, A.C., Rossi, G., Dierckx, E., Bouckaert, F. & Oude Voshaar, R.C. (2015). Personality disorders in older adults: emerging research issues. Current Psychiatry Reports, 17, 538. 

Videler, A.C., van Alphen, S.P.J., van Royen, R.J.J., van der Feltz-Cornelis, C.M., Rossi, G., & Arntz, A. (2017). Schema therapy for personality disorders in older adults: a multiple-baseline study. Aging & Mental Health, http://dx.doi.org/10.1080/13607863.2017.1318260 

Khasho, D., Ouwens, M.A., van Alphen, S.P.J., Arntz, A., & Videler, A.C. (in prep.). Schema therapy for borderline personality disorder in later life: protocol of a multiple-baseline case series study.

Segment 3

Title: Group schema therapy modified for older adults with personality disorders

Presenter: Sylvia Heijnen-Kohl

Group schema therapy modified for older adults with personality disorders 

Sylvia Heijnen-Kohl, Mondriaan Psychiatric Hospital, Heerlen/Maastricht, the Netherlands. 

Introduction 

Schema-Focused Cognitive Behavioral Therapy for Groups (SCBT-g) has been studied in older adults with recurrent mood disorders and maladaptive personality traits and was found to be somewhat less effective compared to younger adults. Therefore, adaptations for older adults, as suggested in the literature, were integrated into a new protocol for group schema therapy for older adults with personality disorders to enhance its feasibility and effectiveness. 

Method 

The adapted group schema therapy protocol is currently being investigated in a multi-centre trial using a pre-, mid- and post-test design in order to investigate the outcome of this adapted form of SCBT-g for a homogeneous group of older adults diagnosed with mixed PDs. The results will be compared with the study of Videler et al. (2014). 

Results 

As this study is still ongoing, preliminary findings will be presented. 

Discussion 

Preliminary findings support the increased feasibility of group schema therapy, modified for older adults. 

Conclusion 

An adapted protocol for group schema therapy in older adults is a feasible and probably more effective treatment for personality disorders in older adults. 

Broersen, J., & van Vreeswijk, M. (2012). Schema therapy in groups: a short-term schema CBT protocol. In: M. van Vreeswijk, J. Broersen, M. & Nadort (Eds.), The Wiley-Blackwell Handbook of Schema Therapy. Chichester: John Wiley & Sons. 

Videler, A.C., Rossi, G., Schoevaars, M., van der Feltz-Cornelis, C., & van Alphen, S.P.J. (2014). Effects of schema group therapy in elderly outpatients: a proof of concept study. International Psychogeriatrics, 26, 1709-1717. 

van Beest, Videler, A.C., Heijnen-Kohl, S.M.J., Ouwens, M.A., & van Alphen, S.P.J. (in prep.). Adapted group schema therapy for personality disorders in older adults.

Segment 4

Title: Exploration of the schema-structure in an elderly population 

Presenter: Marjolein Legra

Exploration of the schema-structure in an elderly population Drs. M.J.H. (Marjolein) Legra, GGz WNB, the Netherlands 

Introduction 

Schema-theory and schema-therapy as developed by Young (1994) are an accepted framework for the treatment of patients with personality disorders. However, when it comes to an aging population (>65), literature on schema theory is scarce. Moreover, we do not know whether maladaptive schemas can be generalized across the lifespan up to the elderly. 

In this study we try to address this gap in our knowledge by exploring the schema-structure of the Dutch Schema Questionnaire for the Elderly (YSQ-SFE) in older adults in the general population. 

Method: 100 male and 120 female participants, extracted from a general population, filled out the YSQ-SFE. Data were analyzed using confirmative factor-analysis. 

Results: Only six schema domains were (partly) confirmed by factor-analysis, namely Emotional deprivation, Failure, Dependence/Vulnerability to harm and illness, Enmeshment and Self-sacrifice. Two schemas group together, namely Social isolation and Undesirability. 

Discussion 

Our first results indicate that the schema-structure is hardly confirmed in a Dutch community-dwelling population. These results are striking, because of the adequate psychometric properties of the YSQ in a younger adult population. Possible explanations will be discussed as well as suggestions for future research (e.g., analyzing clinical and nonclinical data by Mokken Scale Analysis). 

Conclusion 

The schema-structure is only partly confirmed in a nonclinical sample. 

M.J.H. Legra, F.R.J. Verheij & S.P.J. van Alphen (in prep.). Exploration of the schema-structure in an elderly population.

About the Presenters:

Dr. Arjan Videler

Dr. A.C. (Arjan) Videler is head of PersonaCura, clinical center of excellence for geriatric psychiatry and personality disorders in older adults, of GGz Breburg, Tilburg, the Netherlands. Besides his clinical work as apsychotherapist and mental-health psychologist, Arjan is certified supervisor of the Dutch association of cognitive-behavioral therapy, and teaches psychotherapy in older adults and assessment of personality disorders in older adults at RINO Zuid in Eindhoven and RINO Group in Utrecht, both institutes for continuing education in mental health. He is also a senior researcher at Tilburg University, Tranzo department. Throughout his clinical work, teaching and research activities, Arjan has always been intrigued by personality disorders in later life, and enhancing the outcome of psychotherapy for older adults.

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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