Abstract
Abstract A first empirical study into group schema therapy in older adults with mood disorders and personality disorder (PD) features has shown that brief group schema therapy has potential to decrease psychological distress and to change early maladaptive schemas (EMS). Effect sizes however were smaller than those found in similar studies in younger adults. Therefore, we set out to adapt the treatment protocol for older adults in order to enhance its feasibility and outcome in this age group. We examined this adapted protocol in 29 older adults (mean age 66 years) with PDs from four Dutch mental health institutes. The primary outcome was symptomatic distress, measured by the Brief Symptom Inventory. Secondary outcomes were measured by the Young Schema Questionnaire, the Schema Mode Inventory, and the short version of the Severity Indices of Personality Problems. Contrary to our expectations, the adapted treatment protocol yielded only a small effect size in our primary outcome, and no significant improvement in EMS, modes and personality functioning. Patients pointed out that they were more aware of their dysfunctional patterns, but maybe they had not been able yet to work on behavioural change due to this schema therapy treatment being too brief. We recommend more intensive treatment for older patients with PDs, as they might benefit from more schema therapy sessions, similar to the treatment dosage in younger PD patients. They might also benefit from a combination of group therapy and individual treatment sessions. Key learning aims (1) How to adapt group schema therapy for older adults. (2) How to explore feasibility and outcome. (3) Treat older personality disorder patients as intensively as younger adults.
Highlights
Personality disorders (PDs) are complex mental health problems, associated with chronic dysfunction in several life domains across the life course (Hutsebaut et al, 2019; Newton-Howes et al, 2015)
In this study we explored the applicability, feasibility and outcome of an adapted form of brief group schema therapy for older adults with mixed PDs
Most patients showed a positive change in symptomatic distress, early maladaptive schemas (EMS), schema modes and personality functioning over time, but the magnitude of change differed from one patient to another
Summary
Personality disorders (PDs) are complex mental health problems, associated with chronic dysfunction in several life domains across the life course (Hutsebaut et al, 2019; Newton-Howes et al, 2015). In older adults (over the age of 60), the behavioural manifestation and intensity of a PD differs due to biological, psychological and social aspects of ageing (van Alphen et al, 2015). Older adults with (comorbid) PDs in geriatric psychiatry are characterized by many symptoms, a complicated course of treatment and a poorer treatment prognosis compared with older people with other common mental disorders, such as anxiety disorders or depression (Newton-Howes et al, 2015). Research in older patients is challenging because of the complex interaction between biological, social, cultural, and psychological factors
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