Abstract
BackgroundSeveral types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, however studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. This paper describes the design of a randomized controlled trial (RCT). We will evaluate the (cost-)effectiveness of this therapy protocol in specialized mental health care. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare.MethodsA multicenter RCT with a one-year follow-up comparing group schema-focused therapy enriched with psychomotor therapy (group SFT + PMT) and TAU for adults aged 60 years and older who suffer from either a cluster B and/or C personality disorder. The primary outcome is general psychological distress measured with the 53-item Brief Symptom Inventory. Secondary outcomes are the Schema Mode Inventory (118-item version) and the Young Schema Questionnaire. Cost-effectiveness analysis will be performed from a societal perspective with the EuroQol five dimensions questionnaire and structured cost-interviews.DiscussionThis study will add to the knowledge of psychotherapy in later life. The study specifically contributes to the evidence on (cost-) effectiveness of group SFT enriched with PMT adapted to the needs of for older adults with cluster b and/or c personality.Trial registrationNetherlands Trial Register NTR 6621. Registered on 20 August 2017.
Highlights
Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, studies among older patients are lacking
Design We designed a multi-center randomized controlled trial with two parallel treatment groups: 20 sessions of group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) delivered over a 6-months period, versus treatment as usual (TAU) for older adults with cluster B and/or C personality disorders in specialized mental health care
This paper presents the design of the first randomized controlled trial evaluating the effectiveness of group SFT enriched with PMT, for older adults with personality disorders
Summary
Several types of psychotherapy have been proven successful in the treatment of personality disorders in younger age groups, studies among older patients are lacking. We developed a group schema-focused therapy (SFT) enriched with psychomotor therapy (PMT) for older adults with cluster B and/or C personality disorders. We hypothesize that our treatment program is cost-effective and superior to treatment as usual (TAU) in reducing psychological distress and improving quality of life in older adults treated to specialized mental healthcare. The disease burden due to personality disorders is high for patients (lowered quality of life, high levels of psychological distress and a high suicide risk) as well as for society (increased medical consumption and informal care) [5, 6]. Even in specialized mental health care for older adults, personality disorders often remain undiagnosed and undertreated [9, 10]. Among younger patients several psychological therapies, among which schema focused therapy (SFT) have been developed that effectively reduce the burden of personality disorders [11, 12]. SFT helps patients to identify their most important maladaptive schemas and to respond in a more adaptive manner when these maladaptive schemas are triggered in daily life
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