Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-26T08:43:50.098Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of schema group therapy in older outpatients: a proof of concept study‡

Published online by Cambridge University Press:  03 July 2014

A. C. Videler ,
G. Rossi ,
M. Schoevaars ,
C. M. van der Feltz-Cornelis  and
S. P. J. van Alphen
A. C. Videler*
Affiliation:
Breburg Hospital, Department of Old Age Psychiatry, Tilburg, the Netherlands Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium Tilburg University, Tranzo Department, Tilburg, the Netherlands
G. Rossi
Affiliation:
Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
M. Schoevaars
Affiliation:
Psychology Practice Schoevaars, Capelle aan den IJssel, the Netherlands
C. M. van der Feltz-Cornelis
Affiliation:
Tilburg University, Tranzo Department, Tilburg, the Netherlands Clinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands Trimbos Institute, Board, Utrecht, the Netherlands
S. P. J. van Alphen
Affiliation:
Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium Mondriaan Hospital, Department of Old Age Psychiatry, Heerlen-Maastricht, the Netherlands
*
Correspondence should be addressed to: Arjan Videler, Lange akker 18, 5081 MS, Hilvarenbeek, Netherlands. Phone: +31630588253; Fax: +314683438. Email: [email protected].
Get access

Abstract

Background:

Short-term group schema cognitive behavior therapy (SCBT-g) showed improvements in overall symptomatology, early maladaptive schemas (EMS) and schema modes, both in adults and adolescents with personality disorder (PD) features and long-standing mood disorders. However, no research has yet been carried out on the effect in older adults. Therefore, in a proof of concept study, we explored the effect of SCBT-g in older outpatients with PD features and longstanding mood disorders.

Method:

Thirty-one older outpatients, aged 60–78 years with PD features and/or longstanding mood disorders were included in a proof of concept study with pre-mid-post design. Primary outcome was psychological distress (Brief Symptom Inventory) and intermediate outcomes were EMS (Young Schema Questionnaire) and schema modes (Schema Mode Inventory), assessed at baseline, mid-treatment and end-of-treatment. Paired samples t-tests were conducted, and Cohen's d effect sizes reported for pre mid- and post-treatment. As proof of concept analysis, hierarchical regression analyses with residual change scores were used to analyse whether early process changes in EMS (intermediate outcomes) predicted later outcome changes in symptoms.

Results:

SCBT-g led to significant improvement in all three measures of psychological symptoms, EMS and modes with medium effect sizes. Pre-treatment to mid-treatment changes in schema severity predicted symptom improvement from mid- to end-of-treatment.

Conclusion:

This proof of concept study shows that SCBT-g has potential to change EMS and to show significant effect at symptom level in older outpatients with PD features. A control condition in a randomized controlled trial is a necessary step for further research.

Keywords

schema therapygroup therapyolder adultsproof of concept study
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 10 , October 2014 , pp. 1709 - 1717
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

‡

The original version of this article was published with an author name spelt incorrectly. A notice detailing this has been published and the error rectified in the online and print PDF and HTML copies.

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition text revision. Washington DC: American Psychiatric Association.Google Scholar
American Psychological Association (2013). Guidelines for psychological practice with older adults. Washington DC: American Psychological Association.Google Scholar
Arntz, A. and Van Genderen, H. (2009). Schema therapy for borderline personality disorder. Oxford: Wiley-Blackwell.Google Scholar
Balsis, S., Woods, C. M., Gleason, M. E. and Oltmanns, T. F. (2007). Over and underdiagnosis of personality disorders in older adults. American Journal of Geriatric Psychiatry, 15, 742–753. doi: 10.1097/jgp.0b013e31813c6b4e CrossRefGoogle ScholarPubMed
Bamelis, L., Bloo, J., Bernstein, D. and Arntz, A. (2012). Effectiveness studies. In: van Vreeswijk, M., Broersen, J. and Nadort, M. (Eds.). The Wiley-Blackwell Handbook of Schema Therapy. Chichester: John Wiley & Sons.Google Scholar
Bamelis, L. M., Evers, S. M. A. A., Spinhoven, P. and Arntz, A. (2013). Results of a Multicenter Randomized Controlled Trial of the Clinical Effectiveness of Schema Therapy for Personality Disorders. American Journal of Psychiatry in Advance. doi:10.1176/appi.ajp.2013.12040518 CrossRefGoogle Scholar
Beurs, E. de (2011). Brief Symptom Inventory: Dutch Manual. Leiden: PITS.Google Scholar
Broersen, J. and Van Vreeswijk, M. (2012). Schema therapy in groups: a short-term schema CBT protocol. In: van Vreeswijk, M., Broersen, J. and Nadort, M. (Eds.). The Wiley-Blackwell Handbook of Schema Therapy. Chichester: John Wiley & Sons.Google Scholar
Cohen, J. (1988). Statistical power analyses for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.Google Scholar
Derogatis, L. R. (1975a). The Brief Symptom Inventory. Baltimore: Clinical Psychometric Research.Google Scholar
Derogatis, L. R. (1975b). The Symptom Checklist-90-R. Baltimore: Clinical Psychometric Research.Google Scholar
Edwards, D. and Arntz, A. (2012). Schema therapy in historical perspective. In: van Vreeswijk, M., Broersen, J., and Nadort, M. (Eds.). The Wiley-Blackwell Handbook of Schema Therapy. Chichester: John Wiley & Sons.CrossRefGoogle Scholar
Farrell, J. (2012). Introduction to Group schema therapy. In: van Vreeswijk, M., Broersen, J. and Nadort, M. (Eds.). The Wiley-Blackwell Handbook of Schema Therapy. Chichester: John Wiley & Sons.Google Scholar
Finkel, S. E. (1995). Causal analysis with panel data. Thousand Oaks: Sage.CrossRefGoogle Scholar
Giesen-Bloo, J. et al. (2006). Outpatient psychotherapy for borderline personality Disorder: Randomized trial of Schema-focused therapy versus transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–658. doi: 10.1001/archpsyc.63.6.649 CrossRefGoogle Scholar
Hendriks, G. J., Oude Voshaar, R. C., Keijsers, G. P., Hoogduin, C. A. and Van Balkom, A. J. (2008). Cognitive-behavioural therapy for late-life anxiety disorders: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 117, 403–411. DOI: 10.1111/j.1600-0447.2008.01190.x CrossRefGoogle ScholarPubMed
James, I. A. (2008). Schemas and schema-focused approaches with older people. In: Laidlaw, K. and Knight, B. (Eds.) Handbook of Emotional Disorders in Later Life: Assessment and treatment. Oxford: Oxford University Press.Google Scholar
Krishna, M., Jauhari, A., Lepping, P, Turner, J, Crossley, D. and Krishnamoorty, A. (2011). Is group psychotherapy effective in older adults with depression? A systematic review. International Journal of Geriatric Psychiatry, 26 (4), 331–340. DOI: 10.1002/gps.2546 CrossRefGoogle ScholarPubMed
Laidlaw, K. and Thompson, L. W. (2008). Cognitive behaviour therapy with depressed older people. In: Laidlaw, K. and Knight, B. (Eds.) Handbook of Emotional Disorders in Later Life: Assessment and treatment. Oxford: Oxford University Press.CrossRefGoogle Scholar
Lambert, M. J., Hansen, N. B. and Bauer, S. (2008). Assessing the clinical significance of outcome results. In: Nezu, A. and Nezu, C.M. (Eds.) Evidence-based Outcome research: A Practical Guide to conducting randomized controlled trials for psychosocial interventions. New York: Oxford University Press.Google Scholar
Lawrence Gould, A. (2005). Timing of futility analyses for ‘proof of concept’ trials. Statistics in Medicine, 24, 1815–1835. DOI: 10.1002/sim.2087 CrossRefGoogle ScholarPubMed
Lobbestael, J., Van Vreeswijk, M. F., Arntz, A., Spinhoven, P. and `t Hoen, T. (2005). Dutch translation of the young atkinson mode inventory (YAMI). Maastricht: Maastricht University.Google Scholar
Lobbestael, J., Van Vreeswijk, M. F., Spinhoven, P., Schouten, E. and Arntz, A. (2010). Reliability and validity of the Short Schema Mode Inventory (SMI). Behavioural and Cognitive Psychotherapy, 38, 437–458. doi: 10.1017/S1352465810000226 CrossRefGoogle ScholarPubMed
Oltmanns, T. F. and Balsis, S. (2011). Personality disorders in later life: Questions about the measurement, course and impact of disorders. Annual Review of Clinical Psychology, 27, 321–349. doi: 10.1146/annurev-clinpsy-090310-120435 Google Scholar
Pauwels, E. et al. (2014). Age neutrality of the Young Schema Questionnaire in patients with a substance use disorder. International Psychogeriatrics, 3, 1–10. doi: 10.1017/S1041610214000519 CrossRefGoogle Scholar
Pinquart, M., Duberstein, P. R. and Lynness, J. M. (2007). Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis. Journal of Aging and Mental Health, 11, 645–57. doi: 10.1080/13607860701529635 CrossRefGoogle ScholarPubMed
Renner, F., Van Goor, M., Huibers, M., Arntz, A., Butz, B. and Bernstein, D. (2013). Short-term Group schema cognitive-behavioral therapy for Young adults with personality disorder features: Associations with changes in symptomatic distress, schemas, schema modes and coping styles. Behaviour Research and Therapy, 51, 487–492. doi: 10.1016/j.brat.2013.05.011 CrossRefGoogle ScholarPubMed
Rijkeboer, M. M., Van den Bergh, H. and Van den Bout, J. (2005). Stability and discriminative power of the Young Schema Questionnaire. Journal of Behavioral Therapy and Experimental Psychiatry, 36, 129–144. doi: 10.1016/j.jbtep.2004.08.005 CrossRefGoogle ScholarPubMed
Scogin, F., Welsh, D., Hanson, A., Stump, J. and Coates, A. (2005). Evidence-based psychotherapies for depression in older adults. Clinical Psychology: Science and Practice. 12, 222–237. doi: 10.1093/clipsy.bpi033 Google Scholar
Sterk, F. and Rijkeboer, M. (1997). Schema-Vragenlijst [Schema questionnairre]. Utrecht: Ambulatorium Universiteit Utrecht.Google Scholar
Van Alphen, S. P. J. (2011). Treatment of avoidant personality pathology in late life. International Psychogeriatrics, 30, 1–4. doi:10.1017/S1041610213001312 Google Scholar
Van Alphen, S. P. J., Derksen, J. J. L., Sadavoy, J. and Rosowsky, E. (2012). Features and challenges of personality disorders in later life. Aging & Mental Health, 16, 805–810. doi:10.1080/13607863.2012.667781 CrossRefGoogle Scholar
Van Alphen, S. P. J. et al. (2012). Age related aspects and clinical implications of diagnosis and treatment of personality disorders in older adults. Clinical Gerontologist, 35, 27–41. doi: 10.1080/07317115.2011.628368 CrossRefGoogle Scholar
Van Asselt, A. D. I. et al. (2008). Out-patient psychotherapy for borderline personality disorder: Cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy. British Journal of Psychiatry, 192, 450–457. doi:10.1192/bjp.bp.106.033597 CrossRefGoogle ScholarPubMed
Van der Feltz-Cornelis, C. M. et al. (submitted). Towards Horizon 2020: Challenges and advances for clinical mental health research. Outcome of an expert survey. Neuropsychiatric Disease and Treatment. Google Scholar
Van Vreeswijk, M. F., Spinhoven, P., Eurelings-Bontekoe, E. H. M. and Broersen, J. (2012). Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short-term schema cognitive behavioural group therapy: A naturalistic pre-treatment and post-treatment design in an outpatient clinic. Clinical Psychology and Psychotherapy, doi: 10.1002/cpp.1813.CrossRefGoogle Scholar
Videler, A. C., Van Royen, R. J. J. and Van Alphen, S. P. J. (2012). Schema therapy for older adults: Call for evidence. International Psychogeriatrics, 24, 1186–1187. doi: 10.1017/S1041610211002638 CrossRefGoogle ScholarPubMed
Young, J. E. (1990). Cognitive Therapy for Personality Disorders: a Schema-focused Approach. Sarasota: Professional Resource Press.Google Scholar
Young, J. E. and Brown, G. (1994). Young Schema-Questionnaire (2nd ed.). In Young, J. E. (Ed.) Cognitive therapy for personality disorders: A schema-focused approach. Sarasota: Professional Resource Press.Google Scholar
Young, J. E., Klosko, J. and Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. New York: The Guilford Press.Google Scholar
Zarit, S. H. and Zarit, J. M. (2011). Mental disorders in older adults: Fundamentals of Assessment and Treatment. New York: Guilford Press.Google Scholar