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Positive schemas in schema therapy with older adults: clinical implications and research suggestions

Published online by Cambridge University Press:  10 March 2020

Arjan C. Videler Open the ORCID record for Arjan C. Videler [Opens in a new window] ,
Rita J.J. van Royen ,
Marjolein J.H. Legra  and
Machteld A. Ouwens
Arjan C. Videler*
Affiliation:
PersonaCura, GGz Breburg, Tilburg, The Netherlands Tranzo Department, Tilburg University, Tilburg, The Netherlands
Rita J.J. van Royen
Affiliation:
Centre for Psychotherapy, Beuningen, The Netherlands
Marjolein J.H. Legra
Affiliation:
PersonaCura, GGz Breburg, Tilburg, The Netherlands
Machteld A. Ouwens
Affiliation:
PersonaCura, GGz Breburg, Tilburg, The Netherlands Tranzo Department, Tilburg University, Tilburg, The Netherlands
*
*Corresponding author. Email: a.videler@ggzbreburg.nl
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Abstract

Background:

Schema therapy is an effective treatment for borderline personality disorder and other complex disorders. Schema therapy is feasible in older adults, and the first empirical support for its effectiveness in later life was provided in older patients with a cluster C personality disorder. The central concept of the schema therapy model is the early maladaptive schema (EMS). Early adaptive schemas (EAS) give rise to adaptive behaviour, and they also emerge during childhood, when core emotional needs are adequately met by primary caregivers.

Aims:

To examine the concept of EAS and its application in schema therapy with older adults.

Method:

Literature review and case example: the role of EAS in schema therapy with older adults is discussed and suggestions for integrating EAS in schema therapy in later life are proposed.

Results:

Directing attention in therapy to EAS may help strengthen the healthy adult mode, and it might also help change a negative life review. Working with positive schemas may be an important avenue for re-awakening positive aspects of patients, reinforcing the therapeutic relationship, creating a positive working atmosphere, and also for facilitating the introduction of experiential schema therapy techniques.

Conclusions:

This review suggests that positive schemas may be important vehicles of therapeutic change when working with older people. There is a need for validating the Young Positive Schema Questionnaire (YPSQ) in older adults, and for examining whether integrating EAS in schema therapy with older adults indeed has a positive effect on therapy outcome.

Keywords

older adultspositive schemasschema therapy
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 4 , July 2020 , pp. 481 - 491
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Antoine, P., Antoine, C., & Nandrino, J. L. (2008). Development and validation of the cognitive inventory of subjective distress. International Journal of Geriatric Psychiatry, 23, 1175–1181.CrossRefGoogle ScholarPubMed
Arntz, A., & Lobbestael, J. (2018). Cognitive structures and processes in personality disorders. In Livesley, J. W. & Larstone, R. (eds), Handbook of Personality Disorders: Theory, Research, and Treatment (pp. 141–154). New York, USA: Guilford Press.Google Scholar
Bamelis, L. M., Evers, S. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 305–322.CrossRefGoogle ScholarPubMed
Bach, B., Lockwood, G., & Young, J. E. (2018). A new look at the schema therapy model: organization and role of early maladaptive schemas. Cognitive Behaviour Therapy, 47, 328–349.CrossRefGoogle Scholar
Beck, A. T. (1996). Beyond belief: a theory of modes, personality, and psychopathology. In Salkovskis, P. M. (ed), Frontiers of Cognitive Therapy (pp. 1–25). New York, NY, USA: Guilford Press.Google Scholar
Bhar, S. S. (2014). Reminiscence therapy: a review. In Pachana, N. A. & Laidlaw, K. (eds), The Oxford Handbook of Clinical Geropsychology (pp. 675–690). Oxford, UK: Oxford University Press.Google Scholar
Broersen, J., & Van Vreeswijk, M. (2012). Schema therapy in groups: a short-term schema CBT protocol. In Vreeswijk, M. van, Broersen, J. and Nadort, M. (eds), The Wiley-Blackwell Handbook of Schema Therapy. Chichester, UK: John Wiley & Sons.Google Scholar
Butler, R. N. (1974). Successful aging and the role of the life review. International Journal of Aging and Human Development, 22, 35–38.Google Scholar
Cockram, D. M., Drummond, P. D., & Lee, C. W. (2010). Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clinical Psychology & Psychotherapy, 17, 165–182.Google ScholarPubMed
Dickhaut, V., & Arntz, A. (2014). Combined group and individual schema therapy for borderline personality disorder: a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 45, 242–251.CrossRefGoogle ScholarPubMed
Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40, 317–328.CrossRefGoogle ScholarPubMed
First, M. B., Williams, J. B., Benjamin, L. S., & Spitzer, R. L. (2016). Structured Clinical Interview for DSM-5 Personality Disorders: SCID-5-PD. Arlington, VA, USA: American Psychiatric Association Publishing.Google Scholar
Giesen-Bloo, J., Van Dyck, R., Spinhoven, P., Van Tilburg, W., Dirksen, C., Van Asselt, T., … & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–658.CrossRefGoogle ScholarPubMed
Gilboa, A., & Marlatte, H. (2017). Neurobiology of schemas and schema-mediated memory. Trends in Cognitive Sciences, 21, 618–631.CrossRefGoogle ScholarPubMed
Hyler, S. E. (1994). The Personality Diagnostic Questionnaire 4+. New York, USA: New York State Psychiatric Institute.Google Scholar
Hutsebaut, J., Videler, A. C., Verheul, R., & Van Alphen, S. P. J. (2019). Managing borderline personality disorder from a life course perspective: clinical staging and health management. Personality Disorders, 10, 309–316.CrossRefGoogle ScholarPubMed
James, I. A. (2003). Working with older people: implications for schema theory. Clinical Psychology & Psychotherapy, 10, 133–143.CrossRefGoogle Scholar
James, I. A. (2008). Schemas and schema-focused approaches in older people. In Laidlaw, K. & Knight, B. (eds), Handbook of Emotional Disorders in Later Life: Assessment and Treatment (pp. 117–140). Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
James, I. A., Kendell, K., & Reichelt, F. K. (1999). Conceptualizations of depression in older people: the interaction of positive and negative beliefs. Behavioural and Cognitive Psychotherapy, 27, 285–290.CrossRefGoogle Scholar
Khasho, D. A., van Alphen, S. P. J., Heijnen-Kohl, S. M. J., Ouwens, M. A., Arntz, A., & Videler, A. C. (2019). The effectiveness of individual schema therapy in older adults with borderline personality disorder: protocol of a multiple-baseline study. Contemporary Clinical Trials Communications, 14, 100330.CrossRefGoogle ScholarPubMed
Laidlaw, K., & McAlpine, S. (2008). Cognitive behaviour therapy: how is it different with older people? Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26, 250–262.CrossRefGoogle Scholar
Legra, M. J. H., Verhey, F. R. J., & Van Alphen, S. P. J. (2017). A first step toward integrating schema theory in geriatric psychiatry: a Delphi study. International Psychogeriatrics, 29, 1069–1076.CrossRefGoogle ScholarPubMed
Lockwood, G., & Perris, P. (2012). A new look at core emotional needs. In van Vreeswijk, M., Broersen, J., & Nadort, M. (eds), The Wiley-Blackwell Handbook of ST: Theory, Research and Science (pp. 41–66). Chichester, UK: Wiley-Blackwell.CrossRefGoogle Scholar
Louis, J. P., & Louis, K. M. (2015). Good Enough Parenting: An In-Depth Perspective on Meeting Core Emotional Needs and Avoiding Exasperation. New York, USA: Morgan James Publishing.Google Scholar
Louis, J. P., Wood, A. M., Lockwood, G., Ho, M. H. R., & Ferguson, E. (2018). Positive clinical psychology and Schema Therapy (ST): the development of the Young Positive Schema Questionnaire (YPSQ) to complement the Young Schema Questionnaire 3 Short Form (YSQ-S3). Psychological Assessment, 30, 1199–1213.CrossRefGoogle Scholar
Malogiannis, I. A., Arntz, A., Spyropoulou, A., Tsartsara, E., Aggeli, A., Karveli, S., … & Zervas, I. (2014). Schema therapy for patients with chronic depression: a single case series study. Journal of Behavior Therapy and Experimental Psychiatry, 45, 319–329.CrossRefGoogle ScholarPubMed
Maslach, C., Jackson, S. E., & Leiter, M. P. (2016). Maslach Burnout Inventory Manual (4th edition). Menlo Park, CA, USA: Mind Garden, Inc.Google Scholar
Nadort, M., Arntz, A., Smit, J. H., Giesen-Bloo, J., Eikelenboom, M., Spinhoven, P., … & van Dyck, R. (2009). Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: a randomized trial. Behaviour Research and Therapy, 47, 961–973.CrossRefGoogle ScholarPubMed
Pauwels, E., Claes, L., Dierckx, E., Debast, I., Van Alphen, S. P. J., Rossi, G., … & Peuskens, H. (2014). Age neutrality of the Young Schema Questionnaire in patients with a substance use disorder. International Psychogeriatrics, 26, 1317–1326.CrossRefGoogle Scholar
Phillips, K., Brockman, R., Bailey, P. E., & Kneebone, I. I. (2019). Young Schema Questionnaire-Short Form Version 3 (YSQ-S3): preliminary validation in older adults. Aging and Mental Health, 23, 140–147.CrossRefGoogle ScholarPubMed
Plotkin, D. A. (2014). Older adults and psychoanalytic treatment: it’s about time. Psychodynamic Psychiatry, 42, 23–50.CrossRefGoogle ScholarPubMed
Renner, F., Arntz, A., Peeters, F. P., Lobbestael, J., & Huibers, M. J. (2016). Schema therapy for chronic depression: results of a multiple single case series. Journal of Behavior Therapy and Experimental Psychiatry, 51, 66–73.CrossRefGoogle ScholarPubMed
Renner, F., DeRubeis, R., Arntz, A., Peeters, F., Lobbestael, J., & Huibers, M. J. (2018). Exploring mechanisms of change in schema therapy for chronic depression. Journal of Behavior Therapy and Experimental Psychiatry, 58, 97–105.CrossRefGoogle ScholarPubMed
Rosowsky, E., Young, A. S., Malloy, M. C., Van Alphen, S. P. J., & Ellison, J. M. (2018). A cross-validation Delphi method approach to the diagnosis and treatment of personality disorders in older adults. Aging & Mental Health, 22, 371–378.CrossRefGoogle ScholarPubMed
Rossi, G., Van den Broeck, J., Dierckx, E., Segal, D. L., and Van Alphen, S. P. J. (2014). Personality assessment among older adults: the value of personality questionnaires unraveled. Aging & Mental Health, 18, 936–940.CrossRefGoogle ScholarPubMed
Simpson, S. G., Morrow, E., & Reid, C. (2010). Group schema therapy for eating disorders: a pilot study. Frontiers in Psychology, 1, 182. doi: 10.3389/fpsyg.2010.00182CrossRefGoogle ScholarPubMed
Taylor, C. D., Bee, P., & Haddock, G. (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and Psychotherapy: Theory, Research and Practice, 90, 456–479.CrossRefGoogle ScholarPubMed
Thiel, N., Jacob, G. A., Tuschen-Caffier, B., Herbst, N., Külz, A. K., Hertenstein, E., … & Voderholzer, U. (2016). Schema therapy augmented exposure and response prevention in patients with obsessive-compulsive disorder: feasibility and efficacy of a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 52, 59–67.CrossRefGoogle ScholarPubMed
Van Alphen, S. P. J., Bolwerk, N., Videler, A. C., Tummers, J. H. A., van Royen, R. J. J., Barendse, H. P. J., … & Rosowsky, E. (2012a). Age-related aspects and clinical implications of diagnosis and treatment of personality disorders in older adults. Clinical Gerontologist, 35, 27–41.CrossRefGoogle Scholar
Van Alphen, S. P. J., Derksen, J. J. L., Sadavoy, J., & Rosowsky, E. (2012b). Features and challenges of personality disorders in late life. Aging and Mental Health, 16, 805–810.CrossRefGoogle ScholarPubMed
van Dijk, S. D. M., Veenstra, M. S., Bouman, R., Peekel, J., Veenstra, D. H., van Dalen, P. J., … & Voshaar, R. O. (2019). Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial. BMC Psychiatry, 19, 26.CrossRefGoogle ScholarPubMed
Videler, A. C., Hutsebaut, J., Schulkens, E. M. J., Sobczak, S. & Van Alphen, S. P. J. (2019). A life span perspective on borderline personality disorder. Current Psychiatry Reports, 21, 51. doi: 10.1007/s11920-019-1040-1CrossRefGoogle ScholarPubMed
Videler, A. C., Rossi, G., Schoevaars, M., Van der Feltz-Cornelis, C. M., & Van Alphen, S. P. J. (2014). Effects of schema group therapy in elderly outpatients: a proof of concept study. International Psychogeriatrics, 26, 1709–1717.CrossRefGoogle ScholarPubMed
Videler, A. C., Van Alphen, S. P. J., Rossi, G., Van der Feltz-Cornelis, C. M., Van Royen, R. J. J., & Arntz, A. (2018). Schema therapy in older adults: a multiple baseline case series. Aging and Mental Health, 22, 738–747.CrossRefGoogle Scholar
Videler, A. C., Van der Feltz-Cornelis, C. M., Rossi, G., Van Royen, R. J. J., Rosowsky, E., & Van Alphen, S. P. J. (2015). Psychotherapeutic treatment levels of personality disorders in older adults. Clinical Gerontologist, 38, 325–341.CrossRefGoogle Scholar
Videler, A. C., Van Royen, R. J. J., & Van Alphen, S. P. J. (2012). Schema therapy with older adults: call for evidence. International Psychogeriatrics, 7, 1186–1187.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
Wood, A., & Johnson, J. (2016). The Wiley Handbook on Positive Clinical Psychology. Chichester, UK: Wiley-Blackwell.Google Scholar
Young, J. E. (2005). Young Schema Questionnaire-Short Form 3 (YSQ-S3). New York, NY, USA: Cognitive Therapy Centre.CrossRefGoogle Scholar
Young, J. E., & Brown, G. (1994). Young Schema Questionnaire. In Young, J. E. (ed), Cognitive Therapy for Personality Disorders: A Schema-Focused Approach (2nd edn, revised) (pp. 63–76). Sarasota, FL, USA: Professional Resource Press.Google Scholar
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. New York, USA: Guilford Press.Google Scholar
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