Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T15:02:43.542Z Has data issue: false hasContentIssue false
  • English
  • Français

A first step toward integrating schema theory in geriatric psychiatry: a Delphi study

Published online by Cambridge University Press:  10 April 2017

M. J. H. Legra ,
F. R. J. Verhey  and
S. P. J. van Alphen
M. J. H. Legra*
Affiliation:
GGZWNB, Bergen op Zoom, the Netherlands
F. R. J. Verhey
Affiliation:
Alzheimer Center Limburg/School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
S. P. J. van Alphen
Affiliation:
Department of Clinical and Lifespan Psychology, Free University of Brussels (VUB), Brussels, Belgium Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen-Maastricht, the Netherlands
*
Correspondence should be addressed to: Mrs. Dr M.J.H. Legra, GGZWNB, Rooseveltlaan 148, 4624 DE Bergen op Zoom, the Netherlands. Phone: +31164289777. Email: m.legra@ggzwnb.nl.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Schematherapy (ST) is an effective therapy for personality disorders (PD's) in adults, however, empirical research into ST in older adults is limited. The manifestation of schemas over the life course is unclear. Besides, long-term patterns of schemas in old age and whether schemas change during the aging process remain unknown.

Methods:

We performed a Delphi study involving a group meeting of nine experts in the field of ST in older adults.

Results:

Full consensus was achieved that schemas vary later in life, and that this is due to biopsychosocial factors. The concepts of schema triggering (the chance that a maladaptive schema is activated) and schema coping (the psychological and behavioral effort a person makes to minimize the stress that comes with the schema) in the past are important in clinical practice. Understanding how schemas are triggered during the life course and how patients deal with their schemas throughout life will help the therapist to complete the diagnostic puzzle in older individuals and to choose appropriate interventions.

Conclusion:

Schemas are flexible and dynamic constructs that can fade or intensify due to multiple factors. This study is a first step toward advancing the state of knowledge regarding schema theory in an aging population. The results will contribute to improvements in ST in older adults by developing an understanding of the plasticity of schemas during the life course.

Keywords

psychotherapyschema therapyolder adultspersonality disordersDelphi technique
Type
Review Article
Information
International Psychogeriatrics , Volume 29 , Issue 7 , July 2017 , pp. 1069 - 1076
Copyright
Copyright © International Psychogeriatric Association 2017 

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.)

References

American Psychiatric Association (2013). Diagnostical and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Publishing.Google Scholar
Antoine, P., Antoine, C. and Poinsot, R. (2007a). Détresse du sujet âgé :identification des schémas cognitifs. Psychologie & Neuropsychiatrie Vieillisement, 5, 305–314.Google Scholar
Antoine, P., Antoine, C., Poinsot, R. and Balieu, D. (2007b). Identification de schémas de type II chez le sujet âgé. Journal de Thérapie Comportementale et Cognitive, 17, 14–24.Google Scholar
Antoine, P., Antoine, C. and Nandrino, J. (2008). Development and validation of the cognitive inventory of subjective distress. International Journal of Geriatric Psychiatry, 23, 1175–1181. doi: 10.1002/gps.2051.Google Scholar
Arntz, A., Klokman, J. and Sieswerda, S. (2005). An experimental test of the schema mode model of borderline personality disorder. Journal of Behavioral Therapy and Experimental Psychiatry, 36, 226–239.Google Scholar
Bamelis, L. L. M., Evers, S. M. A. A., Spinhoven, P. and 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. doi: 10.1176/appi.ajp.2013.12040518.Google Scholar
Debast, I. et al. (2014). Personality traits and personality disorders in late middle and old age: do they remain stable? A literature review. Clinical Gerontologist, 37, 253–271. doi: 10.1080/07317115.2014.885917.Google Scholar
Delbecq, A. L., van de Ven, A. H. and Gustafson, D. H. (1975). Group Techniques for Program Planning: A Guide to Nominal and Delphi Processes. Glenview, IL: Scott, Foresman and Co.Google Scholar
Farrell, J. M., Shaw, I. A. and 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. doi: 10.1016/j.jbtep.2009.01.002.CrossRefGoogle ScholarPubMed
Fink, A., Kosecoff, J., Chassin, M. and Brook, R. H. (1991). Consensus Methods: Characteristics and Guidelines for Use. Santa Monica, CA: RAND.Google 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.Google Scholar
James, I. A. (2003). Working with older people: implications for schematherapy. Clinical Psychology and Psychotherapy, 10, 133–143. doi: 10.1002/cpp.364.Google Scholar
Kindynis, S., Burlacu, S., Louville, P. and Limosin, F. (2013). Effect of schema-focused therapy on depression, anxiety and maladaptive cognitive schemas in the elderly. Encephale, 39, 393–400. doi: 10.1016/j.encep.2013.04.002.Google Scholar
Lee, C. W., Taylor, G. and Dunn, J. (1999). Factor structure of the schema questionnaire in a large clinical sample. Cognitive Therapy and Research, 23, 441–451. doi: 10.1023/A:1018712202933.Google Scholar
Linstone, H. and Turoff, M. (1975). The Delphi Method: Techniques and Applications. Reading, MA: Addison-Wesley.Google Scholar
Pauwels, E. et al. (2014). Age neutrality of the young schema questionnaire in patients with a substance use disorder. International Psychogeriatrics, 26, 1–10. doi: 10.1017/S1041610214000519.Google Scholar
Powell, C. (2003).The Delphi technique: myths and realities. Journal of Advanced Nursing, 41, 376–382.CrossRefGoogle ScholarPubMed
Schema Therapy Institute (c2004). An Integrative Therapy for Personality Change. Retrieved 23 January 2015, Available from http://www.schematherapy.com.Google Scholar
Schmidt, N. B., Joiner, T. E., Young, J. E. and Telch, M. J. (1995). The schema questionnaire; investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemas. CognitiveTherapy and Research, 19, 295–321. doi: 10.1007/BF02230402.Google Scholar
Van Alphen, S. P. J. et al. (2015). Personality disorders in older adults: Emerging research issues. Current Psychiatry Reports, 17, 538–545. doi: 10.1007/s11920-014-0538-9.Google Scholar
Videler, A. C., Rossi, G., Schoevaars, M., van der Feltz, C. and van Alphen, S. P. J. (2014). Effects of a schema group therapy in older outpatients: a proof of concept study. International Psychogeriatrics, 26, 1709–1717. doi: 10.1017/S1041610214001264.CrossRefGoogle ScholarPubMed
Young, J. E., Klosko, J. S. and Weishaar, M. E. (2005). Schemagerichte Therapie. Handboek Voor Therapeuten. Houten: Bohn Stafleu van Loghum.Google Scholar
Young, J. E. (1994). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach, 2nd edn. Sarasota, FL: Profession-al Resource Press.Google Scholar