Skip to main content

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

  • M. J. H. Legra (a1), F. R. J. Verhey (a2) and S. P. J. van Alphen (a3) (a4)

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.


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


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.


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.

Corresponding author
Correspondence should be addressed to: Mrs. Dr M.J.H. Legra, GGZWNB, Rooseveltlaan 148, 4624 DE Bergen op Zoom, the Netherlands. Phone: +31164289777. Email:
Hide All
American Psychiatric Association (2013). Diagnostical and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Publishing.
Antoine, P., Antoine, C. and Poinsot, R. (2007a). Détresse du sujet âgé :identification des schémas cognitifs. Psychologie & Neuropsychiatrie Vieillisement, 5, 305314.
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, 1424.
Antoine, P., Antoine, C. and Nandrino, J. (2008). Development and validation of the cognitive inventory of subjective distress. International Journal of Geriatric Psychiatry, 23, 11751181. doi: 10.1002/gps.2051.
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, 226239.
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, 305322. doi: 10.1176/appi.ajp.2013.12040518.
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, 253271. doi: 10.1080/07317115.2014.885917.
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.
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, 317328. doi: 10.1016/j.jbtep.2009.01.002.
Fink, A., Kosecoff, J., Chassin, M. and Brook, R. H. (1991). Consensus Methods: Characteristics and Guidelines for Use. Santa Monica, CA: RAND.
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, 649658.
James, I. A. (2003). Working with older people: implications for schematherapy. Clinical Psychology and Psychotherapy, 10, 133143. doi: 10.1002/cpp.364.
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, 393400. doi: 10.1016/j.encep.2013.04.002.
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, 441451. doi: 10.1023/A:1018712202933.
Linstone, H. and Turoff, M. (1975). The Delphi Method: Techniques and Applications. Reading, MA: Addison-Wesley.
Pauwels, E. et al. (2014). Age neutrality of the young schema questionnaire in patients with a substance use disorder. International Psychogeriatrics, 26, 110. doi: 10.1017/S1041610214000519.
Powell, C. (2003).The Delphi technique: myths and realities. Journal of Advanced Nursing, 41, 376382.
Schema Therapy Institute (c2004). An Integrative Therapy for Personality Change. Retrieved 23 January 2015, Available from
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, 295321. doi: 10.1007/BF02230402.
Van Alphen, S. P. J. et al. (2015). Personality disorders in older adults: Emerging research issues. Current Psychiatry Reports, 17, 538545. doi: 10.1007/s11920-014-0538-9.
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, 17091717. doi: 10.1017/S1041610214001264.
Young, J. E., Klosko, J. S. and Weishaar, M. E. (2005). Schemagerichte Therapie. Handboek Voor Therapeuten. Houten: Bohn Stafleu van Loghum.
Young, J. E. (1994). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach, 2nd edn. Sarasota, FL: Profession-al Resource Press.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed