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

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.

Personality Disorders in Late Life

“…In a proof-of-concept study of 31 older outpatients with PD features and/or mood disorders, short-term group schema cognitive behavior therapy was found to improve overall symptomatology, early maladaptive schemas, and psychological distress (Cohen’s d = 0.23–0.54) (Videler et al, 2014). To date, no randomized controlled trials studying schema-focused therapy in older adults exist, though one multicenter randomized controlled trial studying older adults with Cluster B and/or C PDs is in progress (Van Dijk et al, 2019).…”

(Vi)-rushed Into Online Group Schema Therapy Based Day-Treatment for Older Adults by the COVID-19 Outbreak in the Netherlands

“…In geriatric psychiatry, we focus on three (instead of five) most prominent maladaptive schemas to minimize cognitive burden. 8 Treatment is given twice weekly in an open group, with a maximum of 8 patients at the same time over a 20-week period. To maintain a safe treatment environment, treatment adherence is considered mandatory and has been discussed prior to start.…”

Effects of Arts and Psychomotor Therapies in Personality Disorders. Developing a Treatment Guideline Based on a Systematic Review Using GRADE

“…An elaboration of PMT in personality disorders can be found in Drewes et al ( 47 ). A multi-center RCT is taking place to study the effectiveness of schema therapy for older persons with a personality disorder, enriched with PMT arrangements ( 48 , 49 ). A number of relaxation methods are used in PMT, such as functional relaxation ( 50 ), progressive relaxation ( 51 , 52 ), autogenic training of Schulz ( 53 ), training in breathing ( 54 , 55 ).…”

“…For example, Styla ( 77 ) described positive results of treatment programmes for Personality Disorders in which psychodrama was part of the treatment offered. Van Dijk et al ( 49 ) decribe the effect of a group-focused SFT programme enriched with PMT for the elderly. Many more examples can be cited [e.g., ( 78 , 79 )].…”