van Donzel L, Ouwens M A, van Alphen S P J, Bouwmeester S, Videler A C
GGZ Oost Brabant, Boekel, the Netherlands.
PersonaCura, Clinical Centre of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, the Netherlands.
Contemp Clin Trials Commun. 2021 Jan 30;21:100715. doi: 10.1016/j.conctc.2021.100715. eCollection 2021 Mar.
Schema therapy (ST) is an efficacious psychotherapy for personality disorders (PDs) in adults. The first empirical support for the effectiveness of ST in older adults with cluster C PDs was provided recently. ST partly focusses on the positive, but there is an increasing awareness of imbalance in the ST community because of the emphasis on negative schemas versus attention to positive schemas. Positive schemas may be important vehicles of therapeutic change in psychotherapy with older people, as it may help strengthen the healthy adult mode, and it might also help change a negative life review. Suggestions were made to increase the efficacy and feasibility of ST in older adults, including adjusting the case conceptualisation, modifying the experiential techniques, making use of the patient's wisdom and reactivating positive schemas. The aim of the current study is to investigate the feasibility and effectiveness of adapted individual ST for older adults.
METHODS/DESIGN: A multiple baseline design is used with positive and negative core beliefs as primary outcome measures. Ten older adults (age > 60 years) with cluster C PDs are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying randomly from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions. Symptomatic distress, schema modes, early maladaptive schemas (EMS) and early adaptive schemas (EAS) are secondary outcome measures. PD will be diagnosed before baseline and after treatment phase. EAS are assessed with the Dutch version of the Young Positive Schema Questionnaire (YPSQ).
To the best of our knowledge, this is the first empirical study in which positive schemas are integrated in ST treatment to examine the efficacy of an adapted form of ST for older adults. This is in line with wider developments supporting the integration of positive schema's into ST. It offers the possibility to improve the effectiveness of ST in older adults.
The Netherlands National Trial Register NL8346, registered 1 February 2020.
图式疗法（ST）是一种针对成人人格障碍（PDs）的有效心理治疗方法。最近首次有实证支持ST对患有C类人格障碍的老年人有效。ST部分聚焦于积极方面，但由于强调消极图式而忽视积极图式，ST领域越来越意识到这种不平衡。积极图式可能是针对老年人的心理治疗中治疗性改变的重要载体，因为它可能有助于强化健康的成人模式，也可能有助于改变消极的生活回顾。有人提出了提高ST对老年人的疗效和可行性的建议，包括调整病例概念化、修改体验技术、利用患者的智慧以及重新激活积极图式。本研究的目的是调查针对老年人的适应性个体ST的可行性和有效性。
方法/设计：采用多基线设计，将积极和消极核心信念作为主要结局指标。10名患有C类人格障碍的老年人（年龄>60岁）接受图式疗法治疗，为期一年，每周一次治疗 session。在这个治疗阶段之前是一个基线阶段，基线阶段随机为4至8周。治疗后，有一个为期6个月的随访阶段，每月进行强化 session。症状困扰、图式模式、早期适应不良图式（EMS）和早期适应图式（EAS）是次要结局指标。在基线前和治疗阶段后将诊断人格障碍。使用荷兰版的《青年积极图式问卷》（YPSQ）评估EAS。
据我们所知，这是第一项将积极图式纳入ST治疗以检验适应性ST对老年人疗效的实证研究。这与支持将积极图式纳入ST的更广泛发展趋势一致。它为提高ST对老年人的有效性提供了可能性。
荷兰国家试验注册NL8346，于2020年2月1日注册。
