TY - JOUR
T1 - Group schema therapy combined with psychomotor therapy for older adults with a personality disorder
T2 - an open-label, multicentre, randomised controlled trial
AU - Veenstra-Spruit, Martine S
AU - Bouman, Renske
AU - van Dijk, Silvia DM
AU - van Asselt, Antoinette DI
AU - van Alphen, Sebastiaan PJ
AU - Veenstra, Dorothee H
AU - de Ruiter, Marije
AU - Troost, Saskia E
AU - Lammers, Monique W
AU - Vulker, Frank
AU - Smeets-Janssen, Maureen MJ
AU - van den Brink, Rob HS
AU - Oude Voshaar, Richard C
N1 - Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.
PY - 2024/4
Y1 - 2024/4
N2 - BACKGROUND: Although several types of psychotherapy effectively reduce psychological distress associated with personality disorders, randomised controlled trials (RCT) have systematically excluded older patients. We aimed to examine the effectiveness of group schema therapy combined with psychomotor therapy (GST + PMT) in later life compared with treatment as usual (TAU).METHODS: We did an open-label, multicentre, RCT in eight outpatient clinics for geriatric psychiatry in the Netherlands. Adults aged 60 years or older with a full or subthreshold cluster B or C personality disorder according to DSM criteria were included and randomly assigned 1:1 to GST + PMT or TAU by an independent researcher applying a computer-generated sequence per study site when 8 to 16 patients had given informed consent; investigators and interviewers were kept blinded until end of follow-up. Included individuals received 20 weekly sessions of GST + PMT or TAU with 1 year of follow-up. The primary outcome was psychological distress, measured with the 53-item Brief Symptom Inventory. The trial was registered with International Clinical Trials Registry Platform, NTR6621.FINDINGS: Of the 145 study participants recruited between Feb 21, 2018, and Jan 21, 2020, 102 patients (median age of 69 years [IQR 63-71], 62 [61%] female) who concluded therapy before the COVID-19 pandemic (cutoff March 20, 2020) were included in the intention-to-treat analysis (51 in each study group), because COVID-19 measures substantially disrupted delivery of group therapy. GST + PMT significantly improved psychological distress compared with TAU over the 6-month treatment period (Cohen's d 0·42, 95% CI 0·16 to 0·68; p=0·0016). The pre-post effect of GST + PMT remained stable during follow-up, whereas patients receiving TAU further improved, resulting in a non-significant difference between groups at 1 year (Cohen's d 0·21, 95% CI -0·07 to 0·48; p=0·14). No patients reported adverse events.INTERPRETATION: Psychotherapy focused on personality disorders is effective in later life, resulting in a faster improvement in psychopathology than TAU. Future studies should focus on increasing effectiveness by intensifying or prolonging treatment.FUNDING: Netherlands Organization for Health Research and Development.TRANSLATION: For the Dutch translation of the abstract see Supplementary Materials section.
AB - BACKGROUND: Although several types of psychotherapy effectively reduce psychological distress associated with personality disorders, randomised controlled trials (RCT) have systematically excluded older patients. We aimed to examine the effectiveness of group schema therapy combined with psychomotor therapy (GST + PMT) in later life compared with treatment as usual (TAU).METHODS: We did an open-label, multicentre, RCT in eight outpatient clinics for geriatric psychiatry in the Netherlands. Adults aged 60 years or older with a full or subthreshold cluster B or C personality disorder according to DSM criteria were included and randomly assigned 1:1 to GST + PMT or TAU by an independent researcher applying a computer-generated sequence per study site when 8 to 16 patients had given informed consent; investigators and interviewers were kept blinded until end of follow-up. Included individuals received 20 weekly sessions of GST + PMT or TAU with 1 year of follow-up. The primary outcome was psychological distress, measured with the 53-item Brief Symptom Inventory. The trial was registered with International Clinical Trials Registry Platform, NTR6621.FINDINGS: Of the 145 study participants recruited between Feb 21, 2018, and Jan 21, 2020, 102 patients (median age of 69 years [IQR 63-71], 62 [61%] female) who concluded therapy before the COVID-19 pandemic (cutoff March 20, 2020) were included in the intention-to-treat analysis (51 in each study group), because COVID-19 measures substantially disrupted delivery of group therapy. GST + PMT significantly improved psychological distress compared with TAU over the 6-month treatment period (Cohen's d 0·42, 95% CI 0·16 to 0·68; p=0·0016). The pre-post effect of GST + PMT remained stable during follow-up, whereas patients receiving TAU further improved, resulting in a non-significant difference between groups at 1 year (Cohen's d 0·21, 95% CI -0·07 to 0·48; p=0·14). No patients reported adverse events.INTERPRETATION: Psychotherapy focused on personality disorders is effective in later life, resulting in a faster improvement in psychopathology than TAU. Future studies should focus on increasing effectiveness by intensifying or prolonging treatment.FUNDING: Netherlands Organization for Health Research and Development.TRANSLATION: For the Dutch translation of the abstract see Supplementary Materials section.
KW - Female
KW - Humans
KW - Aged
KW - Male
KW - Schema Therapy
KW - Treatment Outcome
KW - Psychotherapy, Group/methods
KW - Psychotherapy/methods
KW - Personality Disorders/therapy
KW - Randomized Controlled Trials as Topic
U2 - 10.1016/S2666-7568(24)00001-1
DO - 10.1016/S2666-7568(24)00001-1
M3 - Article
C2 - 38555919
SN - 2666-7568
VL - 5
SP - e245-e254
JO - The Lancet Healthy Longevity
JF - The Lancet Healthy Longevity
IS - 4
ER -