1. Maladaptive schema in an aging population
Marjolein Legra
Clinical psychologist/ psychotherapist
PhD Student
Expertisecentrum PersonaCura
Specialist in Personality and behavior

2. Contents Short introduction schematherapy
Schema in the elderly; Delphi
Schema structure in the elderly; factor analysis
Ad 2: Schema in the elderly
Are there new schemata during the life course and are they healthy. Links to the attachement theory en development during the life course
Delphy

3. Schema focused therapy
Developed by Dr. Jeffrey Young
Schema therapy integrates elements of cognitive therapy, behavior therapy, object relations and gestalt therapy into one unified, systematic approach to treatment.
Treats personality disorders, chronic depression,  and other difficult individual and couples problems.

4. Definition schema (1) A broad, pervasive theme or pattern
Comprised of memories, bodily sensations, emotions & cognitions
Regarding oneself and one's relationships with others
Developed during childhood or adolescence, and elaborated throughout one's lifetime
Dysfunctional
Source:

5. Definition schema (2)
A schema relates to a basic emotional need of a child which is not met.
Each of the 18 schemas represent specific emotional needs that were not adequately met in childhood or adolescence.
A schema is comfortable and familiar
A schema fights for survival
Source:

6. 18 maladaptive schema Mistrust Abandonment Enmeshment Subjugation
Self-sacrifice
Grandiosity
Vulnaribility
Failure
dependence
Emotional deprivation
Defectiveness
Social isolation
Insufficient selfcontrol
Approval seeking
Punitiveniss
Emotional inhibition
Unrelenting standards
Negativity

7. Schema Modes
Schema Modes are the moment-to-moment emotional states and coping responses that we all experience.  
Often our schema modes are triggered by life situations that we are oversensitive to (our "emotional buttons").  Many schema modes lead us to overreact to situations, or to act in ways that end up hurting us.
Source:

8. Schema modes Child modes Vulnarable child Angry child
Undisciplined child Parent modes
Happy child Punitive parent
Critical parent
Coping modes
Compliant surrender Healthy adult
Detached protector
Overcompensator

9. Treatment Personality disorders are caused by maladaptive schema
Pathology will subside when maladaptive schema are replaced by adaptive schema
Experimental techniques are necesarry
Effectivity studies show promising results, not only for borderline, but also for other PD’s

10. Experiential Techniques
The cognitive way on itself doesn’t work!
You have to approach the affective ways

11. Schemas in an aging population
How do schema manifest itself in an aging population?
What can be said about the evolution of schema during the life course
Can we construct an schema questionnaire for the elderly?
Clinical relevance

12. An example from clinical practice (1) mistrust
The intens belief that eventually everybody is out to get you.
Solution during the life course:
I don’t need nobody
And then you get old and disabled

13. An example from clinical practice (2) grandiosity
The intens belief that one is special and is entitled to special treatment. Others serve to admire you.
Solution during the life course: Outshine and
create an admiring audience.
But then you get old and the catching up by a younger generation takes place

14. Current state of knowledge (SFT)
James;the first to publice
James, I. A. (2003). Working with older people: implications for schematherapy. Clinical Psychology and Psychotherapy, 10,
Kindnys and colleagues: Chronic depression and anxiety (2013)
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,
Videler and colleagues: group schema therapy (2014);PD’s cluster C (2017); Adaptations in ST for older adults (2017).
Videler, A.C., Rossi, G., Schoevaars, M., van der Feltz-Cornelis, C., & van Alphen, S.P.J. (2014). Effects of schema group therapy in elderly outpatients; a proof of concept study. International psychogeriatrics, 26, Videler, A.C. van Alphen, S.P.J., Rossi, G., van der Feltz-Cornelis, C.M., van Royen, R.J.J., & A. Arntz. e.a. (2017). Schema therapy for personality disorders in older adults: a multiple- baseline study. Aging and Mental Health, Epub ahead of print
Videler, A.C. et al. (2017). Adapting schema therapy for personality disorders in older adults. International Journal of Cognitive Therapy, 10,

15. Current state of knowledge (schemastructure)
Antoine and colleagues:
introducing 3 new schemas;
Loss of Identity
Disengagement
Refusal of assistence
P. ANTOINE C. ANTOINE, R. POINSOT, D. BALIEU. IDENTIFICATION DE SCHÉMAS DE TYPE II CHEZ LE SUJET ÂGÉ. Journal de hérapie Comportementale et Cognitive2007, 17, 1, 14-24
PASCAL ANTOINE1 CHRISTINE ANTOINE2 ROLLON POINSOT3 Détresse du sujet âgé :identification des schémas cognitifs Elderly distress: cognitive schemas identification. Psychol NeuroPsychiatr Vieil 2007 ; 5 (4) :

16. Empirical validation Antoine (2007;2008) Validation of 12 schemata
24 items
N=67 (62-97); Geriatric residence

17. Prof. Dr. Sp.P.J. Van Alphen, PhD
Our research
M.J.H. Legra, PhD student Maastricht University, the Netherlands GGZWNB/ GGZBREBURG
Prof. Dr.F Verhey MD/PhD
Prof. Dr. Sp.P.J. Van Alphen, PhD

18. Delphi Study Are schemas stable or do they vary during the life span?
RESEARCH QUESTIONS
Are schemas stable or do they vary during the life span?
If there is change what are the possible causes of this change.
Legra, M.J.H, Verhey, F.R.J., & Alphen, van S.P.J. (2017) A first step toward integrating schema theory in geriatric
psychiatry: A Delphi study. International Psychogeriatrics, 29,

19. Delphy (4) Findings
Lowering of Defectiveness, Subjugation and Unrelenting standards
Increase of Vulnaribility to harm or disease
Early risen schema are less variable (Emotional deprivation, Mistrust, Social isolation)
Later risen schema are more variable (subjugation, self sacrifice, unrelenting standards and emotional inhibition)
Severity of trauma matters
Schema coping/ Schema triggering

20. Implications for treatment
Schemas are dynamic structures
Heterotypical continuity
Search the life course of schema

21. RESULTS CONFIRMED NOT CONFIRMED Grandiosity Group Together
Mistrust
Abandonment
Self-sacrifice
Vulnaribility
Failure
Dependence
Insufficient selfcontrol
Emotional inhibition
Unrelenting standards
NOT CONFIRMED
Grandiosity
Group Together
Emotional deprivation
Social Isolation
Sociale isolatie en emot depri laadden op 1 factor

22. New schema in the elderly
Antoine adds three schema based on
clinical experience and theoretical assumptions
Loss of Identity
Disengagement
Refusal of assistence
Confirmed in CFA
Theoretisch aangejaagd - Voortkomend uit gedachtes bij CGT bij ouderen met depressie en angst
Avoident attachment style
onderzoeken laten hoge scores op vermijdende hechting zien in de latere levensfases (Chopik,
Edelstein & Fraley, 2013; Consedine & Magai, 2003; Magai e.a., 2001). Mogelijk
weerspiegelt deze stijl een normaal verouderingsproces in een fase waarin terugtrekkende
bewegingen plaatsvinden; met het ouder worden nemen de rollen en de sociale relaties af en
keert men zich meer in zichzelf.

23. Empirical validation in a Dutch sample
Step 1 Reduction of the YSQ items to 80 items (M. Rijkeboer) Step 2 Confirmatory Factor analysis in a nonclinical sample N=240

24. Results Confirmed Enmeshment Emotional deprivation Failure
Vulnaribility
Self sacrifice
Dependence
Social isolation
Not confirmed
Abandonment
Mistrust
Defectiveness
Grandiosity
Insufficient self-control
Subjugation
Emotional inhibition
Unrelenting standards

25. Explanations
Differentiation is too low due to the nonclinical population
Itempool
Manifestation in an elderly population differs from an adult population

26. Current Study From a confirmative to a exploratory approach
using Mokken Scale Analysis
Clinical and nonclinical sample

27. Future research
Informant data versus respondent data; do they correspond?
N=240, nonclinical sample