Integrating Positive Schemas in Schema Therapy for Cluster C Personality Disorders in Older Adults: A Multiple Baseline Study

Abstract

Schema therapy (ST) is an effective psychotherapy for personality disorders in (older) adults. There is an increasing awareness of the imbalance in the ST community because of the emphasis on negative schemas versus attention to positive schemas. This study aimed to evaluate the effectiveness of an adapted ST approach that integrates positive schemas. Using a multiple baseline design, the study assessed 10 older adults (aged > 60) with Cluster C personality disorders through 1 year of weekly individual ST sessions, followed by a 6-month follow-up. Baseline consisted of 4–8 weeks without intervention. Primary outcomes were credibility of positive and negative core beliefs; secondary measures examined symptomatic distress, schema modes, early maladaptive and positive schemas. Results showed mixed individual outcomes. Positive core beliefs significantly improved in 38% of participants during treatment and 50% at follow-up, whereas negative core beliefs decreased significantly for 25% of participants during treatment and 67% at follow-up. At the group level, significant increases with very large effect sizes were observed in positive core beliefs in baseline versus follow-up and reductions in negative beliefs in baseline versus treatment and versus follow-up. Secondary outcomes revealed significant reductions in symptomatic distress and PD criteria, alongside increased positive schemas. No significant changes were found for schema modes or maladaptive schemas. This first study underscores the potential of integrating positive schemas into ST for older adults, suggesting preliminary efficacy. Further research is essential to generalize findings across different age groups and diagnoses and to identify which aspects of positive schemas enhance therapy outcomes.