New therapy for elderly people with a personality disorder

People over 60 with a personality disorder, such as narcissism or borderline, did not yet have good therapy. Now, good therapy is there, thanks to research by scientists at the University Center for Psychiatry (UCP). The scientists put together a combination therapy: schema therapy, along with therapy in a gymnasium, all in the form of group sessions. The UCP now offers combination therapy, to help people over 60 with their personality disorder.

'A personality disorder sometimes only emerges at a later age,' says lead researcher and healthcare psychologist Martine Spruit-Veenstra. 'This can be due to a major life change, such as retirement or the loss of a partner. That personality disorder was not visible before the major change, because the patient's situation suppressed it, as it were.' 

Combination therapy helps 

The scientists found that the combination therapy helps better than current care: conversations with nurses or psychologists. Previous research already showed that schema therapy improves the mental health of people under the age of 60. During the study, Spruit-Veenstra saw that the participants had fewer mental health complaints after the combination therapy.  

Changing behavioral patterns

In group schema therapy, psychologists talk with a group of patients about ingrained behavioral patterns of the patients, also known as 'schemas'. With schema therapy, patients learn to recognize and adjust their behavioral patterns. During the study, the patients went to a gymnasium after the group schema therapy session. Here they did exercises to learn to better recognize and change their schedules. Spruit-Veenstra says that through this combination therapy, patients recognize what they are up against as a result of their personality disorder. 'As a result, the participants in the study were able to reflect on it with the psychologist'.  

Assignments in the gym

During the group assignments in the gymnasium, participants found out how they and other participants reacted to each other, for example when they had to keep a ball in the air with a parachute. According to Spruit-Veenstra, this gave participants a lot of personal insights. 'Participants were also allowed to act out their problems with materials in the gymnasium. For example, one participant wrapped ropes around her body, as if she was trapped by her dependency disorder. The assignment allowed the participant to express herself better than just with words.' 

Personality disorders 

Patients with personality disorders can sometimes react thoughtlessly and quickly, be very precise, or hesitate about everything. According to the researchers, this can hinder patients and the people around them. Spruit-Veenstra: 'It can sometimes be difficult for someone with a personality disorder to enter into or maintain relationships.' 

Being together physically is important 

The scientists also discovered that being physically together is important for the combination therapy to succeed. According to Spruit-Veenstra, this happened to come to light because of the  corona measures: 'The last participants started the therapy in February 2020. A month later, the first corona measures were introduced, and these participants were no longer allowed to meet physically.' According to her, the 'corona participants' achieved less success from the combination therapy than the participants who were allowed to get together. 

Combination therapy at the UMCG 

Since the combination therapy was successful during the study, the UCP and other institutions are now offering it for patients. Spruit-Veenstra says she thinks even more psychiatrists and psychologists will start offering the combination therapy, so that many more patients in the Netherlands can receive this help.   


Collaborations within this research 

The UCP conducted this research together with other geriatric medicine departments and seven mental health care institutions throughout the Netherlands. Five of these institutions are members of the Rob Giel Research Center of the University Center for Psychiatry; a regional partnership that has focused on applied research in mental health care in the North and East of the Netherlands, since 2001. 

The results of the study were published in The Lancet.