[Effect of schema-focused therapy on depression, anxiety and maladaptive cognitive schemas in the elderly]

Abstract

Introduction: Depression is one of the most frequent mental disorders in older people, known to increase rates of disability and mortality. Depression in late life, commonly accompanied by multiple medical illnesses, reduces quality of life and is a strong risk factor for suicide. Despite its clinical significance, depression remains underdiagnosed and inadequately treated in older patients. Cognitive-behavioural psychotherapies have the most empirical support in treating late-life depression, and are recommended by numerous guidelines in this indication. Group interventions are also recommended for older adults because they offer peer support, mitigate social isolation, encourage shared empathy and provide a context for peer feedback help from the group. Previous studies have shown that maladaptive schemas have an important role in the development or maintenance of depression and anxiety in older people, either as risk factors or as vulnerability markers, but there are no studies that have examined the effectiveness of schema-focused therapy to improve depression in late life.

Objectives: The main goals of the present study were to explore the relationship of maladaptive schemas with depression and anxiety severity in aged inpatients, and to evaluate the efficacy of a cognitive-behavioural individual and group treatment program that includes schema-focused therapy on depression, anxiety, and cognitive schemas activation.

Methods: The sample consisted of aged depressed inpatients (n=51) treated in a psychiatric unit. Participants completed measures of depression (Geriatric Depression Scale [GDS]) and anxiety (State-Trait Anxiety Inventory [STAI]) severity and maladaptive schemas (Cognitive Inventory of Subjective Distress [CISD]) at pre- and post-intervention (mean hospital stay: 4weeks).

Results: The maladaptive schemas Loss of Individuality, Refusal of Assistance and Vulnerability are more activated in our sample of depressed subjects with regard to the reference population. Most of specific maladaptive schemas (except Fear of Losing Control) were significantly correlated to depression and anxiety-state severity. The GDS and the STAI scores, and the activation of five of seven maladaptive schemas measured by the CISD decreased significantly after treatment.

Discussion: This study confirms the results of previous research and shows that specific maladaptive schemas are related to depression and anxiety severity in clinically depressed aged patients. Contrary to other previous studies, we find that the activation of maladaptive schemas can decrease during a group psychotherapeutic program that includes schema-focused therapy. These findings support the feasibility of individual and group schema-focused therapy to assist older people suffering from depression effectively.

Keywords: Depression; Dépression; Elderly people; Group psychotherapy; Maladaptive cognitive schemas; Schema-focused therapy; Schémas cognitifs inadaptés; Sujet âgé; Thérapie basée sur les schémas; Thérapie de groupe.