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Objective Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group therapy in which patients with personality disorder are taught emotion and behaviour regulation skills. Since older adults regulate their emotions differently than younger adults, age-specific aspects are suggested to be taken into account in the treatment. Objectives of this study were to determine expert consensus on the applicability of STEPPS for older adults and determine which adjustments should possibly be implemented for a better fit for older adults with personality disorder. Method A group meeting involving seven experts, with expertise in psychological therapies with older adults, was held. The Delphi method was applied in order to reach consensus on three main statements regarding the applicability of STEPPS in older adults with personality disorder. Results Most experts (86%) voted against the statement implying the current STEPPS program is applicable for older adults. All experts voted in favour of the statement that adjustments to the STEPPS program at the content level are required. Consensus (≥66.7%) was reached among the experts that adjustments to the STEPPS program are also required at the process level. Conclusions STEPPS is considered to be applicable for older adults with emotion regulation problems and personality disorder but needs adaptations to enhance its feasibility and efficacy in later life.

Objective The aim of this study was to explore the effectiveness of schema therapy(ST) in older adults with borderline personality disorder (BPD). Methods Multiple baseline case series design with five BPD patients, with a mean age of 66. After a baseline phase with random length, patients received weekly ST sessions for a year, followed by follow-up sessions during 6 months. Participants rated the credibility of negative core beliefs weekly; various secondary outcome measures were assessed every 6 months (severity of BPD, early maladaptive schemas, schema modes, personality functioning, maladaptive personality traits, psychological distress and quality of life), and BPD diagnosis was assessed before baseline and after follow-up. Data were analysed with mixed regression analyses and paired t-tests. Results Results revealed that ST led to a significant decrease in credibility of negative core beliefs, with high effect sizes. All participants remitted from their BPD diagnosis. Conclusion This is the first study exploring the effectiveness of ST for BPD in older adults, and it suggests that ST can be a powerful intervention for this group of patients

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment program for patients with borderline personality disorder (BPD). The program was intended to be highly accessible, both for patients and therapists. During STEPPS, patients are taught emotion regulation and behavior management skills. This systematic review synthesizes the current empirical status of STEPPS, focusing on research designs, quality of studies, target groups, protocols, and outcome. We selected 20 studies, with three randomized controlled trials. Patients with BPD, subthreshold BPD, and patients with BPD and comorbid antisocial personality disorder were investigated. One study was conducted in adolescents. There were no studies in older adults. Results demonstrated STEPPS to be associated with reduced BPD symptoms, improved quality of life, decreased depressive symptoms, and decreased negative affectivity. Mixed results were found for impulsivity and suicidal behaviors. STEPPS has both been studied as an add-on therapy to patients' ongoing treatment, and, with the addition of individual STEPPS sessions, as a stand-alone treatment. High attrition rates were found in patients attending STEPPS, complicating the generalizability of the results. Although the evidence for STEPPS is promising, further research is needed before firm conclusions can be drawn. Recommendations for future research are discussed.

Objective Genetic vulnerability factors and adverse childhood experiences (ACE) are associated with an increased risk of psychopathology and other adverse health outcomes across the lifespan. However, less is known about how childhood experiences of parental mental illness affect psychological and physical wellbeing in adulthood. This review synthesizes research on the consequences of growing up as a child of a parent with mental illness (COPMI) for adult psychological and physical wellbeing. Methods A systematic review was conducted following PRISMA guidelines using a mixed-method-studies approach to enable evaluation of the broad array of research designs (Prospero registration #CRD42020221983). Results Qualitative studies (k = 10; N = 361) revealed that a COPMI background is associated with substantial psychological challenges in adulthood. Quantitative studies (k = 21; N = 865.402) suggested that COPMI are at increased risk of adult psychopathology, including anxiety and depressive disorders, suicidality, somatoform disorders, substance abuse, but also general medical morbidity and mortality. Conclusions Growing up with a mentally ill parent is associated with adverse psychological and physical outcomes in adulthood, but the evidence-base is limited. Longitudinal studies are needed that go beyond establishing genetic and environmental risk factors to further evaluate how a COPMI background influences wellbeing in adulthood and which targeted clinical interventions could be developed.

In tr od uc ti on : Sc he ma th er ap y (S T) is an ef fi ca ci ou s ps y ch ot he r ap y fo r pe r so n al it y di s or de rs (P Ds ) in ad ul ts . Th e fi rs t em pi r i ca l su p po rt fo r th e ef fe c ti ve ne ss of ST in ol de r ad ul ts wi th cl us te r C PD s wa s pr o vi de d re ce nt ly . ST pa rt ly fo cu ss es on th e po s i ti ve , bu t th er e is an in cr ea s in g aw ar e ne ss of im ba l an ce in th e ST co m mu ni ty be ca us e of th e em ph a si s on ne g a ti ve sc he ma s ve r su s at te n ti on to po s i ti ve sc he ma s. Po s i ti ve sc he ma s ma y be im po r ta nt ve hi cl es of th er a pe u ti c ch an ge in ps y ch ot he r ap y wi th ol de r pe o pl e, as it ma y he lp st re ng th en th e he al th y ad ul t mo de , an d it mi gh t al so he lp ch an ge a ne g a ti ve li fe re vi ew . Su g ge s ti on s we re ma de to in cr ea se th e ef fi ca cy an d fe a si bi l it y of ST in ol de r ad ul ts , in cl ud in g ad ju st in g th e ca se co n ce p tu al i sa ti on , mo d i fy in g th e ex pe ri en ti al te ch ni qu es , ma k in g us e of th e pa ti en t' s wi s do m an d re ac ti va t in g po s i ti ve sc he ma s. Th e ai m of th e cu r re nt st ud y is to in ve s ti ga te th e fe a si bi l it y an d ef fe c ti ve ne ss of ad ap te d in di vi d ua l ST fo r ol de r ad ul ts . Me th od s/ de si gn : A mu l ti pl e ba se li ne de si gn is us ed wi th po s i ti ve an d ne g a ti ve co re be li ef s as pr i ma ry ou t co me me a su re s. Te n ol de r ad ul ts (a ge > 60 ye ar s) wi th cl us te r C PD s ar e tr ea te d wi th sc he ma th er ap y, wi th we ek ly se s si on s du r in g on e ye ar . Th is tr ea t me nt ph as e is pr e ce de d by a ba se li ne ph as e va ry in g ra n do ml y fr om 4 to

Background The treatment of borderline personality disorder (BPD) has been examined extensively in adults up to the age of fifty in the past quarter of a century, but there is still a world to discover in treating BPD in older adults. The aim of the study is to investigate the effectiveness of schema therapy in older adults with BPD. Methods/design A multiple baseline design is used in which participants are randomly assigned to baseline length. The primary outcome measure is assessed weekly and consists of the credibility of negative core beliefs. Secondary outcome measures are quality of life, psychological distress, early maladaptive schemas, schema modes, severity of BPD symptoms and meeting the criteria for BPD. Ten older adults (age > 60 years) with BPD are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions. Discussion To our knowledge, this is the first empirical study of the effectiveness of psychotherapeutic treatment for BPD in older adults. Because of the different manifestation of BPD in later life, besides section II DSM-5 criteria, the alternative, dimensional model for personality disorders of DSM-5 is used to assess BPD in older adults.

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Background: Elderly patients with somatic symptom disorder (SSD) put a great burden on the health care delivery system. Cognitive behavioral therapy (CBT) is effective in adults with SSD. However, no studies have been conducted yet into CBT for SSD in later life. Objectives: We explored the feasibility of CBT for SSD in the elderly. Methods: This is a prospective pilot study comparing two outpatient specialty mental health settings for adults (<60 years; n=13) a

Elderly patients with somatic symptom disorder (SSD) put a great burden on the health care delivery system. Cognitive behavioral therapy (CBT) is effective in adults with SSD. However, no studies have been conducted yet into CBT for SSD in later life. We explored the feasibility of CBT for SSD in the elderly. Methods: This is a prospective pilot study comparing two outpatient specialty mental health settings for adults (<60 years; n=13) and for elderly patients (≥60 years; n=9) with SSD. Intervention was 18 structured, protocoled, and supervised CBT sessions. Outcomes were somatic symptoms, pain intensity, pain disability, quality of life, depressive symptoms, and generalized anxiety symptoms. Feasibility of the CBT intervention was explored with self-developed questions, both for the therapists and the patients. Both therapists and elderly patients evaluated the treatment as positive. Somatic symptoms improved significantly in the adult group but not in the elderly group. There was a large, significant decrease in pain intensity and pain disability in elderly patients compared to the adults. Social functioning, vitality, and anxiety symptoms improved significantly in the adults. Presence of chronic medical conditions did not influence these results. This study shows that CBT is feasible as a treatment for SSD in older adults and has encouraging results. Replication in an RCT is warranted.