Integrating personalized experience sampling methodology in schema therapy for late-life depression and comorbid...

Case conceptualization is essential to provide a holistic and person-tailored working theory for psychotherapy. The objective of this study was to illustrate the way how personalized Experience Sampling Method (ESM) can support this process by systematically monitoring daily-life experiences and providing structured feedback during schema therapy in later life.

A mixed-method case illustration of a patient in her seventies diagnosed with a recurrent depressive disorder and avoidant personality disorder, whose schema therapy had stalled. During eight weeks of schema therapy in an outpatient clinic for geriatric mental health care, she completed a personalized ESM diary assessing momentary affect (e.g., sadness), activities, (social) context, core beliefs, and coping strategies five times daily, tailored to her case-conceptualization and treatment goals. Feedback was delivered in three sessions via interactive reports visualizing ESM data trajectories, person-specific network graphs, and contextual notes.

The patient completed 228/235 (97%) ESM assessments during six weeks and five days. Feedback sessions focused on 1) sadness, showing a reactive pattern to psychosocial stressors; 2) energy and physical activity, in relation to somatic complaints and mood; and 3) restlessness, which partially improved but persisted as a residual symptom. Evaluation of the collaborative feedback sessions with patient, therapist and researcher showed enhanced shared understanding of psychiatric complaints and more informed therapeutic decision-making.

Integrating personalized ESM and ESM-based feedback in schema therapy appears feasible in later life, fostering awareness, insight, and self-management in patients. Systematic self-monitoring of complex symptom dynamics may complement case-conceptualization in psychotherapy.