STEPPS: Systems Training for Emotional Predictability and Problem Solving in women offenders with borderline personality disorder in prison--a pilot study

Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder: A systematic review

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.

Effectiveness of Nonsuicidal Self-Injury Interventions among Incarcerated Women in Correctional Facilities and Secure Settings: An Integrative Review

Nonsuicidal self-injury (NSSI) is prevalent among incarcerated women in correctional facilities. This poses a challenge in selecting appropriate intervention. This integrative review aimed to identify effective interventions for managing NSSI among incarcerated women. Whittemore and Knafl's framework for integrative reviews was used, and eight databases were searched with 11 papers meeting the inclusion criteria. Six interventions for NSSI for incarcerated women were identified as promising in reducing the rate of NSSI. Data did not support the effectiveness of gender-specific interventions for incarcerated women. There is a need for further research to identify appropriate interventions to target NSSI among incarcerated women.

Investigating Effectiveness and Predicting Outcome and Dropout From Systems Training for Emotional Predictability and Problem Solving for Emotional Intensity Difficulties (STEPPS EI) in UK Primary Care

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder (BPD) has been adapted for a primary care setting into a 13-week group treatment for emotional intensity difficulties (STEPPS EI). This is the first study to examine the effectiveness and potential outcome and dropout predictors of STEPPS EI in a primary care setting. Severity of BPD, depression, and anxiety symptoms were measured pre- and postintervention for 148 participants. Treatment completers showed improvements in depression, anxiety, and BPD symptoms with medium to large effect sizes. A predictor of symptom improvement was higher baseline severity for each of the symptom measures. Attending a psychoeducational group prior to STEPPS EI was associated with lower odds of dropout. The findings support the use of STEPPS EI in a primary care setting, with the potential to alleviate the burden from other local services.

Does response to the STEPPS program differ by sex, age, or race in offenders with borderline personality disorder?

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is an evidence-based group treatment program for ambulatory patients with borderline personality disorder (BPD). The program was introduced to the Iowa correctional system in 2005, and groups have been ongoing ever since. In this analysis, we examine whether response to the STEPPS program differs based on sex, age (<40/≥40 years), or race/ethnicity (minority/non-minority) using data collected in Iowa prisons and in community corrections. Subjects were recruited and assessed by correctional staff. Offenders with BPD were offered the opportunity to participate in the STEPPS program. The presence of BPD was assessed using a module from the Structured Interview for DSM-IV Personality. Efficacy assessments included the Borderline Evaluation of Severity Over Time Scale, the Beck Depression Inventory, and the Positive and Negative Affectivity Scale. The Client Satisfaction Questionnaire-8 assessed program satisfaction. Data on 77 offenders were analyzed. All participated in the STEPPS program and 53% completed all 20 weeks. The analysis showed that there were no significant differences in response to STEPPS in terms of sex, age, or race/ethnicity on any of the three efficacy measures. Women expressed greater satisfaction than men, but there were no differences with regard to age or race/ethnicity. The implications of the findings are discussed.

Do people with borderline personality disorder complicated by antisocial personality disorder benefit from the STEPPS treatment program?

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for persons with borderline personality disorder (BPD). We describe results from two data sets on outcome in persons who participated in STEPPS with BPD alone or BPD plus antisocial personality disorder (ASPD). In Study 1, we examined the effect of comorbid ASPD on outcome in 65 persons with BPD who participated in a randomized controlled trial at an academic medical centre. In Study 2, we examined the effect of comorbid ASPD on outcome in 64 offenders with BPD who participated in STEPPS in correctional settings. All subjects were assessed for the presence of BPD and ASPD. In Study 1, subjects with ASPD experienced greater improvement in BPD symptoms, impulsiveness and global symptoms. In Study 2, offenders with ASPD experienced greater improvement in positive and negative behaviours and positive affectivity. We conclude that persons with BPD plus ASPD benefit from STEPPS in community and correctional settings. The findings suggest that persons with BPD plus ASPD show greater improvement in some domains than persons with BPD only. People with ASPD should not be automatically excluded from participation in the program. Copyright © 2015 John Wiley & Sons, Ltd.

[Dialectical behavior therapy : a review of studies on skills training groups and applications in psychiatric settings]

Patients suffering from borderline personality disorder (BPD) represent a substantial proportion of hospitalized and outpatient patients in psychiatry. They use up to 40% of mental health resources. Dialectical behavioral therapy (DBT) is one of the best studied treatment for this population. Unfortunately, its deployment in Quebec remains quite limited partly because resources are lacking to provide individual therapy and a response to emergency calls. Although the complete package, as originally studied, is not widely available, several psychiatric departments offer skills training groups for patients with BPD. This article aims to provide a brief overview of the DBT model, review studies on DBT groups and some existing adaptations to the original model. The author will also present the model used in two psychiatric settings, the Centre de Santé et Services Sociaux du Sud de Lanaudière and Pavilion Albert-Prévost, as well as the adaptations in the context of transfers to community health settings.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) group treatment for offenders with borderline personality disorder

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a manual-based group treatment of persons with borderline personality disorder (BPD). We report results from a study of offenders supervised by the Iowa Department of Corrections. Seventy-seven offenders participated in STEPPS groups. The offenders experienced clinically significant improvement in BPD-related symptoms (d = 1.30), mood, and negative affectivity. Suicidal behaviors and disciplinary infractions were reduced. Baseline severity was inversely associated with improvement. The offenders indicated satisfaction with STEPPS. We conclude that STEPPS can be successfully integrated into the care of offenders with BPD in prison and community corrections settings.

Psychotherapy for personality disorders

Personality disorders are widely prevalent among those seeking mental health services, resulting in substantial distress and a heavy burden on public assistance and health resources. We conducted a qualitative review of randomized controlled trials (RCTs) of psychosocial interventions for personality disorders. Articles were identified through searches of electronic databases and classified based on the focus of the psychological intervention. Data regarding treatment, participants and outcomes were identified. We identified 33 RCTs that evaluated the efficacy of various psychosocial treatments. Of these studies, 19 focused on treatment of borderline personality disorder, and suggested that there are several efficacious treatments and one well-established treatment for this disorder. In contrast, only five RCTs examined the efficacy of treatments for Cluster C personality disorders, and no RCTs tested the efficacy of treatments for Cluster A personality disorders. Although other personality disorders, especially Cluster A, place heavy demands on public assistance, and in spite of recommendations that psychosocial interventions should be the first line of treatment for these disorders, our review underscored the dearth of treatment research for many of these personality disorders. We highlight some obstacles to such research and suggest directions for future research.

Treatment completion in psychotherapy for borderline personality disorder: a systematic review and meta-analysis

OBJECTIVE

Psychotherapy for borderline personality disorder (BPD) has been associated with problematically low treatment completion rates.

METHOD

PsycInfo and Medline were systematically searched to identify studies providing information on treatment completion in psychotherapy models that have been shown to be effective for BPD. A meta-analysis of treatment completion rates and a narrative analysis of factors predicting dropout were conducted.

RESULTS

Forty-one studies were included, with completion rates ranging from 36% to 100%- a substantial between-study heterogeneity. Random effects meta-analyses yielded an overall completion rate of 75% (95% CI: 68-82%) for interventions of <12 months duration, and 71% (95% CI: 65-76%) for longer interventions. Egger's test for publication bias was significant for both analyses (P ≤ 0.01). Study characteristics such as treatment model and treatment setting did not explain between-study heterogeneity. In individual studies, factors predicting dropout status included commitment to change, the therapeutic relationship and impulsivity, whilst sociodemographics were consistently non-predictive.

CONCLUSION

Borderline personality disorder should no longer be associated with high rates of dropout from treatment. However, the substantial variation in completion rates between studies remains unexplained. Research on the psychological processes involved in dropping out of treatment could further improve dropout rates.

The effectiveness of cognitive behavioral therapy for personality disorders

This article provides a comprehensive review of cognitive behavioral therapy (CBT) treatments for personality disorders (PDs), including a description of the available treatments and empirical support, drawing on research published between 1980 and 2009. Research generally supports the conclusion that CBT is an effective treatment modality for reducing symptoms and enhancing functional outcomes among patients with PDs, thereby making it a useful framework for clinicians working with patients with PD symptomatology. There is a clear need, however, to develop and evaluate CBT in order to provide specific and more unambiguous treatment recommendations with particular relevance for understudied PDs.

A randomized controlled trial of a Dutch version of systems training for emotional predictability and problem solving for borderline personality disorder

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for persons with borderline personality disorder (BPD) that is relatively easy to implement. We investigated the efficacy of a Dutch version of this treatment (VERS). Seventy-nine DSM-IV BPD patients were randomly assigned to STEPPS plus an adjunctive individual therapy, or to treatment as usual. Assessments took place before and after the intervention, and at a 6-month follow-up. STEPPS recipients showed a significantly greater reduction in general psychiatric and BPD-specific symptomatology than subjects assigned to treatment as usual; these differences remained significant at follow-up. STEPPS also led to greater improvement in quality of life, especially at follow-up. No differences in impulsive or parasuicidal behavior were observed. Effect sizes for the differences between the treatments were moderate to large. The results suggest that the brief STEPPS program combined with limited individual therapy can improve BPD-treatment in a number of ways.