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Vol. 80, No. 3, 2011
Issue release date: April 2011
Section title: Regular Article
Psychother Psychosom 2011;80:173–181
(DOI:10.1159/000321793)

Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Borderline Personality Problems in a ‘Real-World’ Sample: Moderation by Diagnosis or Severity?

Bos E.H. · van Wel E.B. · Appelo M.T. · Verbraak M.J.P.M.
aLentis and bUniversity Center for Psychiatry, University Medical Center Groningen, Groningen, cDimence Mental Health Care Overijssel, Deventer, and dBehavioral Science Institute, Radboud University, Nijmegen, The Netherlands

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Article / Publication Details

First-Page Preview
Abstract of Regular Article

Received: 3/15/2010
Accepted: 3/10/2010
Published online: 3/9/2011

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: http://www.karger.com/PPS

Abstract

Background: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not meet the DSM-IV criteria for BPD were excluded, which were many. We investigated the effectiveness of STEPPS in a sample representative of routine clinical practice and examined whether DSM-IV diagnosis and/or baseline severity were related to differential effectiveness. Methods: Patients whom their practicing clinician diagnosed with BPD were randomized to STEPPS plus adjunctive individual therapy (STEPPS, n = 84) or to treatment as usual (TAU, n = 84). Results: STEPPS recipients showed more improvement on measures of general and BPD-specific psychopathology as well as quality of life than TAU recipients, both at the end of treatment and at a 6-month follow-up. Presence of DSM-IV-diagnosed BPD was not related to differential treatment effectiveness, but dimensional measures of symptom severity were; STEPPS was superior to TAU particularly in patients with higher baseline severity scores. Conclusions: The findings show the effectiveness of STEPPS in a ‘real-world’ sample, and underscore the importance of dimensional versus categorical measures of personality disturbance.


Article / Publication Details

First-Page Preview
Abstract of Regular Article

Received: 3/15/2010
Accepted: 3/10/2010
Published online: 3/9/2011

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: http://www.karger.com/PPS


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References

  1. Paris J: The nature of borderline personality disorder: multiple dimensions, multiple symptoms, but one category. J Personal Disord 2007;21:457–473.
  2. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR: Prediction of the 10-year course of borderline personality disorder. Am J Psychiatry 2006;163:827–832.
  3. Tyrer P: Temporal change: the third dimension of personality disorder. J Personal Disord 2005;19:573–580.
  4. Mulder R: Is borderline personality disorder really a personality disorder? (editorial). Personal Ment Health 2009;3:85.

    External Resources

  5. Verheul R: Taxonomic implications of three prospective studies on the course and outcome of personality disorders. J Personal Disord 2005;19:581–585.
  6. Linehan MM: Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guilford Press, 1993.
  7. Linehan MM, Dexter-Mazza ET: Dialectical behavior therapy for borderline personality disorder; in Barlow DH (ed): Clinical Handbook of Psychological Disorders. A Step-by-Step Treatment, Manual, ed 4. New York, Guilford Press, 2008, pp 365–420.
  8. Verheul R, Van den Bosch LMC, Koeter MWJ, De Ridder MAJ, Stijnen T, Van den Brink W: Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomized clinical trial in The Netherlands. Br J Psychiatry 2003;182:135–140.
  9. Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999;156:1563–1569.
  10. Giesen-Bloo J, Van Dyck R, Spinhoven P, Van Tilburg W, Dirksen C, Van Asselt T, Kremers I, Nadort M, Arntz A: Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006;63:649–658.
  11. Davidson K, Norrie J, Tyrer P, Gumley A, Tata P, Murray H, Palmer S: The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. J Personal Disord 2006;20:450–465.
  12. Cottraux J, Note ID, Boutitie F, Milliery M, Genouihlac V, Yao SN, Note B, Mollard E, Bonasse F, Gaillard S, Djamoussian D, Mey Guillard C de, Culem A, Gueyffier F: Cognitive therapy versus Rogerian supportive therapy in borderline personality disorder: two-year follow-up of a controlled pilot study. Psychother Psychosom 2009;78:307–316.
  13. Bos EH, van Wel EB, Appelo MT, Verbraak MJPM: A randomized controlled trial of a Dutch version of Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder. J Nerv Mental Dis 2010;198:299–304.
  14. Blum N, St John D, Pfohl B, Stuart S, McCormick B, Allen J, Arndt S, Black DW: Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry 2008;165:468–478.
  15. Black DW, Blum N, Pfohl B, St John D: The STEPPS group treatment program for outpatients with borderline personality disorder. J Contemp Psychother 2004;34:193–210.

    External Resources

  16. van Wel B, Kockmann I, Blum N, Pfohl B, Black DW, Heesterman W: STEPPS group treatment for borderline personality disorder in The Netherlands. Ann Clin Psychiatry 2006;18:63–67.
  17. Howard KI, Moras K, Brill PL, Martinovich Z, Lutz W: Evaluation of psychotherapy: efficacy, effectiveness, and patient progress. Am Psychol 1996;51:1059–1064.
  18. Nathan PE, Stuart SP, Dolan SL: Research on psychotherapy efficacy and effectiveness: between Scylla and Charybdis? Psychol Bull 2000;126:964–981.
  19. Persons JB, Silberschatz G: Are results of randomized controlled trials useful to psychotherapists? J Consult Clin Psychol 1998;66:126–135.
  20. Britton A, McKee M, Black N, McPherson K, Sanderson C, Bain C: Threats to applicability of randomised trials: exclusion and selective participation. J Health Serv Res Policy 1999;4:112–121.
  21. Stirman SW, DeRubeis RJ, Crits-Christoph P, Brody PE: Are samples in randomized controlled trials of psychotherapy representative of community outpatients? A new methodology and initial findings. J Consult Clin Psychol 2003;71:963–972.
  22. Stirman SW, DeRubeis RJ, Crits-Christoph P, Rothman A: Can the randomized controlled trial literature generalize to non-randomized patients? J Consult Clin Psychol 2005;73:127–135.
  23. First MB, Spitzer RL, Gibbon M, Williams JBW, Benjamin LS: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, American Psychiatric Press, 1997.
  24. Verheul R: Clinical utility of dimensional models for personality pathology. J Personal Disord 2005;19:283–302.
  25. Westen D: Divergences between clinical and research methods for assessing personality disorders: implications for research and the evolution of axis II. Am J Psychiatry 1997;154:895–903.
  26. Clark LA: Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization. Ann Rev Psychol 2007;58:227–257.
  27. Tyrer P: The problem of severity in the classification of personality disorder.J Personal Disord 2005;19:309–314.
  28. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision. Washington, American Psychiatric Association, 2000.
  29. Hyler SE: PDQ-4+ Personality Diagnostic Questionnaire. New York, New York State Psychiatric Institute, 1994.
  30. Akkerhuis GW, Kupka RW, Van Groenestijn MAC, Nolen WA: PDQ-4+, Vragenlijst voor persoonlijkheidskenmerken. Utrecht, HC Rümkegroep, 1994.
  31. Weertman A, Arntz A, Kerkhofs MLM: Gestructureerd klinisch interview voor DSM-IV persoonlijkheidsstoornissen (SCID-II). Amsterdam, Swets, 1996.
  32. Arrindell WA, Ettema JHM: SCL-90. Handleiding bij een multidimensionele psychopathologie-indicator. Lisse, Swets & Zeitlinger, 2003.
  33. Giesen-Bloo J, Arntz A, Schouten E: The Borderline Personality Disorder Checklist: psychometric evaluation and factorial structure in clinical and nonclinical samples; in Giesen-Bloo J: Crossing Borders: Theory, Assessment and Treatment in Borderline Personality Disorder. Maastricht, Universitaire Pers, 2006, pp 85–101.
  34. Trompenaars FJ, Masthoff ED, Van Heck GL, Hodiamont PP, De Vries J: Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients. Qual Life Res 2005;14:151–160.
  35. Jacobson NS, Truax P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991;59:12–19.
  36. Zimmerman M: Diagnosing personality disorders. a review of issues and research methods. Arch Gen Psychiatry 1994;47:527–631.
  37. Tyrer P, Coombs N, Ibrahimi F, Mathilakath A, Bajaj P, Ranger M, Rao B, Din R: Critical developments in the assessment of personality disorder. Br J Psychiatry 2007;190(suppl 49):s51–s59.

    External Resources

  38. Black DW, Allen J, St John D, Pfohl B, McCormick B, Blum N: Predictors of response to Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder. Acta Psychiatr Scand 2009;120:53–61.
  39. Regier DA, Narrow WE, Kuhl EA, Kupfer DJ: The conceptual development of DSM-V. Commentary. Am J Psychiatry 2009;166:645–650.
  40. Westen D, Arkowitz-Westen L: Limitations of axis II in diagnosing personality pathology in clinical practice. Am J Psychiatry 1998;155:1767–1771.
  41. van Wel EB, Bos EH, Appelo MT, Berendsen EM, Willgeroth FC, Verbraak MJPM: The efficacy of the Skills training Emotion Regulation Disorder (VERS) in the treatment of borderline personality disorder: a randomized controlled trial. Dutch J Psychiatry 2009;51:291–301.
  42. Mohr DC, Spring B, Freedland KE, Beckner V, Arean P, Hollon SD, Ockene J, Kaplan R: The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychother Psychosom 2009;78:275–284.