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.

Systems training for emotional predictability and problem solving in older adults with personality disorders: a pilot study.

BACKGROUND: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults. AIM: The aim was to explore the outcome of STEPPS in older adults with personality disorders. METHOD: In this naturalistic pre- vs post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning. RESULTS: Twenty-four patients, with a mean age of 63.9 years (SD=4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- vs post-treatment decrease of BPD symptoms, with a large effect size (Cohen's d=1.577). Self-control improved significantly and demonstrated a large effect size (r=.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen's d=.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning. CONCLUSIONS: The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed.

Feasibility of the Cognitive Model for Behavioral Interventions in Older Adults with Behavioral and Psychological Symptoms of Dementia.

Objectives: The purpose of this study was to develop an individually tailored, non-pharmacological treatment model, the Cognitive Model for Behavioral Interventions (CoMBI), for patients with Behavioral and Psychological Symptoms of Dementia (BPSD) and comorbid maladaptive personality traits (CMPT), and to explore its feasibility and effectiveness.Methods: CoMBI was developed and implemented in two geriatric psychiatric inpatient wards in the Netherlands. In this single-group pretest-posttest, feasibility study, 40 patients with BPSD and CMPT (M = 73.8, SD = 8.5) were treated with CoMBI. BPSD and CMPT were assessed using informant-based questionnaires. Wilcoxon signed-rank tests and effect size calculations were conducted to determine differences.Results: Wilcoxon signed-rank tests demonstrated a significant decrease of BPSD with medium (r = 0.45) to large (r = 0.56) effect sizes. CoMBI demonstrated high acceptability and compliance by health-care professionals and family members.Conclusions: CoMBI is a feasible treatment model for challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease in challenging behaviors regardless of etiology.Clinical implications: Focusing on personality and associated core needs could have a key role in the non-pharmacological treatment of the elderly with BPSD.

[The Cognitive Model for Behavioural Interventions for older adults with neurocognitive disorders and co-morbid maladaptive personality traits]. / Mediatieve behandeling bij mensen met zowel neuro­cognitieve stoornissen als persoonlijkheids­problematiek.

The starting point of this study is that comorbid maladaptive personality traits (CMPT) influence behavioral and psychological symptoms of dementia (BPSD). The purpose of this study was to develop and investigate the feasibility of the Cognitive Model for Behavioral Interventions (CoMBI). Forty patients with BPSD and CMPT from two geriatric psychiatric departments were treated with CoMBI. Feasibility was assessed through patient flow, compliance to, and acceptability of the treatment for family members and psychiatric nurses. CMPT was assessed using informant-based questionnaires. Change in BPSD was assessed using pre- and posttests. To determine differences in BPSD, Wilcoxon signed rank tests were conducted and effect sizes were computed. Of 312 patients admitted to the geriatric psychiatric wards, 138 patients were found eligible. 64 (46.4%) patients were discharged from the wards before or shortly after the pretest, in 28 (20.3%) cases CoMBI could not be not applied. Eventually, forty (29.0%) patients were included for analysis. Wilcoxon signed rank tests demonstrated a significant decrease of BPSD with medium (r=0.45) to large (r=0.56) effect sizes. CoMBI is highly feasible for treating challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease of challenging behaviors regardless of etiology.

Possible correlations between the deficient affective experience and negative symptoms of psychosis: an exploratory study in (forensic) psychiatric patients.

BACKGROUND: Deficient affective experience (DAE), the affective and perhaps fundamental component of psychopathy, has some resemblance to the core affective disturbances of schizophrenia. There has, however, been little attempt to test relationships between these concepts, but this could be useful because of the high prevalence of schizophrenia among people in forensic mental health services and evidence that the DAE may be a useful predictor of violent behaviour. AIMS: Our primary aim was to explore possible correlations between DAE and negative symptoms of schizophrenia and to test the hypotheses that the DAE would differentiate people with and without personality disorder co-morbidity in a sample with psychosis and, separately, people with main diagnoses of personality disorder or schizophrenia. METHOD: On the basis of an interview and a review of institutional files, DAE total and facet scores were calculated and compared with scores on the negative symptom scale of the Positive and Negative Syndrome Scale among forensic and general psychiatric patients. Partial correlation and rank order coefficients were calculated. RESULTS: We found no correlation between total DAE scores and total negative Positive and Negative Syndrome Scale scores among patients with psychosis, suggesting that the concepts probably do not overlap. Our hypotheses on diagnostic associations with the DAE were partially sustained. DAE scores differentiated psychosis and personality disorder groups but did not differentiate psychosis groups with and without personality pathology. CONCLUSIONS AND IMPLICATIONS: This study, using typical clinical samples, suggested that one aspect of the affective disturbance of schizophrenia has little in common with the deficient emotional experience of psychopath. Measurement of DAE is unlikely to help detect co-morbid personality disorder among people with psychosis, but given our small sample size and the rarity of study in this field, further research would be warranted, perhaps also including a measure of incongruity of affect.