ABSTRACT
OBJECTIVE: To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group training for adolescents with borderline personality disorder (BPD) symptoms. METHOD: One hundred nine adolescents with borderline traits (73% meeting the full criteria for BPD) were randomized to treatment as usual only (TAU) or ERT + TAU. Outcome measurements included severity of BPD symptoms, general psychopathology, and quality of life. Multilevel analyses were conducted on an intent-to-treat basis. Clinical significant change was determined by normative comparisons on a primary outcome measurement. RESULTS: Independent of treatment condition, the two groups improved equally on the severity of BPD symptoms, general psychopathology, and quality of life. Nineteen percent of the ERT group was remitted according to the cutoff score after treatment (at 6 months) versus 12% of the control group. Follow-up assessments in the ERT group at 12 months showed some further improvement (33% remittance). With regard to predictors of outcomes, adolescents with higher levels of depression or attention-deficit/hyperactivity disorder or oppositional-defiant disorder at baseline and who reported a history of abuse had worse outcomes, regardless of treatment condition. The attrition rate for the ERT sessions was remarkably low (19%). CONCLUSIONS: Early interventions for BPD symptoms in adolescence are feasible and necessary. No additional effect of ERT over TAU could be demonstrated in the present study. There is a clear need for developing effective interventions for adolescents with persistent BPD symptomatology. Clinical trial registration information-Evaluation of Group Training for Adolescents (Emotion Regulation Training) with Emotion Regulation Problems: A Randomized Controlled Clinical Trial; http://trailregister.nl/; ISRCTN97589104.
Subject(s)
Affective Symptoms , Behavior Control , Borderline Personality Disorder , Psychotherapy/methods , Adolescent , Affective Symptoms/etiology , Affective Symptoms/psychology , Affective Symptoms/therapy , Attention Deficit Disorder with Hyperactivity/complications , Attention Deficit and Disruptive Behavior Disorders/complications , Behavior Control/methods , Behavior Control/psychology , Borderline Personality Disorder/complications , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/psychology , Borderline Personality Disorder/therapy , Child , Depression/complications , Female , Humans , Male , Psychiatric Status Rating Scales , Quality of Life , Treatment OutcomeABSTRACT
Emotion Regulation Training (ERT) was developed for adolescents with symptoms of borderline personality disorder (BPD) and emotion dysregulation. ERT is an adaptation of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme. This paper describes the background of the programme, and gives an outline of the treatment programme. The effectiveness of ERT was examined in a randomized controlled pilot study with 43 youth (aged 14-19 years) in five mental health centres in the Netherlands. Subjects were assessed before and after random assignment to ERT plus treatment as usual (TAU) (n = 23) or to TAU alone (n = 20). Outcome measures included assessment of BPD symptoms, locus of control, and internalizing and externalizing behaviour. Both groups showed equal reductions in BPD symptoms over time. The group receiving ERT plus TAU (and not the TAU-only group) had a significant increase in internal locus of control: ERT participants reported more sense of control over their own mood swings, and attributed changes in mood swings not only to external factors. The study was complicated by a high attrition. The implications of the findings are discussed, including the difficulties inherent in treating and researching an adolescent population, and the need for researchers to develop age-appropriate assessments.
