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This study aims to perform a quantitative synthesis of research literature yielding empirical evidence of the efficacy of System Training for Emotional Predictability and Problem Solving (STEPPS; Blum, Bartels, John and Pfohl, 2002) in the treatment of Borderline Personality Disorder (BPD). A search in the SCOPUS and PsychInfo databases yielded 7 studies (4 longitudinal, «open label» and 3 RCT), which provided data concerning the efficacy of STEPPS in reducing BPD symptom severity, as well as in reducing self-report depressive and general psychiatric symptoms. Although heterogeneity statistics were highly significant, cumulative effect size estimates (Cohen d) evidence high efficacy of STEPPS in reducing the severity of both self-reported (dw= 0.91) and observer-rated (dw= 1.24) BPD symptoms, as well as self-reported depressive symptoms (dw= 0.89); STEPPS showed moderate cumulative efficacy in reducing self-reported general psychiatric symptoms (dw= 0.65). Although the number of available studies on STEPPS efficacy was at best moderate, the results of our meta-analysis support the clinical utility of STEPPS in treating BPD.

ObjectiveDespite the common opinion about the difficulty of treating patientswith personality disorders, significant research data support the efficacyof different techniques of treatment, both cognitive-behaviouraland dynamic. The aim of our preliminary study is to analyzethe effectiveness of the model of STEPPS group therapy (SystemsTraining for Emotional Predictability and Problem Solving) in a sampleof inpatients with personality disorders comorbid with mooddisorders, using a longitudinal design with a 6-month follow-up.MethodsOur sample included 20 inpatients with BPD or prominent BPDfeatures comorbid with mood disorders, as assessed with theSCID-II. Outcome measures were the number of self-destructivebehaviours and hospitalizations during the STEPPS treatmentand 6 months after the end of therapy.All patients completed a self-report questionnaire (Filter Questionnaire)to identify distorted thoughts before starting therapy,at the end of treatment and 6 months later. During treatment,patients were asked to fill-out a daily diary (EIC) to assess theiremotional reactions. Our aims were to monitor emotional intensityover time and to identify their key triggers and how tomanage emotional crises.ResultsNine of the 20 subjects (45%) included in the sample completedSTEPPS: drop-out rate was 55%. There were no significantdifferences in number of hospitalizations and self-destructivebehaviours between subjects who completed the program andsubjects who dropped-out. The presence of more Histrionic(U = 23.5, p < .01) and Passive-Aggressive (U = 32.5, p < .05)traits was the only significant difference between the two groups.Patients who completed the program showed a significant andprogressive decrease in the number of self-destructive behaviours(χ2 = 11.47, p < 0.01) and hospitalizations (χ2 = 16.85,p < 0.001).Friedman test showed a significant decrease of “Distrust” overtime (χ2 = 7.68, p < 0.05) and a significant decrease of EICscores over time (χ2 = 58.71, p < .005).ConclusionsDespite the small sample and the lack of a control group, ourpreliminary results could suggest that STEPPS is effective inreducing the number of self-destructive behaviours and hospitalizationsand that these results may be stable also at followup.The score reduction on “Distrust” at the 6-month followupmay indicate that STEPPS decreases pessimistic expectationsabout self and others and that it mobilizes resourcesand skills that patients are able to rely on even after the endof the group treatment. The trend of EIC shows that also theperceived emotional intensity in relation to distressing eventsdecreases over time.

In this study we present a clinical application of the STEPPS model in an Italian sample of severely affected patients with borderline personality disorder (BPD) or personality disorder (PD) with prominent borderline features in comorbidity with a mood disorder. The aims of this work are: 1) to confirm our preliminary results in a larger sample and at a 12-month follow-up, and 2) to identify predictors of drop-out vs completion of STEPPS in order to understand which characteristics of patients make them suitable or not for this treatment. The sample is composed of 32 subjects recruited from a population of inpatients of the Mood Disorders Center, Department of Clinical Neurosciences, Hospital San Raffaele-Turro, Milan. To confirm STEPPS efficacy at 12-month follow-up, we selected the following outcome criteria: reduction in the number of hospitalizations related to self-harm acts; reduction in the number of suicidal attempts; reduction of perceived emotional intensity levels; changes in cognitive filter scores; changes in the scores on self-report questionnaires. To identify predictors of drop-out vs completion, we analysed the following variables: demographic features (sex, marital status, school level achieved, and job status); Axis-I diagnosis; Axis-II categorical and dimensional diagnosis; and personality features. Seventeen (53%) subjects completed the treatment successfully. The drop-out rate was 47%. Patients who completed the program show a significant decrease in the number of hospitalizations, both at the end of the treatment and at 12-month follow-up. Friedman ANOVA test shows a significant decrease in suicidal attempts during and after STEPPS, and at 12-month follow-up. Analysis of drop-outs showed no significant differences with regard to sex, marital status, school level and job status between the two groups. Axis-I and Axis-II categorical diagnoses did not discriminate between the two groups. Those patients who dropped differ significantly from completers in histrionic personality traits and magical thinking index, given by the interaction between low scores in Self-Directedness and high scores in Self-Transcendence.