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Borderline personality disorder: STEPPS improves symptoms.
- Source :
-
Evidence-based Mental Health . Nov2008, Vol. 11 Issue 4, p120-120. 1p. - Publication Year :
- 2008
-
Abstract
- Question: How effective is the STEPPS programme for people with a borderline personality disorder?Patients: 165 people with DSM-IV borderline personality disorder (>=18 years; 83% female). Main exclusions: psychotic or primary neurological disorder; cognitive impairment; substance abuse or dependence; recent suicidal thoughts or self-harm behaviour.Setting: Outpatient setting, Iowa, USA; recruitment 2002-2006. Intervention: Systems Training for Emotional Predictability and Problem Solving (STEPPS) plus usual care or usual care alone (including medication, individual psychotherapy and case management). STEPPS is a manual-based group treatment programme involving psychoeducation, and emotion and behaviour management skills training, delivered in once weekly 2-hour sessions over 20 weeks, which includes education for a friend or relative. Outcomes: Primary outcome: symptoms (Zanarini Rating Scale for Borderline Personality Disorder Affective (ZRS-BPD), a scale which assesses cognitive disturbance, disturbed relationships, and impulsivity). Secondary outcomes: thoughts, feelings and behaviour (Borderline Evaluation of Severity Over Time scale (BESOT)); positive and negative disposition (Positive and Negative Affect Schedule (PANAS)); Beck Depression Inventory (BDI); Symptom Checklist-90-Revised (SCL90R); Social Adjustment Scale (SAS); Barratt Impulsiveness Scale (BIS); use of medication or other therapies; physician or crisis contact; suicide or self-harm. Outcomes were assessed every 4 weeks during treatment, and every 3 months post-intervention.Patient follow-up:58.2% at 20 weeks, 75.2% included in post-treatment 20 week intention-to-treat (ITT) analysis; 49.7% assessed at least once during 1 year follow-up.METHODSDesign: Randomised controlled trial.Allocation: Unconcealed.Blinding: Unclear.Follow-up period: One year (post-intervention).MAIN RESULTSThe STEPPS intervention plus usual care improved total symptoms at the end of 20 weeks' treatment compared to usual care alone (mean decrease in ZRS-BPD score from baseline: 9.1 with STEPPS vs 3.9 with control; p = 0.001). For secondary outcomes at 20 weeks, the STEPPS group showed significantly greater improvement than controls on global functioning and depression measures (CGI-S and CGI-I, GAS, BDI, SCL90R Global Severity Index), impulsiveness (BIS), negative affect (PANAS), and thoughts and feelings (BESOT). The primary outcome (ZRS-BPD) was not reported over post-intervention follow-up; there were no significant differences between treatment groups in changes in any of the secondary outcome scales from the end of treatment to one year follow-up. Emergency department visits were significantly less frequent with STEPPS compared to control (visits in an average of: 0.97 months per year with STEPPS vs 1.53 months per year with control, p = 0.04).CONCLUSIONSSTEPPS plus treatment as usual for people with borderline personality disorder, can improve symptoms, behaviour and global functioning across a range of scales. Outcomes remain relatively stable after 1 year. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 13620347
- Volume :
- 11
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Evidence-based Mental Health
- Publication Type :
- Academic Journal
- Accession number :
- 105583820
- Full Text :
- https://doi.org/10.1136/ebmh.11.4.120