Systems Training for Emotional Predictability and Problem Solving (STEPPS): modello di intervento, adattamento clinico e dati preliminari di efficacia in un campione di pazienti ricoverati con diagnosi di disturbo dell’umore e disturbo di personalità

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.