A Randomized Controlled Trial of a Dutch Version of Systems Training for Emotional Predictability and Problem Solving for Borderline Personality Disorder

Bos, Elisabeth H.; Wel, E B van; Appelo, Martin; Verbraak, Marc

doi:10.1097/nmd.0b013e3181d619cf

Cited by 74 publications

(67 citation statements)

References 20 publications

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“…In five trials [33][34][35][36][37], a reliable change index [38] was used to identify whether a proportion of participants had deteriorated. Six trials [39][40][41][42][43][44] used the clinical global impression of improvement (CGI-I) [45], which is a clinician-administered scale ranging from 1 (very much improved) to 7 (very much worse).…”

Section: Accepted M Manuscriptmentioning

confidence: 99%

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

Jönsson

Alaie

Parling

et al. 2014

Contemporary Clinical Trials

141

123

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Section: Accepted M Manuscriptmentioning

confidence: 99%

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

Jönsson

Alaie

Parling

et al. 2014

Contemporary Clinical Trials

141

123

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“…59 (387) 1 (7) 4 (24) 37 (378) 1 (6) 5 (32) 4 (20) Class/group at a leisure centre 3 (18) 8 (70) 2 (12) 2 (12) 24 (252) 5 (50) 4 (37) 4 (39) Adult education class 2 (7) 31 (251) 3 (16) 4 (23) 13 (100) 18 (121) 3 (20) 5 (29) Other day care activity provided by team…”

Section: Health Economics Analysismentioning

confidence: 99%

“…Improvements in secondary outcomes (including GAF, negative affectivity, depression, impulsiveness) and symptoms were also significantly greater for the STEPPS group post treatment but not at the 1-year follow-up. In another RCT, 20 those who completed STEPPS (n = 33) were compared with those who received treatment as usual (n = 33), with no significant group differences in PD or other psychological symptoms at the 6-month follow-up, although the STEPPS group showed a significantly greater improvement in overall quality of life. There are clearly improvements to be made to problem-solving approaches for people with PD in terms of enhancing and sustaining outcomes and, as mentioned, offering a problem-solving approach to people with PDs other than borderline is a more practical prospect.…”

Section: Personality Disordermentioning

confidence: 99%

Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning

McMurran

Crawford

Reilly

et al. 2016

Health Technol Assess

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If effective, less intensive treatments for people with personality disorder have the potential to serve more people.To compare the clinical effectiveness and cost-effectiveness of psychoeducation with problem-solving (PEPS) therapy plus usual treatment against usual treatment alone in improving social problem-solving with adults with personality disorder.Multisite two-arm, parallel-group, pragmatic randomised controlled superiority trial.Community mental health services in three NHS trusts in England and Wales.Community-dwelling adults with any personality disorder recruited from community mental health services.Up to four individual sessions of psychoeducation, a collaborative dialogue about personality disorder, followed by 12 group sessions of problem-solving therapy to help participants learn a process for solving interpersonal problems.The primary outcome was measured by the Social Functioning Questionnaire (SFQ). Secondary outcomes were service use (general practitioner records), mood (measured via the Hospital Anxiety and Depression Scale) and client-specified three main problems rated by severity. We studied the mechanism of change using the Social Problem-Solving Inventory. Costs were identified using the Client Service Receipt Inventory and quality of life was identified by the European Quality of Life-5 Dimensions questionnaire. Research assistants blinded to treatment allocation collected follow-up information.There were 739 people referred for the trial and 444 were eligible. More adverse events in the PEPS arm led to a halt to recruitment after 306 people were randomised (90% of planned sample size); 154 participants received PEPS and 152 received usual treatment. The mean age was 38 years and 67% were women. Follow-up at 72 weeks after randomisation was completed for 62% of participants in the usual-treatment arm and 73% in the PEPS arm. Intention-to-treat analyses compared individuals as randomised, regardless of treatment received or availability of 72-week follow-up SFQ data. Median attendance at psychoeducation sessions was approximately 90% and for problem-solving sessions was approximately 50%. PEPS therapy plus usual treatment was no more effective than usual treatment alone for the primary outcome [adjusted difference in means for SFQ -0.73 points, 95% confidence interval (CI) -1.83 to 0.38 points; p = 0.19], any of the secondary outcomes or social problem-solving. Over the follow-up, PEPS costs were, on average, £182 less than for usual treatment. It also resulted in 0.0148 more quality-adjusted life-years. Neither difference was statistically significant. At the National Institute for Health and Care Excellence thresholds, the intervention had a 64% likelihood of being the more cost-effective option. More adverse events, mainly incidents of self-harm, occurred in the PEPS arm, but the difference was not significant (adjusted incidence rate ratio 1.24, 95% CI 0.93 to 1.64).There was possible bias in adverse event recording because of dependence on self-disclosure or reporting by the clini...

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“…A number of psychological interventions for individuals with BPD have received empirical support in randomized controlled trials (RCTs) [6,8,9,10,11,12,13,14]. One of these is Systems Training for Emotional Predictability and Problem Solving (STEPPS) [13,14].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Borderline Personality Problems in a ‘Real-World’ Sample: Moderation by Diagnosis or Severity?

Bos

Wel

Appelo

et al. 2011

Psychother Psychosom

Self Cite

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Background: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not meet the DSM-IV criteria for BPD were excluded, which were many. We investigated the effectiveness of STEPPS in a sample representative of routine clinical practice and examined whether DSM-IV diagnosis and/or baseline severity were related to differential effectiveness. Methods: Patients whom their practicing clinician diagnosed with BPD were randomized to STEPPS plus adjunctive individual therapy (STEPPS, n = 84) or to treatment as usual (TAU, n = 84). Results: STEPPS recipients showed more improvement on measures of general and BPD-specific psychopathology as well as quality of life than TAU recipients, both at the end of treatment and at a 6-month follow-up. Presence of DSM-IV-diagnosed BPD was not related to differential treatment effectiveness, but dimensional measures of symptom severity were; STEPPS was superior to TAU particularly in patients with higher baseline severity scores. Conclusions: The findings show the effectiveness of STEPPS in a ‘real-world’ sample, and underscore the importance of dimensional versus categorical measures of personality disturbance.

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A Randomized Controlled Trial of a Dutch Version of Systems Training for Emotional Predictability and Problem Solving for Borderline Personality Disorder

Cited by 74 publications

References 20 publications

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice

Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning

Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Borderline Personality Problems in a ‘Real-World’ Sample: Moderation by Diagnosis or Severity?

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