Effectiveness of an emotion regulation group training for adolescents—a randomized controlled pilot study

Abstract

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.

Are Profiles of Adaptive and Maladaptive Anger Regulation Differently Related to Adjustment in Early Adolescence?

“…Particularly, it might be promising to integrate additional training of adaptive anger regulation strategies in case of externalizing problem behavior. Initial ER trainings have been developed for children (e.g., Wyman, Cross, Brown, Yu, Tu, & Eberly, 2010) and adolescents (e.g., Schuppert, Giesen-Bloo, van Gemert, Wiersema, Minderaa et al, 2009). Our findings support the relevance of such ER training approaches for clinical child and adolescent psychology.…”

Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research

“…First, do no harm: dropout and iatrogenic harm: A more disheartening finding from the previously described RCTs for borderline PD in adolescence is that the dropout rates appear to be relatively high across the studies and in both the treatment and control groups (181,188,194,196,197). As a result of differences in defining and reporting dropout in the trials, it is not possible to compute and compare exact estimates of dropout rates across the trials and treatment conditions.…”

“…In both studies, the effectiveness of ERT was compared with TAU. In the first study (196), 43 adolescents were randomized to ERT plus TAU or TAU alone. The results revealed a significant decrease in borderline PD symptoms in both groups, and there was no significant difference between the two groups in terms of improvements.…”

Borderline Personality Disorder in Adolescence

“…9 Data also suggest considerable flexibility and malleability of BPD traits in youth, 115 making this a key developmental period during which to intervene, and adolescent BPD features have been shown to respond to intervention. 116,117 It has been strongly argued that standalone universal (whole population) prevention of BPD is not currently justified or feasible because the condition is not sufficiently prevalent, and it is unclear what form or dose of intervention would be appropriate. 9 Similarly, selective prevention (targeting those with risk factors for BPD) is currently impractical because of the lack of specificity of most risk factors (particularly environmental factors, such as childhood adversity) associated with BPD.…”

“…These principles are drawn from the work of the Helping Young People Early (HYPE) program in Melbourne, Australia 95 but are common to more recently established early intervention services for BPD, such as the Dutch emotion regulation training (ERT) program, 117 or the German outreach clinic for Adolescent Risk-taking and Self-harm behaviors (AtR!Sk). 119 Beyond these principles, the main differences among the programs are related to the model of individual psychotherapy that is practiced at each center.…”