Investigating Effectiveness and Predicting Outcome and Dropout From Systems Training for Emotional Predictability and Problem Solving for Emotional Intensity Difficulties (STEPPS EI) in UK Primary Care

Abstract

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality disorder (BPD) has been adapted for a primary care setting into a 13-week group treatment for emotional intensity difficulties (STEPPS EI). This is the first study to examine the effectiveness and potential outcome and dropout predictors of STEPPS EI in a primary care setting. Severity of BPD, depression, and anxiety symptoms were measured pre- and postintervention for 148 participants. Treatment completers showed improvements in depression, anxiety, and BPD symptoms with medium to large effect sizes. A predictor of symptom improvement was higher baseline severity for each of the symptom measures. Attending a psychoeducational group prior to STEPPS EI was associated with lower odds of dropout. The findings support the use of STEPPS EI in a primary care setting, with the potential to alleviate the burden from other local services.

Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder: A systematic review

“…Three RCTs have been performed on STEPPS (Blum et al, 2008; Bos et al, 2010; Bos et al, 2011), with all three reporting follow‐up data. Eleven (uncontrolled) pretreatment versus posttreatment research designs were found (Alesiani et al, 2014; Black et al, 2008, 2013; Blum et al, 2002; Boccalon et al, 2017; González‐González et al, 2021; Guillén et al, 2021; Harvey et al, 2010; Hezelyova et al, 2021; Hill et al, 2016; Llorens Ruiz et al, 2020). One study compared STEPPS with another form of psychotherapy (i.e., DBT; Guillén Botella et al, 2021).…”

“…Baseline characteristics, such as gender, age, and ethnicity, were not associated with greater improvement after treatment (Black et al, 2018a). Nonetheless, higher educational level, better patient collaboration, higher baseline symptom severity, and absence of a bipolar disorder did predict better outcome (González‐González et al, 2021; Hezelyova et al, 2021). Analyses of dropouts demonstrate no significant differences in sex, school level, and DSM diagnoses between dropouts and completers (Alesiani et al, 2014).…”

“…In this study, participants had one-on-one skills reinforcement sessions on a weekly basis. Furthermore, Hezelyova et al (2021) studied the shortened, less-intensive 13-week STEPPS Early Intervention for participants with emotional intensity difficulties in primary care facilities in the United Kingdom.…”