STEPPS treatment programme for borderline personality disorder: Which scale items improve? An item-level analysis

Area of Science:

• Psychiatry
• Clinical Psychology
• Mental Health Treatment

Background:

• Borderline Personality Disorder (BPD) is a complex mental health condition characterized by emotional instability and interpersonal difficulties.
• Effective treatment strategies for BPD are crucial for improving patient outcomes.
• Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a structured intervention designed to manage BPD symptoms.

Purpose of the Study:

• To evaluate the specific symptom improvements in patients with Borderline Personality Disorder undergoing the STEPPS program.
• To identify which symptom clusters, as measured by the Borderline Evaluation of Severity Over Time (BEST) and Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), show the most significant change.
• To determine the overall effect size of STEPPS in reducing BPD symptom severity.

Main Methods:

• Analysis of data from 193 subjects across a randomized controlled trial (RCT) and uncontrolled correctional system data.
• Comparison of STEPPS + treatment as usual (TAU) against TAU alone within the RCT to estimate STEPPS effect size.
• Assessment of improvements on specific items of the BEST and ZAN-BPD scales.

Main Results:

• STEPPS demonstrated significant improvement in affective instability, identity disturbance, and abandonment fears (BEST scale).
• Mood instability, chronic emptiness, and identity disturbance showed notable improvement (ZAN-BPD scale).
• Significant STEPPS effect sizes were observed for paranoia, problem-avoidance behaviors (BEST), paranoia, impulsivity, chronic emptiness, and unstable relationships (ZAN-BPD).

Conclusions:

• STEPPS is effective in alleviating a range of core Borderline Personality Disorder symptoms.
• The findings suggest STEPPS can be tailored to address specific symptom profiles in BPD patients.
• Future research can guide personalized treatment matching for BPD based on symptom presentation and intervention effectiveness.