Borderline personality disorder (BPD), which is characterized by difficulty regulating emotions and behaviors, can disrupt all aspects of life. Mood swings, turbulent relationships, impulsiveness, and risky actions are common symptoms and have a significant effect on individuals with BPD as well as those close to them. Treatment for these patients has traditionally been viewed as difficult, but in recent years, researchers have developed new forms of therapy specifically for BPD. A study in this month's American Journal of Psychiatry supports a specific form of group therapy as an effective treatment option for individuals with BPD.
Systems Training for Emotional Predictability and Problem Solving (STEPPS), a 20 week group therapy program, was developed in 1995 and first introduced in the Netherlands in 1998. Designed for patients with BPD, the program combines aspects of cognitive behavioral therapy and skills training, while also involving people who often closely interact with the patient. Each patient brings "system members" with them— friends, family members, or mental health professionals. Together, the patients and their system members learn about BPD. In later sessions, patients receive training on strategies for more effectively managing their moods, thoughts, and behaviors, while system members receive training on how to interact with the patient. Rather than replace other forms of treatment, STEPPS is intended to accompany and support additional therapy or medication.
To test the effectiveness of STEPPS, a team of researchers from the University of Iowa randomly assigned 124 patients to either continue with other forms of treatment they had been receiving prior to the study (termed "treatment as usual") or participate in STEPPS in addition to treatment as usual. Patients involved in STEPPS saw a greater improvement in symptoms of BPD and depression, a common comorbid condition, and their symptoms also subsided more rapidly than those not participating in STEPPS. Those participating in STEPPS were more likely to rate themselves "very much" or "much improved" and more likely to be rated "very much" or "much improved." Additionally, while patients in the STEPPS program saw improvement in symptoms throughout the program's 20 week course, those receiving treatment as usual did not have sustained improvement over 20 weeks, and most of their improvements occurred during the first half of the study. Followups throughout the following year indicated that these effects did not dissipate after the end of therapy.
One of this study's biggest limitations is common to many other studies on BPD: a high dropout rate. Nearly 25% of the study's participants dropped out at some point, shedding some doubt on its findings. Still, research is beginning to indicate that therapy can be beneficial for individuals with BPD, and STEPPS may be an important form of treatment for many, perhaps due to its focus on social support and inclusion of people close to the patient. More research is necessary to understand which therapies are most effective in helping individuals with BPD improve their symptoms and lead more productive and satisfying lives.
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