Evaluating the outcomes of the STEPPS programme in a UK community-based population; implications for the multidisciplinary treatment of borderline personality disorder.

UNLABELLED

WHAT IS KNOWN ON THE SUBJECT?: Individuals with a diagnosis of Borderline Personality Disorder (BPD) now constitute a substantial portion of the caseload for community teams. Specialized treatments for BPD often consume a large portion of available psychology resources and also involve lengthy waiting lists. The STEPPS programme is a treatment approach which is growing in evidence, particularly in the US. However, further evidence for the effectiveness of this programme within the UK healthcare system is needed.

WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE

The results of this study support the preliminary evidence for the effectiveness of STEPPS in a UK community-based population. A reduction in symptom severity was in evidence. Novel measures were used to build on previous evaluations of the STEPPS programme. These measures show a significant reduction in patients' affinity for unhelpful schemas, as well as an increase in patients' self-reported quality of life; an important perspective for a recovery focused approach to treatment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The STEPPS programme has shown its merit as an effective and more accessible treatment option for the community-based treatment of BPD, though some methodological limitations are noted. Furthermore, the results of this study demonstrate that STEPPS can be delivered effectively by teams of facilitators from different professional backgrounds who do not necessarily have extensive training in psychotherapeutic interventions. The result is a well-rounded and diverse skill set possessed by the team of facilitators, adding to the richness of the patient's recovery journey and leading to a more favourable spread of teams' resources.

ABSTRACT

Aims & Background Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for individuals with a diagnosis of Borderline Personality Disorder (BPD) which has a growing evidence base, particularly in the US. Evidence is sparse for its use with UK populations, and this study seeks to assess the reliability of this evidence, whilst adding to existing knowledge through the use of additional measures. Method Thirty patients completed one of four STEPPS groups. Data regarding symptom severity, quality of life and affinity for maladaptive schemas were collected at the start and end of the group to allow pairwise analysis. Results Significant reductions in symptom severity and affinity for maladaptive schemas were in evidence, as well as highly significant increases in patients' self-reported quality of life. Implications The results provide further evidence for the efficacy of STEPPS with a UK sample of patients with a diagnosis of BPD, though limitations with the design of this study warrant caution. They also show that the programme achieves this level of efficacy when delivered by facilitators who are not intensively trained in psychological treatment models. As such, the STEPPS programme provides a resourceful approach to the treatment of BPD in a UK community-based setting.