Systems training for emotional predictability and problem solving in older adults with personality disorders: a pilot study

• Published in: Behavioural and cognitive psychotherapy 2023-01, Vol.51 (1), p.105-109
• Main Authors: Ekiz, Erol, Videler, Arjan C., Ouwens, Machteld A., van Alphen, Sebastiaan P.J.
• Format: Article
• Language: English
• Subjects: Adaptation; Aged; Borderline personality disorder; Brief Clinical Report; Cognitive ability; Emotional regulation; Emotions; Humans; Managerial skills; Middle Aged; Older people; Patients; Personality; Personality disorders; Personality Disorders - therapy; Pilot Projects; Problem solving; Questionnaires; Self control; Self destructive behavior
• ISSN: 1352-4658; 1469-1833
• DOI: 10.1017/S1352465822000443

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults. The aim was to explore the outcome of STEPPS in older adults with personality disorders. In this naturalistic pre- post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning. Twenty-four patients, with a mean age of 63.9 years ( =4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- post-treatment decrease of BPD symptoms, with a large effect size (Cohen's =1.577). Self-control improved significantly and demonstrated a large effect size ( =.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen's =.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning. The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed.