Magazine article Clinical Psychiatry News

CBT Program Promising for Borderline Disorder

Magazine article Clinical Psychiatry News

CBT Program Promising for Borderline Disorder

Article excerpt

SAN FRANCISCO -- Borderline personality disorder is notoriously difficult to treat, but its course and outcome are far more positive than people might think, Dr. Donald W. Black said at the annual meeting of the American Academy of Clinical Psychiatrists.

In particular, an outpatient cognitive-behavioral group approach called Systems Training for Emotional Predictability and Problem Solving (STEPPS) shows promise, and it has been extensively adopted in the Netherlands and other places, said Dr. Black of the University of Iowa, Iowa City.

Dr. Black is currently engaged in a randomized controlled trial of the STEPPS program, and over 3 1/2 years has enrolled 172 patients with borderline personality disorder (BPD) in the study.

Nancee Blum, a University of Iowa social worker, developed the 20-week STEPPS program to address some of these issues. It's a manualized, group format, psychoeducational, cognitive, and behavioral program that attempts to teach a common language to patients and their therapists. They learn how to conceptualize borderline personality, how to talk about the symptoms, and how to talk about the approach to its treatment. Therapists confront the maladaptive schemes that patients have, and patients learn specific skills to help them manage their emotions and behaviors.

Patients review DSM-IV criteria for BPD and are asked to acknowledge their symptoms and give examples from their lives, a technique called "owning the illness." This process is extended to family members and other caregivers so that they, too, can benefit from learning about BPD.

While the STEPPS program started in Iowa and has been adopted in California, Nevada, Ohio, New York, Argentina, and Belgium, it has had the most impact in the Netherlands. The Dutch version of the program is called VERS, a Dutch acronym for Skills Training for Emotion Dysregulation Disorder. The program spread widely after Ms. Blum conducted a series of workshops in 1998.

Since then, nearly 400 therapists have been trained in the program, and it's estimated to be used by more than half of all Dutch BPD treatment programs (Ann. Clin. Psychiatry 2006;18:63-7).

Two open-label pilot studies of STEPPS or VERS have been published containing data on a total of 137 patients. One study demonstrated significant decreases in the Beck Depression Inventory, the Borderline Estimate of Severity Over Time (BEST), and the Positive and Negative Affectivity Scale (PANAS).

The other study also demonstrated a significant decrease in BEST, as well as in the depression, anxiety, and interpersonal sensitivity subscales of the Symptom-Checklist 90 (SCL-90). …

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