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Borderline personality disorder: STEPPS improves symptoms

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How effective is the STEPPS programme for people with a borderline personality disorder?


165 people with DSM-IV borderline personality disorder (⩾18 years; 83% female). Main exclusions: psychotic or primary neurological disorder; cognitive impairment; substance abuse or dependence; recent suicidal thoughts or self-harm behaviour.


Outpatient setting, Iowa, USA; recruitment 2002–2006.


Systems Training for Emotional Predictability and Problem Solving (STEPPS) plus usual care or usual care alone (including medication, individual psychotherapy and case management). STEPPS is a manual-based group treatment programme involving psychoeducation, and emotion and behaviour management skills training, delivered in once weekly 2-hour sessions over 20 weeks, which includes education for a friend or relative.


Primary outcome: symptoms (Zanarini Rating Scale for Borderline Personality Disorder Affective (ZRS-BPD), a scale which assesses cognitive disturbance, disturbed relationships, and impulsivity). Secondary outcomes: thoughts, feelings and behaviour (Borderline Evaluation of Severity Over Time scale (BESOT)); positive and negative disposition (Positive and Negative Affect Schedule (PANAS)); Beck Depression Inventory (BDI); Symptom Checklist-90-Revised (SCL90R); …

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  • Source of funding: Sources of funding: Shire and Forest Laboratories, speaker’s bureau honoraria from Pfizer, honoraria for other consulting from Forest Laboratories and Jazz Pharmaceuticals, AstraZeneca and Wyeth, and Dr Black received grant MH-63746 from NIMH.


  • Competing interests: None.