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STEPPS: Systems Training for Emotional Predictability and Problem Solving in Women Offenders with Borderline Personality Disorder in Prison—A Pilot Study

Published online by Cambridge University Press:  07 November 2014

Donald W. Black ,
Nancee Blum ,
Leanne Eichinger ,
Brett McCormick ,
Jeff Allen  and
Bruce Sieleni
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Abstract

Introduction:

An uncontrolled pilot study of SystemsTraining for Emotional Predictability and Problem Solving (STEPPS) was conducted with incarcerated women offenders. STEPPS is a promising new cognitive-behavioral group treatment for persons with borderline personality disorder (BPD).

Methods:

Twelve women offenders with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD were enrolled in the 20-week program at an Iowa prison. Efficacy assessments included the Borderline Evaluation of Severity overTime, the Positive and Negative Affectivity Scale, and the Beck Depression Inventory. Data were collected at baseline, and weeks 4, 8, 12, 16, and 20. A prison therapist was trained to deliver the STEPPS program.

Results:

The 12 volunteers had a mean age of 34.8±8.5 years. Two women discontinued early because they were released from prison; the others attended all sessions. The analysis showed significant improvements in BPD-related symptoms, negative affectivity, and depression. The Borderline Evaluation of Severity over Time total score was highly significant at week 20 (P=.009), indicating overall improvement in BPD-related symptoms. Effect sizes for the efficacy measures were moderate to large. The prison therapist showed excellent adherence to the model.

Conclusion:

This study demonstrated the successful implementation of the STEPPS program in a women's prison. Participants achieved “real-world” benefits, including a reduction in the negative thoughts and behaviors associated with BPD, negative affectivity, and depression. Implications of the findings are discussed.

Type
Original Research
Information
CNS Spectrums , Volume 13 , Issue 10 , October 2008 , pp. 881 - 886
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1.Paris, J. Social Factors in Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment. New York, NY: Cambridge University Press; 1996.Google Scholar
2.Swartz, MS, Blazer, D, George, L, et al.Estimating the prevalence of borderline personality disorder in the community. J Personal Disord. 1990;4:257–272.Google Scholar
3.Widiger, TA, Frances, AJ. Epidemiology, diagnosis, and comorbidity of borderline personality disorder. In: Tasman, A, Hales, RE, Frances, AJ, eds. American Psychiatric Press Review of Psychiatry. vol 8. Washington, DC: American Psychiatric Press; 1989:8–24.Google Scholar
4.Blackburn, R, Coid, JW. Empirical clusters of DSM-III personality disorder in violent offenders. J Personal Disord. 1999;13:18–34.Google Scholar
5.Singleton, N, Meltzer, H, Gatward, R, et al.Psychiatric Morbidity Among Prisoners: Summary Report. London, UK: Depatment of Health; 1997.Google Scholar
6.Jordan, BK, Schlenger, WE, Fairbank, JA, Caddell, JM. Prevalence of psychiatric disorders among incarcerated women. II. Convicted felons entering prison. Arch Gen Psychiatry. 1996;53:513–519.Google Scholar
7.Zlotnick, C. Antisocial personality disorder, affect dysregulation and childhood abuse among incarcerated women. J Personal Disord. 1999;13:90–95.Google Scholar
8.Black, DW, Gunter, T, Allen, J, et al.Borderline personality disorder in male and female offenders newly committed to prison. Compr Psychiatry. 2007;48:400–405.Google Scholar
9.Gunter, TD, Arndt, S, Wenman, G, et al.Frequency of mental and addictive disorders among 320 men and women entering the Iowa prison system: use of the MINI-Plus. J Am Acad Psychiatry Law. 2008;36:27–34.Google Scholar
10.Warren, JI, Burnette, M, South, SC, Chauhan, P, Bale, R, Friend, R. Personality disorders and violence among female prison inmates. J Am Acad Psychiatry Law. 2002;30:502–509.Google ScholarPubMed
11.Raine, A. Features of borderline personality and violence. J Clin Psychol. 1993;49:277–281.3.0.CO;2-C>CrossRefGoogle ScholarPubMed
12.Adams, K. Former mental patients in a prison and parole system. Crim Justice Behav. 1983;10:358–384.CrossRefGoogle Scholar
13.McShane, MD. The bus stop revisited: discipline and psychiatric patients in prison. J Psychiatry Law. 1989;Fall:413–433.CrossRefGoogle Scholar
14.Coid, J. An affective syndrome in psychopaths with borderline personality disorder? Br J Psychiatry. 1993;162:641–650.Google Scholar
15.McMurran, M. Offenders with personality disorders. In: Hollin, C, ed. Handbook of Offender Assessment and Treatment. Chichester, UK: Wiley; 2001:239–251.Google Scholar
16.American Psychiatric Association Practice Guidelines. Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. Am J Psychiatry. 2001;158(suppl 1):1–52.Google Scholar
17.Zanarini, MC. Update on pharmacotherapy of borderline personality disorder. Curr Psychiatry Rep. 2004;6:66–70.Google Scholar
18.Linehan, MM, Comtois, KA, Murray, AM, et al.Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry. 2006;63:757–766.Google Scholar
19.Bateman, A, Fonagy, P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999;156:1563–1569.Google Scholar
20.Davidson, K, Norrie, J, Tyrer, P, et al.The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. J Personal Disord. 2006;20:450–465.Google Scholar
21.Giesen-Bloo, J, van Dyck, R, Spinhoven, P, et al.Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006;63:649–658.Google Scholar
22.Clarkin, JF, Levy, KN, Lenzenweger, MF, Kernberg, OF. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry. 2007;164:922–923.Google Scholar
23.Blum, N, Pfohl, B, John, DS, Monahan, P, Black, DW. STEPPS: a cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder—a preliminary report. Compr Psychiatry. 2002;43:301–310.CrossRefGoogle ScholarPubMed
24.Black, DW, Blum, N, Pfohl, B, St. John, D. The STEPPS group treatment program for outpatients with borderline personality disorder. J Contemp Psychotherapy. 2004;34:193–210.Google Scholar
25.Van Wei, B, Kockmann, I, Blum, N, et al.STEPPS group treatment for borderline personality disorder in The Netherlands. Ann Clin Psychiatry. 2006;18:63–67.Google Scholar
26.Freije, H, Dietz, B, Appelo, M. Behandling van de borderline persoonlijk heidsstoornis met de VERS: de Vaardigheidstraining emotionele regulatiestoornis. Directive Therapies. 2002;4:367–378.Google Scholar
27.van Wel, B. VERS: RCT on Dutch STEPPS. Abstracted presented at the meeting of the International Society for the Study of Personality Disorders. September 21, 2007. Den Haag, The Netherlands.Google Scholar
28.Blum, N, St. John, D, Pfohl, B, et al.Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry. 2008;165:468–478.CrossRefGoogle ScholarPubMed
29.Berzins, LG, Trestman, RL. The development and implementation of dialectical behavior therapy in forensic settings. Int J Foren Ment Health. 2004;3:93–103.Google Scholar
30.McCann, RA, Ball, EM, Ivanoff, A. DBT with an inpatient forensic population: the CMHIP forensic model. Cog Behav Pract. 2000;7:447–456.CrossRefGoogle Scholar
31.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
32.Pfohl, B, Blum, N, Zimmerman, M. Structured Interview for DSM-IV Personality (SIDP-IV). Washington, DC: American Psychiatric Press; 1997.Google Scholar
33.Pfohl, B, Blum, N, McCormick, B, et al.Reliability and validity of the Borderline Evaluation of Severity Over Time (BEST): a new scale to measure severity and change in borderline personality disorder. J Personal Disord. In press.Google Scholar
34.Watson, D, Clark, LA. The PANAS-Manual for the Positive and Negative Affect Schedule – Expanded Form. Iowa City, la: The University of Iowa; 1994.Google Scholar
35.Beck, AT. Depression Inventory. Philadelphia, Penn: Philadelphia Center for Cognitive Therapy; 1978.Google Scholar
36.Attkisson, CC, Greenfield, TK. The UCSF Client Satisfaction Questionnaire (CSQ) Scales: the Client Satisfaction Questionnaire-8. In: Maruish, ME, ed. Psychological Testing: Treatment Planning and Outcome Assessment. 2nd ed. Hillsdale, NJ: Earlbaum; 1999:1333–1346Google Scholar
37.SAS. SAS/STAT User's Guide: Version 8. Cary, NC: SAS Institute, Inc.; 1999.Google Scholar
38.Gabbard, GO. Do all roads lead to Rome? New findings on borderline personality disorder [editorial]. Am J Psychiatry.2007;164:853–855.Google Scholar
39.McCormick, B, Blum, N, Hansel, R, et al.Relatioinship of sex to symptom severity, psychiatric comorbidity, and health care utilization in 163 subjects with borderline personality disorder. Compr Psychiatry. 2007;48:406–412.Google Scholar