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Subthreshold personality disorder: how feasible is treatment in primary care?

Published online by Cambridge University Press:  24 March 2021

William Barber Open the ORCID record for William Barber [Opens in a new window] ,
Frances Apps ,
Clara Strauss Open the ORCID record for Clara Strauss [Opens in a new window] ,
Helen Startup  and
Juliet Couche
William Barber
Affiliation:
Sussex Partnership NHS Foundation Trust, Research and Development, Sussex Education Centre, Hove, UK
Frances Apps
Affiliation:
Sussex Partnership NHS Foundation Trust, Bluebell House, Burgess Hill, UK
Clara Strauss
Affiliation:
Sussex Partnership NHS Foundation Trust, Research and Development, Sussex Education Centre, Hove, UK
Helen Startup
Affiliation:
Sussex Partnership NHS Foundation Trust, Research and Development, Sussex Education Centre, Hove, UK
Juliet Couche*
Affiliation:
Health in Mind, Woodside, Hellingly, Hailsham, UK
*
*Corresponding author. Email: [email protected]
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Abstract

Individuals with subthreshold borderline personality disorder (BPD) are commonly encountered in primary care settings, yet the psychological treatments they receive are rarely tailored to their needs. In an effort to capture and treat this group of individuals in a targeted and meaningful way, some primary care settings offer Systems Training for Emotional Predictability and Problem Solving – Emotional Intensity (STEPPS-EI). This evaluation sought to assess the feasibility of STEPPS-EI within NHS primary care services. Employing an uncontrolled design, the evaluation examined recruitment, retention, effectiveness and group appraisal. Findings supported three out of four evaluation objectives for feasibility: uptake of the group was high at 74%, the group was well received by the group and significantly effective at reducing symptoms of BPD, depression and anxiety. However, retention rates were low, with only 43% classed as ‘completers’ of the programme. The results indicate preliminary evidence for STEPPS-EI as a potentially feasible intervention with possible modification to enhance retention and avenues for further study.

Key learning aims

After reading this paper, the reader will be aware of:

  1. (1) Recent developments in the classification and diagnosis of personality disorder leading to the conceptualisation of subthreshold presentations.

  2. (2) The feasibility of conducting a primary care intervention for individuals with emotional intensity difficulties.

  3. (3) The preliminary beneficial outcomes of utilising a primary care intervention for individuals with emotional intensity difficulties.

  4. (4) Potential issues for participants and providers of primary care programmes with future direction for improvement and implementation.

Keywords

mental healthpersonality disorderprimary careSTEPPS-EIsubthreshold
Type
Empirically Grounded Clinical Guidance Paper
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e12
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2021

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References

Further reading

Goddard, E., Wingrove, J., & Moran, P. (2015). The impact of comorbid personality difficulties on response to IAPT treatment for depression and anxiety. Behaviour Research and Therapy, 73, 1–7.CrossRefGoogle ScholarPubMed
Hepgul, N., King, S., Amarasinghe, M., Breen, G., Grant, N., Grey, N., … & Wingrove, J. (2016). Clinical characteristics of patients assessed within an Improving Access to Psychological Therapies (IAPT) service: results from a naturalistic cohort study (Predicting Outcome Following Psychological Therapy; PROMPT). BMC Psychiatry, 16, 52.CrossRefGoogle Scholar
Karukivi, M., Vahlberg, T., Horjamo, K., Nevalainen, M., & Korkeila, J. (2017). Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders. BMC Psychiatry, 17, 16.CrossRefGoogle ScholarPubMed

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