Systems Training for Emotional Predictability and Problem Solving (STEPPS): modello di intervento, adattamento clinico e dati preliminari di efficacia in un campione di pazienti ricoverati con diagnosi di disturbo dell’umore e disturbo di personalità
Systems Training for Emotional Predictability and Problem Solving (STEPPS): theoretical model, clinical application, and preliminary efficacy data in a sample of inpatients with personality disorders in comorbidity with mood disorders
S. Boccalon1, R. Alesiani1, L. Giarolli1, L. Franchini2, C. Colombo2, N. Blum3, A. Fossati1
1 Università Vita-Salute San Raffaele, Milano, e Servizio di Psicologia Clinica e Psicoterapia, San Raffaele Turro, Istituto Scientifico “San Raffaele”, Milano; 2 Università Vita-Salute San Raffaele, Milano e Unità Operativa di Riabilitazione dei Disturbi dell’Umore, San Raffaele Turro, Istituto Scientifico “San Raffaele”, Milano; 3 Department of Psychiatry, University of Iowa College of Medicine and University of Iowa Health Care, Iowa City, IA
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Summary
Objective
Despite the common opinion about the difficulty of treating patients with personality disorders, significant research data support the efficacy of different techniques of treatment, both cognitive-behavioural and dynamic. The aim of our preliminary study is to analyze the effectiveness of the model of STEPPS group therapy (Systems Training for Emotional Predictability and Problem Solving) in a sample of inpatients with personality disorders comorbid with mood disorders, using a longitudinal design with a 6-month follow-up.
Methods
Our sample included 20 inpatients with BPD or
prominent BPD features comorbid with mood disorders, as assessed with
the SCID-II. Outcome measures were the number of self-destructive behaviours
and hospitalizations during the STEPPS treatment and 6 months after
the end of therapy.
All patients completed a self-report questionnaire (Filter Questionnaire)
to identify distorted thoughts before starting therapy, at the end of
treatment and 6 months later. During treatment, patients were asked
to fill-out a daily diary (EIC) to assess their emotional reactions.
Our aims were to monitor emotional intensity over time and to identify
their key triggers and how to manage emotional crises.
Results
Nine of the 20 subjects (45%) included in the
sample completed STEPPS: drop-out rate was 55%. There were no significant
differences in number of hospitalizations and self-destructive behaviours
between subjects who completed the program and subjects who dropped-out.
The presence of more Histrionic (U = 23.5, p < .01) and Passive-Aggressive
(U = 32.5, p < .05) traits was the only significant difference between
the two groups. Patients who completed the program showed a significant
and progressive decrease in the number of self-destructive behaviours
(X2 = 11.47, p < 0.01) and hospitalizations (X2 = 16.85,
p < 0.001).
Friedman test showed a significant decrease of "Distrust"
over time (X2 = 7.68, p < 0.05) and a significant decrease
of EIC scores over time (X2 = 58.71, p < .005).
Conclusions
Despite the small sample and the lack of a control
group, our preliminary results could suggest that STEPPS is effective
in reducing the number of self-destructive behaviours and hospitalizations
and that these results may be stable also at followup.
The score reduction on "Distrust" at the 6-month followup
may indicate that STEPPS decreases pessimistic expectations about self
and others and that it mobilizes resources and skills that patients
are able to rely on even after the end of the group treatment. The trend
of EIC shows that also the perceived emotional intensity in relation
to distressing events decreases over time.