Evaluation of Systems Training for Emotional Predictability and Problem Solving (STEPPS) in Egyptian Patients with Borderline Personality Disorder
Authors: Ghoraba Eman Abd Elghaffar , Seleem Mohammad Abdel Hakeem , Ramadan Ehab El Sayed , Eissa Mai Abdel-Raouf 
Published: September 2023

Background: Recently, there has been tremendous progress in the treatment of this malady with various techniques of psychotherapy that were shown to be effective in RCTs. One of these techniques is System Training for Emotional Predictability and Problem Solving (STEPPS), which is a group psychotherapy approach developed in the 1990s at the University of Iowa in the US. Our study’s objective was to assess the effectiveness of STEPPS in treatment of patients with borderline personality disorder in Egyptian Arabic speaking community and to evaluate the association between baseline clinical characteristics, treatment response, and early treatment cessation to understand which patients’ characteristics make them suitable or not for this new treatment.

Methods: This research was performed in Neuropsychiatry Department of Tanta University Hospitals. Fifty-six patients were collected from the inpatient and outpatient departments. The study, however, was conducted as an outpatient program in the above-mentioned settings during the period from April 2019 to December 2020. Patients with BPD were assigned at their convenience or according to immediate availability of treatment slot either to Group-I receiving STEPPS (n=27, with only 20 subjects completing the course) or Group-II receiving usual treatment ―TAU‖ (n=29 of which 20 patients remaining till the end of the trial).

Results: STEPPS patients showed better improvement of BEST in comparison to TAU with significantly lower mean of total score of BEST that retained its significant lower values at the 6 months follow-up after treatment period. The decrease in the mean of BEST scores in the Experimental group in comparison to TAU was also significant for the mean values of all BEST subscales, significant variations was maintained at 6 months follow up between Experimental and TAU cases among all BEST subscales. STEPPS patients had better improvement of emotion regulation in comparison to TAU wih significant lower mean of total score of DERS that retained its significantly lower values at the 6 months follow-up after treatment period. The decrease in mean of DERS scores was significant for the mean value of all DERS subscales in the STEPPS group in comparison to TAU. Again, the outcomes obtained at the end of treatment year were all maintained at 6 months follow up with statistically significant differences between STEPPS and TAU patients among all DERS subscales. STEPPS patients showed better improvement of quality of life in comparison to TAU as shown in the statistically significant higher mean of total score of quality of life that retained its statistically significant higher values at the 6 month follow up following treatment year. The STEPPS group had significantly increased mean quality-of-life scores in comparison to TAU in the mean values of all quality-of-life subscales. Again, the outcomes obtained at the end of treatment year were all maintained at 6 months follow up with statistically significant differences between STEPPS and TAU patients among all quality-of-life subscales. Although STEPPS patients showed definitive improvement on the Filter Questionnaire in post-test in comparison to baseline test, the differences were not statistically significant in most of the filters.

Conclusions: STEPPS as a sole (not add-on) intervention proved superior efficacy in comparison to TAU (cognitive behaviour therapy) for treating patients suffering from borderline personality disorder in Tanta University Hospital, as evidenced by the lower attrition rate of borderline patients who received STEPPS therapy in comparison to those who were managed by TAU. Patients in the STEPPS group had better improvement of emotion regulation, borderline symptoms and quality of life in comparison to TAU as demonstrated in the significantly lower mean of total score of DERS scale, BEST scale and the significantly higher mean of total score of WHO quality of life scale, both at the end of the treatment period after 6 months of follow up.  Improvement in schema questionnaire   in STEPPS group was limited as schema is rigid and need more duration to be changed.