Systems training for emotional predictability and problem solving in older adults with personality disorders:A pilot study

Background: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults. Aim: The aim was to explore the outcome of STEPPS in older adults with personality disorders. Method: In this naturalistic pre- vs post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning. Results: Twenty-four patients, with a mean age of 63.9 years (SD=4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- vs post-treatment decrease of BPD symptoms, with a large effect size (Cohen’s d=1.577). Self-control improved significantly and demonstrated a large effect size (r=.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen’s d=.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning. Conclusions: The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed

Systems training for emotional predictability and problem solving for borderline personality disorder:A systematic review

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment program for patients with borderline personality disorder (BPD). The program was intended to be highly accessible, both for patients and therapists. During STEPPS, patients are taught emotion regulation and behavior management skills. This systematic review synthesizes the current empirical status of STEPPS, focusing on research designs, quality of studies, target groups, protocols, and outcome. We selected 20 studies, with three randomized controlled trials. Patients with BPD, subthreshold BPD, and patients with BPD and comorbid antisocial personality disorder were investigated. One study was conducted in adolescents. There were no studies in older adults. Results demonstrated STEPPS to be associated with reduced BPD symptoms, improved quality of life, decreased depressive symptoms, and decreased negative affectivity. Mixed results were found for impulsivity and suicidal behaviors. STEPPS has both been studied as an add-on therapy to patients' ongoing treatment, and, with the addition of individual STEPPS sessions, as a stand-alone treatment. High attrition rates were found in patients attending STEPPS, complicating the generalizability of the results. Although the evidence for STEPPS is promising, further research is needed before firm conclusions can be drawn. Recommendations for future research are discussed

Ondersteuning van oudere partners van mensen met ASS

Een van de aanbevelingen in de Zorgstandaard Autisme is de naasten van clienten met een autismespectrumstoornis (ASS) ondersteuning te geven in hun behoefte aan kennis en handvatten te geven om met de cliënt om te gaan. Ook is het belangrijk na te gaan hoe je als naaste in emotioneel opzicht goed voor jezelf kunt zorgen. Daarom hebben we een groepsaanbod ontwikkeld voor partners van mensen met autisme genaamd ‘Samen leven op eigen kracht’. Deze module is oorspronkelijk ontwikkeld door de NVA en het centrum ASS Volwassenen van GGzE en aangepast voor ouderen. We hebben de effecten van dit innovatieve groepsaanbod verkend in een pre-post-follow-up design. Deelname aan de partnermodule resulteerde in meer kennis over herkenning van ASS bij de partner, herkenning in en erkenning door de andere partners, vermindering van psychische klachten en verbetering van het zelfbeeld. Een aanpassing van de module wordt voorgesteld

Ondersteuning van oudere partners van mensen met ASS

Een van de aanbevelingen in de Zorgstandaard Autisme is de naasten van clienten met een autismespectrumstoornis (ASS) ondersteuning te geven in hun behoefte aan kennis en handvatten te geven om met de cliënt om te gaan. Ook is het belangrijk na te gaan hoe je als naaste in emotioneel opzicht goed voor jezelf kunt zorgen. Daarom hebben we een groepsaanbod ontwikkeld voor partners van mensen met autisme genaamd ‘Samen leven op eigen kracht’. Deze module is oorspronkelijk ontwikkeld door de NVA en het centrum ASS Volwassenen van GGzE en aangepast voor ouderen. We hebben de effecten van dit innovatieve groepsaanbod verkend in een pre-post-follow-up design. Deelname aan de partnermodule resulteerde in meer kennis over herkenning van ASS bij de partner, herkenning in en erkenning door de andere partners, vermindering van psychische klachten en verbetering van het zelfbeeld. Een aanpassing van de module wordt voorgesteld

Clinical staging as a novel approach for selecting psychological treatment levels for older adults with borderline personality disorder

Objectives: In this paper, a novel approach is presented for selecting psychological treatment levels for older adults with borderline personality disorder (BPD). BPD tends to be a lifelong disorder persisting into old age, with a specific presentation of BPD symptoms in later life, which is illustrated by three different clinical cases. Methods: Recently, a clinical staging and health management model for BPD was presented to assist in selecting appropriate treatment approaches. Results: We combined this clinical staging model for BPD across the lifespan with psychotherapeutic treatment levels for older adults with personality disorders. Conclusions: This may allow for a more accurate treatment selection for older adults with BPD and was applied to the three clinical cases. Finally, implications for research and clinical practice are discussed

Systems training for emotional predictability and problem solving in older adults with personality disorders: A pilot study

Background: Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults. Aim: The aim was to explore the outcome of STEPPS in older adults with personality disorders. Method: In this naturalistic pre- vs post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning. Results: Twenty-four patients, with a mean age of 63.9 years (SD=4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- vs post-treatment decrease of BPD symptoms, with a large effect size (Cohen’s d=1.577). Self-control improved significantly and demonstrated a large effect size (r=.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen’s d=.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning. Conclusions: The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed

sj-docx-1-aut-10.1177_13623613231219745 – Supplemental material for First things first: An exploration of the effects of psychoeducation for older autistic adults

Supplemental material, sj-docx-1-aut-10.1177_13623613231219745 for First things first: An exploration of the effects of psychoeducation for older autistic adults by Maartje Lenders, Machteld A Ouwens, Rosalien M H J Wilting and Arjan C Videler in Autism</p

Mediation of emotional and external eating between dieting and food intake or BMI gain in women

Objective: Dieting to control body weight is often associated with weight gain, particularly so in women; however, the underlying mechanisms are unclear. In a series of studies on women, we examined whether the relationship between dieting and weight gain can be explained by (serial) mediation of emotional eating (EE) and/or subsequent external eating (EX). Methods: In a pilot study (116 women), we first assessed this (serial) mediation between dieting or dietary restraint and actual food consumption in the laboratory. In Study 1, a four-year follow up on patients with newly diagnosed type 2 diabetes (51 women), we assessed this (serial) mediation between dietary restraint and change in BMI and intake of energy (Kcal; Food Frequency Questionnaire). In Study 2, a three-year follow up study in a representative Dutch sample (287 women), we assessed this (serial) mediation between dieting and change in BMI. Results: There was consistent support for (serial) mediation: In the pilot study, frequency of dieting and dietary restraint were both indirectly associated with grams of crackers eaten through EE and EX. In study 1, dietary restraint had a significant (95% CI) indirect association with subsequent change in measured BMI and a marginally (90% CI) significant indirect association with intake of energy through EE and EX. In study 2, EE marginally (90% CI) acted as a mediator between frequency of dieting and subsequent self-reported change in BMI. In the subsample of overweight women (n = 146) frequency of dieting was indirectly associated with subsequent self-reported change in BMI through EE and EX. Conclusion: The possibility that female dieters may gain weight through EE and/or subsequent EX should be taken into account when treating women with overweight or obesity.</p