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

Personality factors and cognitive functioning in patients with somatic symptom and related disorders

Objective Somatic symptom and related disorders (SSRD) are often complicated by cognitive symptoms, including reduced information processing speed, memory, and planning. Depression has been related to poor cognitive functioning in SSRD, but the role of underlying personality factors is poorly understood. This study investigates the association between personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) with cognitive functioning in patients with SSRD. Methods Data from 366 patients with SSRD from a tertiary care expert center (mean age = 42.1 years (SD = 13.4), 59.6% women) were analyzed using a cross-sectional design. Neuropsychological assessments included measures of information processing speed, memory, attention, and executive function. Personality factors were assessed using the NEO-FFI and depressive symptoms using the PHQ-9. Results Regression analyses showed associations between neuroticism with poorer performance on visual memory (B = −0.09, SE = 0.04, β = −0.14, p = .019), and planning (B = −0.09. SE = 0.02, β = −0.23, p < .001). Extraversion was also inversely associated with visual memory (B = −0.13, SE = 0.05, β = −0.18, p = .011) and planning (B = −0.07, SE = 0.03, β = −0.17, p = .021) and openness was associated with better visual memory (B = 0.17, SE = 0.05, β = 0.19, p = .002). These associations were attenuated but remained significant after adjusting for depressive symptoms. Conclusion Neuroticism, extraversion, and low openness were associated with lower cognitive functioning (particularly planning and visual memory) in patients with SSRD, which remained significant after taking depressive symptoms into account

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

Establishing Zebrafish as a Novel Exercise Model: Swimming Economy, Swimming-Enhanced Growth and Muscle Growth Marker Gene Expression

Zebrafish has been largely accepted as a vertebrate multidisciplinary model but its usefulness as a model for exercise physiology has been hampered by the scarce knowledge on its swimming economy, optimal swimming speeds and cost of transport. Therefore, we have performed individual and group-wise swimming experiments to quantify swimming economy and to demonstrate the exercise effects on growth in adult zebrafish

Swimming physiology of European silver eels (Anguilla anguilla L.): energetic costs and effects on sexual maturation and reproduction

The European eel migrates 5,000–6,000 km to the Sargasso Sea to reproduce. Because they venture into the ocean in a pre-pubertal state and reproduce after swimming for months, a strong interaction between swimming and sexual maturation is expected. Many swimming trials have been performed in 22 swim tunnels to elucidate their performance and the impact on maturation. European eels are able to swim long distances at a cost of 10–12 mg fat/km which is 4–6 times more efficient than salmonids. The total energy costs of reproduction correspond to 67% of the fat stores. During long distance swimming, the body composition stays the same showing that energy consumption calculations cannot be based on fat alone but need to be compensated for protein oxidation. The optimal swimming speed is 0.61–0.67 m s−1, which is ~60% higher than the generally assumed cruise speed of 0.4 m s−1 and implies that female eels may reach the Sargasso Sea within 3.5 months instead of the assumed 6 months. Swimming trials showed lipid deposition and oocyte growth, which are the first steps of sexual maturation. To investigate effects of oceanic migration on maturation, we simulated group-wise migration in a large swim-gutter with seawater. These trials showed suppressed gonadotropin expression and vitellogenesis in females, while in contrast continued sexual maturation was observed in silver males. The induction of lipid deposition in the oocytes and the inhibition of vitellogenesis by swimming in females suggest a natural sequence of events quite different from artificial maturation protocols

Feasibility of the cognitive model for behavioral interventions in older adults with behavioral and psychological symptoms of dementia

Objectives: The purpose of this study was to develop an individually tailored, non-pharmacological treatment model, the Cognitive Model for Behavioral Interventions (CoMBI), for patients with Behavioral and Psychological Symptoms of Dementia (BPSD) and comorbid maladaptive personality traits (CMPT), and to explore its feasibility and effectiveness. Methods: CoMBI was developed and implemented in two geriatric psychiatric inpatient wards in the Netherlands. In this single-group pretest-posttest, feasibility study, 40 patients with BPSD and CMPT (M = 73.8, SD = 8.5) were treated with CoMBI. BPSD and CMPT were assessed using informant-based questionnaires. Wilcoxon signed-rank tests and effect size calculations were conducted to determine differences. Results: Wilcoxon signed-rank tests demonstrated a significant decrease of BPSD with medium (r = 0.45) to large (r = 0.56) effect sizes. CoMBI demonstrated high acceptability and compliance by health-care professionals and family members. Conclusions: CoMBI is a feasible treatment model for challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease in challenging behaviors regardless of etiology. Clinical implications: Focusing on personality and associated core needs could have a key role in the non-pharmacological treatment of the elderly with BPSD. Netherlands Trial Register (Trial NL6478/NTR6665)