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Group Therapy Program Offers Meaningful Gains for People with Borderline Personality Disorder

Science Update

A 20-week group therapy program focusing on cognitive behavioral and skills training, when used in conjunction with usual care, helped reduce symptoms of borderline personality disorder and improve overall functioning, reported NIMH-funded researchers. Their findings were published online February 15, 2008 in the American Journal of Psychiatry.

Borderline personality disorder is a serious mental illness noted by unstable moods, behavior and relationships. Each year, 1.4 percent of adults in the United States have this disorder, which is widely viewed as being difficult to treat. However, recent advances in treatment research for specific symptoms of borderline personality disorder, such as dialectical behavioral therapy to reduce suicidal thinking or behavior, have shown reasons to continue exploring options for therapy.

In this study, led by Donald W. Black, M.D., of the University of Iowa, researchers tested the effectiveness of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program for treating people with borderline personality disorder. STEPPS, developed by lead author Nancee Blum, MSW, and colleagues, is a structured treatment program involving 20 weekly meetings that each last for two hours. Over the course of the program, participants learn about the disorder as well as skills for controlling problematic emotions and behaviors. Family members also receive a two-hour session to learn about the illness and best ways to interact with their loved one. STEPPS is meant to be used along with other forms of treatment, such as medication or individual therapy.

The researchers randomly assigned 165 men and women ages 18 and older to receive either STEPPS plus any other care they had previously been receiving (“treatment as usual”), or treatment as usual alone. During the 20-week treatment period, people who received STEPPS plus treatment as usual had greater and more rapid improvement in borderline-related and depressive symptoms (which affected 78 percent of study participants) than people who received treatment as usual alone.

Also, participants in the STEPPS group continued to improve over the entire 20 weeks of the program, whereas improvements in the group that received only treatment as usual leveled off after 10 weeks.

Furthermore, people who received STEPPS plus treatment as usual were more likely to rate themselves, and to be rated by their study therapist, as “very much” or “much” improved, compared to the other group. At follow up visits during the year after the end of treatment, improvements of the STEPPS plus treatment as usual group were maintained.

Fewer participants who received STEPPS had emergency department visits, compared to the group that received treatment as usual alone. There were no significant differences between the two treatment groups in the number or frequency of suicide attempts, self-harming acts, or hospitalization. Also, similar to other studies of borderline personality disorder, there was a relatively high rate of dropout from the study from both treatment groups, roughly 25 percent of the 165 randomly assigned participants.

The researchers suggest that a relatively brief therapy program offers “real world” benefits because their study mirrored common treatment situations in which people are already receiving other types of mental health care.

Following similar results in earlier studies, STEPPS has been widely adopted in The Netherlands as the primary group treatment for borderline personality disorder. Other countries, including the United States, have been evaluating more widespread use of this program as well.


Blum N, St. John D, Pfohl B, Stuart S, McCormick B, Allen J, Arndt S, Black DW. Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients with Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up . Am J Psychiatry. 15 Feb 2008 [online ahead of print].