Acceptability of STEPPS for outpatient adolescents in the United States: A case study

Abstract Background. Borderline personality disorder (BPD) is a severe mental illness that typically onsets during adolescence. Emotion dysregulation is a key feature of BPD, and several interventions have been developed to target these difficulties. However, many barriers to care exist for adolescents with BPD, such as difficult-to-find and time-consuming treatment. Considering these limitations, the evidence-based group treatment Systems Training for Emotional Predictability and Problem Solving (STEPPS) was previously adapted for adolescents with BPD or symptoms of BPD and has shown promise in a preliminary study, but more work is needed examining STEPPS for use in adolescents. Methods. This paper uses a case study approach to evaluate STEPPS in two adolescents and their parents who completed 18 weeks of STEPPS intervention. Adolescents and their parents completed the STEPPS assessment of borderline personality features weekly during treatment to track changes over time. Moreover, participants completed assessments of emotion regulation, interpersonal difficulties, and general psychopathology before treatment, after program completion, and at 6- and 12-month follow-ups. Results. Results showed that both adolescents reported a decline in BPD features following STEPPS, albeit with unique patterns in decline. Parent reports of youth BPD features were less straightforward but suggested improvement in BPD features during treatment, but stability or small increases in symptoms at post-treatment and follow-up assessments. Results also illustrated improvements in emotion regulation, reduced stress in the parent-adolescent relationship, improvement in inadequate parent-adolescent boundaries, and a decline in functional impairment. Conclusions. Overall, STEPPS may offer a brief and cost-effective treatment for BPD, although more research is needed to fully establish its efficacy in adolescents.