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CNS Spectr. 2008 Oct;13(10):881-6.

STEPPS: Systems Training for Emotional Predictability and Problem Solving in women offenders with borderline personality disorder in prison--a pilot study.

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  • 1Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.



An uncontrolled pilot study of Systems Training for Emotional Predictability and Problem Solving (STEPPS) was conducted with incarcerated women offenders. STEPPS is a promising new cognitive-behavioral group treatment for persons with borderline personality disorder (BPD).


Twelve women offenders with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD were enrolled in the 20-week program at an Iowa prison. Efficacy assessments included the Borderline Evaluation of Severity over Time, the Positive and Negative Affectivity Scale, and the Beck Depression Inventory. Data were collected at baseline, and weeks 4, 8, 12, 16, and 20. A prison therapist was trained to deliver the STEPPS program.


The 12 volunteers had a mean age of 34.8+/-8.5 years. Two women discontinued early because they were released from prison; the others attended all sessions. The analysis showed significant improvements in BPD-related symptoms, negative affectivity, and depression. The Borderline Evaluation of Severity over Time total score was highly significant at week 20 (P=.009), indicating overall improvement in BPD-related symptoms. Effect sizes for the efficacy measures were moderate to large. The prison therapist showed excellent adherence to the model.


This study demonstrated the successful implementation of the STEPPS program in a women's prison. Participants achieved "real-world" benefits, including a reduction in the negative thoughts and behaviors associated with BPD, negative affectivity, and depression. Implications of the findings are discussed.

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