Adapting Systems Training for Emotional Predictability and Problem Solving (STEPPS) for older adults with personality disorder: a Dutch Delphi study

ABSTRACT

Objective

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group therapy in which patients with personality disorder are taught emotion and behaviour regulation skills. Since older adults regulate their emotions differently than younger adults, age-specific aspects are suggested to be taken into account in the treatment. Objectives of this study were to determine expert consensus on the applicability of STEPPS for older adults and determine which adjustments should possibly be implemented for a better fit for older adults with personality disorder.

Method

A group meeting involving seven experts, with expertise in psychological therapies with older adults, was held. The Delphi method was applied in order to reach consensus on three main statements regarding the applicability of STEPPS in older adults with personality disorder.

Results

Most experts (86%) voted against the statement implying the current STEPPS program is applicable for older adults. All experts voted in favour of the statement that adjustments to the STEPPS program at the content level are required. Consensus (≥66.7%) was reached among the experts that adjustments to the STEPPS program are also required at the process level.

Conclusions

STEPPS is considered to be applicable for older adults with emotion regulation problems and personality disorder but needs adaptations to enhance its feasibility and efficacy in later life.

Key Points

What is already known about this topic:

(1)   Systems Training for Emotional Predictability and Problem Solving (STEPPS) is an evidence-based psychotherapeutic treatment for patients with borderline personality disorder.

(2)   Promising results have been found for STEPPS in older adults.

(3)   Several studies recommend adapting psychotherapeutic treatments for older adults.

What this topic adds:

(1)   Consensus was reached among experts, stating that STEPPS needs adaptations to enhance its feasibility and efficacy in later life.

(2)  Adapting STEPPS for the young old (60–75 years) is recommended as a useful starting point.

(3)   A main recommendation concerned including themes into the STEPPS program that are more relevant for ageing.

KEYWORDS:

• STEPPS
• borderline personality disorder
• emotion regulation
• older adults
• Delphi study

Acknowledgments

We would like to thank Horusta Freije and the participating experts for offering their valuable time and input in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical statement

The authors have abided by the ethical principles of the Declaration of Helsinki. All subjects were provided oral and written information concerning the study. Subjects’ informed consents were documented. The study was approved by research ethics committee of GGz Breburg, Tilburg, the Netherlands (reference number CWO 2020–03).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.