systems training for emotional predictability and problem solving

Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up

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Assessment of Efficacy: 1-Year Follow-Up

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Systems Training for Emotional Predictability and Problem Solving (STEPPS)

• First Online: 01 January 2014

Cite this chapter

• Renee Harvey 3 ,
• Nancee Blum 4 , 5 ,
• Donald W. Black 4 , 5 ,
• Jo Burgess 6 &
• Paula Henley-Cragg 7  

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STEPPS (Systems Training for Emotional Predictability and Problem Solving) is a manualized, cognitive-behavioral, skills-based group treatment program originally developed in the USA for adults with borderline personality disorder (BPD) (Black, Blum, Pfohl, & St. John, 2004, 2012; Blum, Bartels, St. John, & Pfohl, 2002); the manual was also adapted for use in the UK (Blum, Bartels, St. John, & Pfohl, 2009), and the program is widely used in the Netherlands under the title VERS (Van Wel et al., 2006). The program is evidence based, as designated by the National Registry for Evidence-Based Practices (NREPP 2012). Although it was originally conceptualized as an outpatient program, STEPPS has been successfully adapted and implemented in a variety of settings, including inpatient units, partial hospital, day treatment programs, residential treatment facilities, substance abuse treatment, and correctional settings, including both male and female offenders in prisons and community corrections. In this chapter, an adaptation of STEPPS for adolescents in the UK will be described.

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Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention

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Acknowledgements

With thanks to Charlotte Wilcox, Research Assistant, Group co-facilitators Jude Jarrett (Clinical Psychologist) and Tansy Walker (Clinical Psychologist), and Stephanie Field who provided administrative support.

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Bluebell House, Recovery Support Centre, Royal George Road, Burgess Hill, RH15 9NZ, West Sussex, Great Britain

Renee Harvey

Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA

Nancee Blum & Donald W. Black

Iowa Department of Corrections, Des Moines, IA, USA

Child and Adolescent Mental Health Service, Sussex Partnership NHs Foundation Trust, Burgess Hill, West Sussex, Great Britain

Worthing Child and Adolescent Mental Health Service, Sussex Partnership NHS Foundation Trust, Burgess Hill, West Sussex, Great Britain

Paula Henley-Cragg

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Correspondence to Renee Harvey .

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Dept. Psychology, University of Houston, Houston, Texas, USA

Carla Sharp

Jennifer L. Tackett

Appendix: A “Typical” STEPPS Lesson

Every STEPPS lesson is structured according to an agenda, which is handed out with the notes. The agendas are all broadly similar. This provides a predicable pattern, which helps the participant to feel less anxious and enables them to concentrate on the new material being presented each week.

Described here is Lesson 10, which is the first of two on “Managing Problems.” By this stage, the participant has been introduced to the concept of emotional intensity difficulties (as an alternative to a diagnosis of BPD) and has been given a series of emotion management skills to underpin the work on behavior change to follow (See Chap. 27 for a description of these). Comments in square brackets explain the process.

Complete a QuEST scale and record the score [Symptom measure which is done weekly]

Relaxation [A brief relaxation session, each week introducing a different method so that participants have a choice]

Review EIC [Here there is an opportunity for participants to describe how the past week has been, and for the group to share how they have filled in the 5-point EIC form relative to any incidents they experienced. There is usually an example done in the lesson on the whiteboard, with all encouraged to comment, make suggestions, and share their own responses.]

Review Skills Monitoring Card [Participants have been encouraged to use a tick list of skills every day.]

Review of homework exercises from the previous week.

Presentation of the week’s lesson and homework exercises.

In the Managing Problems lesson, participants begin with problem identification and potential solution strategies, but with particular attention paid to understanding the role of “filters” (schemas/core beliefs) in contributing to the intensity of their reactions and the obstacles in their way. All the skills learned so far are brought to bear in understanding how they might find a possible solution and how to overcome resistances and self-sabotaging which may have played a role in past failures. The group contributes by making suggestions, encouraging each other, and sharing experiences of what has been helpful for them. In the lessons to come, feedback from each of the previous lesson is used to build the skills of the next.

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Harvey, R., Blum, N., Black, D.W., Burgess, J., Henley-Cragg, P. (2014). Systems Training for Emotional Predictability and Problem Solving (STEPPS). In: Sharp, C., Tackett, J. (eds) Handbook of Borderline Personality Disorder in Children and Adolescents. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0591-1_26

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DOI : https://doi.org/10.1007/978-1-4939-0591-1_26

Published : 28 March 2014

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Online ISBN : 978-1-4939-0591-1

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Systems training for emotional predictability and problem solving in older adults with personality disorders: a pilot study

Affiliations.

• 1 PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.
• 2 Tranzo, Scientific Centre for Care and Wellbeing of the Tilburg School of Social and Behavioral Sciences of Tilburg University, Tilburg, The Netherlands.
• 3 Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Mental Health Center, Heerlen-Maastricht, The Netherlands.
• 4 Personality and Psychopathology research group (PEPS), Department of Psychology (PE), Vrije Universiteit Brussels (VUB), Brussels, Belgium.
• 5 Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
• PMID: 36258278
• DOI: 10.1017/S1352465822000443

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.

Keywords: STEPPS; borderline personality disorder; emotion regulation; older adults.

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