systems training for emotional predictability and …€¦ · what do group members think of...
TRANSCRIPT
What happens during a typical STEPPS Session?
Typically all of the sessions follow this format:
1. Group members are first asked to fill out the Borderline Evaluation of Severity over
Time (BEST). This is a short questionnaire used to evaluate the effectiveness of
treatment and measure symptoms of BPD over the last week.
2. Group members also fill out the Emotional Intensity Continuum (EIC) (or known to
members at the “Pot” form). This is used to keep a record of your strength of
emotions over the last week.
3. In the first hour will usually include a recap of previous sessions and a relaxation
exercise .Examples of some of the exercises include: relaxation breathing, creating a
collage depicting a safe place, blowing bubbles and creating a portable beach collage.
4. Then the group takes a short break (10-15minutes).
5. In the second half of the session, a new topic/skill is introduced.
6. The session will end with setting tasks to complete before the next session
(ie. Practice skills and work through worksheets).
Awareness of Illness: describing and understanding BPD
Filters: to be aware of patterns of thinking which filter our thoughts
Distancing: learning to step back from the intensity of the disorder
Communicating: learning to describe how we feel, psychical sensations, thoughts, filter and action urges
Challenging: identify distorted patterns thinking and develop alternative ways of thinking
Distracting: Behaviours that lower our emotional intensity
Managing Problems: identify problems and plan/carry out action steps
Setting Goals: develop strategies to manage specific problematic behaviours
Eating: Balanced eating habits
Sleeping: Good sleep habits
Exercise: Regular and balanced exercise
Leisure: Regular leisure activities
Physical Health: Working effectively with health professionals
Abuse avoidance: Strategies to replace abusive behaviours
Relationship Behaviours: Developing healthy relationships and defining healthy boundaries.
What exactly is STEPPS?
STEPPS is a weekly 2hour CBT based group programme, which takes place in a
classroom format. STEPPS is run by staff from different disciplines, including
psychology, occupational therapy and nursing. The programme is composed of three
areas: Awareness of Illness, Emotional Management Skills training and Behavioural
Management Skills training. The skills taught include:
Who is STEPPS aimed at?
The STEPPS programme was primarily designed to support people with a diagnosis of
BPD. Group members may have differing diagnosis but all present with borderline traits
and have difficulty in managing their emotions. The authors of STEPPS have suggested
the term ‘Borderline Personality Disorder’ is not a helpful description. For this reason
they have termed the condition ‘Emotional Intensity Disorder’ (EID)?
What is EID?
People with EID are desperately afraid of being abandoned, this fear can be real or
imagined. Many will go to great lengths to avoid being on their own.
Often people with EID will be involved in very intense relationships with people,
characterised by swinging from extreme idealisation and devaluation.
A key characteristic of EID is struggling to find your own identity, which often leaves
people with an overwhelming sense of emptiness.
Another feature of EID is impulsivity (i.e. spending, binge eating).
Engaging in behaviours that look suicidal is often a symptom of EID.
EID is often characterised by experiencing intense emotions. Intense episodes of
anger, anxiety and irritability are common.
Other symptoms include stress related paranoid ideation or severe
episodes of dissociation.
Systems Training for Emotional Predictability and Problem Solving
Group Treatment Programme for Borderline Personality Disorder (BPD)
An example of a ‘safe place collage’ from a current
STEPPS member. An example of ‘portable beach’ collage
from a current STEPPS member.
Greatly enhanced
understanding of EID/
BPD and supporting
STEPPS work
Very interested and
informative session. My
understanding of BPD has
developed
Found this training very useful, learning info on BPS, techniques to help
aid recovery.
Really enjoyed the train-
ing, it made me aware of
certain clients behaviour.
I have thoroughly enjoyed the session and look forward to putting some of the things into practice.
Very relevant, interesting and well delivered. A very useful tool that I am sure I will use in my working role and within my general day
Extremely relevant for our
client group and how to
work effectively with clients
with BPD.
What is STEPPS Reinforcer?
The goal of STEPPS is to equip the person with EID, their family, friends and other professionals
treating them with a common language to communicate clearly about the disorder and the skills to
manage it. As well as teaching group members emotional and behavioural management skills,
attendees also identify key professionals, friends and family to be part of their “reinforcement team”.
These individuals are invited to learn about STEPPS and are encouraged to support the group
member by reinforcing the STEPPS skills taught. Professionals are invited to take part in specialised
“Reinforcer training” to learn about EID and how STEPPS helps to manage symptoms. The group
member is encouraged to meet up regularly with their professional Reinforcer to discuss their
progress. Family and friends are invited to attend evening sessions led by the group facilitators to
discuss what STEPPS is about and to have the opportunity to ask questions. Each Reinforcer is given
a ‘Reinforcers Guide’ which provides a guide to each weeks sessions, as well as proving prompts to
help reinforce each topic. Feedback received from the training events has been very positive.
Here are some of the comments received...
I found the course really
interesting and informative.
I found the training very insightful
What do group members think of STEPPS?
There are currently two STEPPS groups running via the Recovery Intervention Service, this is a multidisciplinary secondary care service. One group is running in Walsall
(currently run at Broadway North Resource Centre) and the other is running in Dudley (currently run at The Poplars). The Community Drug and Alcohol Treatment Service in
Walsall also facilitate a STEPPS group (based at Lantern House). Here are some of the comments current STEPPS group members made...
What have you enjoyed about attending the group?
“A safe place to discuss and get feedback about
emotional difficulties.”
“Learning new skills to help me along my way.”
“The opportunity to learn different coping skills.”
“Meeting people with similar issues to me.”
“It has helped add structure to my day.”
“I now have an identity which I never had before and I
am functioning reasonable well with daily life.”
“Working through problems with the group.”
“Reviewing skills usage in the week.”
What have you learnt from attending the group?
“I can know step back from a situation, deal with the
issue and find a distraction to keep the situation
under control.”
“The skills learnt in the group help me deal with day
to day life.”
“Many ways to try to combat intense feelings and
hopefully lessen the intensity.”
“… I learnt how to manage, deal with and cope with
(BDP symptoms) them.”
“I have learnt you need to own your illness and your
behaviours.”
How have you found the group so far?
“It has been difficult at times, but overall it has been
helpful.”
“I have found the group friendly and open. Group
members have been supportive, as have the staff”.
“Extremely helpful.”
“Rewarding.”
“Would have either been dead in the gutter or ended
up in a mental health hospital (if not for the group)” .
“Valuable.”
“Thought provoking.”
Is the STEPPS group effective in reducing the symptoms of BPD?
Each session begins by filling in a short self-report questionnaire called the Borderline Evaluation of Severity over Time (BEST), it is used to evaluate the effectiveness of the
treatment and to check on the progress of each group member. The BEST asks group member to rate intensity of their thoughts and feelings, as well as rating how often they
exhibited positive and negative behaviours (which are often associated with EID) over the last week. Table1 below illustrates the reduction in BEST scores over the course of the
programme for group members in Walsall and Dudley. There is also a marked decrease in average BEST scores at the first and end/current session. Results like these indicate
STEPPS has had a positive impact on reducing the number of symptoms associated with EID.
What do STEPPS facilitators think?
We asked the current STEPPS facilitators how they thought the current group
members were getting on. We asked them to rate group attendees on their
engagement with the material so far, using the following scale:
0 -Does not use the skills, does not complete homework
1- Generally fail complete homework but uses the skills; finds them ineffective
2- Generally completes homework and uses the skills; finds them ineffective
3- Generally fails to complete homework but uses the skills; finds them effective
4- Generally completes homework and uses the skills; finds them moderately
effective
The above graph shows the progress of average BEST scores collated from four STEPPS groups across
Walsall and Dudley.
The graph above displays a comparison of average BEST scores for Adult Mental Health STEPPS groups and
Substance Misuse Substance STEPPS group at the beginning and end/current STEPPS sessions.
Facilitators commented that 90%
of the current group members
were using the skills learnt in the
STEPPS group.
And a from that 70% of current
group members were finding the
skills learnt were effective in
helping them manage their
emotions day to day.
Is STEPPS effective in reducing emotional intensity?
Each week group members are asked to complete the Emotional Intensity
Continuum (EIC). We liken this measure to a pot of water on the stove and for this
reason this is also known as the ‘Pot’ form. This asks group members to record the
percentage of time they have been in varying levels of emotional intensity. The
levels range from level1: feeling calm and relaxed (the water in the pot is still and
cool), to level5: the highest level of intensity, feeling like loosing emotional control
(the pot of water boils over). This aims to help group members spot an emotional
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Session0
5
10
15
20
25
30
35
40
45
50
Adult Mental Health STEPPS groups Substance Misuse STEPPS groups
BEST score at begining of therapy BEST score at end of therapy
1 2 3 4 5
Level of Emotional Intensity
Pre Average Post Average
The graph above displays the average EIC percentages in each level at the first session
in comparison to last/current session. It illustrates that STEPPS has had a positive
impact on reducing the level of emotional intensity when experiencing an emotional
episode.
Systems Training for Emotional Predictability and Problem Solving
Group Treatment Programme for Borderline Personality Disorder (BPD)