systems training for emotional predictability and …€¦ · what do group members think of...

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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 Evaluaon of Severity over Time (BEST). This is a short quesonnaire used to evaluate the effecveness of treatment and measure symptoms of BPD over the last week. 2. Group members also fill out the Emoonal Intensity Connuum (EIC) (or known to members at the “Pot” form). This is used to keep a record of your strength of emoons over the last week. 3. In the first hour will usually include a recap of previous sessions and a relaxaon exercise .Examples of some of the exercises include: relaxaon breathing, creang a collage depicng a safe place, blowing bubbles and creang 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 seng tasks to complete before the next session (ie. Pracce skills and work through worksheets). Awareness of Illness: describing and understanding BPD Filters: to be aware of paerns of thinking which filter our thoughts Distancing: learning to step back from the intensity of the disorder Communicang: learning to describe how we feel, psychical sensaons, thoughts, filter and acon urges Challenging: idenfy distorted paerns thinking and develop alternave ways of thinking Distracng: Behaviours that lower our emoonal intensity Managing Problems: idenfy problems and plan/carry out acon steps Seng Goals: develop strategies to manage specific problemac behaviours Eang: Balanced eang habits Sleeping: Good sleep habits Exercise: Regular and balanced exercise Leisure: Regular leisure acvies Physical Health: Working effecvely with health professionals Abuse avoidance: Strategies to replace abusive behaviours Relaonship Behaviours: Developing healthy relaonships 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, occupaonal therapy and nursing. The programme is composed of three areas: Awareness of Illness, Emoonal 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 emoons. The authors of STEPPS have suggested the term ‘Borderline Personality Disorder’ is not a helpful descripon. For this reason they have termed the condion ‘Emoonal 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. Oſten people with EID will be involved in very intense relaonships with people, characterised by swinging from extreme idealisaon and devaluaon. A key characterisc of EID is struggling to find your own identy, which oſten leaves people with an overwhelming sense of empness. Another feature of EID is impulsivity (i.e. spending, binge eang). Engaging in behaviours that look suicidal is oſten a symptom of EID. EID is oſten characterised by experiencing intense emoons. Intense episodes of anger, anxiety and irritability are common. Other symptoms include stress related paranoid ideaon or severe episodes of dissociaon. Systems Training for Emoonal 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 supporng STEPPS work Very interested and informave 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 pung some of the things into pracce. Very relevant, interesng 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 effecvely 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 treang them with a common language to communicate clearly about the disorder and the skills to manage it. As well as teaching group members emoonal and behavioural management skills, aendees also idenfy 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 aend evening sessions led by the group facilitators to discuss what STEPPS is about and to have the opportunity to ask quesons. 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 posive. Here are some of the comments received... I found the course really interesng and informave. I found the training very insighul

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Page 1: Systems Training for Emotional Predictability and …€¦ · What do group members think of STEPPS? There are currently two STEPPS groups running via the Recovery Intervention Service,

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

Page 2: Systems Training for Emotional Predictability and …€¦ · What do group members think of STEPPS? There are currently two STEPPS groups running via the Recovery Intervention Service,

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)