STEPP by STEPP: Implementing a
STEPPS group in NHS Lanarkshire.
Veronika Braunton,
Cognitive Behavioural Therapist
And Dr Alison Campbell,
Clinical Psychologist
What is STEPPS?
Systems
Training for
Emotional
Predictability and
ProblemSolving
Evidence for STEPPS
• The Matrix : A Guide to delivering evidence-based
Psychological Therapies in Scotland
• Blum et al. (2008) STEPPS for outpatients with
BPD: a RCT and 1-year follow up
• Bos et al. (2010) A RCT of a Dutch Version of
STEPPS for BPD
• Black et al. (2013) STEPPS Group Treatment for
Offenders with BPD
• Blum & Black (2015) STEPPS for the Treatment of
BPD
Systems Training for Emotional
Predictability & Problem Solving
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Evidence based approach
Psycho-educational approach
20 week, Group format
Manual-driven
CBT model + skills training
How STEPPS works
Skill-Building
STEP 1: AWARENESS OF ILLNESS
STEP 2: EMOTION MANAGEMENT
SKILLS
STEP 3: BEHAVIOUR MANAGEMENT
SKILLS
Reinforcement
Systems Training for Emotional
Predictability & Problem Solving
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•
•
•
•
•
•
Evidence based approach
Psycho-educational approach
20 week, Group format
Manual-driven
CBT model + skills training
Teaches a common language
Confronts early maladaptive schemas (cognitive
filters)
• Includes reinforcement team
The Reinforcement Team
THE ‘REAL WORLD’
REINFORCERS:
- Family
- Friends
THE STAFF REINFORCERS:
- Assistant Psychologist
- CPNs
WHAT THEY DID:
- Regular contact
- Skills monitoring and
development
- Assistance with
homework tasks
- Provision of support, a
‘listening ear’
- Practise in using a ‘shared
language’ to describe
difficulties
Emotion management skills
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Distancing
Challenging
Communicating
Distracting
Behaviour management skills
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Managing problems
Eating
Exercise
Physical Health
Relationship Behaviours
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Setting Goals
Sleeping
Leisure
Abuse Avoidance
The Lanarkshire experience
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12 referrals made and assessed
10 invited to attend
9 Attended 2 or more sessions
5 Attended 12 or more sessions
Quantitative and qualitative data taken
Outcome Measures
• MCMI-III (Millon Clinical Multiaxial InventoryIII)
• ZAN-BPD (Zanarini Rating Scale for Borderline
Personality Disorder)
• BDI (Beck Depression Index)
• All measures repeated at outset, midway and
on completion of the group
Outcome Measures
• ZAN-BPD reduced from average 8.75 (at
assessment) to 6 (at completion). No longer
clinically significant
• BDI reduced from average 31.7 (severe range,
at assessment) to 12.7 (mild range, at
completion)
Skill-building feedback:
distancing & situation appraisal
• ‘I’ve been thinking about it…I sort of stop and
think before I act’
• ‘It’s not so much just black and white any more, it
might have a wee bit of middle ground, just a
splash of colour’
• ‘It makes you sort of, frame the way you’re
looking at things’
• ‘Taking myself away and looking at the situation
as it arises and no just thinking a big grey
mountain’
Skill-building feedback:
recognising trigger situations
• ‘I’ll break it down to where it started, where
my trigger was, how did I react, could I change
it’
• ‘You start understanding, oh, maybe that’s
why this happened or that’s why that
happened and it’s giving me the stepping
stones to find a reason for something’
Skill-building feedback:
recognising skill-set
• ‘It’s made me realise that I DO have these skills…I
can’t change every situation, I’m no magician, but
I can try and control it’
• ‘Still a work in progress, it’s better than what it
was’
• ‘What a difference it’s made to me in my
everyday life because I can see things much
better, clearer, a much brighter perspective’
• ‘I just have so much knowledge and these
techniques that I’ve been able to use so I’ve really
benefitted from it’
Feedback on intra- & interpersonal
aspects
Fear of negative appraisal
from others
Feeling accepted, not judged
Sense of isolation and
exclusion
Sense of community,
inclusion
Feeling ‘invisible’ &
worthless
Feeling valued, respected,
‘seen & heard’
What did we learn?
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Accommodation
Reinforcers
Dealing with the crisis of the day
Working as two trainers
American English is not British English
Fewer paper exercises - more group discussion
Getting a ‘new thing’ started is hard work
Having FUN
Next STEPPS
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Next group January to June 2016
Planned increase in numbers
Reinforcing the reinforcers
Reinforcers and trainers from broader discipline
range (canvassing psychiatry, OT as well as
nursing)
• And... ... ... More data
Contact Information
Veronika Braunton
Dr Alison Campbell
Cognitive Behavioural
Therapist
Clinical Psychologist
01698 242 440
01355 597 454
vbraunton@nhs.net
alison.campbell5@nhs.net
www.stepsforbpd.com