1. STEPP by STEPP: Implementing a STEPPS group in NHS Lanarkshire. Veronika Braunton, Cognitive Behavioural Therapist And Dr Alison Campbell, Clinical Psychologist

2. What is STEPPS? Systems Training for Emotional Predictability and Problem- Solving

4. 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

5. Systems Training for Emotional Predictability & Problem Solving Evidence based approach Psycho-educational approach 20 week, Group format Manual-driven CBT model + skills training

6. How STEPPS works Skill-Building STEP 1: AWARENESS OF ILLNESS STEP 2: EMOTION MANAGEMENT SKILLS STEP 3: BEHAVIOUR MANAGEMENT SKILLS Reinforcement

7. Systems Training for Emotional Predictability & Problem Solving 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

8. 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

9. Emotion management skills Distancing Challenging Communicating Distracting

10. Behaviour management skills Managing problems Eating Exercise Physical Health Relationship Behaviours Setting Goals Sleeping Leisure Abuse Avoidance

11. The Lanarkshire experience 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

12. Outcome Measures MCMI-III (Millon Clinical Multiaxial Inventory- III) 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

13. 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)

14. 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’

15. 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’

16. 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’

17. 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’

18. What did we learn? 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

19. Next STEPPS 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

21. Contact Information Veronika Braunton Dr Alison Campbell Cognitive Behavioural Clinical Psychologist Therapist 01698 242 440 01355 597 454 vbraunton@nhs.net alison.campbell5@nhs.net www.stepsforbpd.com