Volume 28, Part 1

Treating Borderline Personality Disorder with the STEPPS Model (Systems Training for Emotional Predictability and Problem-Solving)

Don St. John, MA, PA-C

Mr. St. John is Adult Outpatient psychiatrist, Department of Psychiatry, University of Iowa, Iowa City, IA.

Nancee Blum, LISW

Ms. Blum is Social Work Specialist, Department of Psychiatry, University of Iowa, Iowa City, IA.

Donald W Black, MD

Dr. Black is Professor of Psychiatry, Department of Psychiatry, University of Iowa, Iowa City, IA.

Abstract

Borderline personality disorder (BPD) is associated with impaired quality of life, disturbed interpersonal relationships, and impulsive and self-destructive behaviors. The disorder often contributes to excessive use of health care resources and is widely considered to be difficult to treat. Individual therapy has been the treatment mainstay for decades, though evidence-based group treatments are now making inroads. At the same time, medications have been intensively studied, and while there are no standard or approved medications, many patients will benefit from pharmacotherapy. In this lesson, the authors describe STEPPS (Systems Training for Emotional Predictability and Problem-Solving), a new add-on group therapy for the treatment of BPD, developed and refined over the past decade, and now used by clinicians around the world. Patients enrolled in STEPPS are encouraged to continue with their usual treatment (e.g. individual psychotherapy, pharmacotherapy, case management). Based on cognitive-behavior therapy (CBT) techniques commonly taught in post-graduate psychotherapy programs, STEPPS is easily learned by therapists and can be adapted to suit a variety of clinical settings. Two uncontrolled studies have documented the effectiveness of STEPPS, and a large randomized controlled trial has recently been completed by the authors, showing that the treatment is superior to usual treatment alone. In this paper, the therapeutic components of STEPPS are described and clinical application is discussed.