ABOUT YP and EI
About STEPPS YP
Making a diagnosis of BPD in those under the age of 18 has been controversial. STEPPS YP aims to provide an intervention for that group without the need to formally make the diagnosis, provide a non-pathologizing approach where the diagnosis has been made already, or serve as an early intervention. As in the previously published evidence-based STEPPS programs (STEPPS, Second Edition, and STEPPS UK), STEPPS YP is a group treatment, cognitive-behavioral, skills-training approach.
STEPPS (for adults) is designed to meet weekly for 20 weeks (plus two additional optional sessions – a separate introductory/intake session and a second for groups that meet during the Festive Season). STEPPS YP has been revised to 18 group sessions (plus the two optional sessions) with a suggested break after Lesson 9. This schedule may be modified to allow breaks as required for school/college schedules.
The program assists mental health professionals with a group treatment for adolescents. In the STEPPS YP workbook pages for group participants, the term Borderline Personality Disorder, or Emotional Intensity Disorder, has been changed to Emotional Intensity Difficulties (EID). In our experience, some young people have already self-diagnosed, and some will recognize this program and its contents as relevant to BPD. Our approach is not to deny this but to redirect into what we believe is a more promising, recovery-orientated, or educative/developmental approach.
PLEASE NOTE: This version of STEPPS was first developed in partnership with a working group from the Sussex Partnership NHS Foundation Trust in the UK. Therefore, certain spelling and wording conventions specific to the UK were used. The program is distributed on a USB Flash Drive.
For ordering information for STEPPS YP, click here.
Read the first few pages of the YP Facilitator Guidelines.
About Stepps EI
STEPPS EI is a cognitive-behavioral, skills-training approach developed for people attending Primary Care Services in the UK who are identified as struggling with high levels of emotional intensity. Some may already be diagnosed with Borderline Personality Disorder (BPD) or maybe recognized as falling just below the threshold for such a diagnosis. This program aims to provide an early intervention without the need to make the diagnosis formally, provide a non-pathologizing approach where one has been made already, or serve as an early intervention. In the STEPPS EI program, we consistently use emotional intensity difficulties (EID) rather than BPD.
The Systems Component of STEPPS EI
Whether it is cause or effect, the individual coming to the group is usually enmeshed in a system of relationships in which even concerned and well-intentioned friends and significant others respond to the individual with EID in a manner that reinforces problematic behavior. For example, the individual experiencing a perceptual distortion that others dislike may become irritated and behave in ways that turn the distortion into a reality. This new reality then serves to reinforce cognitive distortions and maladaptive behaviors.
During the treatment program, the STEPPS EI group becomes a mini-system in which the participant receives instruction in new ways of thinking and new behaviors. Participants receive positive reinforcement in support from group leaders and other group members. The new behaviors are designed to influence the individual's more extensive support system, which also begins to reinforce healthy behaviors. STEPPS EI emphasizes that group member scan and should take responsibility for taking steps to help key players in their system respond more effectively. Specifically, STEPPS EI incorporates the following 4 components to address the participants' support system:
- Teaching the participant to challenge cognitive distortions and developmore realistic expectations about what types of support are appropriatefrom key players in their support team.
- Teaching strategies (skills) for dealing with anxiety, anger, depression, andself-destructive thoughts can be accomplished independently or with a level of input from others that the support system can comfortably provide.
- Encouraging the participant to share appropriate sections from their folder with close friends and significant others (as well as their other care providers) so these individuals can better understand EID, the terminology, and ways of responding that help reinforces the skills taught in the STEPPSEI program.
- Offering at least one evening session in which key members of the support team are invited to come and learn about EID, how STEPPS EI works, and what they can do to help.
Integrating STEPPS EI With Other Treatments
STEPPS EI is not a comprehensive treatment program for managing individuals with Borderline Personality Disorder or Emotional Intensity Difficulties. From its inception, STEPPS EI was designed to be a "value added" or supplemental treatment intervention that augments, rather than replaces, the existing network of mental health providers. STEPPS EI has been implemented in various settings and is usually well-received by other providers who provide mental health services to individuals enrolled in the STEPPS EI program.
Clients in the STEPPS EI program are often treated with one or more psychopharmacological agents, most often antidepressants and mood stabilizers. The program addresses adherence to prescribed medications as an essential enabling factor for the group therapy program. Substance abuse is viewed as treatment-disabling, and clients are required to seek appropriate substance abuse treatment and maintain abstinence either before or concurrently with the STEPPS EI program. Clients with a severe eating disorder are similarly needed to appropriate treatment programs.
Facilitators should note that in developing this approach, the need for traditional individual therapy might be reduced. A team approach to working with a person with EID who is familiar with the skills and behavior patterns might be preferable to an individual policy. The optimal treatment system is one in which the Person with EID receives skill and behavior pattern reinforcement from all treatment system team members, family, and friends in addition to the weekly skills training. This approach encourages the Person with EID to rely on peers, family, and others for reinforcement. It reduces the possibility that the Person with EID will focus exclusively on a single therapist, who then runs the risk of being alternately over-idealized and devalued by the Person with EID.
NOTE: Although this program was developed specifically for use in Primary Care Services in the UK, the program may be equally suitable in various settings outside the UK. The manual contains a brief glossary of UK terms with their US definition for US users.